Bioethics Discussion Blog: Patient Modesty: Volume 63

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Sunday, February 09, 2014

Patient Modesty: Volume 63







As we start our sixty-third Volume, after reading all the descriptions of "criminality" inside the medical profession within the context of "patient modesty",  I just wondered, to start Volume 63 if we should really define what we are specifically referring to when we use the term "patient modesty". The other aspect of the expression which needs clarification is to whom does the term apply?  Does it apply to every human who is a patient,  including infants and children, to the elderly and demented and to those who are unconscious from anesthesia or in a permanent coma (persistent vegetative state) or, in fact, a patient who is dead?  I think we should all set an accepted definition of the term and to whom the term applies before we argue the case to those within the medical system in an effort to change the system to fully attend to the issues of patient modesty.  So let this be the goal of beginning this Volume.   I repeat, what exactly is "patient modesty" and to whom does it apply or, in fact, not apply? ..Maurice.


NOTICE: AS OF TODAY MARCH 18 2014 "PATIENT MODESTY: VOLUME 63" WILL BE CLOSED FOR FURTHER COMMENTS. YOU CAN CONTINUE POSTING COMMENTS ON VOLUME 64

Graphic: Modesty in the Dictionary: Photograph taken by me 2-9-2014.

173 Comments:

At Monday, February 10, 2014 6:19:00 PM, Anonymous Anonymous said...

I agree with your approach Dr. Bernstein but I am apprehensive we will have any agreement. We seem to have two camps, providers are evil sexual preditors (especially males) and those who feel modesty violations as were intended to be addressed at the begining of this thread are a different issue. Palerider's last post on volume 62 is an indication of the chasim between the two camps. I did notice on your graphic the words "regard for decency". And there may be the crux of the issue. Regard, does the medical community provide proper regard for the decency of the patients. The answer is the medical community provides regard from their perspective which is designed as more to suit their need than the patients. Likewise those that demand only same gender providers for all ignore the wishes of those who feel regard for decency is not an matter of gender. Regard, like beauty is in the eye of the beholder. I don't have anything more to add to my statement that i do not believe providers are sinister, abusers, rapist, or likely potential abusers, rapist, and evil. I feel quite the opposite, I think most are fine people who fall into line with the agenda the medical communities self serving protocol has evolved to. The question there is now what, for each it is as individual as our personal feelings that define "regard". To me it means I will take more responsibilty and be more vocal and assertive for what I feel is "proper regard" for my modesty. I will do my best to push for a wider recognition from the medical community, but I won't depend on it to benefit me in the meantime. For those who chose to view provider as these evil being whom we need protected from lest they assualt us when we are vulnerable, I hope you find some solution to YOUR version of this, but it is YOUR version, not mine. When you choose to paint male providers as you do, you include people like Dr. Bernstein whom are working for your benefit. I don't think I can agree with you so not sure how we resolve this unless we just default to Dr. Bernstien's version, it was his vision that started this thread and I assume he had something in mind...don

 
At Monday, February 10, 2014 9:00:00 PM, Blogger Maurice Bernstein, M.D. said...

Interestingly, "modesty" is defined as a personal attribute of the one who is modest in which that person has a "regard for decency of behavior, speech, dress, etc". Thus as it stands "modesty" has only a personal self-attribute.

Don, I believe as medical practice exists now, practitioners are more interested in the clinical results rather than worry about the details how the patient defines their own "decency" except for gross exceptions as medical students are taught to examine by undraping the patient sequentially as necessary for the examination and the cautions for the genital examination. The remainder of the "decency" definition is for the patient to communicate that personal definition to the healthcare provider.

With regard to my vision of this thread when it started, I frankly had no vision except to allow my visitors to react to a posting "Naked" (August 2005) based on Atul Gawande MD's New England Journal of Medicine article of the same title. I was, at the time, from the "old school" (basic,simple concern for patient's modesty but that health trumped modesty) and everything that was written by my visitors then was "new to me" since as I have written here previously, I never received comments about personal modesty issues by my patients.

Don, now. obviously, I have "something in mind". It is to encourage my visitors to do something constructive to correct deficiencies of modesty concerns within the medical system. And I agree that further painting physicians and nurses with a criminality paintbrush will do nothing constructive to that goal.

As I suggested at the outset of this Volume, let's define "patient modesty" if it is not present or wrongly defined in the dictionaries and then go on to create changes in medical system behavior. ..Maurice.

 
At Tuesday, February 11, 2014 10:06:00 AM, Anonymous Medcial Patient Modesty said...

I realize that some people will disagree with me here. I will share my thoughts about modesty.

