Bioethics Discussion Blog: Patient Modesty: Volume 56

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Saturday, July 06, 2013

Patient Modesty: Volume 56









I am sure that everyone can spot the "chaperon"  for the patient in this classic photograph of the operating room used at Johns Hopkins Hospital from 1892 to 1927.  And I am sure that everyone can find the "gawkers"  who are present in the photograph. But do you really think that some patient chaperon, if one was actually present, in this operating room would have any clout? Regardless of the validity of our assumptions, I think that this photograph is pertinent to the many years of discussions on this blog thread. 

In my opinion, the photograph suggests the challenges that face the patient particularly within a hospital or particularly a teaching hospital today if the patient expects his or her modesty issues to be strictly attended.  What do you think? ..Maurice.

Graphic:  Photograph  from U.C.L.A. library website  obtained through Google Images.

NOTICE: AS OF TODAY AUGUST 26, 2013  "PATIENT MODESTY: VOLUME 56" WILL BE CLOSED FOR FURTHER COMMENTS. YOU CAN CONTINUE POSTING COMMENTS ON VOLUME 57.

148 Comments:

At Saturday, July 06, 2013 1:30:00 PM, Anonymous Medical Patient Modesty said...

A personal chaperone could be very helpful to protect a patient's wishes because he/she could ask certain people to leave the operating room. The doctors and nurses who made an agreement with the patient would know that they could not back down on what they agreed because they are being watched by an advocate. A husband told a male scrub he could not come in the operating room with his wife who was having C-Section.

I think there are way too many people in this picture. I bet many of them are medical students observing the surgery. While some patients are fine with medical students observing their surgeries, many do not want medical students present.

Misty

 
At Saturday, July 06, 2013 2:22:00 PM, Anonymous Anonymous said...

Misty. Here's another story for you. Goggle ( Cna's take nude photos of assisted living residents-Wbay )Enough said. AL

 
At Saturday, July 06, 2013 2:50:00 PM, Anonymous Medical Patient Modesty said...

It really bothers me that many hospitals won’t let a family member be present in operating room with their loved ones and they let multiple people such as medical students and even non-medical professionals such as janitor and sales rep come in the operating room. I am glad that most hospitals will allow the husband to be present for his wife’s C-Section today.

I was very disturbed by this policy on one hospital’s web site about why family is not allowed in the operating room.

Will my family be allowed in the Operating Room?
No, in order to maintain the highest level of sterility in the surgical environment; this is not allowed.

My response: I disagree with this. I would be more concerned about medical professionals having germs than an outside advocate who could easily take a shower and put on scrubs. Why are janitors, medical students, and sales representatives who may be “dirty” allowed in the operating room? I do not believe that doctors and nurses are completely sterile. Many of them have handled other patients prior to a particular patient. Sometimes, doctors and nurses will take a lunch break in middle of surgery and then return. Also, many surgical staff members go to eat in the hospital cafeteria throughout the day. Think about how the cafeteria is full of germs. Think about the germs they will bring in the operating room.

Another issue to consider is that many surgery staff members take bathroom breaks. Think about how unsterile a restroom at a hospital is. I am not sure if any of you have given thought to this issue before. But every time you flush a toilet with an open lid, bacteria spray into the air around your toilet (http://www.prevention.com/health/healthy-living/health-concerns-how-toilets-spread-germs). Most toilets in public restrooms do not have lids. I bet most nurses are not told that flushing a toilet can spread germs.

Not having a family member present does not help to maintain a sterile environment at all. The more people you have in the operating room, the more germs there will be. There are way too many people in the operating room in the picture above. Scrubs and masks that the medical professionals are not 100% sterile.

I believe one of the main reasons hospitals do not want family members to be present is because they do not want them to see any mistreatment that may happen. You may be promised that your underwear will not be removed, but once you are under anesthesia they could deceive you and remove your underwear since you cannot speak up. Medical malpractice suits are very hard to win because only medical professionals are present. Most medical professionals are not going to testify against a negligent medical professional. The nurse who told my aunt what happened to my paternal grandmother during surgery (she bleed to death) would not testify against the negligent doctor probably due to the fear she would lose her job.

Misty

 
At Saturday, July 06, 2013 3:32:00 PM, Blogger Maurice Bernstein, M.D. said...

Misty, I suspect that the old photograph of the operating room was a celebratory type picture, nevertheless, I have used this as the graphic for this Volume because it, though exaggerated, the picture does suggest a "formality" and population which might be present for a surgical operation. I use the word "formality" because there is an operating room protocol or standards of practice which I truly wonder whether it can be off-set by patients or visitors requests. Further, with regard to population, one could expect individuals within the operating room who were non-participants in the operation itself. So, I can see situations where a patient's informed consent with patient stipulations may not be accepted by the hospital or clinic. ..Maurice.

 
At Saturday, July 06, 2013 4:22:00 PM, Anonymous Anonymous said...

When a toilet is flushed, particulate material can be
ejected as high as 3 feet above the toilet. The direction
of rotation of water in either direction is a myth due to
the misunderstanding of the coriolis effect. If surgical
personnel are wearing surgical scrubs and leave the
surgical suite to visit the toilet,they could very well
contaminate the surgical area. Provided they don't
change scrubs upon re-entry, the laminar flow could
very well displace ejected material deposited on their
scrubs provided they stand upstream of laminar flow.

The nurse in any particular surgery case will only
log names of those involved in the actual surgery, not
those who are onlookers, gawkers or other words
have no real business being in there. Medical reps
who present themselves for the purpose of
demonstrating medical equipment during surgery
are never allowed according to regulations to know
the patients identity, but we all know that is never
the case.

Any patient ought to be able to have an advocate
present during surgery, where is the harm. As long as
they are cleared through nursing and administration
I don't see a problem. The reason hospitals don't like
them present is simply because they become a witness
when medical mistakes happen.

Hospital gawkers never become a witness in that
they say they never saw anything, why would they
implicate themselves being somewhere that they don't
belong. A more appropriate term for gawk is to leer,
gawkers are those people who stop or slowly roll
through an accident scene. Leering is what countless
medical and non-medical personnel do each day at
medical facilities, I guess they think it's part of their
role.


PT

 
At Saturday, July 06, 2013 4:49:00 PM, Anonymous Anonymous said...

Misty, You are so right about germs. I have only seen three individuals [none in medicine] that seriously followed the principles of the germ theory.
Naturally, they are made fun of at times, but would we make fun of hospitals that actually followed the germ theory? Every time I walk out of a medical facility, I have to resist the temptation to write down all the violations of the germ theory. What's sad is that many administrators will defend their policies/practices/procedures [P/P/P] regarding "sanitation" and some administrators are ignorant enough of the germ theory to believe that their facility is doing a good job. Even worse, how many patients [and I suppose some visitors] die each year for the lax enforcement of their inadequate P/P/P?
Their business model is a bureaucracy in which perfunctory compliance and tokenism is a way of life. Accordingly, why should we think that the administrators have any more than token interest in patient modesty?
BJTNT

 
At Sunday, July 07, 2013 8:43:00 AM, Anonymous Anonymous said...

Maurice,

What obligation does the medical community have to protect patients who have previously been victimized?

My last post lists a scenario where a patient comes prepared with papers stating competency and need for same gender care.

Your opinion is important to us. How do you feel about protecting a patient's mental and medical health?
Thanks
Belinda

 
At Sunday, July 07, 2013 11:17:00 AM, Anonymous Anonymous said...

Good catch don. One of the best known phrases in the Bible refers to modesty. And who were they hiding their nudity from? The only other beings around were God and each other. I guess if doctors, nurses or medical aides were around they would trump God himself as well as their significant other.

Maybe there isn't much mention of modesty during medical procedures in the Bible because doctors didn't run patients through production lines back then and actually treated their patients with respect. If there wasn't a problem, why mention it in holy scripture?

There's no mention in the Bible about not taking pictures of naked patients, because there were no camara phones back then. There's no mention of the need for segregated public restrooms or shower rooms either, yet Americans accept it as a norm in our society. There's also no Biblical reference about the sin of posting naked pictures of minors on the internet, yet pedophiles are universally despised in our society.

I don't think we can compare our modern lack of medical ethics to what's written in the Bible. Americans have the right (or at least SHOULD have the right )to decide for themselves what level of morality they choose for their lives. Unfortunately the medical profession takes that choice away from us through force, by lying to us and by bullying us.
----

 
At Sunday, July 07, 2013 12:05:00 PM, Blogger Maurice Bernstein, M.D. said...

Belinda, you ask "What obligation does the medical community have to protect patients who have previously been victimized?" I think that the medical community has a professional duty to provide emotional support and, as necessary, formal psychiatric and pharmaceutical treatment if necessary once the professionals obtain a history of the patient's sexual or modesty victimization. To obtain such a history requires the patient inform the professionals.

To come to the doctor with a paper stating "the need for same gender care" requires that the patient also discuss with the doctor the reason for the request. And, yes, the doctor as part of the emotional support for the patient, should make every effort to find a way to meet the patient's request. The practicalities of the request may lead to a delay in the procedure or an attempt to transfer care to another institution which may be able to meet the patient's requirements. At times, especially if the care is emergent or shouldn't be delayed may require the patient to make their own serious personal medical decisions regarding meeting personal requirements vs accepting the emergent essential treatments.

Yes, "protecting a patient's mental and medical health" is part of the medical professional's responsibility but it must be related to the practicalities of the medical system where the professional is practicing. To further the ability to protect would then require a change in the standards and behavior of that system. So the job for all of us now is to try to make that change including the changes written about on this blog thread. ..Maurice.

 
At Sunday, July 07, 2013 1:58:00 PM, Anonymous Anonymous said...

Thank you!!!! I was hoping you felt that way and I agree with everything
you wrote.

It's important ton note that the "piece of paper" could make the difference between that patient refusing to go to a hospital altogether.

Remember, from a certain mindset, going to the hospital puts that person in danger. Nobody who has been abused wants any version of a repeat performance and that little piece of paper enables the patient to make important decisions as they go along.
belinda

 
At Sunday, July 07, 2013 6:56:00 PM, Anonymous Anonymous said...

While the Bible may not address medical procedures and nudity, it may have some impact on why we feel as we do about modesty. For many of us our religion, our faith is a if not the major influance in our lives. It is just one part of our upbringing that connects nudity with shame and embarassment. That theme is repeated over and over in numerous aspects. Our parents teach us to be embarassed of being exposed, our teachers seperate locker rooms, we are subject to penalties and punishment for either esposing ourselves to opposite gender or attempting to seeking to view. Being seen nude by the opposite gender is humiliating. Yet, providers think all of these years of endocrination is suddenly suspended when we enter their world. Dr. Bernstein, do you understand our contention that we understand the contxt of treatment may change the nesescity but that does not eliminate the embarassment that come with exposure, esp to opposite gender. Do you understand our contention that context and gender nuetral are concepts that providers embrace but not nesicarily patients? I am not asking for you to agree with them, just asking if your understand that you are taking the perspective of a provider and it is the perspective of the patient that matters. While gender nuetral and context are well intended, are they completely different than I have seen it all before? Are they not concepts from the provider side in an attmept to make the patient feel better about what the PROVIDER wants to offer and perhaps to help the provider feel more comfortable with what they are about to do? I am not trying to be confrontational here, I just think point of perspective is such a huge piece of this discussion....don

 
At Sunday, July 07, 2013 7:20:00 PM, Anonymous Medical Patient Modesty said...

Al: It is sad that those CNAs took pictures of nude patients. It is pretty common for elderly residents to be abused and neglected in nursing homes. My great aunt had negligent care at a nursing home in Florida. That is why it is best for family to hire a caregiver to take care of an elderly person at home if possible. My grandma hired a female caregiver to help with her mom (my great-grandmother) who had Alzheimer’s Disease.

Dr. Bernstein: Yes, I’m sure that the picture you used was a celebrity picture. The number of people in operating room varies at each hospital. It also varies for surgeries. But I’m sure that there are that many people in the operating room at certain medical facilities. I am not sure if you have watched the movie, ”Gifted Hands” about Dr. Ben Carson, an amazing neurosurgeon. I really loved that movie and I personally have a lot of respect for Dr. Carson. There were many medical personnel in the operating room for the conjoined twins that he successfully separated. It was crucial that they had many doctors and nurses there because the surgery was very complicated. I do not really feel patient modesty was relevant in this surgery. Most people who feel strongly about patient modesty do not think it’s a big deal for infants and toddlers to run around naked. My point is I do understand that there are certain surgeries that require many medical personnel. But at the same time, there are many surgeries that only require a few medical professionals. I heard of a case where a man had a vasectomy done by a male doctor with no other medical personnel.

I appreciate your response to Belinda about patients who have previously been abused. Some patients who have been abused in the past avoid medical care because they feel medical personnel won’t honor their wishes. I also feel that patients could bring in paperwork demanding that they need same gender care for other reasons. For example, a Christian lady who has strong convictions that no male doctors or nurses should be a part of her gynecological procedure could bring paperwork and state that no males may be part of her medical care.

PT: You made some excellent points. You are right that many medical facilities do not want an advocate not employed by the facility to be present because they could potentially witness unethical things or mistakes that the doctors and nurses may make.

BJTNT: One of my friends’ husband contracted a MRSA infection from knee surgery he had at the hospital he worked at. He almost died. He is severely disabled today. There is no chance to maintain a 100% sterile environment. It bothers me that medical professionals claim that if you bring a family member that it could contaminate the surgical area when their surgical staff often bring germs in the operating room.

Anonymous at 11:17 AM on Sunday, July 7, 2013 You have made some interesting points. I am sure you would be interested in checking out the following articles: Christian Husband Who Is Against Male Gynecologists , Modesty and Your Physician (Truth Magazine), and Should Christian Women Visit Male Gynecologists?

Misty

 
At Tuesday, July 09, 2013 8:05:00 AM, Blogger Maurice Bernstein, M.D. said...

Here is another new thread I put up which I think is pertinent to the discussions on the Patient Modesty thread: "As a Patient: I Am My Own Doctor. Trust Me"

Take a look at it and write your comments there if you have some. ..Maurice.

 
At Wednesday, July 10, 2013 6:52:00 PM, Anonymous Medical Patient Modesty said...

I wanted to let you all know that I had the privilege of helping a man this week who was concerned about modesty for colonoscopy. He found the article about colonoscopy on Medical Patient Modesty's web site at http://patientmodesty.org/colonoscopymodesty.aspx. He asked me about colonoscopy shorts and wearing your boxer shorts backwards. He was concerned because the receptionist at a clinic told him she did not know anything about colonoscopy shorts. I shared some information with him and encouraged him to talk to the doctor. He did and the doctor responded favorably to his request that he wanted to wear colonoscopy shorts or boxer shorts backwards. He also asked that he not be sedated. He also spoke to the female head nurse about his wishes for colonoscopy shorts and all male team. She was very receptive. You can see some of his comments to me below. It was very encouraging that he found a doctor and head nurse sensitive to his wishes. We should always show our appreciation to doctors and nurses who honor patients’ wishes for modesty. There are certainly some good doctors and nurses out there. I really admire this man for speaking up.

Here are the man’s comments after he spoke up about his modesty concerns:


thought I would let you know that I had a consultation today and the doctor was willing to allow me to wear colonoscopy shorts or boxers backwards, as well as having an all male team and limiting the tech to one, since he only has one male tech. he is also willing to do it without sedation, demoral only. I also spoke with the head nurse at the facility where the procedure is being done and she told me that they will order shorts with a flap, but if they dont come in before the procedure they have shorts and will cut a hole in them for access....she also said that she will make sure the team is all male, and the staff will be limited to one tech rather than two...I could not be happier, hope the procedure goes as well but I have no anxiety about it....they said they want to make me as comfortable as possible and address any and all of my modesty needs....all doctors and facilities should be this accommodating. If they were, there would not be all of the horror stories you hear about....thanks again for your help, I would not have known to ask if it were not for your help.



