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Patient Modesty: Volume 62
The argument of what all healthcare providers are thinking
in terms of sexuality, sexual feelings and sexual intent when they are
attending to patients of either gender is truly an empty argument since we will
never know. And as Don (writing in Volume 61) pointed out, the
providers will be damned by patients both if they admit their thoughts or
refused to admit. So, instead, let's all gather
around the tables for discussion of what is most important: how to get the
medical system understand that there is to some patients considerable more to
patient modesty concerns than what is taught to the doctors and nurses and
techs in school. That is now what this
thread is all about. ..Maurice.
NOTICE: AS OF TODAY FEBRUARY 9 2014 "PATIENT MODESTY: VOLUME 62" WILL BE CLOSED FOR FURTHER
COMMENTS. YOU CAN CONTINUE POSTING COMMENTS ON VOLUME 63.
Graphic: "Empty Tables" A photograph taken by me of an eating area at the Getty Museum, Los Angeles 1-2-2014
149 Comments:
I think the first place to start is with education and training of healthcare providers. When I went through CNA training the topic was essentially ignored. On the first day of clinicals, one of my classmates asked our instructor if the patients would have a problem with us seeing them naked and the instructor said, “No. We’re professional. We’re respectful. They will not have any problem with it.”
Well, some of them did. The showers were certainly an awkward place for me to be in. I remember walking in one time and there was a foreign woman standing naked right in front of me. I kind of stared at the ground, but out of the corner of my eye I could see here eyeing me with horror. The other CNAs didn’t seem to pick up on this and were coaxing her into the shower. I was supposed to be “shadowing” a CNA that worked there, but I opted to just walk out of the room and answer call bells. However, the other student (also male) who was shadowing the same CNA stayed.
A lot of the posters here overestimate how easy it would be to implement across-the-board same-gender care in every scenario. Where I worked we offered same gender care upon request (though male patients were sometimes out of luck in this regard). As a male CNA I encountered this a great deal and it did often come with a significant loss of efficiency, at the expense of other patients. In my situation, it was feasible but not without problems. In other scenarios (e.g. the ER or the OR) it’s a lot more difficult than just hiring male CNAs and nurses. As an analogy, imagine if you walked into a busy McDonald’s at lunch rush where half the staff is male and half the staff is female. Then imagine you, the manager, have been instructed to make sure that all workers serve only same-gender customers. Anytime a woman comes up to the register or drive-thru, a female employee has to come and take her order, another female has to make the sandwiches, and another female has to prepare the bag or tray. Now imagine, furthermore, that all of these employees are licensed professionals, some of them costing you eighty dollars an hour. It’s going to cost you a lot more and you’re going to sell a lot less due to the loss of efficiency. I’m sure many patients would love the idea of guaranteed same gender care, but I still think most people would rather pass when if they saw the increased costs and decreased service.
Having said that, there are a lot of simple things that healthcare employees could do without any trouble other than a little increased mindfulness. Many times I’ve seen nurses leave the door wide open while doing procedures that involve exposing the patient. This generally happens when they have to repeatedly go back to their cart to get something but there’s still no excuse for that when it takes all of half a second to pull the door behind you. Often CNAs would pull a patient out of the (curtained) shower bay to dry them off in an area where we kept Hoyer lifts and other supplies. I walked in on many a naked patient that way. Another time I helped another CNA do a chair-to-bed transfer on a patient who had expressed that she wanted female-only care. After doing the transfer, the female CNA immediately ripped this woman’s shirt off right in front of me (nothing on underneath) before I even had a chance to turn around and walk out.
Certainly this could be fixed if patients spoke up, but I don’t think that patients speaking up is going to end up being the solution for the simple reason that patients are probably going to continue to not speak up. In my work, while women (and, once in a blue moon, male) patients did request (and get) same gender care, I have never heard (or heard of) a patient complaining about modesty violations after they happened.
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I can think of several reasons why patients don’t complain. For one, patients always had multiple issues going on that they also needed to complain about (our most common complaint was excessive noise and loud talking). They also had a lot of serious health, pain, and finance concerns that took priority. Second, I imagine many patients felt powerless to change the issue – they have many individuals involved in their care and it’s hard for one person to change the whole system. Third, many patients probably had become desensitized to modesty concerns, much like some caregivers. Finally, in my particular experience, many of the patients simply did not have the mental competency to advocate for themselves.
You might read some of the above incidents and think that I worked at a crummy facility run by insensitive managers, yet this is simply not true (at least for the work I did after clinicals). I worked at a four-star facility. We had a good nurse-to-patient ratio. Management was constantly talking to us about issues of patient dignity. For example: I had a dementia patient who, whenever he was in the dining room, would move back and forth in his wheelchair, bumping into employees and other patients. I came up with the solution of sitting him at a table in the corner where he could harmlessly move back and forth without bumping into anything other than the wall. My nurse manager told me this was a no-no because it was a form of restraint, which violated the patient’s dignity (though any other patient could be seated at the same spot). Another time I saw employees tell a fib to a patient with advanced dementia to get him to step off the elevator so other patients and family could use it. Again we were told that misleading the patient like that is forbidden – it violates their dignity. We were regularly reminded not to use the terms “diaper” and “bib” but rather “incontinence brief” and “clothing protector” – again for the patient’s dignity. Yet modesty was rarely brought up except to say that patient requests for same gender care needed to be honored. Part of the reason is certainly because patients didn’t speak up about modesty issues, but I don’t think patients or families spoke up about those other issues either – CNAs regularly used the term “diaper” without incident.
Patients didn’t speak up about these other (and, in my opinion, lesser) matters of dignity, yet these things were still addressed and attended to. Why? A big, big, part of it is that the facility pays attention to dignity issues that the state pays attention to, yet this raises the question of why the state inspectors don’t pay more attention to modesty issues. That is something that has mystified me. In my training, too, I had a sincere and sweet veteran RN instructing us. She had spent years volunteering in a third world country. She truly, genuinely cared for her patients and like any good nursing instructor she regularly talked to us about how to attend to patients’ spiritual and emotional needs. Again, patients didn’t speak up to us about doing a better job of meeting their emotional and spiritual needs and yet these issues were still being brought up and are thought of as an integral element of nursing care and training, whereas modesty issues are shoved aside. Why? I think if we could figure out the answer to that question then the solution to this problem might present itself.
Despite many of the conspiracy theories that circulate in these discussions, there are a lot of caring and considerate professionals who went into medicine to help others and would willingly take up the modesty issue if they understood how important it is to some patients. The heart is there. The understanding is not.
I thought you all would be interested in checking out an OB/GYN practice, Round Rock OB/GYN in Texas that has a male OB/GYN and a female OB/GYN who are married to each other. I know the husbands here who are against their wives going to a male OB/GYN would be fine with the female OB/GYN in this practice treating their wives. But I find it so strange that a female OB/GYN would be okay with her husband being an OB/GYN too. I am sure she is well aware that her husband treats some very attractive women. I wonder how the female OB/GYN responds when women tell her that they do not want a male gynecologist under any circumstances.
I personally could not handle being married to a male OB/GYN. What are your thoughts? I especially would like to hear from women and husbands who have strong moral convictions that male gynecologists are wrong. I also wonder how a male urologist would feel if his wife was also an urologist who treated men. One man shared with me about how upset he was that his wife who was a nurse did intimate procedures on men.
Misty
I would like to add my own idea for getting the medical establishment to acknowledge the modesty issue: I believe that if a well-conducted study (published in a respected journal) showed hard evidence that modesty prevented people from getting medical care, then the medical establishment would take a serious look at the issue.
I also think this is the path that is most feasible for a handful of individuals to execute. Maybe, for instance, we could find a social psychologist who specializes in a related issue and convince him or her to conduct a study. Thoughts?
R Williams I think you answered your own question. Why, because it costs nothing to call a diaper incontenance clothing. You yourself challenged the idea of providing same gender on grounds of effiency and cost. Medical care of course is first and formost a business. Why are there not more male providers, because it would take money and effort. Your experiences show the lack of concern for something providers don't see they can change so they accept it, and end up promoting it. You said most don't challenge, some do, most men are out of luck....but, you obviously saw first hand some of the patients were disturbed and upset by it. Do you think the other providers were blind to the discomort. You walked from the rool of the naked women in the shower, the other trainee stayed, was he blind to the discomfort? Wasn't at least some of the time their discomfort obvious? Your circumstances were a little different, your patients were not all their of their own wishes, many did not have the option of walking out. As per the Stockholm syndrome hostages start identifying with their captors. People who can not leave, whom are essentially captive and dependant on staff can not be expected to challenge what they find offensive. That said, I agree 100% the majority of providers are not preditors or pervs, they are people in a system and institution who know who signs the check and follow protocol. The answer is pretty simple really, these unfortunate folks for the most part don;t have the ability to take their money elsewhere, if they did, they would have a little more power to balance the field.
Misty, when you ask for people who have strong feelings supporting your position you get just that. Wouldn;t it be more productive asking for people who don't agree, those who don't mind having a male gyn, those who don;t care if their husband is a gyn? If we expect providers to listen and try to understand us, should we not do the same? I think I have learned a lot from Dr. Bernstein, don't always agree with him but he has been helpful in my understanding a little bit of provider mentality and which helps me understand a little how to interact with them....don
It does not surprise me about how patient modesty was dismissed as an important issue by R Williams’ instructor. I am well aware that many nursing schools and CNA certification classes do not address patient modesty issues. In fact, one lady who got her nursing degree at the local community college shared with me that the nursing school did not even address patient modesty issues.
It is sad about how medical and nursing schools work to desensitize their medical & nursing school students to accept that patient modesty does not matter. No wonder why so many doctors, nurses, and CNAs make comments like “We are professionals. We’ve seen everything” when patients do complain about their modesty. The medical system also has “trained” many patients to lose their modesty as well. Most young people and teenagers are very uncomfortable with opposite sex intimate care, but they are “forced” to accept it later on. This is exactly why I have passion for helping young people to stand up for their wishes for modesty in medical settings. I think that all patients should simply walk away from the medical facility if they refuse to respect their wishes for modesty or same gender intimate care.
I do not feel the example about McDonald’s is a good example. Customers are not required to get naked at McDonald’s to get their food. It does not matter about the gender of people who prepare your food. It is completely different in medical settings because you are required to have some intimate procedures.
It is so sad about how vulnerable many patients are. Many patients feel so intimidated that they cannot speak up or even leave.
Misty
I agree with R.Williams with regard how to change the medical system: facts will trump feelings. "Moaning and groaning" itself will not provoke a change but presenting the system with some statistics about the amount and distribution of that "moaning and groaning" may make a difference in results.
Think of it: Wouldn't it be EXCITING if through the activities by participants to this very blog thread could end up with a powerful contribution to make a change in the medical system: MORE ATTENTION TO PATIENT MODESTY in all of its manifestations?? So I say, let's follow R. William's suggestion and see how we can precipitate the gathering of pertinent FACTS.
And Don, you are quite correct that the approach of providing the best information regarding how to proceed is not to dwell on "strong feelings" supporting one's own modesty feelings but to look to those who don't share the same such feelings as the majority of those commenting here in order to learn how they cope. It may be very revealing and something of use in attempting to change the medical system. ..Maurice.
I encourage you all to read this article about modesty during assisted bathing. Dignity Resource Council has some bathing garments that protect a patient's modesty. I personally think every nursing home should use those garments.
Misty
Can we please stop using "moaning and groaning" to describe users sharing their personal stories?
Stories touch and influence people. You may not like it, but it's the truth.
I use "argument from authority" all the time, even though I know it's not a logical way to argue. Why? Because it works.
-RJ
RJ,
I agree with your statement: Stories touch and influence people. You may not like it, but it's the truth.
Medical Patient Modesty gives patients the opportunity to submit their modesty violation stories at http://patientmodesty.org/modesty.aspx. Some of the cases we have received have made me write articles about certain issues. For example, the sad case of Maggie from Utah who was deceived about who all would be present for her hysterectomy played a role in my decision to do two articles on hysterectomy: Concerns About Modesty During Hysterectomy and Why Are Hysterectomies Often Unnecessary?
Misty
Misty, I would have no problem if my husband became a doctor who practiced in the areas of ob/gyn, urology, gastro, etc. that involved exposure of opposite sex patients.
Private practice patients choose their doctor. They know the gender of that physician and if they don't care, why would I?
What I would care about are the issues that we discuss here and would share protocols and processes that could be put into place to eliminate traumatic psychological reaction from feeling or being violated.
If I were a doctor in the same fields as above, male patient modesty would be at the top of my list for my male patients. Just the idea that a doctor cared enough to make their patient comfortable emphasizes the idea of respect, honoring their dignity. Those male patients would be happy. Isn't this what this is really all about?
I have met many male caregivers along the way, nice, respectful and I do put my needs before theirs but I also carefully explain why and that it has nothing to do with them. It makes me actually feel sad to turn away a nice, competent, male worker for intimate care but also feel that my needs must come first and that they deserve an explanation.
I also put my feelings squarely on the shoulders of the medical community because they changed how I feel, they acted in an egregious way and they did not help me heal from that trauma; in fact, they made it worse.
My relative (an elderly women) was being showered while a patient in the hospital. There was a male nurse who also worked in a uniformed capacity elsewhere. While she was naked, he walked in the bath facility in his uniform.
My aunt talked about this the rest of her life and how mortified she was. I wondered if she would have felt the same way had he been dressed in scrubs and appeared to be part of the health team. He, in his uniform, now was part of the public. Both workers had a total disregard of respect and dignity of the patient.
Isn't this what it's really all about? Leaving doors open, intimate caring for patients in semi-public areas is inhumane, disrespectful and not even considered sexual impropriety in the heads and minds of healthcare workers. This, is what has to change and that change starts at the top.
Maurice, I'd be curious to see how you feel about this and connection between patient harm, trauma and stand of care. Thanks!
Misty, I respect your right to feel the way that you do, don't really understand it because I wasn't brought up in that culture. Given that, it just shows how we are all different based on our religious convictions and experience and how important all of that is to all of us and we all deserve to be heard and respected in our opinions.
belinda
The ethics of intimate examinations—teaching tomorrow's doctors...
by Yvette Coldicott, Catherine Pope & Clive Robert.