Many people make the decision to be modest in other settings and their feelings do not change in medical settings. Many modest people especially women choose to be careful about how they dress in public because they do not want their private parts to be exposed to men who are not their husbands. For example, many women choose to not wear shirts that expose their cleavage. Many people were taught as children to be modest after a certain age and that they should never expose their private parts to the opposite sex except for their spouses. Why do we have separate restrooms for women and men? There are some public gender neutral restrooms in the US now of course. I personally do not think public gender neutral restrooms are a good idea because this increases the chances that sexual predators could take advantage of people.

It is odd that the medical profession expects us to give up our modesty and morals. Many patients feel that their modesty is still important even in medical settings. Our society teaches us that we should let medical professionals do anything and that we should forget about our modesty.

I personally do not think patient modesty is a concern for babies in most cases. It does not bother me to think about how there is a mixture of both male and female medical professionals in NICU. It is not a big deal for a 2 year old boy to use a women’s bathroom in my opinion. There is a certain age that every child becomes modest at. Many parents teach their children when they are older that they should no longer expose their private parts to opposite sex. Many children also learn the importance of modesty from the fact that they cannot go to a public restroom for the opposite sex.

I personally believe patient modesty matters for children of certain ages and all adults. I believe patient modesty is important for elderly and adults with dementia and patients who are under anesthesia or in a permanent coma. One man shared with me about how his ex-girlfriend who was a trauma nurse made fun of male patients’ genitals while they were in a coma with her nurse friends. A patient who is under anesthesia or in a coma is still a human being who deserves to have his / her wishes for modesty protected as much as possible.

There are certainly patients who do not care about modesty of course, but the medical industry should not expect all patients to not be modest. The medical industry should always work to respect patients’ wishes for modesty and same gender medical providers for certain procedures regardless of reasons.

Here are some common reasons patients feel strongly about modesty and having same gender intimate care:

1.) Moral and religious convictions
2.) Embarrassed with being exposed to opposite sex
3.) Protect intimacy in their marriages
4.) Past sexual abuse
5.) Privacy and much more comfortable with same gender care

I encourage everyone to check out a list of reasons many women prefer a female gynecologist at http://www.patientmodesty.org/obgynpatients.aspx

Misty

 
At Tuesday, February 11, 2014 6:49:00 PM, Anonymous Anonymous said...

Dr. Bernstein I went back and happened upon a post of mine from 2005, my how time flys when your having fun. I have moved a bit in my position on this falls on the patient to express their wants and needs. While I stand by my position that it should fall on providers to ask, the culture is one that will not,only by making known what we want, and using our feet to achieve what we want will we get attention and movement. Worst case scenerio, you personally get what we want and don't affect change. The vast differences makes it nearly impossible for providers to provide a one size fits all, asking and attempting to provide individual care for each person is costly so to expect it I now feel is unreaslistic. That doesn't mean we have to be sheep and accept our fate, we do control the relationship for ourselves to a large degree.

I think the definition of modesty is as individualistic as our individual wants and desires so i support your attempt to come up with an agreed definition, i think perhaps you, Jean, Ed, and some others could come to an agreement but palerider, RJ, and others would gravitate to another. That said, good luck...don

 
At Tuesday, February 11, 2014 7:22:00 PM, Anonymous Medical Patient Modesty said...

I was very encouraged to see an ad with a picture of woman on this all-female ob/gyn practice’s web site that has a caption that says, “I feel more comfortable with a woman doctor”. I also really appreciated this sentence on the web site: Women, M.D. is a group of women OB/GYN doctors here to help women with their most intimate problems.

This practice is very sensitive to women who are modest. It is encouraging that there are doctors who really care about patient modesty. I just wish there were more all-male urology clinics for modest male patients.

Misty

 
At Wednesday, February 12, 2014 7:02:00 AM, Anonymous Anonymous said...

I agree that the definition of modesty, especially medical modesty, is going to be very individualistic. And I also agree that patients will probably have to speak up on their own behalf to get what they want out of the system. Those who have modesty concerns because of past sexual trauma should not, in my opinion, hesitate to tell medical providers the reason for their needs. Those of us who have modesty concerns merely because that is a part of us, due to our upbringing, culture, etc., should also make our wishes known and let providers know what will make us more comfortable. At this point I just say nothing ventured, nothing lost. I honestly feel that providers, when "clued in" will make their best effort to accommodate and make the experience one the patient can be comfortable with. In the end if this doesn't happen the individual always has the option to leave and find care elsewhere. This is what I plan to do in the future. Jean

 
At Wednesday, February 12, 2014 8:17:00 AM, Blogger Maurice Bernstein, M.D. said...

Within the article "Naked" written by Dr. Atul Gawande in the New England Journal of Medicine and was the basis for my ongoing Volumes regarding "Patient Modesty", he wrote:

A surgical colleague who
practices in Iraq told me about
the customs of physical examination
there. He said he feels no
hesitation about examining female
patients completely when
necessary, but because a doctor
and a patient of opposite sex cannot
be alone together without
eyebrows being raised, a family
member will always accompany
them for the exam. Women do
not remove their clothes or change
into a gown for the exam, and
only a small portion of the body
is uncovered at any one time. A
nurse, he said, is rarely asked to
chaperone: if the doctor is female,
it is not necessary, and if male,
the family is there to ensure that
nothing unseemly occurs.