I was very pleased to learn that there is an all-male urology clinic in San Antonio according to http://nowcastsa.com/blogs/urologists-bring-sensitive-men%E2%80%99s-health-issues-front-and-center-new-men-only-clinic. I called the office to confirm that it was true that they have an all-male urology medical team. I was informed that the only female employee of this clinic was the receptionist. This is wonderful. I wish there were more urology clinics like this one. I encourage men who participate in this discussion who are against female nurses or doctors for intimate medical care to consider sending a letter to this clinic thanking them for being sensitive to male patient modesty. I found this clinic as I was doing research on Google for all male urology clinics after a man shared that he wishes there was an online directory of all-male urology clinics. This was the only one I found so far. Does anyone know of any other all-male urology clinics? If you ever hear of any urologists saying that they cannot hire male nurses or assistants, you should show them this article about the all-male urology clinic in San Antonio. It really disturbed me about a month ago when a male urologist commented on this blog about how he could not hire male nurses or assistants.

Misty

 
At Thursday, July 11, 2013 5:08:00 AM, Anonymous Anonymous said...

Misty,

Why not write to the office manager and the managing physician asking them why they decided to do this and any statistics on how their business is doing after implementing the male staff.

This could then be used as a marketing tool and perhaps be marketed through your non profit organization. All you need to do is create doubt to other providers that they are losing business and their self interest in profits may
outweigh the outdated protection to the medical community norms that we are trying to erode on this issue.
belinda

 
At Friday, July 12, 2013 3:22:00 PM, Anonymous Anonymous said...

Maurice said "...join as various community committee members in those systems and help direct and help 'drive' the systems to better functioning for all patients."
Being a community member works, but only for a limited number of the public. How about allowing the pubic to more fully participate in public meetings by allowing them to listen to everything [it's not even necessary to talk]? For example, I use to attend the public hearings on MD disciplines by the Med Board of CA when they were in the LA area. I realized they were just show meetings when one MD who badly wanted to be reinstated spoke up when his lawyer was doing a poor job. The MD went off-script. It was the only time I was ever allowed to hear anything of significance since all other times the Board Chair would announce a vote and that the public had to leave. This made me realize why the vote took so long because then the real issues were being discussed. There are several non-MDs on the Med Board which is good. I always obtained better information by just listening during the coffee and donuts period before the official meeting began because it was assumed that I was part of the elite. I was always the only member of the public present.
I consoled myself with not getting any good info on MD disciplines at the Med Board meetings by reading the charges [some/all?] on-line until a few years ago when the Med Board stopped providing that info, except for rare cases. BJTNT

 
At Saturday, July 13, 2013 2:35:00 PM, Blogger Maurice Bernstein, M.D. said...

On 7-9-2013, DP attempted to post the following personal experience but it wasn't accepted by blogger.com due to it's length. Here is what was written divided in 2 parts. ..Maurice.
Before having surgery, I had never considered the subject of patient privacy, assuming that doctors did what was necessary during surgery with the best interest of the patient in mind. That is, until I had a terrible experience at a local teaching hospital. I was admitted by my physician for correction of what was termed an anal fistula. In addition, my doctor intended to perform a colonoscopy before the surgery.
On the day of the surgery, my first, 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. The anesthesiologist came in to pre-op and introduced himself, but at no time was I informed or introduced to the other people that would be present in the operating room.
At the appointed time I was wheeled into the operating room and helped from the gurney onto the operating table. 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 11 people. I was trying to register all of this as a drug named Versed was administered to me via an IV in my hand. At about the same time, the gown was removed and I was asked to lean forward for what I later found out was a needle in my lower spine. I was never informed of what was going to take place once I was in the OR and I was never informed as to who all of the staff present were.
I later discovered that my operation had been observed by a number of nurses and nursing students. When I wrote to the hospital to protest this gross invasion of my modesty, dignity and privacy, I was informed that the hospital is a teaching institution 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, unconscious with my genitals fully exposed to young male and female students, without the hospital or my doctor even mentioning that this might, let alone would, happen!
According to the medical records of my operation that I obtained, the patient (me) was placed on his left side and a colonoscopy was performed. There is no mention whatsoever of any draping or adherence to patient modesty standards as this procedure was performed not only for my benefit but for the benefit of unnecessary nurses and student nurses. The records further show that AFTER the colonoscopy, I was placed in a jackknife position on the operating table, still undraped in any way. I was then “prepped” by a nurse, again in full view of students, my buttocks were spread and taped open, and only then was I draped. At this point the anal fistula surgery was performed. All of this in front of people that I had no idea would be present and who were allowed to view an extremely private surgery that they had no business being there for. The concept of INFORMED consent was never addressed in my case. D.P.

 
At Saturday, July 13, 2013 2:37:00 PM, Blogger Maurice Bernstein, M.D. said...

Continuing with the posting by D.P. ..Maurice.


In my opinion this is at best pure voyeurism on the part of the hospital staff, and my doctor was totally complicit by allowing this to occur. To be treated as a subject of an “educational” experience without my informed consent is, in my opinion, criminal behavior. They went out of their way to never mention what was going to occur, nor to inform me ahead of time. My pre-op meeting consisted of my doctor informing me that I needed the surgery, the anesthesiologist introducing himself to me 15 minutes before surgery and no mention of observers being present during my surgery. This was all about the power differential between the doctor and me, the patient, who was unconscious and unable to object. To find out later what occurred has engendered anger and constant thoughts about what occurred while I was vulnerable and unable to protest.
When I asked my surgeon why he allowed this to occur, his answer only served to make me more upset. He babbled on about how this was nothing that everyone in the room had seen before and besides, since I was unconscious, what harm was done? Since my operation, I have spoken with many other people who have undergone surgeries, many who have confessed to similar experiences. The internet is awash with examples of this attitude towards patients with example after example of far more invasive procedures performed on unconscious patient. I take scant comfort in knowing that I can now be counted in their numbers.
I mention all of this because now, almost 6 years later I just went in for the second surgery of my life. I will post my comments about this surgery later, but suffice it to say for now that deception and obfuscation are alive and well in the medical community today.

D.P.

 
At Saturday, July 13, 2013 4:52:00 PM, Blogger Maurice Bernstein, M.D. said...

And so, does the experience of D.P. and others who have presented their OR experiences here represent the crimes of assault, battery or both?
..Maurice.

From "The Free Dictionary"
ASSAULT:

Generally, the essential elements of assault consist of an act intended to cause an apprehension of harmful or offensive contact that causes apprehension of such contact in the victim.

The act required for an assault must be overt. Although words alone are insufficient, they might create an assault when coupled with some action that indicates the ability to carry out the threat. A mere threat to harm is not an assault; however, a threat combined with a raised fist might be sufficient if it causes a reasonable apprehension of harm in the victim.

Intent is an essential element of assault. In tort law, it can be specific intent—if the assailant intends to cause the apprehension of harmful or offensive contact in the victim—or general intent—if he or she intends to do the act that causes such apprehension. In addition, the intent element is satisfied if it is substantially certain, to a reasonable person, that the act will cause the result. A defendant who holds a gun to a victim's head possesses the requisite intent, since it is substantially certain that this act will produce an apprehension in the victim. In all cases, intent to kill or harm is irrelevant.

In criminal law, the attempted battery type of assault requires a Specific Intent to commit battery. An intent to frighten will not suffice for this form of assault.

There can be no assault if the act does not produce a true apprehension of harm in the victim. There must be a reasonable fear of injury. The usual test applied is whether the act would induce such apprehension in the mind of a reasonable person. The status of the victim is taken into account. A threat made to a child might be sufficient to constitute an assault, while an identical threat made to an adult might not.

Virtually all jurisdictions agree that the victim must be aware of the danger. This element is not required, however, for the attempted battery type of assault. A defendant who throws a rock at a sleeping victim can only be guilty of the attempted battery assault, since the victim would not be aware of the possible harm.


 
At Saturday, July 13, 2013 4:53:00 PM, Blogger Maurice Bernstein, M.D. said...

BATTERY:
The following elements must be proven to establish a case for battery: (1) an act by a defendant; (2) an intent to cause harmful or offensive contact on the part of the defendant; and (3) harmful or offensive contact to the plaintiff.

The Act The act must result in one of two forms of contact. Causing any physical harm or injury to the victim—such as a cut, a burn, or a bullet wound—could constitute battery, but actual injury is not required. Even though there is no apparent bruise following harmful contact, the defendant can still be guilty of battery; occurrence of a physical illness subsequent to the contact may also be actionable. The second type of contact that may constitute battery causes no actual physical harm but is, instead, offensive or insulting to the victim. Examples include spitting in someone's face or offensively touching someone against his or her will.

Touching the person of someone is defined as including not only contacts with the body, but also with anything closely connected with the body, such as clothing or an item carried in the person's hand. For example, a battery may be committed by intentionally knocking a hat off someone's head or knocking a glass out of some-one's hand.

Intent Although the contact must be intended, there is no requirement that the defendant intend to harm or injure the victim. In Tort Law, the intent must be either specific intent—the contact was specifically intended—or general intent—the defendant was substantially certain that the act would cause the contact. The intent element is satisfied in Criminal Law when the act is done with an intent to injure or with criminal negligence—failure to use care to avoid criminal consequences. The intent for criminal law is also present when the defendant's conduct is unlawful even though it does not amount to criminal negligence.

Intent is not negated if the aim of the contact was a joke. As with all torts, however, consent is a defense. Under certain circumstances consent to a battery is assumed. A person who walks in a crowded area impliedly consents to a degree of contact that is inevitable and reasonable. Consent may also be assumed if the parties had a prior relationship unless the victim gave the defendant a previous warning.

There is no requirement that the plaintiff be aware of a battery at the time it is committed. The gist of the action is the lack of consent to contact. It is no defense that the victim was sleeping or unconscious at the time.

Harmful or Offensive Conduct It is not necessary for the defendant's wrongful act to result in direct contact with the victim. It is sufficient if the act sets in motion a force that results in the contact. A defendant who whipped a horse on which a plaintiff was riding, causing the plaintiff to fall and be injured, was found guilty of battery. Provided all other elements of the offense are present, the offense may also be committed by causing the victim to harm himself. A defendant who fails to act when he or she has a duty to do so is guilty—as where a nurse fails to warn a blind patient that he is headed toward an open window, causing him to fall and injure himself.

 
At Saturday, July 13, 2013 7:07:00 PM, Anonymous Anonymous said...

Lack of specific informed consent amounts to a forced stripping subjecting the patient to extreme humiliation that could result in psychological damage.

Why aren't patients told what will happen, who will be in attendance in specific terms. The answer...because if they knew, they would not consent.

What happened to this patient amounts to actions that were or would have been clearly against his will, therefore is assault and battery. How long can the medical profession hide behind it's own actions, causing psychological harm that they know happens, yet still perform their procedures with a bunch of gobility gook, hiding behind legal forms.

Maurice, what's your opinion based on your article with regard to what happened to this patient?
belinda

 
At Saturday, July 13, 2013 7:35:00 PM, Anonymous Anonymous said...

Under the umbrella of healthcare many things that would end a person in jail are considered acceptable. Not that long ago a couple of oil ledge kids filmed a sexual encounter and published it. they were brought up on manslaughter chrgs when he killed himself. Yet when a nurse took pictures of an unoncious patient who had an unusual tattoo on his penis and shred the, no criminl chrges at all, just discilined by the hospital. in business if you sign a contract under duress or while impaired it is not vaild yet we sign consent forms while extremely strssed when it is entirely possible to provide them prior so the patient could review at liesure and say you agreed. Under todays wide bearth given providers no it is not assult, under the majority of circumstances probably...don

 
At Saturday, July 13, 2013 9:00:00 PM, Blogger Maurice Bernstein, M.D. said...

Belinda, I have no legal professional background to fully answer your question. I wish we had some lawyers as visitors here to help us. However, notwithstanding my above withdrawal to answer your question, I do agree with Don regarding the issue of signing an informed consent document perhaps not under the legal definition of duress (forced acceptance or action) but instead under emotional stress. This is not an issue that is generally discussed when informed consent for surgery is mentioned. And yet, it should be.
The standard is for the physician to consider the intellectual capacity of the patient to understand the harms and benefits of the upcoming procedure and whether that is acceptable sufficiently for the patient to sign the consent document. But I don't hear in discussion about the standards regarding the emotional capacity to be attentive to accept or reject any notation in the document about what to expect within the environment of the operating room or those attending. And, yes, it does take attention to read the fine print or hear about the operating room methodology or operating room population, if this information is even presented by the doctor or printed on the form. Yet, a patient who is concerned about a recovery and the hazards of the procedure and is perhaps also in physical distress could be expected to be under emotional stress and not attentive to this information.

Perhaps every patient who has to read and sign an informed consent paper for surgery should have present a family member to consider the fine print or, in fact, the presence of the patient's lawyer! ..Maurice.

 
At Sunday, July 14, 2013 5:19:00 AM, Anonymous Anonymous said...

I think the problem exists in the incongruity between patient expectations with regards to privacy that go along with their privacy expectations in the doctor's office.

What happens is that from the patient perspective what occurs is an outrageous breech of privacy.

Taking this part of healthcare out of fine print would do two things. One, clear expectations for the patient and secondly, a greater possibility of avoiding psychological trauma because the treatment is not unexpected.

One could argue that these forms ARE signed under duress as patients are sometimes in great pain or with life threatening issues.

Maurice, would you agree there would be much improvement psychologically if everything were up front and on the table, patient choice as to who is in the room in a teaching situation, giving them some control over their autonomy.

Personally I feel that the medical community is purposefully deceptive to gain access and achieve their full agenda.
belinda

 
At Sunday, July 14, 2013 6:46:00 PM, Anonymous Anonymous said...

While I often feel I am at a different point on the continuum than some including Belinda at times I think she has perhaps summed up a huge portion of this now 56 volumes in he last sentence. I to feel the medical profession is intentionally if not deceptive, guilty by omission to achieve an agenda accepted within the medical community. While the main goal may be achieving an optimal physical benefit for the patient, the secondary and perhaps competive goal is to do is in a financially efficient manner. Surgeries are scheduled days, weeks, even months in advance. Yet consent is signed the day of. When I enter into a business contract paperwork is circulated in advance to give everyone time to read and digest the contents. Yet in he most important decisions of our lives, our health we are expected to sign on the spot never having time to read or digest. When one thinks back on the schedule of a surgery it is rush rush rush. Why would the consent forms NOT be sent in advance? They have your info. To a large degree an ignorant patient is a compliant patient. Just think of the termoil if every patient started demanding the specific accommodations that made them comfortable. The more I read in these threads and the more I think about it I feel the medical profession originated the don't ask don't tell concept......don

 
At Sunday, July 14, 2013 6:59:00 PM, Blogger Maurice Bernstein, M.D. said...

"I feel the medical profession originated the don't ask don't tell concept." On the other hand, what I have written repeatedly here in the past is essentially "if the patient doesn't ask, the doctor is unable to tell." I personally don't mind a patient "speaking up" since it shows me clearly that the patient "cares" about what is happening to themselves. ..Maurice.

 
At Sunday, July 14, 2013 7:01:00 PM, Anonymous Anonymous said...

don [and Belinda], you have [as you stated] reiterated many points that have been made over the last 56 volumes. It can be summed up in the simple phrase "it's all about them".
BJTNT

 
At Sunday, July 14, 2013 9:11:00 PM, Anonymous Anonymous said...