University of Bristol
Medical School, c/o
Centre for Medical
Education, Bristol
BS2 8DZ.
"The teaching of vaginal and rectal examinations poses ethical problems for students and educators, and guidelines exist to protect patients from unethical practice. Yvette Coldicott and colleagues report an exploratory survey, whose findings suggest that best practice is not always followed and that in many cases consent has not been given for procedures..."
WHAT THE STUDENTS HAD TO SAY WHEN QUESTIONED FOR THE SURVEY...
SECOND YEAR STUDENT:
“...Three of us were in theater, the consultant told us to get our gloves on. There was no chance to refuse or get consent. The consultant was a scary chief!”
THIRD YEAR STUDENT:
“...I have never felt able to refuse a consultant, even though I have really felt very unhappy about it...”
FOURTH YEAR STUDENT:
“...You are expected to obey consultants by the fourth year. You can't refuse, and as doctors have to do uncomfortable things, so you just have to start early...”
FOURTH YEAR STUDENT:
“...You couldn't refuse comfortably. It would be very awkward, and you'd be made to feel inadequate and
stupid...”
FOURTH YEAR STUDENT:
“...I was told in the second year that the best way to learn to do PRs (rectal examinations) was when the patient was under anesthetic. That way they would never know...”
Belinda, exposing a patients partially or completely unclothed body to others whether visitors or non-immediate caregivers is NOT any standard of care and represents professionally unwelcome and wrong actions and representing the most basic physical modesty issues that we teach our students. This modesty issue is not open to system debate. ..Maurice.
With regard to Clive Robert's comment, at my school the rectal-vaginal exams performed by 2nd year medical students only have teacher-subjects to learn and practice upon. In the 3rd and 4th year, I would support a student who refuses to do a pelvic exam on a patient who denies consent and even speak to the attending consultant who rejected the student's decision. The latter behavior by the attending physician represents the "hidden curriculum" within the later medical school years. ..Maurice.
Maurice,
The aunt who I spoke about was with a female nurse being bathed and another nurse who walked in wearing a uniform from his other job. They were chatting and had no regard for the feelings of the patient.
You may want to say that this kind of action is not open to debate. However, this nonsense happens all the time whether it's the janitor, the door left open, unannounced people; all within the realm of what happens routinely in hospitals. So, it is part of the debate.
Everyone in healthcare wants to simply ignore this and for many patients, it's a primary source of distress (great for a stroke patient like my aunt).
So...while it may not be considered standard of care (and I could list many of those), it is a behavior system that is rampant throughout hospitals and therefore, is a source of debate and "cleaning up the act" so to speak. Little things like this mean a lot.
I understand your feelings on this issue, and standing from where you are, may have a hard time realizing that these behaviors are the norm, not the exception.
belinda
Belinda, missteps in privacy can almost be "routine" in medical practice despite healthcare providers awareness of the need for privacy. The potential for lack of privacy is going to be always present. What it requires is that the missteps become recognized and acted upon. Sometimes, beyond the provider recognizing the event by closing the door or covering the patient, it also becomes the obligation of the patient to notify the attending staff when a misstep in privacy is observed so that it can be promptly remedied. Belinda, if your aunt was able, she should have "spoken up" to them at the time rather than waiting to speak up to you. ..Maurice.
R Williams I agree with Misty comparing the humilation of a person to a Big Mac isn't really a fair comparison. The part is medical costs are some of the highest we experience should we not expect more as well?
The other part of this is tell me what effort is being made to address it? Is there an attempt to gender balance the staff? The issue of gender embalance in CNA & Nursing is well documented but we see little to no effort to address it. And then there is the issue of even when they can accomodate by simply asking and scheduling accordingly they don;t. It is hard for me to have concern for providers inconvenience when they don't even make an effort when it is so easy and in fact don't even acknowledge what is obvious. Before we worry about the cost of across the board efforts lets just start with the simple stuff and do that, then we can discuss cost.benefit....don
Once again R Williams i appreciate having you here for a look at the other side of this issue. I know you and Dr. Bernstein take a lot of heat for you view point but it is helpful and I hope you stay with us.
I am curious, you stated you saw the horrified expression the naked women had when you and another CNA walked in. Do you have any thoughts on if the others realized what was so obvious to you. Did they realize and just ignore or dismiss it, did they not realize. We got a glimpse into your thoughts, any thoughts on their motivation and how they view this. I do think there is a difference between your experience being long term and mostly elderly but there are some similarities. I think one of the biggest challenges we face is providers are self centered in their approach, while providers claim the patient is their focus, and i believe that the physical is, I think the way they provide that care is self centered. By this I mean the nurse told you "we are professionals so they won't care" the focus of making the encounter is on the provider not the patient. Your concern about the efficiency is on the provider not the patients humiliation. I think thay is systemic not individual malice. Can you shed any light on any of this?..............don
Maurice,
You might want to talk to a colleague who specializes in psychology. A person in the throws of complete humiliation is rendered speechless if they are traumatized. They sometimes dissociate and freeze (as in fight, flight or freeze) as a consequence.
The responsibility to fix this rests on the medical community making these kinds of mistakes as serious as medical mistakes. Patient well being, feeling safe and free from humiliation and psychological trauma is the job of every medical facility and everyone who works in it.
These mistakes wouldn't happen if the consequences were serious enough and to brush it off as a misstep is simply saying that this issue isn't really as important as the healthcare provided.
It is not just as important, it is more important. It causes patients to avoid healthcare, causes psychological trauma, PTSD.
Furthermore, a complete disregard of patient privacy for whatever reason is completely disrespectful to the patient telling them that they are not important, their privacy isn't important, and worst of all, we don't care enough to protect you or your privacy.
belinda
Belinda, the concept of patient historical and physical modesty is an accepted fact in medical education and practice. And this is real life where there will be missteps in practice regarding a patient's modesty issues. It's tough as it is for a surgeon to make a mistake during surgery with the consequences eventually recognized by the patient.
With regard to physical modesty, at some point it is also the responsibility of the patient (or surrogate) to speak up, if no attempts at corrections are made, to those responsible and/or those supervising. ..Maurice.
Maurice,
You are blaming a patient who may not have the ability to speak up once the damage is done.
This mindset is part of the problem.
There's a difference between a misstep and a complete disregard for the patient. Some of these mistakes cause harm. Once the harm is ensued, it's over for the patient.
Should the medical industry be unaware of the deep psychological impact of humiliation and claim it as their own to do everything possible (even though once in a while something might slip through? Anything short of that is irresponsible and doing harm to patients.
Couple that with some who use the vulnerability of the patient as an opportunity to violate their modesty and you have the mess we have now.
Frankly, I'm very disappointed in your response. If I thought you were ignorant to the impact, I wouldn't be. You are too smart and have been dealing with this issue too long to respond in the way that you have regarding making it the patient's problem and to speak up.
Would you ask a patient in a wheelchair to stand up if they want to be heard? That's exactly what you're asking of a person who is sick, afraid, vulnerable and then humiliated beyond their wildest dreams in some cases.
Then to be told "sorry, mistakes happen" isn't good enough and will never be.
Ignoring this issue and assuming this attitude of patient responsibility will one day mushroom into a complete mess of the healthcare system. I'm not saying that patients shouldn't speak up afterwards, but that's after the damage is already done.
It's time the medical industry made this their problem to fix.
Every employee should be made to sign a contract with a section regarding dignity of the patient.
Do it one time too many you're fired, including doctors, nurses, and everyone else. It's time to "clean up the act", to do no harm, protect patient privacy.
Patients need to know after a mistake has happened that the hospital is concerned, the person will have a formal reprimand and an investigation of the events and hat the hospital recognizes that they should have acted better. There's an article entitled, "I'm Sorry" goes a long way in healthcare.
With an attitude that blames the patient you wonder why we on this blog are unwilling to accept the status quo. You wonder how one would avoid healthcare to avoid humiliation. People commit suicide because of the impact of humiliation.
What do you think would happen if a hospital made their number one commitment to dignity, privacy and keeping patients safe.
How do you think someone who was a former sexual assault victim does after a complete violation of their dignity?
I feel like I'm beating a dead horse.
belinda
The more I read of these privacy issues, but more I believe that the issue isn't really privacy - it is control. Patients who are hospitalized lose so much control, and providers want to keep control. If patients didn't feel so intimidated, controlled, etc they would be able to make choices re. modesty as well as other things. To me, it is a pervasive attitude from providers that "We are on control, doctors orders, do what we say, these are our rules, this is our system" that takes so much power, including modesty, away from the patient particularly at times when they are most vulnerable.
TAM
TAM,
I think you are correct. This culture of power and control is so well understood by the insecure that it attracts the insecure to be employees. It's a downward spiral that affects not just modesty, but control of everything within the employees' domain because the administrators couldn't care less so long as the procedures are completed.
BJTNT
it is an interesting discussion. In most of our interactions where we are paying the bill while we depend on the provider of the service for their expertise and knowledge we still demand to be in control. If you are building a house or having your car worked on, you may not have the knowledge to do the work but you retain the control over not only what is done, but how it is done and how you are treated. You would never allow your contractor to make you feel uncomfortable. You would demand that the manner in which they provided the service be on your terms not theirs. While you might not tell the electrician what wire to connect where, you would expect him to follow the parameters you set forth. If he said I am going to do this at night when no one is around and I will just send you a bill with no itemization when I feel like it. No way you would stand for it, it has nothing to do with what he is doing, but how he is interacting with you. Yet when it comes to the medical profession, we do give up so much control. We often blindly accept how we are going to be treated. I am not talking about the medical procedure but what we will wear, even if it makes us uncomfortable, we will allow people who make us uncomfortable to do things to us. We will accept things like stripping naked for wrist surgery even though we don't feel it is needed. Why is that? What are the dynamics that cause us to accept these things we strongly disagree with and say nothing. We own this part of it, so why do we do allow it to happen?....goes a little to Dr. Bernstein's contention that we own part of the problem because we do not speak up.........don
Tam, BJTNT, You are both absolutely right. It's control, loss of dignity, the unexpected. Put all three together and you have a disaster for anyone's mental health.
Only the strong survive. If every patient would take back their power, come prepared for battle (whether you need to pull out the stops or not) is empowering to the patient and enables them to navigate the healthcare system.
It's also important to work with the system, be kind and respectful to workers (whether you're really angry or not) and pick those battles carefully. You don't want to be labeled difficult. I've had great success working with doctors, nurses and other personnel.
This issue is difficult and just like any social change it takes time but more importantly recognition of the issues and the damage that can result.
Who would have though fifty years ago that same gender marriage would be on the table for discussion?
Clearly, preserving patient dignity starting with little changes, medical responsibility and cooperation is a great start to this process.
belinda
Belinda, can you explain the connection between same gender marriage and patients' rights for modesty? Do you personally believe that same gender marriage should be legal and that gays have the rights to marry?
Hi Anonymous,
What I was referring to was not the specific issue of same gender marriage, but how social change can open our eyes to things that now seem unjust when years ago, gay gender issues were taboo to even talk about. Same with unwed mothers. Daughters were sent away or got illegal abortions.
I am a firm supporter of free will and the individual rights of that freedom in every capacity whether it's same gender marriage or same gender healthcare.
Fifty years ago (for those of you who were around) racial equality seemed almost unthinkable to some, and yet, today most feel that social injustice is just plain wrong whether, racial, gender based, religious or whatever I left out.
belinda
Well, Don, I am telling my students to "speak up" to the patient telling them what they intend to do and waiting for explicit or implied (by not resisting) consent. I am also telling the students to "look up" to each patient as they are examining them to detect any signs of emotional concerns or distress and then "speak up" to the patient and inquire about what the student observed.
All of the above was also taught yesterday afternoon when I was instructing 6 groups of 6 students ,each group for 30 minutes. Teaching what? Genital/rectal examination in the male using plastic models. 4 other instructors had their 6 groups each on the same subject. Later, in the evening yesterday, one of my groups was scheduled to perform the exam on teacher-subjects, the others, later. Hopefully, they will learn the need for and the ways to attend to the patients' concerns during the exam from those teacher-subjects. I felt I gave them an introduction and, believe it or not, I was thinking about what has been written on this blog thread in addition to thinking about the anatomy and pathology involved in such exams as I was talking to my students.
I feel comfortable that with my opportunities to teach, I am conveying some of the important points brought up here.
I want to say what I am not teaching. I am not instructing the students that they are entering a profession of potential sexual perverts who describe themselves as physicians nor do I tell them they will be working with sexual perverts as nurses or techs. Why not tell them that? Because.. I just don't believe that generalization! ..Maurice.
AL submitted a posting this evening including a url which goes to a website of commercials. I would ask AL to Google his topic and see if there is the same story published elsewhere in the regular newspaper media and then re-post and explain that issue. Thanks. ..Maurice.
Sorry Maurice. Just google Darrin Washington and pick a story. I think once you read it you will get the connection to this blog. AL
Dr. Bernstein I thank and commend you for you efforts. You can only plant the seed and hope it grows but I do appreciate your efforts both to approach this with and open mind and to introduce new thoughts to your students. Now we, your readers need to not only speak up but encourage others to do the same.
And for the record once again I want to state again I agree 100% that providers be they MD's, nurses, medical students, are not pervs, or molesters. I believe not only is that behavior very rare, acts of malice by providers is a small small percentage of a day. I believe the overwhelming majority go into medicine for the right reason, to help people..don
The reason why professionalism in medical practice is more solidly followed than any other profession, including law, is because what one has to go through and endure to end up a physician. Think of simply getting into a medical school and then the personal cost in money but also time and limitation of "private life". Then upon graduation and moving on in the training experiencing the time, the physical and emotional strain with the hours spent, including those sleepless hours and the patient after patient responsibilities that come with this training. Finally, transitioning into the years of practice with all the pressures of medical practice and associated continued limitations to family life but then the arrival of that wonderful feeling that you have finally "made it". But along with the good feelings is the great personal worry that some mistake in behavior or clinical mistake will ruin your whole career. After all that the doctor has gone through, to lose it by some misbehavior or mistake keeps most all doctors glued to what is set as being a professional doctor. There is too much to be wasted and to lose by misbehaving. It is this understanding of the experiences of becoming and continuing on as a doctor that makes me believe that there are not many "rotten apples" in my profession. ..Maurice.