This brings up an important area for education and discussion which we really have not previously discussed and that is modesty in different cultures and how these other cultures handle the issue with regard to the physical exam and procedures.

As you all realize, this blog tread is being read daily all around the world and the statistics counters show visitors from "non-Western" countries are also reading this thread. I would be interested in reading comments from those visitors in middle-Eastern countries and elsewhere with different cultures and religions than that of the U.S. Canada, England and Australia to relate how medical examinations and procedures are carried out in their parts of the world. Perhaps we can learn from them how they have "modesty" defined and managed there. ..Maurice.

 
At Wednesday, February 12, 2014 12:20:00 PM, Anonymous Medical Patient Modesty said...

Here is an interesting article: Modesty in Health Care: A Cross-cultural Perspective. This article addresses how different cultures view patient modesty.

It is interesting that a male doctor is usually more discreet in Iraq than the US. However, a chaperone does not change the gender of the doctor. Many people are uncomfortable with opposite sex intimate care even if they have chaperones period. A chaperone is often just for the benefit of the medical providers.

Think about those scenarios in non-medical settings:

1.) How would a modest man feel if a female reporter came to the locker room with a male chaperone to watch him changing his clothes? Would the male chaperone really change his mind about how he feels about the female reporter seeing him naked?

2.) How would a modest teenage girl feel about her father watching her taking a shower as long as her mother was present?

3.) How would high school girls feel about a male janitor coming in the girls’ restroom while they were taking showers and changing their clothes as long as the male janitor had at least one female assistant who could be a chaperone?


I feel chaperones are useless for helping to relieve patients who are modest and uncomfortable with opposite sex intimate care. Many modest people do not feel differently in medical settings. I am so tired of this notion that the medical industry often tries to force on us: Modesty does not matter in medical settings. . Also, chaperones do not always help to prevent doctors from doing something wrong. Check out: Do Chaperones Really Protect Patients?

Misty

 
At Wednesday, February 12, 2014 12:45:00 PM, Anonymous Medical Patient Modesty said...

I encourage everyone to check out this interesting article: The role of patient chaperones in clinical practice.

I was especially interested in this powerful male perspective from male_advocate on March 18, 2013:

 
At Wednesday, February 12, 2014 1:35:00 PM, Anonymous Medical Patient Modesty said...

Dr. Bernstein,

I find your statement:

As you all realize, this blog tread is being read daily all around the world and the statistics counters show visitors from "non-Western" countries are also reading this thread very interesting because it does not surprise me that people from different countries have visited your blog.

I have also discovered that people from different countries visit Medical Patient Modesty's web site as well. I have received emails from people from different countries who are concerned about patient modesty. I have discovered that some people have linked to Medical Patient Modesty's web site from their blogs or web sites.

Misty

 
At Wednesday, February 12, 2014 2:58:00 PM, Anonymous Medical Patient Modesty said...

For some reason, my second posting with comments from the male_advocate did not get posted on this blog.


The majority of patients do not want a chaperone, as borne out by the survey above. The real reason why they are so prevalent is because doctors demand it to protect themselves. Has a similar survey ever been done of doctors to find out how many would refuse to do an intimate examination of the opposite sex without one being present? If not, why not? Could it be because it would smash the myth that they are provided for a patients comfort and reassurance?
Let’s now talk about patient dignity double standards. Are statistics kept on the gender of chaperones offered? This should be 50% male/female to be equally fair to both sexes. However, I am certain that it would be show that over 90% of those offered would be female. Have these statistics been published and if not, why not? Could it be because it would reveal to the world that there is institutionalised sexual discrimination against men and a hidden secret of healthcare?

No problem then if you are a woman, but if you are a man, what happened to a right to choose? Is this not a breach of human rights? Now let’s reverse the situation in a hypothetical case.
You are a woman who is forced to agree to a male doctor giving you an intimate examination as a female doctor is not available. To compound the issue, he insists he needs a chaperone to watch (for your comfort!) and only men are available. A young man walks in the room and is not introduced. You had assumed that he would be a nurse or doctor but he is dressed informally and unbeknown to you, actually works in the office doing admin. You object but are told you have nothing he hasn’t seen before and he has been trained in the role and so is a professional. Your case is potentially serious so the examination cannot be delayed so she is forced to agree to it continuing. Does this sound outrageous and implausible? Well it happens to hundreds (thousands?) of men every day but I am sure almost never does to women.
As chaperones do not need to be medics, office PAs, receptionists and general office staff are all available to aid the doctor. However, these are almost always exclusively female and very often, young and attractive, making many men even more aware of their exposure and increasing their humiliation to new levels. How much longer can we allow this to continue?
Men cannot expect women to be concerned about this issue as it does not affect them and some may even find men’s embarrassment amusing and payback for female discrimination in the past.
However, men have been conditioned by society to believe they should have no modesty and anyone who does, is denigrated as being childish, silly or sissy. This attacks a man at his core of manhood and further humiliates and degrades him in a medical situation. That is why the majority of men just suck it up and bite their lip and let it happen rather than complain as they are afraid of the reaction they will get. Men act differently to embarrassment situations. Some make jokes to hide this, often as sexual bravado to mask their true feelings. Some blush and go quiet or complain softly. Some get angry. However, very few will complain about their embarrassment as to admit this only increases their humiliation. They cannot even complain when they get home as male friends will make fun of them and women say they should not be silly. So the status quo continues with no-one willing to drive the changes needed to make healthcare fair to all.