Most employers and particularly
hospitals require employees to take
online classes on cultural diversity and discrimination.
Subject matter such as generalizations and sexual
harrassment are discussed yet,such
comments about patients are made
regularly by staff. Assumptions
that male modesty is irrevelant
is certainly a generalization.
Additionally, all patients shall
recieve the same medical care are
statements made by hospitals yet
how can they back up such comments
when areas such as OB,mammography
and post-op gyn are exclusively
female staffed compared to areas
male patients frequent.

PT

 
At Monday, July 15, 2013 6:20:00 AM, Anonymous Anonymous said...

I wholeheartedly agree with Belinda in as much as the medical community omits information to proceed the way they want. In my way of thinking the omission says that they are fully aware many patients will not say yes if they knew all the facts. How can a patient going into surgery know what to expect and therefore know what questions to ask without some more detailed consent forms? As was said by D.P., patients usually expect the same regard for their privacy/modesty that they receive at their doctor's office once they go into surgery. I can well understand this individual's consternation at finding that not to be the case. (By the way, I think it is insulting to suggest that the patient should not care since they are unconscious!)
Since surgery consent forms are most likely standardized, preprinted documents what would be the problem with providing them to the patient long before the actual surgery so that the patient can read them more carefully and ask questions as needed? Most surgeries are scheduled with ample time to do this. If a patient asked for the forms ahead of time, would they not be provided? I know at this point in my knowledge of medical and modesty issues I would certainly do this and if it was not allowed I would sit in the waiting area and not allow things to move on until I had read the forms word for word, which is definitely within my rights. That might throw their schedule off. Yes, patients are under emotional stress when they read these; why do doctors/hospitals not take this into consideration and provide them ahead of time? Jean

 
At Monday, July 15, 2013 8:32:00 AM, Anonymous Medical Patient Modesty said...

It is sad about how patients are often not informed exactly what will happen to them and who all will be involved in their care. This is one of the big reasons I started Medical Patient Modesty. I hope to reach out to as many people as possible to alert them that they need to be aware that most doctors and nurses do not tell them details about many things including how much exposure they may have for a certain surgery and who all will be involved in the operating room.

Many patients are rushed to sign consent forms without really reading them. Also, most surgery consent forms do not give details about a lot of things. For example, there is no known consent form for urinary catheter. Patients must write that no urinary catheter may be inserted on their forms. I think all patients should get consent forms at least one day before the surgery.

I believe the reason many doctors and nurses do not want patients to know all details is because many patients would back out of surgeries and mess up schedules. Think about the lost revenue hospitals would suffer if many patients backed out from surgeries. It is about medical professionals and not patients. I personally think it is unethical for doctors and nurses to withhold as much information from patients.

Look at one of the rights that patients have in Patient Bills of Rights: Know the names, positions and functions of any hospital staff involved in your care and refuse their treatment, examination or observation. I believe this means that a patient can refuse intimate opposite sex care or even intimate exams. Medical facilities often fail to provide a detailed list of people who would be involved in a patient’s surgery. I bet most patients do not even know about this right.

As for legal options for patients who have been violated, this is really complicated especially if a patient has no personal advocate not employed by the medical facility present for surgeries. This is exactly why Medical Patient Modesty recently hired a legal research intern who is a RN who decided to go to law school. She has been working on a legal article about urinary catheters.

I wanted to let you all know that a well-respected male gynecologist sexually abused a number of female patients in New York. See an article about this doctor at http://www.nydailynews.com/news/crime/sex-abuse-allegations-gynecologist-pile-article-1.1396843?localLinksEnabled=false. This case is very disturbing due to this particular sentence: “Some of the women who have recently come forward will most likely be unable to join the lawsuit because the statute of limitations holds that the assault must have occurred within the previous year.” The statute of limitations protect doctors and do not take into consideration patients at all. It is exactly why patients have limited legal options and this is very sad. It is prudent for every patient to have a personal advocate not employed by medical facility present at all times with him/her especially if he/she will be under anesthesia. I am so tired of hearing this argument: It does not matter what happens once the patient is under anesthesia.

Misty

 
At Monday, July 15, 2013 1:31:00 PM, Anonymous Anonymous said...

Maurice,
The Don't ask, don't tell" attitude is unethical. It's an extension omitting information and limiting one's ability to informed consent. It's breaking the law.

How can the medical community support such a terrible representation that can cause such harm and have people avoiding healthcare? The attitude is short sighted and creates those outliers you speak about. One day soon we might just be the majority.

Shame on the medical profession!
belinda

 
At Monday, July 15, 2013 6:14:00 PM, Anonymous Anonymous said...

I agree Dr. Bernstein in an ideal world there would be open communication. However when the power dynamics are as uneven as the patient provider is open communication is much more difficult. Given we are coming from a historical position where providers were not questioned it is pretty easy to understand why patients are reluctant to speak up. The concept of second opinion and patient focused care are relatively new concepts. With the power being heavily on the provider side the responsiblity also should lay on the provider side. Again the saying those with whom much is given much is expected comes to mind. That said it is in our own best interest to speak up regardless of worse responsiblity it should be to ask. I had a surgery once and email the Dr doing he surgery saying I was nervous about what to expect the day of surgery and could they send me information on what to expect, I got some generic info about the conviction and treatment that looked like it came fresh off the memo graph machine when I was in 5th grade. That was several years ago and today I would not accept it but then I didn't know I could challenge. Same surgery day of, already gowned, signing "some additional" forms. Including a release to film the procedure, the nurse evidently saw the panic on my face and said they very rarely do and it's just a formality.....I again contend Belinda was right and stick to my contention, don't ask don't tell serves a purpose for providers at our expense and it is part of the providers culture....don

 
At Tuesday, July 16, 2013 10:32:00 AM, Anonymous Anonymous said...

Hi,
This is D.P. Thank you, Dr. Mo, for the posting you so graciously did for me. As I said in my e-mail to Dr. Mo, this surgery took place almost 6 years ago.

Now, two weeks ago, I had ACL surgery. I was encouraged before the surgery because the surgeon and staff sent me over "ALL" of the forms needed for my pre-op meeting. Specifically, there was a registration form, patient notification and acknowledgement form about advance directives, privacy practices, etc., a surgical information sheet, pre- anesthesia evaluation and a patient history form. I filled them all out, met with the surgeon, reiterated that I didn't want anyone not directly associated with my surgery there and, since the surgery center was located on premises, asked if it was okay for me to pop my head in and see the center. They said that was fine, so on my way out I stopped by. Met a good guy behind the counter, started talking to him and he asked me if I had filled out all the forms. Since I had a copy of everything, I showed him what I had done. He said, Oh, you don't have the “Authorization for and Consent to Surgery, Care, Treatment, Special Diagnostic or Therapeutic Procedures”.

Ah yes, the consent form. I took it home and read it. Two clauses were of special concern to me out of the SIXTEEN clauses on this page. I quote them here verbatim:

Clause 6: The facility may participate in residency and other training programs for physicians, allied health professionals and other providers of services. All care rendered by individuals in training will be supervised and reviewed, as appropriate, by appropriate personnel. I hereby consent to care and treatment from individuals in training and the review of my patient record by same.”

Clause 9: . I hereby consent to the presence of other person(s) for the sole purpose of observation and/or education. I understand that they will not participate in the actual procedure.”

I was shocked to find this document had not been provided as a part of the package of forms sent to me 2 weeks prior to my pre-op meeting. Now, I don't wish to trivialize the PTSD experiences of veterans, but my response to getting this form can only be described as a form of PTSD. For no apparent reason, I began to obsess on this. Over and over I ran through, in my mind, what had happened the last time and the consequences of clause 9, with its overly broad interpretation (other person(s)) had my mind racing with what the implications of this could mean. More on this later, but the bottom line on all of this is that it doesn't matter what you and your surgeon agree to orally in the pre-op meeting. Signed paper work will trump it every time in a court of law. When you are laying there on a gurney, naked under a gown, and some admissions nurse thrusts this document in your face 45 minutes before you go under, most people will sign it without so much as glancing at it. When you do, all your rights to dignity, privacy and modesty go out the window and its carte blanch. I have a lot more to say about all this, but I'm running out of space for now.

D.P.

 
At Tuesday, July 16, 2013 10:47:00 AM, Anonymous Anonymous said...

To continue, I took the form home and prepared a scathing rebuke to both the timing and the content as it pertained to clauses 6 and 9.. There is little doubt in my mind that had I not thoroughly read that document that was given to me an hour before surgery and protested in writing, ANYBODY could have been present for my surgery and the excuse would be the same - you signed the consent form.

By the way, these consent forms are not shown on the websites of teaching hospitals because they don't want you to know they exist in the hopes that you'll be like most patients and just sign the document when its presented to you. All the other forms are available, but not that form. In addition, the consent forms do not have an opt out clause. They demand you put it in writing that you disagree. (Excuse me nurse, while I'm lying naked under this flimsy gown, could I have a piece of paper and a pen so I can piss off my doctor shortly before I go under general anesthesia and he cuts me open?) No intimidation factor here, is there!

Just the other day in the L.A. Times there was an article about forced sterilization of women prisoners in the CA prison system. These women all gave "consent". Documents that they had no hope of understanding in their confused state were thrust upon them and they signed them. The form may have even been blank and filled in at a later time with the "medical emergency" status needed to get away with this crime. Couple this with the fact that they are even more subservient in the eyes of the medical profession because they are prisoners of the state of California and you begin to realize how doctors, in some twisted paternalistic attitude, decide what is best for ALL of their patients.

While we have made great strides in recent years thanks to the advent of HIPPA, this particularly onerous practice continues EVERY DAY in every hospital in California. There needs to be legislation to control this practice. Patients unknowingly are giving up their most basic rights when they sign these documents. These documents need to be a part of the overall packet of information given to the patient BEFORE their pre-op meeting. At the pre-op, the patient should have an advocate present to explain what this document truly says. To thrust this upon the patient at the last minute may be legal but it is morally reprehensible.

I wrote to the authors of the L.A. times article. The answer I received back was a lackluster thank you for sharing your opinion with us. I expressed the hope that they will do some follow up stories on this issue of forced sterilization. The doctors and administrators involved in this practice need to be criminally prosecuted on assault charges and then sued personally, along with the medical centers that allowed this to occur.

The timing of these consent forms is the dirty little secret that teaching institutions don't want the public to be aware of. The next time you or a loved one is in a hospital setting, you most likely will be visited by medical students, nurses in training, equipment salesmen and God knows who else because you ignorantly signed away your patient rights by agreeing to the consent form.

By the way, try going onto the website for the recently announced best hospital in California, named after a former president. When you get there, you can see ALL of the forms EXCEPT the consent form. Try putting consent form, or variations thereof, into their search engine and see what you get. Comments???
D.P.

 
At Tuesday, July 16, 2013 11:10:00 AM, Anonymous Anonymous said...

DP, As a researcher into the psycho social aspects of medical care that are detrimental to mental health, I have to tell you that many patients develop PTSD as a result of cruel degrading treatment, and circumstances such as your with next
surgery.

Two things that happen to patients who have experiences within the context of "standard of care" is that they fight head on or develop avoidance issues that are part of PTSD.

PTSD comes from different sources. Natural disasters, war, sexual assault. Those that fit into the sexual assault category have a harder time healing as statistics show.

I would be interested in speaking with you, with no monetary gain, and Dr Mo has my e mail if you would like to speak to me.

Wishing you well. By the way, I have my own horror stories that will soon be published in a book that I've been writing.
belinda

 
At Tuesday, July 16, 2013 11:29:00 AM, Anonymous Medical Patient Modesty said...

D.P.,

I am sorry to hear about your bad experience with surgery.

Were you able to wear underwear for the ACL surgery? There is no reason for underwear to be removed for knee surgery.

It's interesting that they did not give you those important forms with the other consent forms. I wonder if they did that on purpose.

Misty

 
At Tuesday, July 16, 2013 2:42:00 PM, Anonymous Medical Patient Modesty said...

I wanted to let you all know that Outpatient Surgery Magazine got some letters from people who were disturbed by picture of the female surgery patient on the front page of June Issue. You all can check out this link to see the letters: Letters & E-mails: Was Positioning Cover Photo Degrading?. It looks like it caused a stir among some medical professionals as well. The medical profession is supposed to be gender neutral and it is interesting that some medical professionals wrote letters. I wonder if some of them were concerned about patients seeing what really goes on when they are under anesthesia. What do you all think?

Misty

 
At Tuesday, July 16, 2013 3:39:00 PM, Anonymous Anonymous said...

I'm willing to bet that if the patient had been male, not a single female provider would have taken the time to complain directly to the magazine.

Ed

 
At Tuesday, July 16, 2013 4:01:00 PM, Anonymous Anonymous said...

When I arrived at the surgery center for the knee surgery, the admitting nurse, after the dust up about the consent form, was, I think, taken aback by what I must admit, was my seemingly hostile attitude. She took me to the PACU/Pre-op area, gave me a gown and asked me to remove all of my clothes. She closed the curtain and I proceeded to undress and get the gown on. I left my underwear on, as I had already discussed this with both the surgeon and the anesthesiologist at pre-op. I was still trying to tie the lower half of the gown and she asked if I was ready. I commented that I was having difficulty with the short leads on the gown and she came in and said she would tie them for me. She noticed I was still wearing underwear and told me that those had to come off. I looked her right in the eye and told her that that wasn't going to happen. She could tell at this point I was not going to be taken advantage of, made a note of it on the admission form and dropped the subject. I had my underwear on the entire time and I insisted on being fully awake for the femoral nerve block. The female anesthesiologist apologized that she had to push my underwear to the side but there was no exposure and I totally understood. She was a real professional, as was my surgeon. The dichotomy of the experience is that really good, caring people are either employees or' like my surgeon, a part owner of the facility. My next meeting with my surgeon is 10 days away and I intend to get to the bottom of this seemingly bipolar approach to patients.
D.P.

 
At Tuesday, July 16, 2013 4:36:00 PM, Anonymous Anonymous said...

not trying to ignite the warof the sexes again but does anyone think this would have been an issue if 3 female nurses were positioning a male patieent? I would lay money no. My point is not to start an argument but to point out that perspective rules how these things are viewed. Providers view context and gender nuetrality through their eyes. I have posed several questions to providers that seem to get ignored when their personal preferneces conflict with their professional practices. Allnurses is filled with posts by nurses who claim accomodating their modesty is different because they know the other providers, then there are those who defend their right not to partcipate in training such as bed baths in class wearing bathing suits but feel entitled to observe a naked patient getting one during their training. We had a female urologist brieffly visit, I asked her the gender of her gyn, her reply, I go to the same one my mother did...read between the lines. Dr. Bernstien I am very very thankful of all you have done here, i respect you as a compassionate person who has done so much for many of us...but I asked you, do you recognize that the concepts of context and gender nuetrality are in the eye of the beholder, and as per the article we were discussing, the patient holds the most relevant position in determining those issues. You did not reply. So I have to respectfully ask the same question, do you recognize the fact that the point of reference for determining the role context and gender nuetrality can vastly differ depending on your point of refernce and it si the patient not the provider that should be given priority in determining what is important or not to THEM? Bravo DP, well said.....don

 
At Tuesday, July 16, 2013 5:14:00 PM, Blogger Maurice Bernstein, M.D. said...

Don, you write "do you recognize the fact that the point of reference for determining the role context and gender neutrality can vastly differ depending on your point of reference and it is the patient not the provider that should be given priority in determining what is important or not to THEM?"
With regard to patient physical modesty issues: OF COURSE! It is the patient who is undressed and it will only be the patient who will be affected by the emotional distress associated with actions that occur which can be or are related to the patient's own modesty issues. That is why I have repeatedly written here for the patient to "speak up". This doesn't mean that the healthcare provider is neutral or immune from any thoughts of concern when examining or performing a procedure on a exposed body of conscious or unconscious patient. There should always be a ongoing concern and attention to maintaining professional behavior. ..Maurice.