Maurice
Thanks so much for opening the door. It means so much and is a very good start.
I agree with you that problem physicians are in a vast minority and it's unfair to blanket the entire medical community with a brand that is unfair.
That said, I think some of the impropriety that exists happens for several reasons. One, being too busy to think (and they aren't really taught to think that dignity is so important), under staffing, rushing,etc. However, there are those who are curious and use their positions to do things that compromise dignity and modesty for no medical reason. And, there are those (who may be a minority) who use their power to control patient behavior through humiliation. While they may be a minority they are there and impact patients.
These people are usually not doctors.
Coming from someone who suffered abuse from both male and female workers, cruel and degrading treatment, that should be a lot.
It's the overall mentality about bodily exposure, taking care of patients for whom this is an issue and accountability and responsibility of the medical profession to weed out those "bad apples".
Together, with changes in teaching is a wonderful start. I hope this spreads to training of nurses, techs etc.
Thanks again
Belinda
You know there is much more to this Bioethics Discussion Blog than this long running "Patient Modesty" thread. There are other threads which extend the discussions here. For example, how about a thread that describes the misbehavior of physicians and how the state medical board deals with those physicians and the reactions of my visitors. ..Maurice.
Dr. Bernstein that is a fantastic view from a perspective I for one never considered. I have friends who are MD's and knew while I was drinking beer they were studying, I know they were sacrificing but never connected the dots to this issue. As you stated why would someone who invested so much risk it all. No doubt some fail to meet the call but given the exceptional dedication to get there....
Belinda, while I understand your position but the lack of a clear definition makes it difficult to convict. What one considers inappropriate behavior another sees as being inconsiderate, another ignorant and others no big deal. Is forcing a female on a male for a scrotal ultra sound one of the above. There was a post about one of Colts QB Andrew Lucks sending a tweet without realizing Luck was naked in the background, if you google it you will notice a woman looking on in the foreground. I find that inappropriate that she would be in the locker room while he is dressing, some think it is no big deal, others argue she has the right to be there. So for this argument without common points of reference it is hard to have an intelligent conversation. We are the 3 blind men describing an elephant. ...don
Don, with respect to what you wrote above, you may be interested in going to the link I also provided above to see examples of those rare but present "rotten apples" to which I am referring. ..Maurice.
Don,
There are two different approaches to gaining reward from damages. one is criminal and one is civil. At the crux of the issue is what kind of damages occurred to the patient to warrant a lawsuit and depending on the actions of the defendant would determine whether criminal or civil action might be the proper way to file.
The idea is harm to the patient. Sexual impropriety could be very difficult to win in a criminal case but much easier in a civil case and mediation is not out of the question either.
A lawsuit whether criminal or civil damages the reputation of the defendant and the hospital whether they win or lose so many times a settlement is reached with a gag order.
belinda
I had several incidents which lead me to stumble upon this site. I was extremely disturbed me and possibly given the length of my involvement with this thread traumatized me though I try to avoid that admission. None of which I personally would characterize as sexually inappropriate. They were wrong for me at such a deep level that they left an indulable mark on me, and will trouble me possibly to the end of my days. But i do not think they were do not think they were sexually inappropriate, abusive, or assault. I do not think there was any malice at all involved in any of them. I do think they were the result of a self serving agenda by the medical profession, one that attempts to delude their patients and themselves into believing what they are doing is natural, normal, and should be acceptable by all involved. This blog has given me cause to think back on this and consider what I my role in this, and what can I do different to prevent from subjecting myself to this and promoting the appearance to providers that this is acceptable, that I am buying this. I have spent a fair share of time examining the role providers play in this. I need to spend some time on my contribution and what I can do differently. Doesn't mean I am letting providers off the hook, I still follow the mantra "to whom much is entrusted, much is expected"....but ultimately it falls on each of us to force the change. I will review the link Dr. Bernstein.......don
I thought you all would be interested in reading this article from Outpatient Surgery Magazine: Medical Malpractice: How Specific Is Your Informed Consent Form?. I feel forms should be more specific about what body parts would be exposed for the surgery. I also think they should discuss any conscious sedatives they may consider giving you such as Versed so you can decline them. I think informed consent forms for surgery are too general and I believe this is the reason so many patients have modesty violations during surgery and pre-op.
Misty
I think if common definitions were set here as in your "rotten apples" blog would help, Some of the offenses were petty some were pretty serious. While there were no numerical data i would assume the % was extremely small.
I just started reading Man's Search For Meaning by Victor E Frankl. Frankl had a MD in Psych and was interned and survived Hitlers concentration camps. His writings are less about the experiences and more about the working of a mans mind in extreme situations. While there is no possible way to equate the horrors of a concentration camp to the issue at hand I could not help but to see some interesting insights. Frankl talks about how a group of prisoners become "Campos" or supervisors. He discusses how they go from being victims to overtime being abusers. I could not help but think how this might also apply as med students shed their intital concerns about patients comfort and embarassment and become just part of the machine. Like wise he talked of "the allusion of reprieve" where prisoners develop this mentality that they will somehow be spared the pain even death that will befall others. I wonder how many patients go into procedures deluding themselves that it won't happen to them, that will be spared. Some of the same mechanisms of self preservation could explain things on both sides. How does the med student move from being concerned about a patients feelings and modesty to claiming to not recognize it exists. Why does a patient enter into these situations and accept them. Again there is no way I am saying at any level there is a comparison between the concentration camps and the medical community. What i am saying is the actions on both side of the gown may not be as simple as they seem. The provider who claims they didn't realize may be denying what they really know to allow themselves to inflict discomfort on patients as the system tells them to. If they work for a institution that says don't ask, don't admit, in order to survive in that system they are going to have to partcipate and rather than deal with what they may know is wrong, they find away to change the reality of it all....don
I just wanted to let you all know I just found an encouraging article about a hospital in UK providing surgical female patients with Digni Bra and dignity underwear at http://www.nuffieldhealth.com/hospitals/news/cardiff-hospital-trials-dignity-underwear
Misty
How would those visitors here separate the definitions of "modesty" and "dignity". Should, what has been written on this thread all these years really be expressed as a matter of dignity? And would that make any difference in the arguments presented? ..Maurice.
I wonder if any of you have heard of the latest trend for busy doctors: using a scribe. Essentially, it's a clerk who "shadows" a doctor to input necessary medical notes thus freeing up the physician to better attend the patient. They also mentioned these scribes are being used in surgeries. The article, if anyone is interested, is on the NY Times online site under the heath tab. (Sorry, but I am not tech savvy enough to provide a link) I am interested how those on this blog feel about this. Of course the article was slanted to show the obvious benefit to the doctor but I suppose it could also benefit patients as they would have more of their doctor's undivided attention. But I see so many problems from this, both from a modesty and from a privacy (HIPAA) viewpoint. There was one small paragraph stating one doctor's concern with that very issue. Also, these scribes are basically just quickly trained clerks which are hired from an agency at a fairly low hourly wage. How would you all feel about someone of this nature being present during an exam and also being present for the entire conversation you would have with your doctor (revealing symptoms, etc.)? Especially the men here: I would highly suspect that the majority of these scribes would be female based on the nature of the job and the pay rate. One other thing that entered my mind is one of cost. Surely that extra cost to a doctor's practice is eventually going to be added to the bill of the payer (private, insurance, government, etc.). Just one more reason to increase costs. I have a general concern/fear that this is the way "health" care in general is headed. Less privacy and attention to
individual preferences and more assembly line type care. I just know that I would not care for a non medically trained clerk or scribe being present when I am having an exam or conversation with a doctor. I greatly prefer that to be a one on one situation. Jean
Jean, thanks for bringing up this pertinent story. The link to the NY Times article is as follows:
http://www.nytimes.com/2014/01/14/health/a-busy-doctors-right-hand-ever-ready-to-type.html
..Maurice.
For any gender specific healthcare, either the scribe (regardless of gender) leaves or I do; non-negotiable! This is a huge invasion of privacy and just another example of how our healthcare has become a spectator sport for expediency and profit.
Ed
And now I suggest you all go to my new blog thread "Shadowing a Doctor: Benefit or Harm?" which deals with a current concept in medical school admittance regarding the suggestion that pre-med college students "shadow" (watch) physicians at work before deciding on a career of medicine and applying for medical school.
I almost know what some of my visitors here will write but go to the above link, read and write an opinion specific to the topic there. OK? ..Maurice.
I am also very concerned about the use of scribes. This is definitely not good for patient modesty and privacy concerns. It bothers me that many doctors are too focused on what would make their work easier than what is best for patients.
I personally would not be opposed to having a scribe for non-intimate procedures and exams such as eye examination, strep throat test, and ear wax irrigation. You are able to wear clothes for all of those procedures without ever changing into gown.
Misty
I really can't believe the scribe thing.
The doctor just needs to get an android cell phone. I send text messages by talking into it, it turns it to text, I send the message. It's pretty impressive. Why pay someone to do it when they already have good software to do it?
-JR
JR,
You have a good suggestion.
Misty
I wanted to let everyone know that a lady, Jenn posted interesting comments about why she did not want a male gynecologist at
http://www.topix.com/forum/med/obstetrics-and-gynecology/THESBUGJMO8HCFNIH/p88#c2040. A number of women feel that their husband should be the only man to see and touch their private parts.
Misty
How about this for a topic of discussion WHAT HAVE I DONE TO ADDRESS THIS ISSUE: This should not be a contest as we each have different means and circumstances. And the discussions with providers has value but not a dollar figure. Some of what I have done as a result of this blog:
1. Told my MD I would not be comfortable with a female NP student shadowing him during my physical.
2. requested a male tech for a scrotal ultra sound.
3. Asked then informed my local hospital that I would not be able to use them for certain procedures as their entire imaging staff was female.
4. Sent a letter of appreciation to my Dermatologist for the consideration and manner in which he respected my modesty & instilled that in his staff.
5. Expressed my appreciation verbally to his nurse when she offered a gown rather than assume I would be fine sitting there in my underwear waiting for the MD
6. Sent a letter to the patient advocate, hospital director, & general mail of a hospital that I felt let me down by not offering choice of gender when it was available (the event that brought me here).
7. Have started a scholarship targeting young men coming into nursing.
8. Sent most of the area hospitals the address of this blog.
9. Talked to my new PCP about this issue and what it meant to me.
10 am working with a local agency & to fund advertising nursing careers to young men.
11. Encouraged others to speak out.
It starts with us, it is not the large organization that I had hoped for but it is a start...anyone else?........don
I
Who, among my visitors here are doing one or more of Don's approaches to the modesty issue? Let's hear about it. They all are a great way to get the "ball rolling" rather than just "moan and groan" about it (yes, I know that some hate that expression but it's true.) ..Maurice.
Don,
You have done many excellent things to address patient modesty. Would it be okay if I included the things you have done on a web page I am thinking about developing about actions patients can take to improve patient modesty?
Also, can you please send a link to Medical Patient Modesty's web site to people and hospitals?
I encourage you to consider looking at male patient modesty articles and Tips For Urology Patients and let me know how MPM can improve awareness about male patient modesty. We definitely need to add more information about how men can stand up for their wishes for modesty in medical settings.
Misty
I wanted to share an interesting article: N.J. obstetrics and gynecology experiencing a major gender shift with you all. It is very encouraging to me that there has been a big increase in female gynecologists. Many years ago, females were prohibited from going to medical schools. Many women especially younger women are uncomfortable with male gynecologists. The increase in female gynecologists have really helped women with patient modesty concerns.
However, many rural areas have not enough or any female gynecologists.
I wish we could see a big increase in male nurses for urology clinics and male patients too.
Misty
I wanted to let you all know that I just learned about a male gynecologist in Ohio who did sexting. Check out the article: The Terrible Tale of the Sexting Gyno. I think it is terrible that they are just give him a few months suspension. Check out his practice web site.
Misty
Misty, must we continually get references to physician or nurse outliers of improper or illegal sexual behavior? We all know there are those "bad apples" who hurt their patients. Does continually advertising their misbehavior provide any help to design ways to make all patients who have significant modesty issues more comfortable? Let's talk about specific ways to change the system to produce that comfort. ..Maurice.
I think this is significant. Cases of sexual abuse would decrease if actions to protect patient modesty were taken.
The case of this doctor I mentioned proves that we cannot trust the medical profession. This is why Medical Patient Modesty encourages women to avoid male doctors for intimate procedures. So many women have been sexually abused by male doctors and nurses. Look at an article on another web site developed by another woman who is concerned about sexual abuse in medical settings: Sexual abuse under guise of health care presents barriers
Ray Barrow made excellent points over a month ago: I submit that the likelihood of sexual abuse among health care providers will diminish as action is taken that effectively increases the protection of patient modesty.
Misty
I wanted to add some very important thoughts. While it is true that sharing stories of medical professionals who have committed sexual abuse in medical settings may make patients who have significant modesty concerns more uncomfortable with trusting the medical profession, they help to raise awareness about ways that patients can protect themselves. We hear stories of women being raped in dark alleys or dangerous places and this helps to raise awareness about tips that women should take to protect themselves.
One of the board members for Medical Patient Modesty shared this very powerful statement: In society, girls and women are always given tips on how to protect themselves from sexual abuse, but you rarely hear about how to prevent sexual abuse in medical settings . Sexual abuse in medical settings is more common than many people realize.
Look at this article: Tips For Female Patients To Prevent Sexual Abuse In Medical Settings. You will notice that some of the tips deal with patient modesty issues. Especially look at the below tips.
3.) Do not allow yourself to be pressured into having a pelvic exam, pap smear, or breast exam at any doctor appointments. Some female patients have gone to the doctor for other health concerns and were pressured into having unnecessary examinations. For instance if you go in for a sore throat and you think you may have strep throat, don't spend time listening to a lecture by the doctor about how important it is to have a pap smear and that you need one today. If something like that happens, tell the doctor you are not interested and you only want to talk about the reason you came in (ex: your throat is sore).
4.) Don't undress or put on a medical gown when it is unnecessary and/or you feel uncomfortable. There are so many procedures and tests that doctors can do on you without you having to change your clothes. For example, there's no need to change into a medical gown for a strep throat test.