In my view it should be mandatory for all practises and hospital departments to have at least 2 men available to act as chaperones at all times. As already mentioned, there will be no shortage of female chaperones available without any extra effort. This will be a first needed first step on the long path to equal healthcare standards for all."


Misty

 
At Thursday, February 13, 2014 10:05:00 AM, Blogger Maurice Bernstein, M.D. said...

A matter of humanism in discussion:
What do you think about attempting to use the descriptor "man" or "woman" in place of "male" or "female" when writing about differences in gender? ..Maurice.

 
At Thursday, February 13, 2014 11:50:00 AM, Anonymous Anonymous said...

A matter of humanism in discussion:
What do you think about attempting to use the descriptor "man" or "woman" in place of "male" or "female" when writing about differences in gender? ..Maurice.
The symbolism is significant. We bloggers use male and female because that is closer to the way the medical industry treats patients, i.e. as objects. When the medical industry treats us humans with respect and dignity, we will use man and woman.
BJTNT

 
At Thursday, February 13, 2014 12:49:00 PM, Blogger Maurice Bernstein, M.D. said...

I would agree with the observation that BJTNT has commented upon. The medical profession DOES describe patients as "male" or "female" and not by "man" and "woman". It is sad because it looks like we are describing genders as one would describe genders within the "Animal Kingdom" and although homo sapiens are within that Kingdom, we are also most importantly men and women! ..Maurice.

 
At Friday, February 14, 2014 12:16:00 PM, Anonymous Medical Patient Modesty said...

What do you all think about advances in medicine improving patient modesty and decreasing invasive procedures in the future? Do you all think those advances could help to address patient modesty concerns? Some patients even go as far as avoiding important procedures due to patient modesty concerns. Screening for colorectal cancer is a good example.

Look at two articles I found about procedures that could replace colonoscopy:

1.) Given Imaging gets FDA clearance for colon camera pill - This is very interesting. I never knew that there was a pill camera. This has been used on patients who had incomplete colonoscopies.

2.) New At-Home Colorectal Cancer Test Proves Effective, and Inexpensive - The Doctor's Channel - I am sure more people would submit to this at-home. There are many people who avoid colonoscopies.

As many of you know, there is an article about colonoscopy and modesty on Medical Patient Modesty's web site. I had the privilege of helping a man to take steps to ensure that his wishes for an all-male team and colonoscopy shorts were respected last year. He emailed me back and said the clinic accommodated his wishes. We do not tell people whether they should have colonoscopy or not. Every patient should have informed consent about the cons and pros of colonoscopy. There are some complications that can result from colonoscopy. One lady recently had a colonoscopy and ended up in the hospital with acute diverticulitis that was triggered by the colonoscopy.

Misty

 
At Saturday, February 15, 2014 1:24:00 PM, Anonymous Anonymous said...

It seems we have two different camps. One that feels that modesty issues are different from sexual impropriety and the other camp that feels that the line is thin and needs to be examined.

For those of you who have never had a bad experience, just because it hasn't happened to you doesn't mean that it doesn't happen more often than thought. Sometimes the line is so thin, you won't recognize it until later or until something else happens. The line, however thin, can create havoc on trust issues with medical care that can and do effect patient medical outcomes and how they react in the future to the medical system and this is why this is so important.

Let's focus on the patient, to do no harm and on an analysis of what
causes harm when bodily exposure is involved and psychological trauma or humiliation results.

It seems to me that in order to fix a problem, the problem needs to be identified.

Just because there are laws and procedures that doesn't mean that they are being followed.

So, it boils down to this. Just like an investigation into patient safety is done on the medical side, one needs to be done on the mental health side. Medically, when something happens to a patient, they go over everything about the incident to find out what could have been done better and whether there was any malpractice involved.

The same holds true for this modesty issue because is effects someone's sense of trust and safety and sometimes trauma.

Complaints that come in need to be evaluated into categories (just like medical mistakes or possible mistakes). The personnel involved need to be tracked when something happens to find out if there is a pattern of either negligence or violation (in whatever form that takes).