 
At Tuesday, July 16, 2013 6:09:00 PM, Anonymous Medical Patient Modesty said...

Don,

I wanted to respond to your statement below:


not trying to ignite the war of the sexes again but does anyone think this would have been an issue if 3 female nurses were positioning a male patient


It makes me sad, but I think people would be less outraged about that picture if it had been a male patient being prepped by 3 female nurses because so many people assume that modesty does not matter for men. Male patient modesty is as important as female patient modesty. I disagree with that completely. In fact, it would have bothered me as much if a male patient had been prepped and positioned by 3 female nurses in that picture. I am pretty sure that this was hip surgery. Think about how a male patient would be exposed in hip surgery due to the fact that underwear gets in way of hip. My dad had hip surgery and I suspect he does not know the truth about how much he was exposed for the surgery.

Misty

 
At Tuesday, July 16, 2013 7:09:00 PM, Anonymous Medical Patient Modesty said...

I found this Youtube Video: Woman Naked under Surgical Sheet is Put Out. People in this video speak German. Does anyone here speak German? If so, can you please tell me all of the words that are spoken? Do you have any idea what kind of surgery she is having? It is disturbing to me. If she is having surgery on her hand or arm, there is definitely no reason for her to be naked under surgical sheet at all.

Misty

 
At Tuesday, July 16, 2013 9:38:00 PM, Anonymous Anonymous said...

I am appalled by the comments left by the two
female nurses regarding the cover of outpatient
surgery magazine. This same magazine broke the
news regarding the female ENT Dr who had groped
male patients during surgery. Reverse the roles of
genders on the picture and I would say no one would
have raised an eyebrow.
In fact, when the article about the female ENT story
broke on all nurses, one nurse, female, actually thought
it was a joke. The mentality of all these people are
very disturbing to me.

PT

 
At Wednesday, July 17, 2013 1:21:00 PM, Anonymous Anonymous said...

@Misty

It is not clear from the clip what kind of surgery they are going to do.
Besides, nothing of relevence is being said. It all boils down to: "There will be no problem with the anestesia."

george

 
At Wednesday, July 17, 2013 6:12:00 PM, Anonymous Anonymous said...

Dr. Bernstein I assumed you did realize this but there is a pattern of providers framing the discussion from their "side". I also agree that most providers are not blind to the patients anxiety. What I am trying to say is by framing the issue from the providers perspective and avoiding acknowledging the issue it makes it easier to violate the patients modesty. I think providers as a whole have empathy for the patient, if they side with the patient that it is at a minimum uncomfortable and to some traumatic they have to acknowledge they are knowingly and willingly inflicting emotional pain on the patient, the very patient they desire to help. By sticking to the mantra the context makes it OK, providers are gender nuetral, and all of the other things we patients find offensive they are able to shed responsiblity and possibly guilt for their actions. Dr. Bernstein, while you have encouraged patients to speak up you have often defended the provider line of context, ignorance of the issue, etc. that is not intended to condemn, but just as we need to speak up for providers to understand us, it would be helpful or us to understand providers, and that may mean pushing them to acknowledge what we feel they know but do not acknowledge ...I am very grateful for all you have done so I find it difficult to "challenge" you. But your challenges have helped me in many ways and I think you will take this in the way it was intended......don

 
At Wednesday, July 17, 2013 9:12:00 PM, Blogger Maurice Bernstein, M.D. said...

Don, if what is meant by "context" is the doctor-patient or nurse-patient or med tech-patient relationship and interaction is that there is a sick patient, in distress from the illness whose goal is to get relief from the suffering and hopefully attain a cure. Yes, that is the context which I think virtually all healthcare providers work under and assume that the relationship is strictly professional with the job to try to attain the patent's goals but in a humane and ethical way. If the context, as viewed by the patient, involves some other major element in the goal then that is when I urge the patient to "speak up" and perhaps elaborate on the patient's view of what should be humane and what should be ethical in the actions of the healthcare provider. I can tell you, as with myself, most doctors and other professionals will listen. How they respond will depend on many factors beyond their own personal characteristics in communication but also many system factors such as patient loads and time, system regulations or standards or even more practical issues in mitigating the patient's concerns.

Yes, I bet most doctors are ignorant of the nature and intensity of the patient modesty concerns which have been repeatedly written on this thread. I, too, was ignorant until 2005 but no longer. In fact, I think there should be attention to the views posted here by those who teach medical students and beyond. To this end, A few days ago I wrote a commentary descriptive of what has been written here to a listserv which is composed of subscribers who are medical school teachers and I provided a link to Patient Modesty Volume 56 to access the views here. I'll keep you informed as to what views I get in return on that listserv.

Don, I hope I answered your question. ..Maurice.

 
At Thursday, July 18, 2013 7:26:00 AM, Anonymous Anonymous said...

Maurice, I share Don's feelings as well. While some of my posts seem "edgy", it's from the outrage of repeated behaviors that are just wrong.

I, too, want to thank you for moving this issue forward.

I will say though, while it's important for the patient to speak up (and you find no surprise that not only do I personally speak up, I walk if I don't like what I'm hearing and telling them why to promote this issue).

As I have said before, patients don't realize that they have to speak up if it's their first hospitalization, first operation, first procedure with intimate exposure.

Speaking up sometimes happens AFTER the damage has already been done.

This issue of privacy as part of informed consent is not only necessary, but will prevent much of the psychological trauma that comes from mistrust, feelings of betrayal, humiliation and worst of all trauma. The medical community has to recognize that these are the outcomes of their own behavior.

From PT's gawkers, to salespeople in the OR, the patients have a right to know.

I have been told, "this is a teaching hospital and you are part of that system". My reply has always been that you are breaking the law and that I am required to educate anyone and that you are required to do what you can based on my experience to make my medical as stress free as possible, and create the environment that we are entitled to. Respectful, dignified care with complete informed consent.

Thanks again Maurice!
belinda

 
At Thursday, July 18, 2013 4:42:00 PM, Anonymous Anonymous said...

I would like to remind our readers that as a patient
in a teaching hospital you have the right to request to
be non-teach. That exempts you from nursing students
and residents as your chart will have the words displayed on the outside as non-teach. You may choose this at any time during your hospitalization.

It should be noted that any student nurse must receive your permission before they may be instructed on your care. This means they may not look in your chart with out your permission. Patients should be told
this before they are hospitalized.

PT

 
At Thursday, July 18, 2013 6:03:00 PM, Blogger Hexanchus said...

What PT said - you always have the right to opt out of students participating in your care. If they push you on it, simply mention the words "coercion", "grievance" and "CMS".

I was doing a little browsing and it turns out that forced nudity, especially with exposure to strangers, is a widely recognized form of psychological torture. Just saying........

Hex

 
At Thursday, July 18, 2013 6:30:00 PM, Anonymous Anonymous said...

PT, you are absolutely right and that's what I was alluding to. They don't want you to know your rights and when you try to exercise them they give you an argument and try to treat you like you're an idiot and intimidate the patient.

Knowing this, I'm prepared and get what I need. The question is...how many people know and secondly, how many are prepared to let them know you know to get what you want?
belinda



 
At Thursday, July 18, 2013 7:23:00 PM, Anonymous Medical Patient Modesty said...

I encourage everyone to look at this link: During surgery do the nurses remove your hospital gown?. A doctor made some very interesting points about what really happens in operating room. You can see his comments below:


"One of the first things I was taught in med school was the "strip 'em and stick 'em" procedure. This literally translated to "get them naked and stick something into them" and you have complete control over a patient. Lying on a bed, gurney, or OR table with only a hospital gown on and having an IV or worse yet, a Foley catheter stuck in a patient will give the patient a sense of helplessness which some Doctor's actually want. I have worked with a lot of General Surgeons, Orthopedist, and (again worse yet) OB/GYN surgeons who want their patients completely nude, uncovered, and completely under anesthesia when they come into the OR. You would not believe the number of Doctors other than OB/GYN's who do pelvic exams on females before doing scheduled surgery that have nothing to do with the OB/GYN field. OH--as far as those hospital gowns being sterile? They are as much sterile as the clothing you wore into the hospital. They are washed, dried, folded, and stacked in a large laundry area, usually contracted off site, and this area is far from being sterile. One OB/GYN I had the pleasure of working with had the hospital order, for his patients only, paper undershorts and bras which are sterile. These clothing items were "one size fits all" but that was fine with the patients. Being as they were a dark blue color we referred to them as "blues". This OB/GYN surgeon only removed the clothing necessary for him to do his surgical work and that was all. Almost all of his patients awoke in PACU with these same blues on as they went to the pre-op area with. Patient moral was so much better. Foley catherters: How many surgeons have told me that they did not order the Foley's for their patients but the patients would up with them because the OR charge nurse would state "it's just something we do". I have seen him do TAH's, VAH's, and laproscopic procedures without the Foley's. There is a much less chance of the patient getting an infection without the Foley. Do OR personnel treat you with modesty and compassion? Absolutely not. they are there to do a job and once you are under the influence of anesthesia they could care less about the patient. OR staff are the worse about drawing other staff member's attention to an outstanding part of the anatomy on either males or females. When I first started doing OR surgery assisting I would hear statements from staff regarding the patient and this would make me sick. When asked why they did this or how they would feel if this were them or a family member the usual reply would be: "They won't know any of this when they awake". Believe me, an OR is not a sacred place where a patient's moral well being is primary."


He also made interesting comments at http://www.answerbag.com/a_view/13595233. I appreciate him exposing the truth that not wearing personal clothing does not help to maintain a sterile environment.

Misty

 
At Friday, July 19, 2013 5:06:00 AM, Anonymous Anonymous said...

Dr. Berstein, I think we are on the same page to a large degree. It would be naive to think that the perception of context and gender are the same for provider and patient. I believe providers do use that for coping, coping with the emotional "trauma" it causes the patients and coping with the systmatic restraints the drive for efficiency and profits are placed on them by the institution. Where I think this becomes paticularly problematic is when it transfers to other area's and expands. While I think the concepts become to a degree a crutch or enabler, where it really shows it's true colors is in non life threatening or lower severity procedures. One could argue where these concepts fall on a patient going through cancer treatment. Patient & provider may differ and that is understandable. However on routine exams, check ups, etc the issue to me is much different yet the concepts are applied by providers the same way. I had a DOT physical and the Dr. wanted to bring in basically a HS student (1st term nursing student) whom wanted to be NP to observe. The issue of teaching hospitals has come up before. The context that providers use is students need to learn so patients should see that and partcipate. Yet, that same concept when nursing students are asked to partcipate so their fellow nursing students can learn is loudly and strongly rejected by nurses. I believe you and I had a conversation on that and you sided with the students. I think I might be able to accept the position in the more severe cases if I felt it was not applied to routine procedures that were not life threatening or even curing a problem and if providers applied that to themselves when they were on the other side of the gown. No doubt some do, but if one reads threads like allnurses, there is an obvious us and them mentality when it comes to doing things for the benefit of teaching and when providers are patients. That is my main problem with concepts like context and gender nuetrality. If a nursing student expects me to expose myself to them for the benefit of their education, why should they not do the same for other nursing students?...that is something that patients feel puts context in question...don

 
At Friday, July 19, 2013 7:34:00 AM, Blogger Maurice Bernstein, M.D. said...

Don, doctors or nurses get sick or have babies and it is not at all unusual to find them on the other side of the bed rail or the patient gown. They end up finding how they feel about their own modesty issues and I am sure to that degree they will anticipate how their patients would have responded with similar situations. ..Maurice.

 
At Friday, July 19, 2013 6:03:00 PM, Anonymous Anonymous said...

I agree, I have read threads on that as well, for some it was a revaluation, some were fine, some complained. What I do see more often are justification for requests for special consideration, justification why they should not have to partcipate in the education of others, etc. I want to state that we should not use a broad brush to paint providers any more than that us. I still contend providers are overwhelmingly compassionate people, the status quo that has developed over time set the course, it is up to us to change it, and help providers see and in cases like this, admit our side has validity.....don

 
At Friday, July 19, 2013 7:06:00 PM, Anonymous Anonymous said...

Dr. Bernstein,

I see that you teach medical students. I have some questions for you.

Is it normal to teach medical students to see patients as objects when they work on them? Mechanics work on cars (objects). I wonder if this perspective that patients are objects make medical students and doctors less sensitive to patient modesty. You indicated that you had not really thought about patient modesty until about 2005. What made you think about patient modesty?

-md

 
At Friday, July 19, 2013 7:07:00 PM, Anonymous Anonymous said...

Dr. Bernstein,

I see that you teach medical students. I have some questions for you.

Is it normal to teach medical students to see patients as objects when they work on them? Mechanics work on cars (objects). I wonder if this perspective that patients are objects make medical students and doctors less sensitive to patient modesty. You indicated that you had not really thought about patient modesty until about 2005. What made you think about patient modesty?

-md

 
At Friday, July 19, 2013 9:08:00 PM, Blogger Maurice Bernstein, M.D. said...

MD, I see you are new to this thread. But I will explain again to you and any other new visitors.

I was aware of patient modesty issues when I started medical school and when 26 years or so ago, I started teaching first and second year medical students. The concept I had in my mind and taught was that all patients, in a medical situation, just as all healthcare providers themselves had some physical modesty and that all doctors and all students should be aware. The degree of modesty would be "modest" but present and so students and doctors should be aware. The awareness should be expressed in having the patient to understand, before laying on hands or eyes, what was going to be done and how the patient would be uncovered. This amounted to what we call "serial undraping" so that all the flesh is not exposed at once but only the parts being specifically examined. Further, the patient should be observed for discomfort in the examination and talked to about that. Sometimes, the exam procedure would need to be modified if patient appeared uncomfortable. Finally, for female genital exams, a female chaperon was required particularly if the examiner was a male. Male genital exams by women usually did not necessarily require a chaperon. So that is it. We didn't teach anything special except general professional behavior in operating rooms. It had seemed to me, because I got no comments about personal modesty issues from my patients, that what I knew and what I taught regarding modesty was adequate.

Well, as I have repeated here over the years, my concept of patient modesty has definitely changed since 2005 when I started this thread after reading every one of the thousands of comments (120-150 comments/Volume times 55 plus volumes). What I have learned is that there is a proportion of the patient population (whether statistical outliers or a hidden majority} with profound physical modesty concerns, some severe enough to forgo life-preserving diagnosis or treatments, to characterize medical experiences related to personal modesty as to cause PTSD and finally bring out the "hidden" concerns about unnecessary and unwanted bodily exposure in operating rooms. All this I learned here. And now I have begun and will continue to make my students aware of the expressions by patients on my blog thread.

MD, you write "what made you think about patient modesty?" I always have, as I was taught and had taught, but in ways much more tame than what has been written here by others. But, fortunately, we all can learn and hopefully all work together to make changes to the medical system both in education and practice to mitigate the issues we have been discussing on this blog thread. ..Maurice.

 
At Saturday, July 20, 2013 6:47:00 AM, Anonymous Anonymous said...

Is there really any difference between unnecessary people viewing a naked, uninformed patient and a peeping Tom watching his neighbor taking a shower in her bathroom, other than trespassing?

 
At Saturday, July 20, 2013 7:01:00 AM, Anonymous Anonymous said...

To answer anonymous' question. There is no difference and that's the problem.
belinda

 
At Saturday, July 20, 2013 9:16:00 AM, Anonymous Medical Patient Modesty said...