5.) Keep in mind that it is unnecessary for you to take your shirt off for the doctor to listen to your heart. You should wear a thin shirt and not a sweatshirt. It is strange, but many doctors don't even ask men to take their shirts off to listen to their hearts, but they ask women to. That tells you something is wrong.
6.) You should think in advance about what parts of your body the doctor should examine and dress accordingly. For instance if you have a knee problem that you want the doctor to check out, you should put shorts instead of pants on so you would not have to take any of your clothes off in the doctor's office.
11.) Make a firm decision that you will not let a male doctor or nurse touch any parts of your body that are covered by a two piece bathing suit. This is a good way to prevent you from being sexually abused by a male medical personnel.
Misty
I think the most important take away from that article is that women to need be aware of grooming behaviors.
Note - this is NOT Moaning and Groaning.
I was staying with a friend over the holidays and her family went to a social event and I came along. A stranger came up to me, leaned his head on my shoulder and started rubbing my back.
I pulled away and stared at him in shock.
He said out loud "Hehe I was trying too see how long it would take before punched me."
Instantly, everyone was telling me "oh he's just like that, he didn't mean anything..." I couldn't get an word in edgewise. Later I was told "if it bothered you you should have said something..." further reinforcing the idea the problem was mine, not his.
The guy was acting like a sexual predator in front of an entire room of people, and no one cared. Everyone excused the behavior.
If you don't believe me, read up on "grooming" and hear it from the experts.
The problem isn't just doctors being excused, it's a problem of all perpetrators being excused. My rapist got 1 year in jail after grooming and raping at least 3 girls under the age of 10.
He is still allowed access to children and is actively grooming them. Child protective services will do nothing, they can't, because the girls he's grooming haven't complained about it. There is no "proof" he is abusing them. The difference between abuse is just this: Will his grooming be successful? Maybe, maybe not. But someday he'll succeed again.
This is the society we live in, and its not a Medical issue per se (though it is an issue in the Medical community as everywhere else).
The answer is to stop permitting abusers to get away with this behavior. Stop blaming victims. Stop teaching women useless strategies to protect themselves from stranger rape. Start teaching women about how sexual predators select their victims (almost always people they know) and groom them into participating. Start teaching men how those men behave so they too can recognize, call it out, and condemn it.
-RJ
Sexual abuse in the medical community is a issue, but it isn't this issue. The issue here is modesty violations. One can argue is it done in malice, ignorance, intentionally or with good but wrong intentions, one can not argue the same about abuse. I understand your concern and outrage but I question whether this is the right forum. If Dr. Bernstein were to counter with multiple case of where patients attacked providers, or perhaps intentionally exposed themselves to providers for enjoyment...would that add value to this discussion on modesty? There are those that do "get off" on this, should we include that as material in this discussion? I disagree with Dr. Bernstein on numerous things, but I have to agree, violation of modesty and abuse, rape, and such are two different things.......don
I, of course, fully agree with Don's interpretation of the relationship of the topic of sexual abuse within the topic of patient physical modesty. To be physically modest is one property of a patient and virtually every patient, I assume, will have such modesty to some degree. As we have seen here, for some, modesty trumps essential diagnosis and treatment. But sexual abuse, in actions described here, represent virtual or actual criminal but relatively rare acts of a healthcare provider upon a patient. Also these acts as described here are acts and not implied thoughts.
The reason I as moderator, have allowed Misty's links and descriptions to be published is out of fairness in discussion and to await for others such as Don to present an opposing view regarding its relationship to the main topic. Let's continue the discussion of how to change the medical system to be more observant and to take actions to minimize their patient's personal modesty issues. ..Maurice.
I read over on Dr Bernstein’s blog and I think his intentions are good and I like that he is teaching his students about modesty. Unfortunately at other times I don’t think he gets that violations of modesty and of bodily autonomy in the medical world are not uncommon. It begins with informed consent. Recently I was at the Dr and again I was presented with the word “have to” and it was only after I refused that I was informed that I could. Ethically any medical test or procedure has to be presented with the option of refusal. To not present the option of refusal and to go ahead is a violation of bodily autonomy and could have psychological implications for the patient. Modesty and sexual assault are also not two separate issues. Sexual assault or assault is not always exhibited with overt behavior but is about power and control over someone. That power and control can be not providing informed consent, exposure when it’s not required, exposure beyond what is required, or not providing adequate coverage or proper draping. A medical professional who has the mind set of being in control is not going to be concerned with a patients modesty.
ADM
Informed consent is not informed unless all the patient's options are presented.
ADM, all I can tell you is that we teach informed consent in that context. We teach the students to be aware of signs of discomfort or rejection on the part of the patient as the physical exam proceeds.
I disagree that simply stating that "sexual assault or assault is not always exhibited with overt behavior but is about power and control over someone." Think of the burden that 3rd and 4th year medical students are under by their superiors: interns, residents and attending physicians in terms of "power and control" when the students know that their graduation from medical school and medical career may be jeopardized by the grading of the student's responses to their superiors' commands. Although occasional sexual misbehavior has been documented in superior-medical student relationships, that misbehavior is not most of the outcomes of that power differential. The goal of all patients is to begin diminishing any power differential, because of medical education and illness, which could be considered by taking one's own opportunity to "speak up". If the doctor doesn't appear interested to listen, consider and respond then you have selected the wrong doctor.
By the way, I am sure that the medical professional never thinks of fully being "in control". The behavior of patients and their diseases along with the professional pressures and the professional's own emotions makes "in control" only someone's hypothesis. ..Maurice.
There are several things here that affect this discussion. First is something I have addressed before, the definition of abuse. To me abuse is intentional physical and in some cases intentional infliction of emotional/mental pain/damage for personal pleasure, satisfaction, or perhaps control of a patient. The links that are posted often involve acts of rape, physical molestation, fondling, filming patients naked, etc. This is a whole lot different than exposing a patient to opposite gender providers, allowing students to observe, being careless with draping, etc. Until we have a common definition of what constitutes abuse we will continue debate not only the validity of inculding it in this discussion but what it is. Perhaps we could ask Dr. Bernstein to give his definitions and work within that framework so we have a common point of reference.
Where I think this is important is how this applies to the issue. I have said before I am reading a book by Frankl. He relates much the same experience in his confinment in a concentration camp about the phsychological aspects. My current section discusses the prison guards, he states "the majority of the guards had been dulled by the number of years in which, in ever increasing doses, they had witnessed the brutal methods of the camp. These morally and mentally hardened men refused to take an active part in sadistic measures. But did not prevent others from carrying them out." While the severity is completely different, does this not possibly explain why providers claim to not realize and partcipate in procedures that once troubled them? If that is the case would not a discussion on how to "resensitize" them be of more value than the criminal activities of the links provided?...don
"The behavior of patients and their diseases along with the professional pressures and the professional's own emotions makes "in control" only someone's hypothesis. ..Maurice.
Dr. B., I disagree with the word hypotheses because there's too much reality involved. There may be an appropriate word for your context, but it isn't hypothesis.
It's fine to accurately define abuse, violation, etc., but pick any one and where is the integrity in the medical industry [thanks Belinda, industry is a better word than operations]. I think the medical industry, especially MDs, like to think their work is a profession. Maybe that's why we call a profession a profession because of the failure of the practitioners to live up to expected standards. Trash collectors could cause serious public health problems, but since they do a great job we don't need to call them a profession.
BJTNT
BJTNT, we call a doctor or nurse professional if they maintain adherence to their professional code of ethics and follow the established standards of their professions. If not, then those folks are "unprofessional". ..Maurice.
Isn't this a contradiction?
-We don't know what is going through a doctor's mind (sexual thoughts) when they give an intimate exam, so we can only review their behavior.
-People do not go into medicine because they like power or control (aka I know what's going through a doctor's mind).
The truth is that people who want control, power, or the ability to abuse people go into positions where they have control, power, or the ability to abuse people.
This means that the medical community has to be on their guard to monitor and catch abusive behaviors.
Yet it seems medical education is all about abusing the medical students.
Sorry previous comment was me.
Don - We can't always know what people are thinking. So it's impossible to define abuse by the intention of the person performing the act.
Part of working with a therapist is understanding what drives you to do certain things. Most of do things and we don't realize why we do them.
Many people who abuse their children don't understand why they do it.
My abuser believed he was teaching me to be a good wife when I grew up. He truly believed it and that was how he justified it.
So does the fact that his intent was good wipe out what he did?
I realized that I hate being photographed because I was videotaped naked as a child (being groomed for child porn).
After that realization, I can allow my friends to take my photos and it doesn't hold the same power over me anymore.
Many people don't realize why they really are doing such things.
So no - intent doesn't really count for anything.
-RJ
Wouldn't everyone here agree that a routine history question for every patient would be "have you ever been sexually abused?" The answer, particularly if the answer is "yes" would be a starting point leading up to that important current issue for the patient: modesty. On the other hand, if one considers even asking that medically important question as a verbal form of "sexual abuse", well, that would end that consideration for understanding the patient.
What, I think that some patients don't consider it is just as important to inform the physician as it is the responsibility of the doctor to inform the patient. And that is why I keep writing "speak up". ..Maurice.
OK RJ let me ask you, Dr. Tawana Sparks exposes and strikes an unconcious males penis saying bad boy while doing a routine ENT procedure that requried no exposure. A male MD fondles and female while she is out. A MD has sex with an unconcous patient. A female tech does a scrotal ultrasound on a male patient when a male tech is available with out asking, a nurse leaves a patient exposed longer than they have to while they attend to other things, are all of these things the same, are they all abuse, are they all to be viewed equally offensive and harmful? No we can not read peoples minds which is why we must judge their actions. If you all feel the "routine" violations of modesty are the result of deviant providers intentionally abusing patients rather than following protocols set by an institution for efficiency and profit, or by providers who have bought into an self serving agenda and become desensitised to their patient angst....I don't know what to say to you other than I feel for you, that must really be difficult to deal with when you need medical attention. i struggle and I feel providers are overwhelmingly good people with good intentions whom are doing the wrong things for various reasons, for the vast majority not including malice...don
If you have a nurse that leaves someone uncovered out of malice, and a nurse that leaves someone uncovered because they got distracted, it's still the same result: the patient was left uncovered.
When someone complains, will the nurse take responsibility and apologize? Will he/she try to change? Generally not. That's the time the patient will get some kind of excuse that accuses them, not the nurse, of being the problem because they don't like being naked and exposed.
Speaking up doesn't work if the person you're speaking to hasn't been trained in how to accommodate those with trauma. There is no way to identify which medical personnel have that kind of training.
Are we really expecting doctor avoidant traumatized people who don't realize that they are traumatized to be the ones to educate their doctors?
The more I learn about the way doctors are trained, the more horrifying it is. Take Informed Consent. We make a big deal about it - but doctors are also taught "implied consent." If the patient shows up for a test, they are consenting. If a patient doesn't object to something, they are consenting.
A big part of the anti-rape movement is called "Enthusiastic Consent". It's what both medical students and teenagers need to be taught:
http://www.doctornerdlove.com/2013/03/enthusiastic-consent/
“No means no” we are taught, that when a woman says “stop”, we stop. That’s good. That’s incredibly important.
But sometimes it’s not enough to just not get a no. You need more.
It’s not just about not getting a “no”. It’s about getting a definitive “yes”.
I used to think it was a few bad apples, but now that I know more about medical personnel are trained, I realize it's the culture of medicine itself that is a problem.
-RJ
Don,
Let me share my opinion with you about the different cases you shared:
Dr. Tawana Sparks exposes and strikes an unconcious males penis saying bad boy while doing a routine ENT procedure that requried no exposure. A male MD fondles and female while she is out. A MD has sex with an unconcous patient. A female tech does a scrotal ultrasound on a male patient when a male tech is available with out asking, a nurse leaves a patient exposed longer than they have to while they attend to other things, are all of these things the same, are they all abuse, are they all to be viewed equally offensive and harmful?
I personally do not see all of them as equally offensive and harmful. I personally see Dr. Sparks doing a genital exam on male patients for ENT procedures under anesthesia, a male doctor fondling a female patient while she is out, and a doctor having sex with a patient under anesthesia as sexual battery / abuse.
For your last two cases, I see them as patient modesty violations. I feel that the female technician and the nurse in the last two cases you mentioned are insensitive to patient modesty.
I know some people may have different opinions from me.
When I first started Medical Patient Modesty, I had no idea that sexual abuse in medical settings that was common. Because I received some cases of sexual abuse by medical professionals, I decided to develop a web site about sexual misconduct by doctors. If more actions were taken to protect patient modesty, sexual abuse would go down. For example, if an ENT patient was allowed to wear underwear for her/his surgery, there would be a less chance that she/he would be sexually abused. It is ridiculous about how some hospitals require patients to remove their underwear for surgeries such as surgery on the nose that have nothing to do with genitals.
Misty
Misty
I agree, abuse and modesty violations are not always the same. Modesty violations CAN lead to abuse. Using the violation of modesty to intentionally inflict pain, humiliation, or discomfort is abuse. The first two are easy to identify, the third is almost impossible, you cannot read minds so is it ingnorance or intentional. There is a difference but the result may be the same so the whole issue of going the extra mile to protect modesty in ALL cases unles the issue has been vetted with the patient and consent (real consent not implied). I think this is where the medical profession fails, the do not attempt to truley vet the issue with patients not because they are totally ignorant, but because it creates issues for they don't know how or want to deal with. I completely agree going the extra to accomodate has the possiblity of preventing some cases of abuse. I just fail to believe there is so much malice in providers and that it is so widespread the average person has to fear being raped or physcially abused when they go in....just my opinion.....don
Misty, Van de Loo trial is to have been started today. So when you state "he actually molested some of them during sports physicals" you should also use the term "alleged" until he is found guilty.
The issue of "unnecessary genital exams" is a controversial issue in terms of "standards of practice". Certainly, one should consider the importance of testicular exams for those between ages 15 and 35, the most common onset ages for testicular cancer. And although self-screening at home is recommended, there is nothing unprofessional in a physician, with patient's permission, to examine the testicles in the office for screening. Genital examination as part of a sports physical itself is still a controversial aspect regarding "standards of practice". That means, there are still arguments on both sides regarding this exam as a "standard".