Then there needs to be a system that makes the changes that need to be made, enforcing procedures that are not being followed, re-training for those who have a history of violations, and then deal with any criminal aspect when there is one.

Tracking medical personnel on modesty violations will establish a pattern whether negligence, mal intent or other issues. Medical personnel will then be identified and attached to their behavior for future reference.

While I agree with Maurice that leaving the door open, having naked patients in view of visitors
happens, we cannot accept this as acceptable. Something needs to be done. So, without making labels, who, on this blog would agree that this is a good place to start?

This post would have been made when we were on topic, but due to illness and power outages, I've been unable to post.

Would appreciate opinions on this posting.
belinda

 
At Saturday, February 15, 2014 6:27:00 PM, Anonymous Anonymous said...

Dear Dr. Bernstein,

Hi and thank you for your time to read this.

My husband recently had hernia surgery. Let me state most important is that he gets the best care there is, his procedure goes text-book well and most important awakens from anesthesia to be the wonderful husband he is and has been for 18 years. I truly DO care more about his procedure and recovery first and foremost.

I am the one those that freaks out that he may have a female staff member viewing his personal area which I feel is private and for MY eyes only due to the trauma I had as a child. With that being said, my kind and caring husband understands and respects MY wishes for an all MALE staff to reduce my stress which of course will reduce his, in all honesty. Don’t get me wrong, we have discussed this and he understands HE is doing this for me. If it were up to him he would be lying on a private nude beach in Florida. But this is for me and many others about a NON FEMALE STAFF that suffer from this fear of public display and to have it respected.

As a medical professional I hear more things than I have ever wanted to hear. “His thing looked very big” and the female nurses made fun and joked about it and said “I wonder if HE is married?” Did you see “that guy’s thing” “hope to see it again as he is gorgeous and can probably deliver as good as he looks”. “If he is married, let me take a few more looks before I have to go back to work”. “Let me take a peak at Mr. ????? thing before he wakes up” as it will totally made my day!”

These comments are unprofessional and it is sickening. Women are worse then men. Men at least say it to your face but these nurses huddle around and talk in the most disgusting fashion. I know, I am there to hear them which makes me rally full heartedly now for same sex medical care for those that want it.

My hubby made it well known to the surgeon and the patient advocate scheduling the surgery that it must be an ALL MALE STAFF. She did raise an eyebrow but wrote it in the chart to reflect his request. Ahhhhh. That’s where the surgical center will prove its worthiness….. In a perfect world, the chart clearly indicates the request weeks in advance so they can prepare and comply with his request.

Now….. let’s see what happens…..

These are the questions and circumstances we encountered AT the time he was admitted. Reminder…. We had it in the notes and the surgeon was supportive but you are at THEIR mercy once you arrive at the surgical facility… It was clearly in the notes but each and every area of the staff fought us with comments like…..
1. We do not have the staffing for this…. ah duh, it has been in the request 1 month ago…
2. Are you sure you have to have this specific request? YES! Do you think we made plans for this in advance to then change our minds about it? NO! We are sure and make it happen, an ALL MALE STAFF!
3. We are not sure we can do this. REALLY? Well, you’d better. We are paying thousands of dollars for this procedure, made our request known far enough in advance and you will make it happen or we are leaving right now. Why did YOU as a medical facility NOT plan for this? Shoes are NOW on the other foot. The patient asks the questions and it is facilities job to adhere to what THEY promised.
4. We asked in advance, YOU agreed. We WILL leave right now. Please note….. They have you and a loved one at their mercy and they THINK you will be ok with it. Guess what? WE WERE NOT! It is fortunate that we have medical insurance. Would you as a person PAY for a $15,000 car that you ordered and NOT get what you ordered?
5. DO NOT BACK DOWN!!!!!! It’s THEIR problem, not YOURS!
6. We won. I have the medical records to support who did what and they were ALL male. DON’T Back DOWN for a MALE or a FEAMLE STAFF!!!!!!!!!!

Did anyone else have this happen to them after making specific arrangements for an ALL male staff or and ALL female staff?

Thank you so much everyone!!!!
Scorpian

 
At Saturday, February 15, 2014 11:49:00 PM, Anonymous Medical Patient Modesty said...

Belinda,

The statement you made below:


For those of you who have never had a bad experience, just because it hasn't happened to you doesn't mean that it doesn't happen more often than thought. Sometimes the line is so thin, you won't recognize it until later or until something else happens.
is very important. We should never pretend that sexual abuse in medical settings is rare. It is much more common than we can imagine. This is exactly why patients should be educated about how to prevent sexual abuse in medical settings. Many sexual abuse cases by medical professionals were caused by patient modesty violations. For example, why would a male doctor demand that a 18 year old girl who came in for swimmer’s ears to disrobe so he can do pelvic and breast exams on her?