I wanted to let you all know I just learned about an anesthesiologist from Ohio who raped a woman in Pre-Op. This is exactly why patients need a personal chaperone not employed by the medical facility with them at all times for surgeries. I am sure she would not have been raped if her husband or someone else had been there. I suspect this doctor has done inappropriate things to other women under anesthesia.

Misty

 
At Saturday, July 20, 2013 11:12:00 AM, Blogger Maurice Bernstein, M.D. said...

Oops, Misty. you wrote "I just learned about an anesthesiologist from Ohio who raped a woman in Pre-Op". You should have written "allegedly raped" or "claimed to have raped" since the detailed facts was not presented in the article and the doctor has denied guilt and has not as yet had a trial in court. Facts are essential in medicine, ethics and law before final conclusions are reached. Now, in cases where rape by doctors have been documented, yes the patient's attentive chaperon would make such illegal behavior unlikely. ..Maurice.

 
At Saturday, July 20, 2013 11:34:00 AM, Blogger Maurice Bernstein, M.D. said...

Anonymous from today wrote: "Is there really any difference between unnecessary people viewing a naked, uninformed patient and a peeping Tom watching his neighbor taking a shower in her bathroom, other than trespassing?"

Yes, there is a difference. First one has to define "unnecessary" which in our current medical system may be debated. Medical, nursing students, medical and surgical residents as part of a training program could hardly be called "unnecessary" without some debate over the word and the value of the experience. Even, one could argue that the presence of a representative of a technology company who is teaching the surgeon in the proper and safe use of new equipment during the surgery might not be considered "unnecessary". On the other hand, the way a "peeping Tom neighbor" is usually described is entirely different particularly since the motivation for the Tom is for prurient self-interest and not for professional self-education or professional education of those "necessary" for the surgery. This argument doesn't mean that I am against the frank and complete "education" of the patient involved. ..Maurice.



 
At Saturday, July 20, 2013 12:16:00 PM, Anonymous Anonymous said...

Maurice, necessary from who's perspective?

When a patient has not given explicit consent for persons present during a procedure (because they were not informed about them or their state of undress), to expose them in front of extraneous personnel is without informed consent and therefore, some patients will say that this happened against their will.

This is at the crux of why patients get so upset. It is sexual battery from the patient perspective.

A pediatrician waiting for an expectant mother to give birth does not give him the right of entitlement of watching them drape and prep the mother. His job doesn't start until his patient is born and without any distress prior to the birth, he does not belong in the room.

The omission of informed consent, and the depth of the privacy violation subjecting patients to what amounts to forced stripping is unethical, humiliating and creates trauma in some.

We cannot forget some of the other posts that talk about the mindset of submission of the naked patient, or the voyeurism that occurs in healthcare. Many of us have been subjected to such behavior.

Why can't the excuses stop and protocols be put into place to protect patients instead of hiding behind standard of care that amounts of a HIPPA violation.
belinda

 
At Saturday, July 20, 2013 12:30:00 PM, Blogger Hexanchus said...

On the subject of abuse by providers,
a 38 year old male RN was recently arrested in Portland, OR and has been charged with multiple counts of rape, sodomy and sex abuse involving multiple women over a period of several months that were seeking treatment in the ER at Legacy Emanuel Hospital where he worked.

 
At Saturday, July 20, 2013 12:43:00 PM, Blogger Maurice Bernstein, M.D. said...

Hex, there are occasional "bad apples" in all professions. This finding is an intrinsic part of behavior within all humanity and not just the medical profession. What are the facts? Is there significantly more sexual misbehavior of workers in the medical profession than all of society or other specified professions? Anyone want to do a bit of research on an answer to my question and publish it here with appropriate references? ..Maurice.

 
At Saturday, July 20, 2013 2:56:00 PM, Anonymous Medical Patient Modesty said...

Belinda made excellent points. A peeping Tom watching his neighbor taking shower in her bathroom and unnecessary people viewing a naked and uninformed patient have one thing in common. They all did not ask the person for permission. Patients should always be asked for permission about who can be a part of their procedure.

Look at one of the rights that patients have in Patient Bills of Rights: Know the names, positions and functions of any hospital staff involved in your care and refuse their treatment, examination or observation. I believe this means that a patient can refuse intimate opposite sex care or even intimate exams. Medical facilities often fail to provide a detailed list of people who would be involved in a patient’s surgery.

Dr. Bernstein, how do you know that all medical professionals do not have lustful thoughts when they see naked patients? Medical professionals will rarely tell you if they have lustful thoughts. Many of them do not act on those thoughts. It is very normal for a man to have lustful thoughts toward an attractive woman who is naked no matter how hard he tries to stay pure in thoughts. It is true that many medical professionals go in the medical field because they desire to help patients get well. But all medical professionals are humans.

I encourage you to consider reading a pastor, Josh Harris’ book, Not Even a Hint (http://www.amazon.com/Not-Even-Hint-published-Multnomah/dp/B008V140VK/ref=sr_1_4?s=books&ie=UTF8&qid=1371757724&sr=1-4&keywords=not+even+a+hint). He updated his book and changed the title to “Sex Is Not the Problem (Lust is). He talked about how he and his family went to a beautiful beach that had some scantily clothed women and that he struggled with lustful thoughts. He shared this on page 66-67 of the book: “After a vacation to a certain beach in Florida one year, I decided I could not go back. The water was great, the beach was great. But it was also crowded with women in revealing swimsuits. Shannon and I talked about the temptations and the next year found a more isolated beach to visit. It was not as nice, but I was not sinning every day and had a much better time”. I know without a doubt that Josh went to the beach to enjoy a vacation with his family. His intentions were not bad. I know there are a lot of medical professionals with great intentions. But can you really say that they never have lustful thoughts when they see opposite sex patients naked? A former male gynecologist, John Smith wrote a book, “Women and Doctors” (http://www.amazon.com/Women-Doctors-John-M-Smith/dp/044050533X) that I read. He said that many of his colleagues would admire unconscious female patients’ private parts while they were out. This doctor boldly says in his books that he doesn’t think men should be gynecologists.

Check out this article, Medic sex abuse 'worse than Church'

Misty

 
At Saturday, July 20, 2013 7:35:00 PM, Anonymous Anonymous said...

i think a simple definition is any one whom is not there for the benefit of the patient. Art Stump wrote a book about the trauma caused him as he was going through prosate cancer when he learned one of the females in scurbs was actually a HS student there on career day. I had a friend who had a colonoscopy and asked if a local HS student (female) could observe. I had a Dr ask if a female student could observe my DOT exam...none of this hand any benefit for the patient They were there for their benefit not the paitent. While the peeping Tom has different motivation, neither are there for the benefit of the person observed. Don't get me wrong, there is a big different between a peeping tom and a nursing student...but .....don

 
At Saturday, July 20, 2013 9:26:00 PM, Anonymous Anonymous said...

What Belinda and Don have written today really does focus on the crux of the issue. My colonoscopy and anal fistula surgery was performed without my informed consent that male and female nursing students would observe.

I am still dealing with this and, even though we're coming up on six years since this occurred, I decided that, for my own sanity and to take charge of the situation, I filed a complaint a couple of days ago with the Joint Commission on Accreditation against the hospital where this surgeon performed my surgery.

I don't suspect that anything will come of it but, just like this blog, getting it out in the open, putting it in writing, and finding out I've to plenty of company, has been cathartic. It's also important, at least for me, to keep all of this in perspective. Many of you have suffered far worse than I, some losing relatives and friends to incompetent medical care, hospital borne infections or, as was recently highlighted on 60 Minutes, angels of death.

What most, if not all violations have in common is an arrogance that sees the patient as someone to whom the provider is doing a huge "favor". They're the ones that studied for all those years, they're the ones who worked the long hours, they're the ones saving lives, they're the ones who "know best". How dare you, the patient, question them!

Now, that's obviously not the mindset of the majority of medical providers, thank God! But these types of attitudes do permeate the medical culture in one form or another. It shows itself in more benign states as a paternalistic attitude. The more egregious examples are doctors like those that decided they could play God and forcibly sterilize female prisoners of the State of California.

In my case, my surgeon being a proctologist, probably didn't even think about the embarrassing nature of this surgery. i was just another guy who needed a surgery he does all the time.and probably figured A) he'll never know what happened so I don't need to ask or B) even uh does find out he won't mind or won't say anything. While I did complain, as described in my earlier post, I never followed through, only to find it come back as a PTSD experience when the next surgery loomed.

Never again will I be a silent partner in my medical care.

D.P.

 
At Saturday, July 20, 2013 9:46:00 PM, Blogger Maurice Bernstein, M.D. said...

DP, I was pleased to read that you checked with the Joint Commission which I had recommended and wrote a complaint. I would recommend that all those visitors writing here who can document specific incidents which have caused distress also write to the Joint Commission. After all, the Joint Commission's duty is to monitor (as they do regularly) with on site survey to each hospital receiving federal payments to assure that regulations and attention are followed to ensure safe and proper patient care. ..Maurice.

 
At Saturday, July 20, 2013 10:18:00 PM, Anonymous Anonymous said...

The joint commission is a worthless agency dedicated
to pursuing donuts and other small edibles provided to
them by hospitals and other medical facilities they visit.

You are provided a reference number once completing an online complaint with the joint commission. That number provided to you is worthless, you never recieve a response to your complaint.

What is the point of receiving a reference number when you never know when your complaint is followed up on,nor what was said or done by the joint commission at all.

In fact, for all you know the joint commission may
not even contact the facility at all and you wouldn't
know it. What proof does a reference number provide.

And finally, how many of you have ever asked your
hospital or facility if they are in fact certified by the joint
commission. Many hospitals are not and if they are it
dosen't mean jack!


PT

 
At Saturday, July 20, 2013 10:38:00 PM, Anonymous Anonymous said...

More about the joint commission

They say they are non-profit, if every business were
non-profit they wouldn't be open very long.

To be accredited with the joint commission requires
a visit every three years.

They certify 20,000 medical facilities, do you think they
have enough employees to visit every facility every
time someone files a complaint.

To be certified by the joint commission only requires
that a medical facility have on hand certain paperwork
and compliance documents.

The e-mail you send them initiates a reference number that is just automatically generated. No one
actually reads your complaint nor visits the medical
facility.

Is the joint commission required to visit only medical
facilities that are certified by the joint commission?

The joint commission is not a watchdog agency and
does not have offices in every city, nor can they put
a team on a plane and dispatch them to every facility
in the country. They don't have disciplinary powers
and they cannot punish medical facilities.

Another worthless agency that patients somehow have the idea they they can complain to.


PT

 
At Saturday, July 20, 2013 10:45:00 PM, Anonymous Anonymous said...

One more comment about the joint commission

They don't investigate modesty, nor privacy violations.

In fact, the last facility I worked at was certified by
the joint commission and when a patient died from
a medical mistake no one came to investigate. It
was announced to the news media.

The only one who called was a medical malpractice
attorney who requested the medical records at the
request of the family, three months later!


PT

 
At Sunday, July 21, 2013 9:21:00 AM, Anonymous Anonymous said...

PT, you seem to know lots about the medical industry. May I ask what is it tht you do in the medical profession?
belinda

 
At Sunday, July 21, 2013 6:43:00 PM, Anonymous Anonymous said...

DP i want to also congratulate you for taking a step toward controling your own destiny. I also struggled with a vist for several years before I wrote the hospital. I would suggest you do the ame. I was very surprised and a little comforted by their response. I think a lot of things have changed as the competition for paying patients ramps up. Send a letter but cc several people in the facility as it generates pressure to deal with it not knowing who all is involved. Do the patient advocate if they have one, the CEO or COO of they have one. and if you can find a board member cc them. ....let us know what their response is. I also agree there is a large degree of diversity in providers. I have seen those who as suggested feel they are doing you a favor by treating you and you should consider your self lucky they are there, so how dare you bother them with modesty issues....then there are there with so much compassion, there is so much difference between people, both side need to remember that....don

 
At Sunday, July 21, 2013 8:59:00 PM, Anonymous Medical Patient Modesty said...

I wanted to let you all know about this discussion forum:
VoyForums: Medical Nudity - How much is necessary?


I found the comments about custodians very interesting:


I wanted to tell everybody about a guy named Miguel. He is a custodian at a local gym. During a normal workday he is assigned to clean up and mop both the men's and women's locker/shower rooms. Three times a day he enters the women's locker/shower room without knocking and mops their floors while women are changing and showering naked in the shower area. He explains to the women that they shouldn't be embarrassed because he is a professional who's just doing his job.

After mopping for about ten minutes he leaves and comes back with three other men. He explains to any naked woman that tries to object that it's OK because two of the men work here too and the teenager is just there to observe because he's receiving on-the-job training and will soon be a professional as well. "Oh, and by the way," he says, "you have nothing to worry about because we're all gender neutral. None of you have anything we haven't seen before". Most of the women reluctantly agree and go on with their business, ignoring the four men.

As most of you have already figured out, this is a fictional account. But is it really any different than what goes on in hospitals and clinics every day? If a "professional" nurse or student nurse don't let naked men get in the way of doing their job, why should professional custodians (or other professionals) be treated any differently for trying to do their professional job?


Misty

 
At Tuesday, July 23, 2013 3:39:00 PM, Anonymous Anonymous said...

there is an interesting thread at alllnurses about why would non medical people come to allnurse. it haas a lot of posts and to me it highlights thee us and them mentality of many providers. a significant numerb do not want to hear from non providers, some aour down right hostile to non providers posting their opinion. to me this seperation of us and them is a big contributor to what we are talking about.

Misty, funny post

 
At Tuesday, July 23, 2013 9:24:00 PM, Blogger Maurice Bernstein, M.D. said...

Considering the topic of "freedom of choice", frequently noted on this thread, you might be interested to go to my new thread "Extra-Marital Sex: Sex by the Demented in Nursing Homes" and write there your view of that subject. ..Maurice.

 
At Saturday, July 27, 2013 11:15:00 AM, Blogger Maurice Bernstein, M.D. said...

Those who read this thread might be interest in a comment made on the thread "Patient Refusal to Leave the Hospital: And Now What?". The comment suggests there are patients who may find ultimate comfort in hospital care. The Anonymous visitor writes:
"They want to stay because its the closest they have ever been to God-like care and consideration in their lives." ..Maurice.

 
At Saturday, July 27, 2013 7:13:00 PM, Anonymous Anonymous said...

Some people feel the same way about prison and can't live on the outside.

They are taken care of, get their three square meals a day and a family like relationship with other prisoners and staff.
belinda

 
At Sunday, July 28, 2013 10:47:00 PM, Anonymous Anonymous said...

Can we adhere to the topic of this thread, gawkers
in healthcare, please.


PT

 
At Monday, July 29, 2013 7:30:00 AM, Blogger Maurice Bernstein, M.D. said...

PT, I presented the comment from the other thread to demonstrate that there are patients who, for whatever indignities or whatever else negative they have experienced, still find, for whatever personal reasons, the hospital and its system a place of comfort and care. This stands in contrast to some expressions written to the Patient Modesty thread that tend in the other direction even to avoid important care because of, for example, anticipating or experiencing indignities. I was just trying to give one other view an expression here despite one can find unpleasant motivations for these "won't leave the hospital" patients. ..Maurice.

 
At Monday, July 29, 2013 8:45:00 PM, Anonymous Anonymous said...

Maurice


My comment was not directed to your other
threads and I apologize to you if that is what you
interpreted,however,the topic tended to veer off
course. In my opinion, this thread is probably the
second most important thread at this point of the
patient modesty series. Why?

Most patients I would venture to say have
lost a considerable amount of trust with the medical
community for allowing gawkers who have no
business observing their medical procedures. At
this point in the series I have to mention to you
and I am certain there is a reason as to why you
have not titled a thread " sexual assault of patients".