Misty, you write " I know some of you disagree with me that sexual abuse can be related to patient modesty violation cases." I'm not disagreeing that sexual abuse can be present in some cases where the patient's modesty concerns were thought by the patient to be violated. Of course, that abuse could be present. But I don't think that what could be called, in any legal or clinical terms "sexual abuse" is occurring most of the time when the patient feels modesty issues have been ignored.
From the Wordnetweb.prinston.edu: Sexual Abuse: sexual assault: a statutory offense that provides that it is a crime to knowingly cause another person to engage in an unwanted sexual act by force or threat; "most states have replaced the common law definition of rape with statutes defining sexual assault"
..Maurice.
I find it a bit unusual that no one has regarded the medical industry as any other business. If one retains a lawyer, an interior designer, a graphic artist or a doctor; these people work for you and take direction from the paying customer. Any person in a business/profession is selling their service for cash-nothing more nothing less. The client calls the shots. A medical must take control of their life, clearly set the limits as to what they want and take control of the situation. Remember that medical staff works for you no matter what title they carry. Yes, and people are intimidated but if you give "professionals" control just like giving a bully control over you, they will seize the control. I have seen doctors back down and attitudes change when I have said "no" and brought them up sharply that they work for my money not the other way around. Needless to say they are pissed by medical quickly fall in line if you set the direction. People in general are intimidated yet in reality intimidation is a bluff for control. Always clearly tell, not communicate, exactly what your expectations and the limitations you are setting. Being to the not evasive gets everyone on the same page. As far as being busy or understaffed that is not the patients problem but that of management and as the paying customer demand that you receive what you are paying for not what some other person feels they want to do. This whole situation of dealing is the same as any implied contractual situation in that failure to preform is breach of contract. Learn to stand up for yourself and don't be pushed around into accepting second rate or second best-it's your money and as in any business the medical industry loves cash! This comes from a shy person who has learned the hard way to stand up for himself in life and who has learned to take control of his life and no longer accepts excuses from others who do not want to preform. The worst that can happen is that someone may say no and then you just devise another plan of maneuvering. You may be surprised just how people will step back and respect and treat you as an equal more. Accept nothing less than being treated less than a person/human being. If the medical profession can't deal with this understanding, then find a good vet as they tend to be the most understanding and compassionate people in medical services. Remember you are a person not another cow in the slaughter house of making money!! DJP
DJP you are right on the money, I think we got so use to letting them make the medical decisions we lost sight of the fact that we do control our own destiny and gave up control becoming lemmings. Or is it the case where they were held at such a high level and we are just now bringing them down our level? In any case you are right, we do have a certain amount of control, the MD shortage makes that a bit tougher, but hospitals etc are spending huge amounts of money to get us to come to them. I find it interesting that a burger place will ask how you want your burger, a hotel what can they do for you, but you have to force the medical community to accommodate you..maybe it is like the old BK advertisement...have it your way........don
Let's promote our campaign of patient respect. We're into 61 volumes of saying "it's all them" - the medical industry.
My understanding of our campaign is:
1. politely demand respect for ourselves or just leave.
2. inform others that they should politely demand respect for themselves or leave.
It's going to be a tough sell because the medical industry culture is well established and the AMA has more than enough money to keep politicians in line.
BJTNT
After 61 volumes it comes down to, don't be a victim. Tell them what you want, don't except less and go somewhere else if they don't or won't accomodate. A wholesale change in the system would help but not likley. I can't change the world, but i can change my world. Seems like Dr. Bernstein's tell them advice rings a little closer for a different reason. Tell them what they should already know become tell them what you want, what you will accept, and what you are paying for. It makes sense if you realize our view of providers has come off the the diety view to ...providers, and now to people we are paying, like everyone else so we have the right to expect being treated like we want, we deserve..don
Dr. Bernstein,
There is another article about Dr. Van de Loo that I encourage you to check out.
Look at some important comments in this article:
Van de Loo told police that he manipulates a penis with his hand to check for sexually transmitted diseases, according to the criminal complaint. But several other doctors told investigators that his actions were not standard procedure and that it is inappropriate for a doctor to stimulate an erection.
Look at how some other doctors actually said his actions were not standard procedures.
What is standard is not always best. I really do not see the need for boys who have no symptoms to have genital exams. I think that if a teenage boy has a genital injury or symptoms that his dad or someone should be present in the room to protect him. It is very disturbing that Dr. Van de Loo asked parents to leave the room and then he did genital exams on those boys. Good doctors do not ask parents to leave the room. Doctors that do genital exams on boys should do the exams as briefly as possible.
I think genital exams should be ended for sports physicals. Forcing a child to expose their genitals with the threat of withholding sports if they don't in any other setting would be considered a crime.
My cousin who is a RN told me that urinary catheters were standard for many surgeries at a hospital even though they were not necessary. Patients need to know the truth that many standard procedures are actually unnecessary so they can refuse them.
Misty
DJP,
You made excellent points. I am glad that you have stood up for your rights. The medical profession needs to know that patients will not give in and that their wishes must be honored.
Misty
Dr. Bernstein,
There is another article about Dr. Van de Loo that I encourage you to check out.
Look at some important comments in this article:
Van de Loo told police that he manipulates a penis with his hand to check for sexually transmitted diseases, according to the criminal complaint. But several other doctors told investigators that his actions were not standard procedure and that it is inappropriate for a doctor to stimulate an erection.
Look at how some other doctors actually said his actions were not standard procedures.
What is standard is not always best. I really do not see the need for boys who have no symptoms to have genital exams. I think that if a teenage boy has a genital injury or symptoms that his dad or someone should be present in the room to protect him. It is very disturbing that Dr. Van de Loo asked parents to leave the room and then he did genital exams on those boys. Good doctors do not ask parents to leave the room. Doctors that do genital exams on boys should do the exams as briefly as possible.
I think genital exams should be ended for sports physicals. Forcing a child to expose their genitals with the threat of withholding sports if they don't in any other setting would be considered a crime.
My cousin who is a RN told me that urinary catheters were standard for many surgeries at a hospital even though they were not really necessary. Patients need to know the truth that many standard procedures are actually unnecessary.
Misty
I wanted to let you all know about this sad story: Cop ruptures 16-year-old’s testicles during frisk. A female police officer ruptured this teenage boy’s testicles. This boy had to undergo surgery. This should have never happened.
Misty
Misty, your last posting is an example of behavior that has nothing to do with the practice of medicine or the issue of patient physical modesty. Don't compare the behavior of other "professionals" with that of physicians and nurses. And, with regard to behavior which has sexual implications and those "bad apples" in all jobs who perform it has nothing to do with what should be the goal of the discussions here. Please let's stick to the issue here of how to improve the entire medical system to attend to the modesty issues exemplified on this blog thread. ..Maurice.
Dr. Bernstein,
This boy had to have surgery on his genitals so it is a patient modesty concern. Think about what he had to endure in the medical system. Many teenage boys are sensitive to modesty.
Misty
Misty, but there is no need to provide a link to a graphic description of obvious inappropriate genital handling by police. Yes, a youth's genitals are examined and surgery is performed for hernia and testicular cancer among other conditions and we would agree that these procedures may be pertinent to a youth's physical modesty issues. But descriptions of acts of legally civil or criminal misbehavior among the various professions is not necessary for the discussion. ..Maurice.
Maurice
Perhaps the point Misty is trying to make
might have to do with a female cop frisking a
young male, yet female cops may only frisk female
suspects. Another double standard to me and this
is a first for this white guy to appeal to Jesse
Jackson for guidance in the matter. Hope the kid
sues for big bucks.
PT
I found an interesting article: Don't like your doctor? This is how to make a clean break. Check it out. It has great suggestions for people who are not happy with their doctor.
If you are not happy with how your doctor accommodates your wishes for modesty, you definitely should look into finding another doctor that is more sensitive to your wishes for modesty.
I believe that if you feel your doctor is not sensitive to patient modesty that you definitely should let the office manager and even the doctor know why you are leaving the practice. Also, I think you should consider posting a review about the doctor on Ratemds.com. If you feel that your doctor has done a great job accommodating your wishes for modesty, be sure to let him/her know how much you appreciate them.
I know some men have been very unhappy with how their male urologists refuse to provide male nurses or CNAs. I feel that urologists who refuse to hire male CNAs and nurses need to be made aware of the fact that many men have left their practice for that reason.
I'd be interested in hearing people's thoughts about this.
Misty
A tad off the subject but it appears they left the identity of the female cop out of the article, and did not identify the gender of the cop in the title. There was famous case in Ohio where police strip searched a female, all the headlines read MALE police strip search female arrestee" even though there were female police present. As PT pointed out, the double standard at work. Sorry Dr. Bernstein totally off the subject I know...don
We really need to increase choices for all male intimate care for male patients who are uncomfortable with female intimate care. As many of you know, I developed an all-female ob/gyn directory that lists hospitals and practices that have all female ob/gyn doctors.
I am very interested in looking at starting an all male urology directory, but there are not many all-male urology clinics in the US. I have found a few. I mentioned this clinic in San Antonio before.
Do any of you know of other all-male urology clinics in the US? It is disappointing that the medical system seems to be more sensitive to female patient modesty than male patient modesty at times. Both are equally important.
Misty
Here are two more all-male staff clinics:
Ohio Men's Medical Clinic
Maryland Men's Medical Clinic
Misty
None that I know of in my state....don
I wanted to share an interesting article: Nurse questions all female OB-GYN practice.
I really appreciate how a hospital defended an all-female ob/gyn practice to only hire female medical staff. Patients should always have the choice of going to an all same gender staffed practices.
Misty
And patients should always have the choice of going to opposite gender staffed practices if they desire. That is why no civil rights law should provide excuses for a practice to prevent hiring and participation in the care of opposite gender patients of any healthcare provider based on gender of that healthcare provider. Period. ..Maurice.
I think men and women should have access to same gender medical facilities. We are given our privacy throughout life with men's and women's change rooms,bathrooms and such. Now you pay money when you are sick or maybe dying and have to have the opposite gender care in very invasive situations. I bet if they had more hospitals that provided same gender care more men and women would be comfortable going and it would save lives.
I believe the patients right to privacy and dignity trumps the equal opportunity employment in these cases. I know the medical field likes to the think health care should be gender neutral but that's not how a lot of people who pay the salaries of these people feel. A lot of people avoid going for procedures due to knowing people of opposite gender will be involved.
It amazes me that the rights of the clothed provider takes precedence over the rights of the naked, bill paying patient. It reeks of the same attitude as a rapist saying she asked for it because of the way she was dressed. It's all about consent. Not implied but verbally communicated. Why don't they ask the patient up front. Because they don't want to deal with a answer different from what they want to hear. Most of the answers they give are nothing more than excuses to get you to comply. What we need is people to quit complaining on this site, put our heads together and come up with a plan to start bringing modesty back to health care for those of us that care. It's all about choice. Ideas anyone ? AL
Al,
I agree completely.
1. Fundamentally, I believe the solution starts with each individual patient. We need to be ready and willing to advocate for ourselves as to what we expect and what we will allow, or have an advocate with us if our condition mandates it.
2. There is a saying in medicine: "If it isn't written down, it didn't happen." Rather than waiting until you are in the situation where care is needed and trying to deal with the system verbally, it might be a better idea to put your preferences in the form of a written document ahead of time that can be signed, dated and handed to them. It's easy for them to blow off a verbal statement - much more difficult to ignore a written one.
3. Choose your words carefully. A statement such as "I prefer same gender care providers in xxx situations..." leaves the door wide open for them to ignore your wishes, while "I do not consent to opposite gender care providers in xxx situations without my specific written consent" is very specific and difficult to ignore without clearly violating the patient's legal rights.
Hex
As can be seen by comments from this urologymatch.com website, there is a population of patients (in this case, men) who do not reject being examined and treated by a woman urologist. And I am sure that there is a population of woman who are satisfied with examination by men OB-GYN physicians. The fact that abhorrence of treatment by a physician of the other gender is not universal supports my previous comment "patients should always have the choice of going to opposite gender staffed practices if they desire. That is why no civil rights law should provide excuses for a practice to prevent hiring and participation in the care of opposite gender patients of any healthcare provider based on gender of that healthcare provider."
I am not saying that patients should be prevented from obtaining the "same gender" if they desire but what I am saying is that civil rights laws should not make exceptions for the provider's gender. ..Maurice.
There have been several court cases where hospitals have successfully defended themselves for having female nurses in their ob/gyn section of the hospital, because patients have a clear preference for female staff there.
I remember seeing a student nurse complaining about patients that wouldn't let a male student nurse watch their delivery, even though they had a male doctor.
There is a huge difference between having a doctor you have a long term relationship with give you medical treatment and having a man you've never met before observing you during a stressful time. But not all people understand that.
-JR
"Also, there is a higher risk that women will be sexually abused if male nurses are allowed to do intimate procedures on them."
Misty, I'm tired of your defamatory and biased accusations with absolutely no factual basis. It's crackpot comments like these that have turned this previously useful blog into a form of yellow journalism. Dr Bernstein, if you're not going to moderate comments, than shut it down. Everything that can be said has been repeatedly stated ad nauseum!
Ed
I wanted to add that I was very pleased to learn that one woman who has very strong convictions against opposite sex intimate care was able to get respectful care from a male maternal fetal specialist in her city. She had to go to a maternal fetal specialist because she has a very high risk pregnancy with some complications. She explained to them clearly that he could not do any intimate exams or see her private parts and that only her abdomen could be exposed. He agreed to honor her requests. She has a female OB who will deliver her baby.
Misty
Ed, I agree. What is being written here is virtually like "preaching to the chorus". And I have also "preached" to this chorus that what is needed is reference to some statistical studies to support the views presented. What is next here?
Let me repeat what I wrote as the introduction to this Volume:
"let's all gather around the tables for discussion of what is most important: how to get the medical system understand that there is to some patients considerable more to patient modesty concerns than what is taught to the doctors and nurses and techs in school. That is now what this thread is all about." And now..that is what this thread is all about. ..Maurice. p.s.- Notice that I don't need statistics for my comment since I used the words "some patients" and I am fully in favor of the medical system considering even those "some patients".