How about us saying that women should not worry about walking alone in a park at night because rape is very rare and most men in the community are wonderful men who would never hurt any women?

I like your idea of tracking medical personnel on modesty violations. I believe that this would help to decrease patient modesty violations.

Misty

 
At Sunday, February 16, 2014 12:06:00 AM, Anonymous Medical Patient Modesty said...

Scorpian,

Welcome to this blog! I am the founder of Medical Patient Modesty, a non-profit organization that works to educate patients about how they can stand up for their wishes for modesty and same gender medical care for certain procedures.

Your feelings that you should be the only woman to see your husband’s private parts are very normal. There are many wives who feel the same way as you do. Unfortunately, there are many female nurses who indeed make fun of men’s genitals. In fact, a man shared with me about how upset he was to hear his ex-girlfriend who was a trauma nurse making fun of male patients’ genitals while they were in a coma with her nurse friends. Your observations of some female nurses are sad. This is exactly why we need more male nurses for male patients.

It is interesting that the patient advocate you all spoke to raised an eye brow. Do you have any idea why she reacted that way? Do you think she thought it was strange that your husband wanted an all-male staff? It is sad, but many people think that men should just let go of their modesty.

You did a great job standing up firmly for what you all wanted. I really appreciate this statement you made: Would you as a person PAY for a $15,000 car that you ordered and NOT get what you ordered? If a patient does not get his/her wishes for all same gender medical team, he/she should simply leave. If more patients walked away, hospitals will be forced to honor their wishes because they would not want to lose money. Surgery is a huge money maker for many hospitals.

Can you tell us the role of each male medical personnel that was involved in your husband’s surgery? Did they put him under general anesthesia?

Misty

 
At Sunday, February 16, 2014 10:07:00 AM, Anonymous Anonymous said...

I agree with what some people have said on here about nurses saying things that are inappropriate. I had always known that if I someday I had to go in for some type of intimate medical procedure chances are there would be women involved all along the way. I had put it out of my mind because the concept seemed too humiliating to even think about. Like a bad dream except it's not over when you wake up.

I was at a friends place and a friend of his wife came over for a visit. There was a few of us sitting around the table when somehow the topic of her being a nurse in the ER came about. She for some reason started going on and on about how funny it is seeing men come in to the ER. Talking about how they sometimes get bored and go check out the guys packages and compare them. She said quite a bit of stuff along those lines and I can't even remember half of it. Us guys just sat there in disbelief of what she was saying. She suddenly left saying to another girl " I guess I said too much" and the girl nodded.

I asked my friends wife a few days later what that was about and she said " You have to understand she works long hours and is tired". I said " If that was a male nurse friend of mine saying such things about female patients you would have kicked him out of your house". She thought about it and looked at me and said " Your right. I would have".

I know she is probably a rare case but I found it interesting that the women listening to her didn't see much wrong with what she was saying. When the genders were hypothetically reversed it seemed to be a different story. Is this maybe our culture and media influencing these ideas. I mean in a movie when a man is uncomfortable and a female nurse tells him to strip down it is written to try and be funny and cute. Would it be funny and cute if a male nurse told a women to strip down with a smile on his face? He would be the bad guy in that flick.

I am not trying to stereotype either men or women in the medical arena. I am just curious why mens modesty seems to be taken as a joke in so many ways.

 
At Sunday, February 16, 2014 10:29:00 AM, Blogger Maurice Bernstein, M.D. said...

I tire with the continuous descriptions of the practice of medicine as either criminal or almost criminal behavior of the practitioners and that behavior as a basis for the development and persistence of patient modesty.
What a waste of time, money and family life for us to even consider to go into the practice of medicine only to be painted with that broad brush of criminality. Those who do this painting, think what you are implying for all of us doctors and nurses who are treating the sick.

I frankly think that virtually everybody develops their physical modesty from the teachings and observation of their own family. And each family will teach and do differently. If there are sexually traumatic events either related or unrelated to the medical profession, the numbers of potential patients with that experience I think are few.

This is my view and I know that most of the visitors writing to this thread will disagree but I think the presentation here of a possible alternate view is what makes a discussion a discussion.

If you are sick and need professional medical care, don't suffer at home because of the fear that the medical office is a park at night and you are going to be raped. This description is unfair for the time, finances and life we doctors and nurses spend in education and our profession developing our skills and all the patient good we accomplish and I do mean good.

I am not intending to ignore that the medical system obviously needs more attention and awareness of the extent and complexities of patient modesty issues that are out there but that we doctors and nurses should as a group be looked upon as potential criminals is shocking, misleading and just wrong. ..Maurice.

 
At Sunday, February 16, 2014 1:35:00 PM, Anonymous Medical Patient Modesty said...