As you know Maurice the effect is profound and
is the strongest deterrent second only to gawking,
discouraging patients to seek much needed
healthcare. The words patient sexual assault are
very much taboo, yet it occurs with a fairly reliable
frequency in healthcare. I'm suggesting there should
be a thread that explores this subject and how it
undermines the positive patient experience, health
care integrity and ultimately patient involvement.


PT


 
At Monday, July 29, 2013 9:14:00 PM, Blogger Maurice Bernstein, M.D. said...

PT, I thought I found experiences of sexual assault of one sort or another repeatedly described on this Patient Modesty thread as one part of the explanation or definition of patient modesty and in its extreme PTSD. I think that sexual assault is set by a legal definition and really there should not be any debate or discussion about it's ethical status--sexual assault if meeting the legal definitions is unequivocally unethical. And if sexual assault is shown to have been carried out by a healthcare professional at any level of the healthcare system it is a worse act than assault by a lay person since it destroys the trust in the entire medical profession and without trust we are no longer a profession. ..Maurice.

 
At Tuesday, July 30, 2013 6:43:00 AM, Anonymous Anonymous said...

Maurice, stripping a patient naked without telling them is sexual assault. Psychologically stripping a patient is one of the most degrading things that can happen. One can presume if they weren't told ahead of time, that this is against the patient's will and results in psychological trauma. So...the lines are not so clear. One doesn't have to be raped to be sexually assaulted.
Below is an article geared to prison strip searching (that does not have to include any touching).]

The medical profession would like to pretend that their standard of practice is for the benefit of the patient. I don't know how stripping someone publicly with a room full of people is beneficial to anyone. There are better ways to do this. Add the gawkers and it creates an even bigger problem, add the janitor, the public, a careless open door, now it's something else, add inappropriate behavior and now it's something else.

You cannot tell me that nothing can be done to ease patients through a difficult time without humiliating them.

http://www.d.umn.edu/cla/faculty/jhamlin/3925/Readings/stripsearches.pdf
belinda



 
At Thursday, August 01, 2013 9:12:00 PM, Blogger Maurice Bernstein, M.D. said...

I seem to be publicizing my newly minted blog threads here on Patient Modesty for at least three reasons:
1. The thread might be pertinent to topic elements discussed on Patient Modesty 2. It seems that virtually all the contributing commentators to this Patient Modesty thread are wonderfully expressive of their views. 3. And finally, Patient Modesty is truly the most popular thread of all my virtually 900 threads and would be a reasonable place to advertise my new thread.
So here I go again:
Start the conversation going on my thread "WITHOUT THE BREAD OF LIFE, YOU ARE TOAST": As a Non-Biblical Expression, This Means What?

..Maurice.

 
At Sunday, August 04, 2013 10:14:00 AM, Blogger Maurice Bernstein, M.D. said...

In case any of my visitors had difficulty reaching the pdf file referenced by Belinda in her July 30 posting, here is link to click on. ..Maurice.

p.s.-Where in the article is there equal concern about the men who are stip-searched? I could find none.

 
At Sunday, August 04, 2013 7:53:00 PM, Anonymous Anonymous said...

There seems to be an incredible imbalance in most populations as to who gets sexually assaulted.

It would seem that while this article is focused on women, that in the prison population as well as healthcare, the statistics are most likely more even. This would make an interesting research project.

Connected to this, the gender of the abusers would also need to be evaluated.
belinda

 
At Sunday, August 04, 2013 10:59:00 PM, Anonymous Anonymous said...

According to the Department of Justice female
prison guards are more likely to sexually assault
male prisoners than male prison guards assaulting
female prisoners. The same is true in juvenile
detention centers. Military induction centers
essentially conducted strip searches on male inductees
for well over 30 years.

Thus Belinda, how do you get the statistics are most
likely more even. I haven't included the health care
arena and yet we know the statistics that 95 % of
nurses are female. We all know that you don't really
have to be a prisoner to be strip searched. It happens
every day in healthcare.


PT

 
At Monday, August 05, 2013 8:27:00 AM, Anonymous Anonymous said...

PT, I said that the gender of the abusers would also need to be evaluated.
belinda

 
At Monday, August 05, 2013 7:12:00 PM, Anonymous Anonymous said...

If you are ever a level 1 trauma at a trauma facility
expect to be strip searched. You really don't need to
be injured either. You could be trauma by mechanism
as determined by some genius ambulance driver called
an EMT. Trauma by mechanism is substantial damage
to your car but you are OK. Don't let them talk you into
it.
They get paid, strap you to a board and drive you
to the hospital where they have a contract. They get
donuts and patted on the back and you get strip searched with 20 to 30 people watching, 15 who have no business being there. All in the name of health care
and by the way. The whole process is usually video
taped and shown to all the surgical residents and any
one else who gets their hands on it.

PT

 
At Tuesday, August 06, 2013 6:43:00 AM, Anonymous Anonymous said...

Several years ago, my vehicle was struck in the rear after I had to make a sudden stop at a construction site. The accident while relatively minor did cause me some neck soreness and pain in the shoulder area where the seat belt had restrained me. The driver of the vehicle that struck me was slightly more seriously injured.
A police officer and later EMT's urged me to go to the local hospital to be examined but I refused. One could argue that this was a mistake on my part but I knew that if I went to the hospital, the trauma staff would most probably insist that a neck and shoulder exam would not be sufficient and I would be stripped naked in front of a room full of people for a full body exam. So I was willing to chance that I was not seriously injured rather than face the certainty of being terribly embarrassed and humiliated at the ER. I saw my PCP the next day and as I expected, he found no serious injuries.
I don't believe that I am unique in the decision I made in this case .When I read motor vehicle accident reports in the local paper, time after time the article concludes by stating that the victims refused medical treatment. I believe that many do so for the same reason that did.
I believe the important point here is that when trauma personnel justify any sort of indignity they force upon their patients, they argue it is necessary to save lives. But do they realize that their callous treatment of patients causes many individuals to refuse treatment at all, which in some cases could lead to serious complications? Perhaps if they did they would be much more careful about limiting patient exposure as well as the number of those who witness that exposure.
MG

 
At Tuesday, August 06, 2013 7:08:00 PM, Anonymous Medical Patient Modesty said...

MG,

I am so glad that you boldly stood up and refused to go to ER. Some ER personnel are insensitive. They only needed to check your shoulder and neck. One nurse who used to work in ER recently informed me that it was pretty common for urinary catheters to be placed when a patient arrives to an emergency department in some situations. She said alert patients could refuse urinary catheters, but that it was common for an unconscious patient to have urinary catheter placed so a urine specimen may be quickly sent to the lab to analyze if the unresponsive patient has an infection or bleeding.

I heard about this case from a man who shared about why MPM was important to him:

Another friend, a pastor, was in a serious automobile accident with a tractor-trailer in Greensboro, NC on I-85. His clothing was cut off him in front of TV cameras. He told me, "There I was in front of TV cameras and lights with my trousers being cut off in open view of everyone."

It is ridiculous about how EMTs and ER personnel sometimes will disregard patient modesty.

Misty

 
At Wednesday, August 07, 2013 4:32:00 PM, Blogger Hexanchus said...

For those concerned about how they may be treated in the ER or other circumstances where you may not be able to advocate for yourself, there is an out.

If your state is one that has it (and many do) tell your PCP that you want to execute a POLST (MOLST in some states).

Unlike an advanced directive, a POLST/MOLST is a medical order and EMT's, paramedics, etc. must follow it by law. On the form you can pick and choose which potentially life saving interventions you do or don't want. You can choose things like no CPR, no IV, no intubation, no nutrition/hydration, do not hospitalize, allow natural death etc.

An added benefit is that in many states the POLST/MOLST exempts you by law from trauma protocols. They may not treat you as a trauma case unless you specifically specify otherwise.

 
At Wednesday, August 07, 2013 9:18:00 PM, Blogger Maurice Bernstein, M.D. said...

For those visitors who are relatively new this Patient Modesty blog thread, you may be interested in an article that Doug Capra and I had published in the Jan 31 2011 issue of the American Medical Association news: amednews.com which deals with doctor-patient communication and physical modesty issues. It's all about "communication more openly". Doug and I created a little scenario between a doctor and a patient in which we described the thoughts of each as they verbally communicated with each other. It was fun to write and we hoped to send all those physicians who read the amednews a hint of what we, on this thread, think is important with regard to the modesty issue. ..Maurice.

 
At Thursday, August 08, 2013 7:39:00 AM, Anonymous Anonymous said...

Maurice,
Through all these postings and comments, I have never heard you say that the medical community must take responsibility for what's happening and the trauma of patients whether intentional or not.
And...the burden is on the medical community to develop protocols that would be acceptable.

In order to ask questions, patients must have enough information to ask the questions. The idea that aspects of care are hidden and not reflected in informed consent is unethical, immoral, and is intentionally made to keep patients in the dark.

When the medical community takes responsibility for informing patients of everything that will take place, who is in attendance, the state of undress of the patient, and details of what kind of anesthesia is used, risks and benefits will there be an equitable distribution of knowledge to empower patients to make their own decisions. Giving patients half a story is like saying, "What they don't know won't hurt them". That, in itself, makes the patient less than the entity they are dealing with and not an equal participating partner. I can't think of a better way to disrespect patient privacy and autonomy.

The idea that you want to put the burden back on the patient to ask the questions when the medical community knows there's a problem, the patients are not informed is an ethics breach and refusal to admit and address this problem.

Please respond to this post. Thanks.
belinda

 
At Thursday, August 08, 2013 8:22:00 AM, Blogger Maurice Bernstein, M.D. said...

But as I have repeatedly written, Belinda, the medical community (including me prior to starting this thread)is unaware that there is a problem. That is why I had written and published on the problem twice to the AMA News, the last along with Doug, to hopefully inform the alleged 200,000 healthcare provider readers about the problem. ..Maurice.

 
At Thursday, August 08, 2013 9:08:00 AM, Anonymous Anonymous said...

Maurice, Thanks for responding. I have written before that a major city hospital, a VP of Assigned Risk Management (who I interviewed)advised me that 40% of complaints filed were involving abuse of physical privacy and cruel and degrading treatment.

While you specifically may not be aware, the medical community as a whole is not unaware, and if they are unaware, then where are all the complaints going? If the medical community is unaware then they are not listening to anyone. Every doctor I interviewed was aware of the problem and I personally was told that what happened to me was one of the worst cases they have ever heard. This cannot be the "island" that it is made out to be and to deny that the problem exists when article after article has been written on the subject is simply absurd.
belinda

 
At Thursday, August 08, 2013 10:54:00 AM, Blogger Doug Capra said...

An interesting article on KevinMD that addresses an important aspect of what we've been talking about here.

The gratitude of a terrified parent when kindness is shown
PAT MASTORS | PATIENT | AUGUST 5, 2013

The author writes about a meditation concept called the Golden Cocoon, a protective all around the patient. It's difficult for patients in pain or trauma to do this themselves. This is where patient advocates, famiily or friends can help.
One quote from this article stands out in my mind:
"The dehumanization of patients is not conscious; it’s a consequence of the staff heeding rhythms, schedules and constraints they are told to serve. But when we let the little “dents” to the patient’s cocoon go unchecked, when no one points out how hurtful these seemingly small wounds are to our spirit and sense of self, it gives tacit permission for bigger ones."

"Not conscious"? Yes, most of the time. There are few bad apples in medicine that purposely enjoy hurting patients. Yes, yes -- medical professionals should always be aware of this -- but they're not. And if we agree that it shouldn't always be up to the patient to bring it up, this is where family and friends come in. Sometimes all it takes is a reminder or two, and they the caregivers know you're looking out for these behaviors. And if enough people did this, the culture of medicine would eventually change.
As far as doctors not knowing about patient modesty concern -- I agree with belinda. It's know. If not from their own practice, then from experience with family and friends who have had care. This is one of these hidden, under the radar topics that many doctors won't even bring up among peers who have violated one of their family members because of "professional courtesy." This needs to change. My experience in talking with doctors is like belinda's. They know and have known. In the past, they may have convinced themselves that it didn't matter. Remember the concept of "seeing." What we don't "see" is what we've been culturally taught not to consider relevant. Not knowing is one thing. Not seeing is another. I think some doctors don't "see" these events any more because they don't consider them important.

 
At Friday, August 09, 2013 5:03:00 PM, Blogger Maurice Bernstein, M.D. said...

Another notification to my visitors here of a great new topic thread I just put up which I think (and hope) will stimulate some interesting responses. It is titled 'Beauty is in the Eye of the Beholder' but to Others DON'T TOUCH!: The Current Gallup Poll Study on Social and Medical Ethics Issues"

The issues covered were: pornography, sex between teen agers, gay or lesbian relations, sex between an unmarried man and woman, having a baby outside of marriage, polygamy, abortion, cloning humans, cloning animals, gambling, doctor-assisted suicide, suicide, married men and women having an affair, divorce, buying and wearing clothes made of animal fur, medical research using stem cells from human embryos, the death penalty, medical testing on animals.

If the topic sounds interesting, go over to the thread and read and write. ..Maurice.

 
At Saturday, August 10, 2013 10:03:00 AM, Anonymous Anonymous said...

I've read so many comments and articles pertaining to the fact there are not enough male nurses in the health care system. That is why male modesty concerns are not accommodated for the most part. I see constant ads for medical staff training programs and in none of these do I see men in the picture. It is as though they say there is not enough male nurses like it is unfortunate but are doing nothing to target men for these programs. The complete lack of effort to attract men into the nursing field should be an obvious sign that they don't want men there. They make more effort recruiting female nurses over seas than they do going after the other half of the local population. Why the lack incentive for men to join the health care system?

 
At Saturday, August 10, 2013 10:21:00 PM, Anonymous Anonymous said...

Privacy should be provided for all patients! Do you
ever see an advertisement with a young female nurse
caring for a young male patient, not. That would be too
suggestive and would cause people to think. It's always
a female nurse and an elderly female patient.

They don't want men there cause they are so afraid
men will do to female patients what female nurses have
be doing to male patients.

Anonymous said: " I've read so many comments and articles pertaining to the fact that there are not enough male nurses in the health care system. That is why male modesty concerns are not accommodated for
the most part."

Anonymous, is this an excuse female nurses use
not to close doors while male patients are changing,
or not to drape adequately? Is this the excuse they
use to have unnecessary observers during procedures?

The excuse being that well, there are no male nurses
available so I guess they are stuck with me and thus
I don't care cause I am the problem. I have insured that
no males work in L&D,mammo or post-op gyn. What
they see is what they get and if they don't like it they
can go elsewhere. Their privacy is not as important as
mine despite what I learned in nursing school about
insuring privacy to all patients. As a female nurse I
am female and no,not all men are created equal where
medical privacy is concerned.

PT

 
At Sunday, August 11, 2013 11:31:00 PM, Anonymous Anonymous said...

PT


This reply is full of false accusations and has nothing to do with the comment I posted!

I simply asked why is there no mainstream advertising incentives for men to join the health care system?

You are obviously correct that not all people are created equal when it comes to privacy concerns. Obviously enough are to post their concerns on this site.

Hecter

 
At Monday, August 12, 2013 5:48:00 AM, Anonymous Anonymous said...