Sounds like someone is having a bad day. Just because you don't agree with someone's post doesn't mean that persons comment should be moderated. I thought I served this country so everyone has the right to free speech. I agree that we should move past complaining and fighting on this blog and come up with a way to move the modesty issue forward on a large scale. As I've asked before, what are you doing ? I may not agree with Doctor B most of the time but I strongly agree with him when he say's it's up to us to speak up. One person will do little to change anything. A group of people with a well thought out plan can. I would hope after 62 volumes we could come up with something positive and stop fighting among ourselves. AL
I guess, as Moderator, I should start the process of coming up with a plan for "changing the medical system with regard to each individual's concern about physical modesty as a patient." This challenge goes beyond simply having each patient "speak up" to their healthcare provider although this action is not to be ignored.
So first: WHAT ARE THE RESOURCES AVAILABLE TO ACCOMPLISH THIS GOAL?
Well, Misty has one resource but is it more than "handy hints" for the patients who come to her website with complaints.
I personally tried an internet petition on one petitions site back in October 2012 which didn't excite many responses at that site. I did ask for assistance from my visitors here with regard to developing petitions elsewhere but got no response to that. Nevertheless, I still think that internet petition drives would be a possible resource.
Anyway, let's see some postings here now of additional approaches to get started on "system change" which seems to be a wanted goal by most here.
I want to see more suggestions about resources to use and get this thing started. ..Maurice.
I think it's silly to ask for statistics that take 30 seconds to google.
The U.S. Bureau of Justice Statistics (1997) stated that 91% of United States people whose rape accusations resulted in convictions against the accused were female and 9% were male. It also stated that 99% of the people convicted of and imprisoned in response to rape accusations were male, with only 1% of those convicted being female.
http://en.wikipedia.org/wiki/Rape_by_gender
You can read more statistics on RAINN's website. But yes, men are more likely to rape women then any other combo. I can't even believe that is being questioned.
-RJ
RJ, this thread is not about rape its all about physical modesty of individuals in a medical environment. The statistics I was writing about was those regarding the proportion of patients of either gender who have interest in same gender care and not gender statistics in rape.
My advice now is to stick to the issue I presented in my last post: finding a way, a resource, to begin the promotion and change the medical system to be more appreciative of the modesty concerns which might appear to one degree or another in any patient and how that change could be facilitated. ..Maurice.
Al, I served this country for 23 plus years so I'm well acquainted with the need for constitutionally protected free speech. My complaint with Misty is her repeated accusations, without a shred of factual data, purporting that our gender is more likely than female providers to commit sexual abuse when providing intimate care. That's like walking into a theater and yelling fire, which is not constitutionally protected free speech, unless of course there is an actual fire.
I've read this blog with interest for a couple of years now, motivated by two particular encounters previously recounted here. In response, I've spoke to the responsible physicians and filed formal complaints with my insurance carrier and the state physician and nursing boards, to no avail. I also wrote negative reviews for the two physicians on websites such as Angies List, Yelp, RateMDs, etc.
I've come to the conclusion that nothing we do will move this issue forward on a large scale because their isn't large scale public interest. I, like most who find themselves in situations we address here, walk into exams rooms daily, never expecting to be treated like slabs of meat; stunned, embarrassed, and angry!
In the future, I intend to schedule appointments like I've always done. However, absolutely no one will be present for any gender specific care without my prior informed consent. That consent will only be granted when I understand why their presence is required and what their professional and educational qualifications are. Short of the emergency room or major surgery, there will be no female providers, with the possible exception of a physician, participating in my care. If they refuse to comply, I'll simply leave, after I've spelled out unequivocally who will be receiving formal and informal complaints. I've concluded the only way we can address these issues is 1 v 1 in hospital and physician exam rooms; I hope I'm wrong!
Ed
If you are going to comment on a public blog you need to be open to all discussions, even the ones you do not agree with. This is simply open and honest discussion.
In todays world there are a plethora of healthcare providers, both male and female, in all arenas of medicine.
I personnaly prefer a same gender provider for intimate procedures. What is the drawback of choice? If you want to have a provider of opposite gender provide your care then please do so.
Being treated as a nuisance for wanting someone of the same gender provide healthcare is becoming unwelcome! Lets remember that the provider is working for the patient here.
BK
Male medical providers are more likely than women providers to sexually abuse patients because males in generally are more likely to commit the abuse, and women are most likely to be victims.
I personally believe this is due to cultural conditioning. Sexual assault in the United States has dropped almost 50% from 1993 because of cultural changes.
I believe not much research has been done into sexual abuse by healthcare workers precisely because researchers do not want to give patients more reasons not to trust healthcare workers. However special populations have been studied, specifically the elderly and mental health patients.
This is specifically sexual abuse in nursing homes from the Pennsylvania Coalition Against Rape:
- Females are 6 times more likely than males to experience elder sexual abuse.
- The majority of elder sexual abuse victims, roughly 83.3%, live in nursing homes or adult care facilities.
- While 83.3% of elder sexual abuse victims live in some form of institutional care facility, 26.8% of those victims experienced the actual act of sexual abuse within a family home or the perpetrator’s home.
- Approximately 76.2% of elder sexual abuse cases have at least one witness.
- In 81% of elder sexual abuse cases, the perpetrator was the actual caregiver to the elderly person.
http://nursinghomeabuseguide.com/elder-abuse/sexual-abuse/
I read elsewhere that sexual abuse in nursing homes only accounts for 3% of abusive acts against elders.
A report by the Victorian Mental Illness Awareness Council (VMIAC) report "found almost half of the women in the state's psychiatric hospitals have been sexually assaulted, a total of 67 per cent have been sexually harassed and 85 per cent say they felt unsafe." This is Australian hospitals, and the perpetrators include patients.
http://www.abc.net.au/news/2013-05-13/sexual-assault-rife-in-psychiatric-hospitals-report/4686480
In 2011, a law was passed in IL that "that requires that regulators permanently revoke the medical licenses of Illinois health care workers convicted of sex crimes, forcible felonies or misdemeanor battery of a patient."
http://articles.chicagotribune.com/2011-08-22/news/ct-met-illinois-health-care-suspensio20110823_1_health-care-workers-medical-licenses-revocations
It seems only 23 states will revoke licences for sexual crime convictions. YIKES.
-RJ
Oh finely - some statistics from a Canadian study:
80% of patients subjected to sexual contact were adult women. Male providers were responsible for 91% of the sexual contacts. Among 567 physicians disciplined by their state medical disciplinary boards between 1989 and 1996 for sexually related offenses involving patients, pediatricians accounted for 14 disciplinary events (2.9%), although they represented 7.8% of all physicians.
Now can we say women are in more danger of being sexually assaulted in medical settings than men?
Here is another statistic:
A study of patients who got psychiatric or counseling care after a former health care provider performed sexual acts upon them found 51% of the care providers were clergy, and 49% were health care professionals. Of those health care professionals, 85% were from various counseling professions, 7.3% were physicians in medical specialties, and 3.7% were nurses.
http://www.coloradosuperlawyer.com/injury-law/medical-malpractice/statistics-laws-regarding-sexual-abuse-by-a-doctor-or-a-health-care-provider/
Here's another one from Rainn about "helping professionals" (doctor, therapist, teacher, priest, professor, police officer, lawyer):
90% of sexual boundary violations occur between a male provider and a female client/patient (Plaut, S.M., 1997, p. 79).
http://www.rainn.org/get-information/types-of-sexual-assault/sexual-exploitation-by-helping-professional
So even though it was already obvious that since men commit the most sexual abuse and sexual assault, that in medical settings we should expect the same ratios, there are some statistics for ya.
"It is estimated that only 4-8% of survivors of sexual exploitation by helping professionals report the exploitation (Gartrell, N., et al.,1987 per TAASA, p. 168, 2004)."
I think this is the real problem:
People don't report sexual exploitation and when they do they aren't believed and are re-victimized.
People don't report modesty violations because when they do they are belittled or not believed and re-victimized too.
I know when I complained about treatment at a doctors office I had to pay for an appointment to complain AND the provider didn't understand why I was complaining when they were just doing their job.
Speaking up: changes nothing.
My choice going forward: If treatment or a test involves taking off my bra or underwear I'm not interested in it. Gender of the provider doesn't matter.
-RJ
Of course some of the problems we face are very frustrating, like, my wife being refused an MRI unless she wore the hospital gown which has no back in it. She refused to wear it and the hospital refused the MRI. It took a lot of talking and re-assuring before we could even get someone to listen ? You would think that if she has a belly bar, piercings, etc (which she does not) that they could still be hidden under a hospital gown as easily as the clothing she had chosen. There is very little compassion and it should be law that every patient be asked by the doctor before he/she is allowed to do any personal examination.
Ed, I hear your frustration in trying to get the providers to hear and understand. I also have done exactly the things you have. I can say it takes awhile but after a while they do start to hear you, but don't let your guard down. But we both have changed only our little part of the world. Most reading this blog have a idea what may happen. They won't be caught completely off guard. Hopefully we can come up with a plan that we can start to use in each of our states.
Dr B. I am pleasantly surprised to hear your offer on trying to move this forward. I only hope that people we step forward and come up with idea's. After all wouldn't everyone benefit from gender choice. You get the care you want, they get a satisfied , paying customer. I already gave Misty some idea's. I'll wait and see what others suggest. AL
The normal tranquility of this website has been disturbed by what seemed to me to be a rather innocuous and accurate comment by Misty- that men are more likely to commit sexual violations - medical setting or not - than females. RJ has done an excellent job of providing the needed documentation, so I will leave that subject and go to the matter of common civility.
Ed, we all applaud your service, I assume in the military. I cannot match that due to circumstances beyond my control, so I hope my 36 years of teaching political science in college will be a useful substitute in permitting me to comment. Others will have to find their own justifications to participate!
In reading through Misty's website, I do notice a strong concern for male modesty, for example in the field of urology. Certainly your annoyance couldn't be prompted by her pro-female bias. I have personally experienced several such embarrassing moments in a urology office. I believe Misty is a strong supporter on these matters.
She also is accurate in stating that courts have ruled in favor of patient choice of gender for intimate exams and procedures (OBGYN -Veleanu v Beth Israel Medical Center, 2000) This modesty site has raised legitimate concerns about male patients being unable to find same-gender care.
So where are the "crackpot comments," the "biased assumptions," where is there evidence of sensational, inaccurate comments? I have posted rarely here but followed this site since its inception; my understanding of medical issues has been greatly enhanced, and I have often expressed my appreciation to Dr. Bernstein. But I must say, I have never read a more intemperate response than the comments by Ed toward Misty. Perhaps the gentleman owes the lady an apology.
DES
My wife is going to have her right eardrum repaired on Friday.The Doctor is a male.Our insurance only gave us him as a choice.To offset her concerns about any males in the OR seeing her totally naked,on the consent form she has to sign Friday before the procedure,she is directing that.1.Only female nurses will attend her during both Pre and Post op.She is keeping her panties on.3.Under no circumstances will a urinary catheter be inserted into her body.This is how she hopes to preserve her modesty.What do you think?
DES, as a Political Science Major in college and a 23 year USAF retiree, I welcome your feedback (actually all feedback is welcome)!
That said there will be no forthcoming apology. Misty stated and I quote "Also, there is a higher risk that women will be sexually abused if male nurses are allowed to do intimate procedures on them." Today, male nurses do intimate procedures on female patients, as they have for years and will continue to do so; none of the statistics cited specifically support her claim. I'm personally offended when an entire profession is assumed to be sexual deviants simply because their male. Now, before you label me as misogynist, or worse, let me tell you what I believe, my opinion alone.
It's reprehensible that female patients have been subjected to the vast majority of substantiated sexual abuse incidents. I also believe male providers are much more likely to be accused, which doesn’t automatically equate to guilt. I mean, really, with the near universal use of exclusively female chaperones for female intimate care, I find it hard to believe a male nurse or physician would risk his professional livelihood with a third party in attendance. That's not to say it hasn't happened in the past nor will it in the future, but the probability is so infinitesimal, the only reason we're talking about it is because of Misty's comment. I also believe males (especially adolescents) are subject to a much higher incidence of sexual abuse on the part of female providers than is reported because we just suck it up and deal with it. I certainly agree Misty is a strong supporter of male modesty rights and agree with the BFOQ references, never said otherwise.
With respect to "sensational, inaccurate" crackpot comments by Misty, here are just a few examples from Volume 62 alone:
"But I find it so strange that a female OB/GYN would be okay with her husband being an OB/GYN too. I am sure she is well aware that her husband treats some very attractive women."
"I especially would like to hear from women and husbands who have strong moral convictions that male gynecologists are wrong.
"I also wonder how a male urologist would feel if his wife was also an urologist who treated men."
The underlying implication in these comments (and others) is clearly that both genders, but especially males, are incapable of separating their professional and sexual lives.
As Don so eloquently stated, "Sexual abuse in the medical community is an issue, but it isn't this issue. The issue here is modesty violations." This blog is not the venue to air those gripes and I think the vast majority of posters here agree. Intemperate, hardly!
Ed
Ed,
I know you will always disagree with me on some issues and that is fine. But I would like to ask that in the future when you disagree with me some issues to please disagree with me in a respectful way. This blog is full of different perspectives. While I disagree with Dr. Bernstein about a lot of things, I really appreciate his dedication to keep the patient modesty blogs going. I know he disagrees with a lot of things people post here, but I am grateful that he allows those postings. He has given some good ideas about how we can work to have our wishes for modesty honored.
I wanted to let you know that I have been very impressed with your wonderful insights about how we can increase choices for male patients who do not want female intimate care. I have learned some great insights from you. In fact, I loved your wonderful comments in response to the urologist who said he could not hire any male assistants for his practice on May 19th. Your insights were wonderful for this article: 3 tips to overcome embarrassment in the doctor-patient relationship .
I feel BFOQ should also apply to all-male urology clinics that want to only hire male doctors and nurses / assistants too. I believe male patient modesty is as important as female patient modesty. I have been very disappointed about how the medical profession seems to put more value on female patient modesty than male patient modesty at times. I personally think that all mixed urology practices should look into hiring more male nurses and assistants so male patients who are uncomfortable with females being involved in their medical care can have the choice of same gender intimate care. There have been some female doctors and nurses who have abused and violated male patients.