Dr. Bernstein,

I believe there are many good doctors and nurses who would not sexually abuse patients. However, we cannot deny that sexual abuse can happen easily in medical settings. It is important that patients be educated about how they can take steps to prevent sexual abuse in medical settings. This is exactly why there are tips on Sexual Misconduct By Doctors’ web site about how to prevent sexual abuse by medical professionals.

I want to respond to your statement below:

If you are sick and need professional medical care, don't suffer at home because of the fear that the medical office is a park at night and you are going to be raped. This description is unfair for the time, finances and life we doctors and nurses spend in education and our profession developing our skills and all the patient good we accomplish and I do mean good.

I certainly do not think patients should avoid medical care. I am simply saying patients need to take precautions to make sure that sexual abuse does not happen. My example about how a woman should avoid walking alone at a park at night simply means that she should take precautions such as not walking alone. She should not avoid walking at the park for exercise. She should walk during the day while it is still light or have another man with her. There are so many wonderful men in the community who would never hurt her. Because there are a few men who could hurt a woman, it is important she takes steps to protect herself.

For example, all teenage girls should be educated that they should never disrobe or submit to breast / pelvic exams by male doctors. Many teenagers feel that they have to trust doctors completely. Think about this case: a male doctor did unnecessary breast exams on teenage girls for sports physicals. He did breast exams on only girls whose mothers were not present.

Look at this article about how a male doctor did pap smear on a 14 year old girl who came in for sore throat. There was no reason for this girl to disrobe or even have a pap smear.

Many years ago, I went to the ER at night for suspected strep throat infection. It is very important to get treated for strep throat because it could cause some serious complications such as rheumatic fever. I had a male doctor. I took steps to protect myself. I told him I only wanted him to do strep throat test and to keep the door opened. I kept all of my clothes on of course. You should be able to keep all of your clothes on for a strep throat test. He complied with my requests. Nothing inappropriate happened at all.

I had a good male pediatrician from the age of 6 until about 16 or 17. He always welcomed my mom to be present with us. I never took any of my clothes off at all for any visits with this pediatrician. A good pediatrician always will welcome parents to be with their children at all times. Dr. Earl Bradley who molested many children convinced parents to leave their children alone with him. That is how he molested those children. Check out tips about how parents can protect their children in medical settings.

Misty

 
At Sunday, February 16, 2014 1:40:00 PM, Anonymous Medical Patient Modesty said...

Anonymous on February 16, 2014 at 10:07 AM:

Unfortunately, it is common for female nurses to make fun of male patients’ genitals and what they see. It is interesting how your friend’s wife responded when you asked her if she would have kicked out a male nurse out of her house if he had talked like that about female patients. It is sad about how many female nurses think that male patient modesty does not matter and that female patient modesty is more important. Some people think that male modesty is a weakness which is not true. I really admire men who are modest.

Misty

 
At Sunday, February 16, 2014 4:37:00 PM, Anonymous Anonymous said...

"few" "few" "few"...

Yes, issues that only effect the few are unimportant and should be dismissed. I mean, there aren't that many gays so who cares what issues they are having. I mean they are like less than 10% of the population. And in some places African Americans make up a really small percentage of the population, so their issues shouldn't matter in those locations. If it's a minority of people, we simply shouldn't care about it.

Of course everything I said above was morally and ethically wrong and I don't support it at all. Understanding and protecting the needs of minorities is very, very, important. That is why this sentence is completely offensive:

"If there are sexually traumatic events either related or unrelated to the medical profession, the numbers of potential patients with that experience I think are few."

-RJ

 
At Sunday, February 16, 2014 6:03:00 PM, Anonymous Anonymous said...

Dr. Bernstein, all I can say is i feel your pain, and I am on the patient side of this discussion....don

 
At Sunday, February 16, 2014 6:27:00 PM, Anonymous Anonymous said...

A few is defined as not many but more than one. We
should not be concerned with the few who for years
looked the other way as was the case of the operating room nurses in the Dr twana sparks case. Nor should we be concerned with the patients of this physician, Dr. Yashwash Giri. "his actions made me question every single doctor,nurse,medical decision I encounter for the rest of my life.

There tends to be a logical breakdown in the thought
process when patients are subjected to any form of
sexual misconduct. The subject is suddenly not applicable in modesty forums because it affects only
a few. Hospitals go to incredible lengths to cover
up such behavior despite laws requiring hospitals
and medical facilities to report such behavior to
law enforcement in 24 hours.

Many state medical boards refuse to remain
transparent by concealing sexual misconduct
among medical staff. The Arizona state nursing
board no longer lists reasons of misconduct in
it's lists of cna and rn reprimands. Apparently,
perhaps it's an embarrassment for the director
to tell the public that yes, many female nurses
have felony records and yes, many are having
their license revoked for boundary violations,
sex with their patients.

By refusing to allow it into discussions is the same
as looking the other way. A behavior that the medical
industry is all to familiar with.


PT

 
At Sunday, February 16, 2014 7:27:00 PM, Anonymous Anonymous said...