Hecter:
I don't know where you live but here in my area I see lots of ads for medical schools (both for nursing and other various medical technical jobs) that include pictures of both men and women. There was also a radio ad some time ago for a college in this area that advertised for their nursing program with the line "are you man enough to be a nurse". So I don't really see it as a lack of effort to get men into the profession but more of a lingering stigma that nursing is a "woman's job", sort of like teaching, especially in the lower grades. It's not productive thinking but I think it still exists and may take some time to change. Actually the last few times I have visited people in the hospital I have noticed that there are more male nurses that I have ever noticed in the past so maybe things are slowly changing. My husband had a male nurse the last time he went to day surgery for a back injection and my sister had several male nurses when she had back surgery. (She passed, however, on their offers to help her shower and she did have female nurses remove her catheter.) I think it is all about choices and patient comfort and perhaps we are slowly seeing an effort to accommodate that (hopefully). And perhaps there are more male nurses in the area where I live because it is home to a large, world renowned medical center. Perhaps smaller cities and towns are still entrenched in the typical male doctor/female nurse scenario. I don't know: what do others think? Jean

 
At Monday, August 12, 2013 5:49:00 AM, Anonymous Anonymous said...

Title VII says that discrimination in the workplace based on race, gender, ethnicity or religion is not allowed.

While there is a privacy clause that states "bona fide job qualification focusing privacy issues, there is no reason why men are not being targeted for healthcare.

It might be interesting to determine how many men actually apply to nursing school. If the numbers are overwhelmingly a female dominated application, then naturally there would be more female nurses.

This is the best place to start. And...if men are not applying, then why? Everyone's problems would be greatly handled with more men in the nursing population, if, at the same time, an effort were made to assign same gender care when expressed by the patient or a normal course of action.

Years ago, that's the way it was. Orderlies provided male intimate care and nurses provided female intimate care. After the Civil Rights Act everything went "out the window" and to the system's stupidity, failed to incorporate how a patient feels when faced with opposite gender intimate care and ignored the bona fide job application for the consumers paying for healthcare.

PT, do you have any statistics on the amount of men applying for nursing positions vs. women and..if what's the ratio between application and employment for these two sectors.
belinda

 
At Monday, August 12, 2013 7:13:00 PM, Anonymous Medical Patient Modesty said...

The truth is some medical facilities are so gender neutral in their nursing assignments today. I am very supportive of us increasing male nurses. But I think that all medical facilities should assign male nurses to only male patients for male intimate care. I also think they should only assign female nurses to female patients for intimate care. I am very disappointed in how many urology clinics do not bother to hire male nurses or assistants. I think that nursing schools should encourage men to become nurses so they can work with male patients for intimate care.

Many hospitals still have policies in their L & D units to not hire male nurses. But there are some hospitals in states such as Utah and Illinois that allow male nurses in the L & D units. The hospital that my grandma had her heart bypass surgery was gender neutral in the Heart Center. I was very upset that they let a male nurse give her bath while she was still out. It really bothered me that there were so many other female nurses around that could have given her a bath. I thought it was so strange that they seemed to assign the male patients on that floor female nurses instead of that male nurse.

Gender neutrality is not good. I think medical facilities should follow the same standards as other non-medical jobs. Gender neutrality in the medical profession is to blame for a lot of patient modesty violation and sexual abuse cases.

I wanted to let you all know about a male nurse who sexually abused some female patients in ER in Oregon at http://www.oregonlive.com/portland/index.ssf/2013/08/alleged_hospital_abuse_by_fire.html. It has triggered a $2.5 million dollar law suit. Sexual abuse in medical settings is a concern that medical facilities may think when they hire nurses for certain departments . Gender neutral nursing assignments increase the risk of sexual abuse. You can also see more articles about this nurse at http://topics.oregonlive.com/tag/jeffrey%20mcallister/index.html. I certainly believe that some female nurses have abused male patients. But most male patients will rarely speak up about abuse that they endure so that’s why we almost never hear about abuse of male patients.

Misty

 
At Monday, August 12, 2013 9:31:00 PM, Anonymous Anonymous said...

I came across a great article regarding gender in medicine.

Here is an exert from this article, followed by the URL to read the entire article.

Many of the points I've been supporting are mentioned here.

------------

"Delicate situations

Several comments dealt with embarrassing situations associated with the body and body examination. Gynaecological examinations were often used as examples as were examinations of male reproductive organs.

"Rectoscopy can be awkward for a man when the doctor is a woman." (female, 42, surgical specialty)

Encounters with patients who have been victims of sexual abuse were also recognized as delicate situations where respect for the integrity of the patient was identified as most important.

Our data also revealed some problem descriptions, mainly from men, connected with sexual attraction and objectification. Examples given were mainly between doctor-patient or teacher-student. The physicians commented on being the object of admiration and attraction from patients or students of the opposite sex, but there were also stories about themselves being attracted.

"You get help from me only because you're attractive." (female, 50, general practitioner quoting a male colleague)

"You are only human. A beautiful and elegant woman will of course be treated more cordially by a male doctor, at least in a stressful situation." (male, 50, non-surgical specialty)"
-------------

http://www.biomedcentral.com/1472-6920/8/10

belinda

 
At Monday, August 12, 2013 10:26:00 PM, Anonymous Anonymous said...

Hector


To maintain the status quo you don't admit to
problems and you certainly don't offer solutions. The
effort has been to keep men out of nursing, keep
them out of mammo, out of L&D and out of post-op
gyn.

When asked on nursing forums why if more
men should be accepted into nursing, the response
is always " yes, so they can help with the heavy
lifting", typical default response. The comment was
never " maybe male patients would like same gender
care. Why would they ever admit to a problem, that
would prompt a solution. Maintain the status quo.

You have completely missed the point, as I was
referring to how the entire nursing industry thinks
on this regard although they will never admit to it.

Does anyone in our society actually come out
and say, yes I discriminate, yes the industry I work
in discriminate.


PT

 
At Wednesday, August 14, 2013 1:42:00 PM, Anonymous Anonymous said...

Misty stated "But I think that all medical facilities should assign male nurses to only male patients for male intimate care. I also think they should only assign female nurses to female patients for intimate care."

Misty, do you also believe that female sports reporters should enter the locker rooms for only female athletes?

Gerald

 
At Wednesday, August 14, 2013 1:57:00 PM, Blogger Maurice Bernstein, M.D. said...

Gerald, should I mention "Freedom of the Press"? I'm not supporting this as an excuse but just stating a common expression. ..Maurice.

 
At Wednesday, August 14, 2013 2:10:00 PM, Anonymous Anonymous said...

Sport is entertainment and not really news. Therefore, I argue that "Freedom of the Press" is not applicable.

Gerald

 
At Wednesday, August 14, 2013 4:21:00 PM, Anonymous Medical Patient Modesty said...

Gerald,

Let me answer your question:
Misty, do you also believe that female sports reporters should enter the locker rooms for only female athletes?

Yes, I think that female sports reporters should only enter locker rooms for female athletes. Public restrooms are specific gender so locker rooms should follow the same standards. I am not against female sports reporters working in gyms and other areas where there is no chance that men are changing their clothes or showering.

I personally think it is ridiculous that female sports reporters are allowed in men's locker rooms. This reminds me so much of gender neutrality in medicine.

Misty

 
At Wednesday, August 14, 2013 4:47:00 PM, Blogger Maurice Bernstein, M.D. said...

Gerald, "Freedom of the Press" applies to news gathering and publication and what is written about sports and sports participants is, in fact, news. The reporters are not themselves participating in the game itself, just reporting the facts, the news. However, I would argue that news people of any gender should not be present in the locker room of any gender. It is a locker room and should be locked, opened only for the players. Think of paparazzi allowed into a actor's/actress' dressing room when they are already shunned on the street. ..Maurice.

 
At Wednesday, August 14, 2013 4:55:00 PM, Anonymous StayingFit said...

Dr. Bernstein, "Freedom of the Press" is an absurd argument in this case. The press would not be banned, but members of the opposite sex would be. If the Associated Press wants to send a representative, they can. However, it is a bona fide occupational qualification that said individual be of the same gender as the locker room into which they wish to enter. Hence, male reporters can enter men's locker rooms, and female reporters can enter women's locker rooms.

Also, as Gerald alluded, the government would not be infringing upon a free press, which is what the first amendment bans. A private organization, such as the NFL, would be restricting access to their personnel, which they have every right to do.

Frankly, I think that the fair solution is to ban all of the press from locker rooms, and to hold press conferences with the players, once they have showered and dressed. We don't cry "freedom of the press" if reporters can't interview the president while he is trying to take a shower, so why should it be any different with athletes?

Yeah, I know, we're off topic, but I couldn't let that pass.

 
At Wednesday, August 14, 2013 5:20:00 PM, Anonymous Medical Patient Modesty said...

Dr. Bernstein,

I agree with you that reporters of any gender should not be present in the locker rooms. I feel locker rooms should be private for the players only. The news reporters can interview the players outside the locker rooms. There are plenty of opportunities for news reporters to interview players outside the locker rooms.

Misty

 
At Wednesday, August 14, 2013 5:39:00 PM, Anonymous Anonymous said...

Maurice, additionally it could be argued that under Title VII that the gender of the reporter must match the gender of the players just like in a restroom where there is a hired attendant.

The sports organizations could take this issue to court if it were that important to them stating that the player's have a right to privacy and the gaze of the opposite gender when dressing.
belinda

 
At Wednesday, August 14, 2013 6:36:00 PM, Blogger Maurice Bernstein, M.D. said...

Belinda, is the reporter's interview duty to detail the player's private anatomy? If not, I agree, interview the players outside the locker room. ..Maurice.

 
At Wednesday, August 14, 2013 6:46:00 PM, Anonymous Anonymous said...

Maurice, a very good point. And...just like in medicine, I would imagine that this issue could be addressed in contracts that the players sign. Do they have to give up their dignity to play? Just like, do we have to give up our dignity to get healthcare?

Let's turn this around, is it not morally unjust to force or coerce patients into being viewed by unnecessary personnel (for patient health) like students, sales, reps and the like?

It is morally wrong if permission wasn't granted by the player just like it is morally and legally wrong in healthcare when patients are not informed who will be present, what is their role, and being forced to participate in a gender neutral healthcare system.

Furthermore, is it morally and legally right for sexual assault victims to be subjected to such practices without their needs becoming paramount just as specified under "delicate situations" in the article/survey I recently posted?

So...to clarify, yes it is morally wrong without player permission for the press to enter, and yes, a player who has a problem with this should be given an exception to the practice by offering private dressing areas in such circumstance. Same is so in healthcare. Gender neutral only works for one side of the equation and the other side is paying for it.

While I have a deep respect for individual healthcare professionals, I do not have any respect for a system that bullies patients, does not treat then as human equals or even intelligent beings, and pretends that there are no problems with this gender situation. It's a disgrace and the refusal to change the system is even worse.

The medical system must learn to earn patient trust or you will find that more and more people will not tend to their health needs. They wonder why and they already know? It boggles my mind that with all the brains, the healthcare system is only treating the physical, ignoring the mental even though they know there is a deep connection to healing and without one you cannot have the other. Please explain that!
belinda

 
At Wednesday, August 14, 2013 6:52:00 PM, Anonymous Anonymous said...

No. It is not and is a further breach of privacy.
belinda

 
At Thursday, August 15, 2013 7:14:00 PM, Anonymous Anonymous said...

go to allnurses or any nursing site, hospital web sites, look up websites for nursing schools while there are more males then in the past, they still overwhelmingly feature female nurses, efforts to recruit males into nursing are rare at best.

I heard an interesting poll, the question was would you go to work naked one day for a million dollars, less than 30% said they would. Hardly a real study but interesting that the fear of nudity is so strong as to pass a million dollars. And yet it is assumed by the medical profession that we would shed those inhibitions when we walk through the door.

And yet, I went to my dermotologist this week. Nurse takes me back and says the Dr. will be doing a full body today, he will need you to remove everything except your shorts. Would you like a gown? i said no but thanks for asking, she smiled and i could tell she appreciated the thanks as much as i did the consideration. My MD does the exam, has me stand, slides the shorts up on the sides and back without ever exposing, Then waited for me to put my pants on before opening the door to leave...some get it....don

 
At Thursday, August 15, 2013 9:37:00 PM, Anonymous Anonymous said...

Go to all nurses under general discussion,then to
the thread " working where you get your medical
care.". Interesting comments. One commentor
said, " I don't want to be naked where I work."


PT

 
At Saturday, August 17, 2013 11:08:00 AM, Anonymous Medical Patient Modesty said...

Dr. Bernstein: I appreciated Belinda’s excellent points the other day. Why should medical professionals not be held to the same standards as news reporters? So many unnecessary medical professionals are present with patients for intimate examinations or prepping, I’d like to hear your thoughts on this.

PT: I found the discussion forum you are referring to on All Nurses forums – working where you get your own medical care .

I wonder if Mulan who made this comment: “I don’t like to be naked where I work” is sensitive to patients’ needs for modesty. I know there are some insensitive medical professionals who care about their modesty, but they think that patients should just forget about their modesty. Also, look at the comments applewhitern made on August 15th.. She/he prefers to go somewhere else and that she did not want to work with people who had seen her/him naked.

Also, note that some nurses do not care about their modesty such as monkeybug who commented on August 15th. She had a male doctor who she knew personally deliver her baby.

Don: The results of a poll asking if you would go to work naked one day for a million dollars is very interesting. This reminds me of the fact that some women would not go to a male gynecologist for $1 Million. This shows how strongly many people feel about their nakedness and modesty. Some people never want to expose their private parts to the opposite sex except for their spouses

Misty

 
At Saturday, August 17, 2013 12:44:00 PM, Blogger Maurice Bernstein, M.D. said...

From PT:


Misty

What's more telling is the statement " I don't want to be naked where I work but it's ok if you are naked where I work." That's the thought process, that is actually what they are thinking. Very few hospital employees actually seek healthcare where they work, why?

What could they be so possibly afraid of. Why they could be told " you have nothing I haven't seen before or " we're all professionals here." I'd like to see how that would go over.
PT

 
At Saturday, August 17, 2013 4:03:00 PM, Anonymous Anonymous said...

It is one thing to be naked in front of a group of strangers, however, psychologically (depending on the previous relationship between the parties), it's more humiliating to be exposed to people you work with.

The reason is that now, not only are you in a submissive position, but your co-workers who know you as an equal, now also see you in a subservient position.

One of the problems in healthcare are self serving, sarcastic, insensitive people. When you are the patient, how would you like a co worker to treat you that way.

And then...have to go to work the following week?
belinda

 
At Sunday, August 18, 2013 6:26:00 PM, Blogger Maurice Bernstein, M.D. said...

You have got to see this cartoon. It portrays exactly the current ongoing discussion here. Click on this link and then return and comment. ..Maurice.

 
At Sunday, August 18, 2013 11:26:00 PM, Anonymous Anonymous said...

In regards to the cartoon, I would not want to see any of my physicians (male or female) like that.

Gerald

 
At Monday, August 19, 2013 7:09:00 AM, Blogger Maurice Bernstein, M.D. said...

I put the link to the cartoon on a bioethics listserv and an ethicist wrote back the following. I thought you all would be interested in what was written. ..Maurice.

Funny Maurice.

So, suppose attending physicians voluntarily began wearing hospital gowns once a
week.

Suppose nurses did.

Replace "Casual Friday" with an internet-organized "Patient Empathy Day."

Might provoke one of those "national conversations" we're said to be needing.

A few congress persons and senators might join reps from the health care
workforce, leading from from behind, showing basic solidarity with patients, a
flip-side of frontal privilege.

 
At Monday, August 19, 2013 7:46:00 AM, Anonymous Anonymous said...

Rather than showing the doctor with an open gown, why not show the patient and doctor with closed gowns.
Isn't that the way it should be anyway?

I do like the idea of doctors wearing an appropriately covering hospital gown so that they feel the depersonalization of what that garment does to one's idenity?
belinda

 
At Monday, August 19, 2013 8:47:00 AM, Blogger Maurice Bernstein, M.D. said...