I know many men have really appreciated your insights. I hope you will continue to contribute insights about male patient modesty.
Misty
Recently my wife went for an MRI of her head at a local hospital. She wore a tee shirt and sweatpants without any metal. She was told that everyone had to disrobe and wear a hospital gown. She refused and we left with the name of the supervisor whom I called the next day. I explained that my wife was not going to "gown-up" for this test as it was not necessary. I told her that I could go to another facility if necessary. She agreed to look into the policy and call me back which she did in a few days. Problem solved! No changing necessary for an MRI. We rescheduled and went back a few days later with no problems.
Phil
Ed,
I know you will probably disagree with me. But I wanted to share some important information with you.
When I first started Medical Patient Modesty, I did not know that sexual abuse in medical settings was that bad. There is a doctor watchdog who constantly emails me links to articles about sexual abuse in medical settings. He also has many of the state medical board reports. I have learned so much. Female nurses or assistants were present in many of those cases.
I have received some very heartbreaking cases from women who were sexually abused by male doctors. Female nurses were present in those cases. Check out one case in the second paragraph at http://patientmodesty.org/allfemalepractices.aspx. This particular female nurse reported the male doctor, but everything happened so quickly. I encourage you to look at this article: Do Chaperones Really Protect Patients?. If something inappropriate happens, many nurses will not report it because they do not want to lose their job or they think the doctor is simply being thorough. Third party chaperones cannot always prevent sexual abuse.
I wanted to let you know that I agree with your statement below:
I also believe males (especially adolescents) are subject to a much higher incidence of sexual abuse on the part of female providers than is reported because we just suck it up and deal with it.
This is why I think we should educate parents about how to protect their children in medical settings. I believe that abuse of male patients is underreported because many men do not feel that they can speak up or complain. I believe complaints of male patients are more likely to be ignored than female patients.
Misty
Let's get down to definitions and see if we can separate criminal sexual activity from the events that may occur in routine medical/surgical care of the patient. Let's look at the CDC (United States Centers for Disease Control and Prevention definition of Sexual Violence.
Sexual Violence: Definitions
Sexual violence (SV) is any sexual act that is perpetrated against someone's will. SV encompasses a range of offenses, including a completed nonconsensual sex act (i.e., rape), an attempted nonconsensual sex act, abusive sexual contact (i.e., unwanted touching), and non-contact sexual abuse (e.g., threatened sexual violence, exhibitionism, verbal sexual harassment). These four types are defined in more detail below. All types involve victims who do not consent, or who are unable to consent or refuse to allow the act.
A completed sex act is defined as contact between the penis and the vulva or the penis and the anus involving penetration, however slight; contact between the mouth and penis, vulva, or anus; or penetration of the anal or genital opening of another person by a hand, finger, or other object.
An attempted (but not completed) sex act
Abusive sexual contact is defined as intentional touching, either directly or through the clothing, of the genitalia, anus, groin, breast, inner thigh, or buttocks of any person without his or her consent, or of a person who is unable to consent or refuse.
Non-contact sexual abuse does not include physical contact of a sexual nature between the perpetrator and the victim. It includes acts such as voyeurism; intentional exposure of an individual to exhibitionism; unwanted exposure to pornography; verbal or behavioral sexual harassment; threats of sexual violence to accomplish some other end; or taking nude photographs of a sexual nature of another person without his or her consent or knowledge, or of a person who is unable to consent or refuse.
Why is a Consistent Definition Important?
A consistent definition is needed to monitor the incidence of SV and examine trends over time. In addition, it helps determine the magnitude of SV and compare the problem across jurisdictions. A consistent definition also helps researchers measure risk and protective factors for victimization in a uniform manner. This ultimately informs prevention and intervention efforts.
Reference
Basile KC, Saltzman LE. Sexual violence surveillance: uniform definitions and recommended data elements version 1.0. Atlanta: Centers for Disease Control and Prevention, National Center for Injury Prevention and Control; 2002. Available from: http://www.cdc.gov/ViolencePrevention/pub/SV_surveillance.html
As we are discussing the consequences of medical professional attention or inattention to patient modesty issues are we really talking about criminal sexual violence as defined by the CDC? ..Maurice.
Bill,
I wanted to respond to your concerns. I believe you are the same man who shared your concerns in the How Husbands Feel About Male Gynecologists Group the other day.
My wife is going to have her right eardrum repaired on Friday.The Doctor is a male.Our insurance only gave us him as a choice.To offset her concerns about any males in the OR seeing her totally naked,on the consent form she has to sign Friday before the procedure,she is directing that.1.Only female nurses will attend her during both Pre and Post op.She is keeping her panties on.3.Under no circumstances will a urinary catheter be inserted into her body.This is how she hopes to preserve her modesty.What do you think?
There is no reason the male ENT should see any of her private parts. You need to make sure that the doctor and all of the nurses know your wishes. The only way you can be guaranteed 100% that her wishes would be honored is for you to insist to be present for Pre and Post-OP and surgery. I know many hospitals won’t let family members be present for surgeries, but it is time for us to stand up and let them know we are not going to follow their ridiculous policy anymore. Also, insist that her gown never be lifted at all. If her gown is taken off, her breasts will be exposed. It would be nice if she could wear a100% cotton bra with no metals or a bra similar to the first picture on http://www.digniproducts.com/Products.html.
Also, you should request that she not be sedated during Pre-OP. Make sure they do not give her Versed.
I hope this is helpful. You can contact me at Medical Patient Modesty.
Misty
Great article about men and modesty in a mainstream magazine:
http://www.theatlantic.com/health/archive/2014/02/men-manliness-and-being-naked-around-other-men/282998/
Ed
I don't think Ed needs to apologize, I understand where he is coming from. It's our job to let him know that just because men are more likely to commit sexual harassment, abuse, or assault, doesn't mean that all men do such things or that we are implying all men do such things. When men feel they are personally being criticized for things they didn't do, the conversation shuts down.
I think Misty's comments are coming from a religious point of view that the only man that should see a woman naked is her husband, rather than an saying that all men are deviant and can't do their jobs. I think her other comments are about risk: women are more at risk from male providers, so to minimize that risk they should use female providers.
Risk of sexual assault is something all women live with every day of our lives. We're told not to stop and help strangers, not to give strangers rides home in our car, not to walk alone in the dark, etc... all around minimizing the risk of sexual assault. Yet, most sexual assault comes from people the women knows and trusts.
I have had a female doctor tell me I couldn't refuse a pelvic exam. I told another doctor to stop a pelvic exam because I was in pain. They stopped - then restarted without asking my consent. I was so traumatized I missed a week of work and had to get counseling.
Now I know doctors are trained to be told "verbal consent isn't necessary, if they show up for the procedure that's consent. If you make a move to do something and they don't stop you, that's consent."
I think that's wrong, wrong, wrong. "Lack of a no doesn't mean a yes" is what should be taught. But knowing that allows me to set boundaries from the get go.
EXPLAIN AND ASK:
You will EXPLAIN everything you are going to do in detail. Then you will verbally ASK me permission before touching me.
Anonymous at 8:31 AM on Thursday, February 6th:
I am sorry to hear about your bad experience with pelvic exams. Some female gynecologists can be very rough and insensitive. You may find a lot of encouragement from this group: For Women Eyes Only. I comment there from time to time.
I really appreciate your below paragraph:
Risk of sexual assault is something all women live with every day of our lives. We're told not to stop and help strangers, not to give strangers rides home in our car, not to walk alone in the dark, etc... all around minimizing the risk of sexual assault. Yet, most sexual assault comes from people the women knows and trusts.
You are correct that it is more common for a woman to be sexually assaulted by someone she knows and trusts. Women often trust doctors too. There have been some cases where male doctors started sexually abusing women after years of seeing them.
Misty
The article that Ed shared has many excellent insights about male modesty. It is sad about how our culture expects men to give up their modesty. I believe that this has really influenced the medical profession to disregard male patient modesty. It is encouraging that the doctor in this article has taken steps to respect male patients’ modesty.
Misty
Sorry - Explain and Ask comment was me.
-JR
My wife and I choose to have same sex medical personnel due to our religious belief that we were married in the eyes of god and took an oath to FORSAKE ALL OTHERS.No where does it say "EXCEPT FOR DOCTORS,NURSES and OTHER MEDICAL PERSONNEL.This is how we live our lives and choose to be.Its not racial as both of us have had Doctors that were Aisian,African American,Indian,ect...
Bill,
Your convictions are very admirable. Many married people are uncomfortable with their spouse having opposite sex intimate care. It is sad about how the medical industry often tries to force us to lower our standards. People like us who have those convictions should not be forced to have opposite sex intimate care. Every medical facility should always have choices for same gender intimate care.
Misty
Are women more likely to be sxually assualted then males, I would guess so. Are women more likely to be assualted by a man than a woman, I would bet so. Are women likely to be assualted, I don't think so. Are they LIKELY to be assualted in a medical setting, of course not. Anything is possible, Dr. Sparks assualted a male patient and got away with it. Are women more likely to get away with modesty violations I would bet so. The implications of these posts are women should have female caregivers because of the liklihood they will be assualted by some depraved male provider because of course that is what men do. RIDICULOUS. You can put all the lipstick on it you want but the tone is the same, you can't trust male providers. While you can say this not an indictment of men, I don't know that I have ever read a few male providers, on rare ocassions, the posts read like males in general. Even so, the odds of being assualted while in medical care has to be so small. And if we are to lead our lives like that, why bother driving to the hospital at all, you will probably be killed on the way to the hospital. Once again, this thread is about modesty not assault, but hey whatever. If it would help to get back to the original issue, lets agree, men bad, male providers are all potential rapists, so can we now look at the original issue of non rape, assault, versions of modesty in the medical community,,,,don
The Explain and Ask comment was me. I've had a couple comments disappear.
In one Australian study by the Victorian Mental Illness Awareness Council found that 45 per cent of women in the state's psychiatric hospitals had been sexually assaulted while in their care. (Note - most of these assaults were from fellow patients. Some patients assaulted multiple women.)
http://www.abc.net.au/news/2013-05-13/sexual-assault-rife-in-psychiatric-hospitals-report/4686480
Females are 6 times more likely than males to experience elder sexual abuse.
The majority of elder sexual abuse victims, roughly 83.3%, live in nursing homes or adult care facilities.
While 83.3% of elder sexual abuse victims live in some form of institutional care facility, 26.8% of those victims experienced the actual act of sexual abuse within a family home or the perpetrator’s home.
Approximately 76.2% of elder sexual abuse cases have at least one witness.
In 81% of elder sexual abuse cases, the perpetrator was the actual caregiver to the elderly person.
http://nursinghomeabuseguide.com/elder-abuse/sexual-abuse/
In one study of 200 adult women with disabilities, 53% had experienced sexual abuse.
http://www.ncea.aoa.gov/Library/Data/index.aspx
I do agree that sexual assault against males is under reported. But does that mean precautions to protect vulnerable populations (including patients) shouldn't be put into place? People in institutions certainly seem to be at a much higher risk of being sexually assaulted based on these numbers.
-RJ
If all this potential and actual criminality within the medical profession is well documented or could be documented and that even going into a doctor's office or into a hospital is taking a real chance to be "attacked" in one way or another and all men and women medical professionals are under suspicion without exceptions. and the patient should be forewarned about the dangers. If this conclusion is true than this sounds like there is no value to my profession and that any good that is delivered is minimal as compared to the potential harm. How can one even accept any good when the harm is so potentially prevalent that there is emotional distress even to consider entry into the system as a patient?
And how about the other "trusted" professions: police, teachers, the Church...? We have all heard about the bad of each of them too.
But if all of this horror within the medical system, the police, the education system and the Church is much less than a universal occurrence, shouldn't we focus our discussion on the issues of patient modesty itself and not criminality and think of ways to make all patients comfortable in that regard while their illnesses are being attempted to effectively managed by their medical providers? Isn't that what this thread is all about? Shouldn't we? I think we should. ..Maurice.
All of life is Risk vs Benefits.
And unfortunately for women, we are always evaluating our risk in any situation.
It's dark out? I'm alone? Pretty risky.
This is one of the big differences between women and men: Women are taught from an early age to constantly be on the guard to sexual assault.
Can it go overboard? You bet! I was denied participating in many activities as a teenager because "I might get raped..." things my brothers were allowed to do. Like go to the library.
That's not a joke. The library was too dangerous because one time, someone was raped when my mother was in college, someone was raped in the library. The entire world probably agrees that is pretty overboard, but not to my mother.
Everyone evaluates risk vs rewards differently.
So, yes, people evaluate the risk vs rewards when deciding to get medical care. Why do you think people wait until the last minute to get care, instead of going to the doctor when they start having symptoms? It takes the elevated symptoms to make them evaluate that going in for care is more important that whatever barrier they have to going to the doctor (financial, worry about modesty, worry about doctor behavior).
About 60% of people live through a traumatic event in their childhood (witnessing assault, murder, suicide, being assaulted or raped, having a severe illness or accident).
Because of that, shouldn't providers be trained in how to make traumatized people comfortable in medical settings? There have been studies to find out what they are and classes providers can take. Yet, most people (including those who are not traumatized and simply conservative or modest who would benefit from the same skill set) are dismissed as being "simply irrational" or "emotional".
If we want to get people in to seek medical care, we have to make medical care comfortable for the people who avoid it. We have to make people feel like its not a "risk" to seek medical care.
And that INCLUDES paying attention to modesty. But it's not the only thing that needs to change.
-RJ
RJ, I agree. So now lets discuss what practical approaches we should use to get the medical system to pay more attention to simple physical modesty and make it easier for patients to decide to get medical attention and not avoid it because of those modesty issues. ..Maurice.
I agree with Don and Dr. B. I think this blog should focus on modesty issues only and should move onto solutions we can all benefit from. While sexual assault perhaps does happen in a medical setting I am convinced that it is not a widespread event and I think that subject should have a separate blog. I am female and while I feel very uncomfortable seeing a male doc for intimate issues it has nothing to do with fear of sexual assault. That thought never entered my mind. I really do not think the vast majority of male doctors and other male providers have the tendency or intent to sexualize medical exams. That said, I do respect those who have that concern but I honestly think that is a different issue than plain old patient modesty. I would like to see this blog concentrate on ways to address that problem. I find many suggestions here helpful as far as approaching the issue one on one and would like to see more but there has been little progress in addressing the issue system wide. It may be that it will never be a mainstream issue, as Ed said previously (and which I do agree with to some extent) so these individual approaches may be our only tool. So more ideas, please. Jean
Dr. Bernstein,
I like Jean’s idea that we have a separate blog about sexual misconduct by medical professionals. You have many blog topics and I think it would be great if you started a separate blog about sexual misconduct by medical professionals. Some patient modesty violation cases have turned into sexual misconduct cases. For example, a lady who goes in for ear ache should never take any of her clothes off. I personally received one case where one college student went to her infirmary for swimmer’s ears and the male doctor coerced her into having pelvic exam and breast exam.
I started an educational web site about Sexual Misconduct by Doctors separated from Medical Patient Modesty’s web site a few years ago.
What do you think about starting a separate blog about sexual misconduct in medical settings?
Misty
Misty, I find no ethical debate (a good vs a bad) in the criminal acts of sexual violence as described by the CDC in my posting 2 days ago. This blog is about ethics and not frank criminality. There are some defined "crimes" in our society that are debatable as to whether they are indeed crimes or criminality such as going to prison for the smoking or growing of marijuana. But this is not so with the sexual violence as previously described. We all accept these acts as crimes and not within some ethical debate unless one wants to debate whether some acts of rape are provoked by the one who was raped.
With regard to degrees of patient physical or even historical modesty there are two sides regarding an ethics conclusion and there is plenty of room for discussion of the ethics of placing 100 percent of the blame for the consequences of the patient's outcome in a medical/surgical experience totally on the medical profession or putting any blame or responsibility at all on the patient.
Misty, if you think that sexual misbehavior is a separate issue than general patient modesty, as you do by having started another website on that topic, I would encourage my visitors to go to your website to support or argue that view. I just don't think that discussing accepted crimes needs much of any ethical debate in our society and I think we should continue discussion of how to encourage the medical system to be aware of the entire spectrum of physical modesty issues as applied to both genders of patients and both genders of healthcare provider. Leave the crimes to the law, courts, medical boards and the news media. None of those crimes are acceptable and none are ethical or debatable. .Maurice.
Ed, excellent article that you mentioned on your February 6th post. Thanks for sharing that.
The article was worth reading, and represented a refreshing change in attitude toward male modesty. Sadly, however, the comments represented the attitudes that we have come to expect.
Most men took the "I got through it and look what it did for me" attitude. While the few women who commented tended toward the "oh, too bad, women have it so much worse" opinion. Unfortunately, the latter is sometimes expressed on this very blog, as well.
However, I was glad to see some guys supporting the author. While in the minority, it is still encouraging to see some men willing to express their opinions on these issues. Not that long ago, very few would have done so.
First I apologize for getting a little carried away on my last post. I stand by the basis and align with Jean and Dr. Bernstein on this. I paticularly identified with the sentiment expressed by Jean, while different as a male I have never felt threatened, I have also really not felt this was about a female provider getting kicks out of seeing me exposed. It is about me feeling uncomfortable, not about what the provider is feeling. I don't know that I can say during my medical encounters I don't recall I have ever experienced anything unprofessional. I have however experienced numerous encounters that were very uncomfortable for me and I believe providers knew this, I believe they could have done more to prevent this, and I believe theydid not because it SOP and it sserved them to pretend it didn't matter and what they were doing was enough. That said, that is a long way from abuse, assualt, rape. We are never going to agree on the prevelance of this type of behavior. Jean, Dr. Bernstein, Ed, and I are aligned it is not a common occurance and is not material to this discussion, RJ and others seem to feel it is common if not inevitable. So could we at least agree it is a seperate issue and could be addressed on a different thread? And Misty, I appreciate all the effort you put into this, I really do respect the energy and investment. However continually citing the offenses of male providers does nothing for this. I realize you try to include consideration for males in urology, etc. but if you review your posts they frequently gravitate to abuses of female patients by male providers.
I agree with Ed and Jean, while years ago when I stumbled on this thread I had hoped for a larger sweeping change, I have settled in with doing what I can to improve my situation and in turn hope it plants the seed to benefit others.....in that vane I I feel I have made significant progress thanks to a large part to this thread, for that I am thankful to everyone here...don
I'd actually prefer not to read articles about providers being charged with sexual assault. But it angers me when people dismiss it as not being an issue, or thinking of it as being "rare". That's why these issues keep getting shoved under the rug.
Look at the ACE Study: http://www.cdc.gov/ace/index.htm
20% of children responded "yes" to this question: An adult or person at least 5 years older ever touched or fondled you in a sexual way, or had you touch their body in a sexual way, or attempted oral, anal, or vaginal intercourse with you or actually had oral, anal, or vaginal intercourse with you.
Does this have medical implications BEYOND modesty and discomfort? ABSOLUTELY. The more "Adverse Childhood Experiences" a person had, the more likely their health as an adult would suffer. Not just mental health - physical health.
30% of children have been physically abused. 12% watched their mothers be treated with violence. 26% grew up in households with substance abuse.
This effects people's ability to get medical care.
There is a new paradigm out there called "Trauma Informed Care" which comes from scientific studies into people who have suffered from trauma who do not necessarily have PTSD.
Honestly, I think Misty had the right of it: create a website. Attend conferences. Spread the word. Get people talking.
Obviously we aren't the only ones noticing. Companies are making products to help with patient modesty. Yes, yes, yes.
But we have to really make a significant cultural change in medicine. Doctors need to stop blowing off "non-compliant" patients, and start using proven techniques, like motivational interviewing, that will help. Patient won't stop drinking? 80% of people with substance abuse problems suffered trauma in their childhood. 80%. But trauma - it's not a medical problem? Not something doctors need to worry about?
I think that making patients feel safe reduces stress which allows people to heal better. Patients who are terrified will have higher blood pressure and hormonal changes like high cortisol which can affect the medical outcome. Patients who are terrified may not even get medical care at all, which certainly isn't good for them.
And making patients feel safe and cared for is just the right thing to do.
-RJ
No, Don we cannot agree that it is a separate issue.
Some hospital personnel use humiliation as a means of control. This is abuse, it happens, it violates a patient's modesty and when it happens, it can be recognized by the patient (although not always at the time).
These issues are so closely interwoven and typical and can be blamed on forgetting to close the door, walking in without knocking, whatever.
It is the intent of the personnel that determines whether there is abuse or not, not necessarily the experience. That's what goes under the radar.
The only way to track this issue is through violations, complaints, and the medical community keeping track of who did what, the number of times, the patient witness complaints and then actions taken by the medical community.
Looking at this as a separate issue is like a doctor telling you they will only treat one half of the body.
belinda
RJ:
I appreciate your excellent points. It also bothers me when people dismiss sexual assault in medical settings as rare. It is much more common than we can imagine. Many women never report sexual abuse by doctors because they know that it is very difficult to get doctors in trouble. I have been very shocked at the high number of sexual abuse cases in medical settings that I have learned about. One of my friends was sexually abused by a male gynecologist when she was 14 or 15 years old. She is in her 40s today and still has not gotten over it.
You might want to consider contributing to this other blog about sexual guise under healthcare.
I have been in contact with some companies who have created products to help with patient modesty. In fact, I was very pleased with an encouraging email I received from one of the nurses who designed Digni-Bra. Those two nurses really care about protecting patient modesty. There are certainly some good doctors and nurses who care about patient modesty which is very encouraging. I also have an appointment to talk to a man about a new company he started to detect hidden cameras. He is very concerned about how some doctors such as Dr. Levy secretly videotaped female patients’ private parts. He also provides spy camera detection services for other areas such as locker rooms, dressing rooms at stores, etc.
Belinda: Welcome back! You have made some excellent points.
Misty
I'm going to come down on the side of Dr. B., Jean & others in that I believe that the instances of sexual abuse by health care providers, while they do indeed occur, are relatively rare and not a prevalent threat.
That said, the failure of health care providers to respect the modesty concerns of patients, and especially their patronizing comments when patients object or show reservations, is indeed a form of emotional abuse.
And while some of the lack of respect may be due to providers indifference or simple lack of concern with the patient's feelings, there are instances where humiliation is used to control patients.
I have mentioned in the past that both my wife and sister are RN's. One of the things they were taught during their training was that if a patient appears to be resistant or difficult, get them naked and in a gown to get them under control. I've asked both and they said it wasn't part of their BSN classroom training, but something they were told during their clinical training - another classic example of Dr. B's "hidden agenda".
I think that two things need to happen to address patient modesty concerns:
1. The patient needs to speak up, state their concerns and stand by them.
2. Providers need to be convinced that they must respect patient's modesty concerns and be willing to work with the patient to take the steps necessary to mitigate those concerns.
Hex
Hex, I'm a little confused about your standing on the issues of separating modesty issues from those of abuse when your own family members explain that nudity is used as a tool to get "difficult" patient in line. This is abuse when not necessary and used as intent to humiliate and control.
You are saying by aligning with another view (by omission) that you find this practice your family talks about acceptable.
belinda
Forget that "nudity is used as a tool to get 'difficult' patient in line" is part of the profession of medical care. It certainly is not taught in medical school and I really doubt that it is taught in nursing schools. One should not connect banter talk between workers as professional policy or guidelines for practice. Any healthcare provider who advocates or practices with such a "tool" should be removed from their profession. Ignoring patients' modesty issues is bad enough but suggesting or using them as a manipulating tool has the smell something worse. ..Maurice.
Belinda,
You need to reread my post - specifically the 2nd paragraph.
With rare exceptions, the vast majority of modesty violations, by definition, do not qualify as sexual abuse. What many do qualify as is psychological or emotional abuse - there is a difference.
I also did not state or imply that either I or my family members condone the behavior I described - none of us do, and in fact find it reprehensible.
What I did was point out something that was said by someone on the hospital nursing staff to nursing students during their clinical rotations, again as an example of what Dr. Bernstein refers to as the hidden curriculum.
I should also point out that this occurred more than 30 years ago, when paternalism was the culture and rule in medicine, and that may have been a factor in the staff member's attitude. Even at that, the reason they remembered the statement was that they were shocked by it.
Hex
The answer is simple. Have same gender Heath clinics set up for both sexes. The mainstream hospitals can remain so called gender neutral. People could then make the choice of which they would prefer. Choice for the paying customer is always good for business and the patient.
Why does almost everyone assume that modesty issues are always gender related ? They aren't. I was taught from a young age that no one should ever see me naked, male or female. I didn't learn modesty, I learned shame.
Surprisingly, I did get married and have a normal physical relationship with my husband.
I'm not sure how this all relates, but I now feel more comfortable with male doctors for intimate care than females. To read this blog, you would think all females prefer female doctors, but I know other women who feel like I do.
We should all have a choice to see whatever gender doctor makes us feel more comfortable. Don't preach at me that it's immoral for a female to choose a male doctor, or for a male to be a gyn.
I don't think it's "preaching" to simply say that (from a husband's point of view), I prefer that MY wife see only female gynecologists. The reason is that as my wife, I am the one that she is intimate with. And I object to having another man (whether a doctor, priest, trash man, etc.) see her naked. I also appreciate her consideration of how this makes me feel and is sensitive and accepting of this condition. HH
Considering whether hugging by the doctor represents an invasion or modesty or an unprofessional sexual issue, here is my introduction to a thread on my blog "Being Hugged By Your Doctor: Invasion of Privacy vs Sign of Compassion?" published Nov. 9 2007.
According to the article in Fox News "Affectionate students are feeling the squeeze around the country as their displays of affection land them in trouble with school administrators." Even if the intent is to express, though the act of a hug, a social connection with their peers on the school grounds, this behavior may be considered sexual harassment. I find this news story has directed me to consider something some of us doctors do as part of being a humanistic human being beyond simply a doctor of medicine. Some of us actually hug our patients or patients' family members. We hug, not out of sexual excitement or anticipation, but out of a sense of the need to express directly compassion and support at the time of a patient crisis. Is hugging a patient professional? Does it exceed boundaries of professional behavior? Does it invade the patient's privacy? Should doctors first ask the patient "may I hug you?" and wait for permission? When you are upset and in distress and need the attention and compassion of someone who shows that he or she cares about your feeling, should you or would you accept a hug from your doctor even without them asking?
There are 40 responses and you might like to go to the thread and read them. Pertinent to our thread here, I present two responses one apparently from a general physician and the other from a surgeon to give you the professional point of view. ..Maurice.
Yes I hug,when I feel it's part of the therapeutic interaction. My "protocol" is to say, "Do you need a hug?" in a neutral enough tone so that "yes" and "no" are equally acceptable answers, which I then honor.
It was a patient several years ago who taught me the "right" way to hug: no pounding (conveys hostility); if you must, a slight rubbing of the back, though no movement is best. Let the patient release first.
I believe it works well for me.
and the other physician:
In my medical role I have to violate all sorts of physical/social boundaries (I am a surgeon). People frequently feel extremely vulnerable, and I don't want to make anyone any more uncomfortable.
I feel the same way about hugging as I do about prayer (not to open up another ethical discussion that you've probably already had). If a patient wants to hold my hands and pray in the preop area, then that is fine with me. I don't feel it would be appropriate for me to propose a prayer (or a hug). What if they say yes, but they wanted to say no? What if they say no, then worry about how that would affect their care?
I make a point of shaking hands when meeting a patient, and of touching their shoulder/etc when rounding. I have no problem hugging a patient, but I let them initiate it. It feels more respectful.
While men are in control of the medical profession there will always be more modesty issues, consider that a male doctor will NEVER offer gender choice for an intimate exam.
Kind of explains it all imo, my surprise is that some women are easily brainwashed, that a male doctor doesn't get aroused, even though it has been highlighted in press articles. pailrider.
NOTICE: AS OF TODAY FEBRUARY 9. 2014 "PATIENT MODESTY: VOLUME 62" WILL BE CLOSED FOR FURTHER COMMENTS. YOU CAN CONTINUE POSTING COMMENTS ON VOLUME 63.
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