A "must-read" article from the Oregonian: Doctors being paid by heart defibrillator company to train the company's sales reps without notifying the patient of their payment nor the reps presence and activity in the operating room. Now, the Oregon State Department of Justice was taking action against this behavior but the doctors and company find nothing but the best interest of the patients at heart. Terrible!! ..Maurice.

 
At Monday, August 19, 2013 12:02:00 PM, Anonymous Anonymous said...

At one time or another, we see drug reps coming or going from the doctor's office.

Doctors are given samples of drugs and I've always wondered if this is a conflict of interest.

I have seen the drug reps leave and then have a patient go in and get that exact drug recommended. It happened to me and I didn't take the drug.

Just as in the real estate industry, where buying and selling agents must sign disclosures, so must any relationship that presents a conflict of interest.

Keeping it a secret from the patient is even more unethical.
And this is an industry we should respect and if so, why?
belinda

 
At Tuesday, August 20, 2013 10:32:00 AM, Anonymous Medical Patient Modesty said...

Dr. Bernstein,

I agree with you that it is terrible for doctors to be paid by a heart defibrillator company to train the company's sales reps without notifying patients. Sales reps should never be allowed in the operating room without a patient's permission. Every patient should have the option of declining a sales rep in the OR. It is very unethical for doctors to allow sales reps in OR without asking the patient for consent. The truth is presence of sales reps have no benefits to the patients.

Misty

 
At Tuesday, August 20, 2013 10:00:00 PM, Blogger Maurice Bernstein, M.D. said...

Misty wrote the following to this thread this evening.



Did anyone watch “The Man With the 132 pound scrotum” on TLC last night? You can see some information about his story on CNN Health. It was so sad. He suffered for about 5 years before finding a doctor who was willing to operate on him. I am sure he went through a lot of humiliation. I’m glad that he found a doctor willing to do the surgery for free. However, it disturbed me that the urologist had some female assistants or nurses around. I wonder if that made the man feel humiliated. I was glad at the end to see at least one male nurse around.

Misty, I am sure that carrying his lymphedematous scrotum around before surgery provided such humiliation that any visualization by urology assistants would not add much more. ..Maurice.

 
At Wednesday, August 21, 2013 6:17:00 AM, Anonymous Anonymous said...

It's difficult to try to read someone elses mind, thoughts and feelings.

While people with anomalies suffer from the humiliation of being stared at, just like a very large pregnant women,it's something else on a deeper level to expose the intimate part that is the source of the humiliation.

So while the man might have felt humiliated by his condition, can one at least consider, that the ultimate humiliation was being exposed to everyone?
belinda

 
At Wednesday, August 21, 2013 8:30:00 AM, Anonymous Anonymous said...

"I am sure that carrying his lymphedematous scrotum around before surgery provided such humiliation that any visualization by urology assistants would not add much more."

While I certainly agree with you, this attitude that providers know how patients feel is fundamental to the problem. It never ceases to amaze me how obtuse providers are! A patients feelings of modesty, dignity, embarrassment, or humiliation have absolutely nothing to do with what any particular provider has seen, the procedures they've performed, their claimed professional status, or what they think!

The American Urological Association Code of Ethics, regarding informed consent, states:

"I will consider informed consent integral to providing appropriate medical or surgical care. I recognize that my patient must be provided with all of the information necessary to consent and to make his own choice of treatment, regardless of my own advice or judgment. The information provided must include known risks and benefits, costs, reasonable expectations and possible complications, available alternative treatments and their cost, AS WELL AS THE IDENTIFICATION OF OTHER MEDICAL PERSONNEL WHO WILL BE PARTICIPATING DIRECTLY IN THE CARE DELIVERY. Wherever feasible, I will respect my patient's rights and be limited by the scope of my patient's consent."

The reason why many Urologists fail this basic requirement is they know a significant percentage of patients will object to opposite gender staff participating in their care. I'm relatively confident, based upon my own experience, that the individual portrayed in the TLC episode was not advised of the ancillary staff participating in his care when informed consent was obtained.

Ed

 
At Wednesday, August 21, 2013 6:18:00 PM, Anonymous Medical Patient Modesty said...

I agree with Belinda that it is hard to read someone’s mind. I am pretty sure that the man was at least a little embarrassed by the TV crew following him in the room with the doctor. I could tell that the man seemed to be somewhat disturbed by a female resident or medical student asking some very personal questions about his genitals by his expression. I believe she was just there to “learn” so it was not really beneficial to the patient. The man seemed to be more comfortable when it was just the male urologist.

This man was very desperate for help because he was almost immobile. Many patients are put in a vulnerable position and they feel that they cannot speak against assistants and medical students they may not want to be a part of their care.

While the man was already humiliated by his condition, we need to consider that he may have been humiliated further by the female assistants and TV crew.

Ed made very excellent points. I am pretty sure that this urologist probably did not ask the man how he felt about having female assistants, nurses, and medical students observe his examination. I think that all urologists should follow the American Urological Association of Ethics. Ed is right that many urologists are afraid that if they ask male patients for permission to have females involved in their care that many of them will object.

Misty

 
At Wednesday, August 21, 2013 7:15:00 PM, Blogger Maurice Bernstein, M.D. said...

Do we know how the TV crew and others got into the room with Mr. Warren? What was the motivation (or benefit)for the patient to accept their presence? I can't believe that these gawkers would have been present without Mr. Warren's consent. I believe if there was "ultimate humiliation" it could not have been through some other mechanism than consensual.

Again, I would say that if humiliation was one of the factors leading to the surgery, there was something going on, trumping any humiliation, which led to Mr. Warren accepting the presence of his gawkers. So, I really don't feel sorry for him in that regard but sorry only for his basic pathology, his lymphedema of the scrotum. ..Maurice.

 
At Wednesday, August 21, 2013 11:59:00 PM, Anonymous Anonymous said...

"Again, I would say that if humiliation was one of the factors leading to the surgery, there was something going on, trumping any humiliation, which led to Mr. Warren accepting the presence of his gawkers. So, I really don't feel sorry for him in that regard but sorry only for his basic pathology, his lymphedema of the scrotum."

Your apparent total lack of empathy for what he endured to receive medical care, while not surprising, is disturbing. It's clear why Mr. Warren submitted to the care he received; he had no choice and yet the Learning Channel profited off his misfortune. Moreover, I'm betting, the hospital, physicians, and ancillary staff were all paid top dollar for their services. Short of the ER, we don't guarantee citizens access to healthcare, lag other industrialized nations in infant mortality and life expectancy, all while spending more as a percentage of GDP and per capita than any other nation. I think it's tragic what Mr. Warren suffered to receive needed healthcare.

Ed

 
At Thursday, August 22, 2013 8:03:00 AM, Blogger Doug Capra said...

Don't doubt that many of not most of the non actor patients on these medical shows get their care paid for in exchange for the exploitation. So -- what real choice do they have? I'm sure producers are scouting around for poor folks who can't afford health care, people who need operations or procedures. That's why the ER shows are so popular, esp. in cities. The poor and those without insurance are most likely to go there. That's what these shows are all about -- ratings and money. Nothing else. And the fact that many doctors participate in the shows is shameful and unprofessional. But it certainly helps their careers.
Now -- I'm not talking about all shows. There are some that are real medical education for the public. Others are pure for profit ventures that have nothing to do with real medicine.

 
At Thursday, August 22, 2013 8:34:00 AM, Blogger Maurice Bernstein, M.D. said...

Ed, the decision was that of Mr. Warren to allow the urologist to perform the surgery and have a TV production along with making an advertisement for the urologist of his case. Whatever the humiliation was associated with the permission was apparently trumped by the clinical and financial benefit to the patient. Without knowing all the facts, nevertheless, it would seem professionally unethical for any surgeon to remove a patient's anonymity or ignore a patient's possible humiliation in order to then offer surgery "for free" as some humanistic and altruistic act.

On another subject: For those of my visitors who are concerned about "awakening" while supposedly "under" general anesthesia and then suffering PTSD from the consequences, I suggest reading the wonderfully descriptive and well-written article "Awakening" in the January/February 2013 issue of The Atlantic. There is much to learn about what is going on outside and inside your brain as reported by what turns out to be a scholarly medical student author. ..Maurice.

 
At Thursday, August 22, 2013 9:52:00 AM, Anonymous Medical Patient Modesty said...

Ed made excellent points. I agree with him that it was tragic about how Mr. Warren was treated. I am not against TLC doing shows on patients with medical issues. But I felt that TLC went too far by going into the room with Mr. Warren when he had intimate examination. I bet that he was not even told that TLC crew would be present for his intimate examination. There are ways that TLC crews could have worked to respect his privacy and dignity. The crew could have been just present for certain discussions between Mr. Warren and the urologist while he was still fully clothed. It was clear that the crew saw Mr. Warren’s private parts because they blocked them out on TV by blurring his private parts.

Many patients like Mr. Warren are put in a vulnerable position and it’s hard for them to say no when everything happens so quickly. I bet that Mr. Warren was not told the truth about how there would be female assistants, residents, etc. observing. I could tell by Mr. Warren’s expression that he was uncomfortable with the female resident or medical student who asked him some very intimate questions. My family was put in a vulnerable position when my grandma had a heart bypass surgery almost 4 years ago. We are very grateful she did very well with the surgery. But I was very upset to find out that they let a male nurse give her a bath while she was still out from surgery without our permission. It should have never happened. It was so hard because we were concerned about her recovering from the surgery. Many patients and family members have no idea how gender neutral many departments at hospitals have become.

I already knew that male patients’ modesty is often disregarded in urology clinics because many urologists fail to ask male patients for their permission about who can be present for their intimate examinations, but Mr. Warren’s case opened my eyes to the seriousness of this problem. It is disappointing that many urology clinics do not bother to hire more male nurses and assistants and ask male patients how they feel about having females present. While it is true that many male patients do not speak up about their discomfort with females being part of their intimate male health care, we have to keep in mind that many male patients do care. Many male patients actually avoid health care instead of speaking up about modesty concerns.

I was very pleased with how TLC respected Anna Duggar’s modesty during childbirth back in June. I was very encouraged to see how the midwife really worked hard to protect Anna’s modesty as she had her baby. She wore a dress in the birthing tub and kept it on as the midwife helped to deliver her baby. It was obvious only Josh (her husband) and the midwife saw her private parts. This proves that anyone especially a male pediatrician or anesthesiologist who has to be in the room with a birthing mother can avoid seeing her private parts.

Misty

 
At Saturday, August 24, 2013 2:05:00 PM, Anonymous Medical Patient Modesty said...

I wanted to let you all know that the man with 132 Lb. Scrotum will be on TLC tonight at 10-11 PM and 1-2 AM Eastern Time. You all can look at TVGuide.com to see what time the show will be on in your area.

Misty

 
At Saturday, August 24, 2013 2:55:00 PM, Blogger Maurice Bernstein, M.D. said...

Misty , by watching the program are not we performing the very gwaking and providing support to the filming which was discussed here as unethical? ..Maurice.

 
At Sunday, August 25, 2013 1:32:00 AM, Anonymous Anonymous said...

An article in Urology Times titled "All-female urology practice's mission is to give women choice in care", cites an Indiana University ethics ruling that patients cannot decline opposite gender providers participating in their healthcare.

Specifically, the author states "When I was a medical student at Indiana University, there was an issue with pelvic exams and our ethics committee got involved. Some patients didn’t want male students involved in their gynecologic care, and it went to the ethics committee to determine whether patients did have a choice in a state-sponsored institution charged with training caregivers. The policy that came out of it was that, at least in an academic teaching institution, the patient didn’t have a choice. That’s the societal burden of training the next generation of providers; if you go to that institution, you are going to interact with the provider that’s assigned to you. I think it’s particularly difficult in state-owned institutions, or wherever public funding is received, to bend to those issues."

Dr Bernstein, you've repeatedly said that patients in teaching hospitals can decline student participation in their healthcare. Can they also decline opposite gender providers, whether student or not? Your thoughts?

The complete article is at:

http://urologytimes.modernmedicine.com/urology-times/news/user-defined-tags/philip-m-hanno/mission-all-female-practice-give-women-choice-ca?page=0,3

Ed

 
At Sunday, August 25, 2013 6:57:00 AM, Anonymous Anonymous said...

Maurice, your comments to Misty regarding the television program were very thought provoking for me.

For the first time, I understood the dilemma from the other side. The answer lies in a simple rule.

You are correct in your assumption that watching this show and others like it promotes the industry for filming such material.

Our intrusion into this mans' life with the mindset that we are examining the psycho social aspects of his experience would have the same validity in it's own worth just as watching for medical reasons.

However, the rule is....complete informed consent from the patient with all the tools and information presented to him before filming. The same holds true in medicine.

This patient seemed so grateful for relief of his experience that his state of bodily dress/undress with blurring techniques, that his state of undress was at the bottom of the list. Additionally, this patient was accustomed to being unclothed in front of both genders.
Only the patient from this production could tell us if he felt coerced into cooperating in order to get free medical care. That should never be the case.

Ed, with regard to this article, the hospital cannot trump patient rights. If this is the position the hospital took, I wish I had the opportunity to argue the problems with that position. The lawsuits from people who have previously been abused both male and female would overrun the system.

And...if every patient declined, there would be no patients. It's the patients who have the power. If men choose not to speak up and tell their providers what they will and won't accept, it will take that much longer for them to get what they need.

An institution does not have the right to overrun someone's autonomy to gain their agenda unless they are a danger to themselves or others.

I'm sure a lawsuit would bring this right up to the state supreme court for a ruling.
belinda

 
At Sunday, August 25, 2013 9:45:00 AM, Blogger Maurice Bernstein, M.D. said...

Ed, I hope no hospital ethics committee says that "the patient doesn't have a choice". As a member of a hospital ethics committee, I know that we are all attentive to what choice the patient has made. Now whether that patient choice will be accepted and followed by the institution is another matter. If any hospital has a policy to reject certain gender choices by the patient, that policy should be stated and explained to the patient before the patient is admitted for care. It cannot be just assumed that the patient recognizes beforehand that such a policy might exist. ..Maurice.

 
At Sunday, August 25, 2013 6:54:00 PM, Anonymous Anonymous said...

The article is interesting in several ways, while she jumps back and forth on the issue of same gender providers she makes a telling comment when she says "takes one to know one" regarding same gender provider. I also found the statement about thats the burden, but who decided it was a fair burden, that would be the medical community that decided. I think it is telling that she states she understands women may want female providers and it is important on cases involving intimate proceedures for patients to be comfortable including gender, yet makes no reference to support staff though hers are all female. If a male were to take that stand, would it be accepted? The medical community decided it is fair for it to impose on patients the "burden". Isn't that a version of what we all are talking about, the medical community deciding what "burden" is reasonable for us.....don

 
At Sunday, August 25, 2013 8:07:00 PM, Anonymous Anonymous said...

Ed


I haven't read the article,however,every
patient that enters a teaching hospital has the right
to request non-teach. That means No to residents,
nursing students and students of any kind. The words
NON-TEACH will appear on your medical chart.
Furthermore, if this ethics committee came
from Indiana University Medical Center at
Indianapolis, I would suggest to them that they focus
on their patient delivery care system first before
forcing opposite gender care on patients. They have
many bad apples on their tree.

PT

 
At Monday, August 26, 2013 8:13:00 AM, Blogger Maurice Bernstein, M.D. said...

NOTICE: AS OF TODAY AUGUST 26, 2013 "PATIENT MODESTY: VOLUME 56" WILL BE CLOSED FOR FURTHER COMMENTS. YOU CAN CONTINUE POSTING COMMENTS ON VOLUME 57.

 

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