It's a common dismissal tactic to say that rape and childhood sexual abuse aren't important because they are rare or unusual.

Unfortunately, they aren't that rare or unusual. 1/6 for Women. 1/33 for men (from Rainn).

We consider Celiac rare. That's 1/133.

It's NOT JUST A FEW PEOPLE. We are your patients! And yes - we are also your nurses and your doctors too. Your co-workers. Your students.

Do I think I'll be sexually assaulted at the Dr's office? Probably not. Do I think I'll be re-traumatized? YES.

And that's what I see everyone here talking about. They are traumatized by the way they were treated in the hospital. Can't stop thinking about it? That's called "intruding thoughts" and it's a typical trauma reaction.

Dealing with this patients in a better way where their modesty is respected and they aren't traumatized will lead to a better work environment for caretakers (less patients acting out), better outcomes for patients (more compliant with treatment, less stress reactions), and less lawsuits.

-RJ

 
At Sunday, February 16, 2014 8:45:00 PM, Blogger Maurice Bernstein, M.D. said...

So, RJ, what's the plan? When do we get started to attempt to meet your goal? And Misty, beyond giving patients "handy hints" how to deal on a one to one basis with their healthcare providers, what is the plan to fully educate and change the medical system to fully understand the patient modesty issues and change the system for the benefit of the patients to whatever degree the patients are uncomfortable with the present system? Let's be specific and let's get started! ..Maurice.

 
At Monday, February 17, 2014 3:43:00 PM, Blogger Maurice Bernstein, M.D. said...

There is merit to putting the public's opinion regarding patient modesty directly to the medical system.

From today's New York Times Op-Ed Contriubtor section:


Despite the intensely personal moments that happen in hospitals, patient privacy can be elusive. Hospitals are multimillion-dollar corporations that look like shopping malls and function like factories. Doctors knock on exam room doors to signal they are about to enter — not to ask permission. The curtain that encircles the hospital bed always lets in a crack of light.

Yet we do expect some degree of privacy in hospitals. We trust doctors with our secrets in part because they take a 2,000-year-old Hippocratic oath to respect our privacy, an oath enforced by laws like the Health Insurance Portability and Accountability Act. But sometimes, doctors have to weigh patients’ privacy against their health and safety, and that’s when things get complicated.

The use of video monitoring — covert or disclosed, of patients or providers — has proliferated as high-quality, inexpensive technology has become increasingly accessible. The possibilities range from watching elderly patients at risk of falling in their rooms to recording doctors and nurses at sinks to make sure they’re washing their hands.


..Maurice.


 
At Monday, February 17, 2014 4:45:00 PM, Anonymous Anonymous said...

Complete Op-Ed link:

http://www.nytimes.com/2014/02/17/opinion/a-watchful-eye-in-hospitals.html?ref=contributors&_r=0

Another physician who seems to "get it."

Ed

 
At Wednesday, February 19, 2014 8:05:00 AM, Blogger Maurice Bernstein, M.D. said...

Since I find those who write here strongly opinionated, may I offer a link to my new thread in which I am asking for an opinion regarding the ethics of a mother requesting that a posthumous retrieval of her son's sperm be obtained in view of his early death because he said to her in the past "he wanted to give her grandchildren". However, he had never discussed or written about making grandchildren after his death. ..Maurice.

 
At Thursday, February 20, 2014 12:57:00 PM, Blogger Maurice Bernstein, M.D. said...

Just to demonstrate that I am actively attempting to spread the word regarding patient modesty.
Today the following request was written by an officer of a medical school to a medical school education listserv. It is followed by MY response to the listserv subscribers.

And what are you all doing to change the system? ..Maurice.


Medical Scribes.

The primary function of a scribe is the creation and maintenance of the patient's medical record, which is done under the supervision of the provider. The scribe will document the patient's story, the provider's interaction with the patient, the procedures performed, the results of laboratory studies, and other pertinent information. This is accomplished by using a laptop or tablet computer, which the scribe takes with him or her throughout the shift.



Questions?

1. What is the future of medical scribes?

2. Is this a fad, or is this something that is more long-term in the face of Electronic Health Records and the economics of healthcare?

3. Now, when a physician come into the exam room, frequently they are actively recording/working a laptop and not facing or having eye contact with the patient. Can the medical scribe assist here with more direct patient contact?

4. What educational (or other training) should individuals be required to complete to be qualified as a medical scribe.


And now MY response to the listserv:



It is so important to preserve a worthwhile patient-doctor relationship, correct? That is why scribes are mentioned to allow the doctor to pay more attention to the patient than the keyboard and screen. But, the scribe that follows the patient and doctor around behind the desk or within the exam room has now created new relationship which may be termed "patient-doctor and scribe" relationship. And does anyone think that such a relationship can flower productively and humanistically? Patients already have varying degrees of modesty both in the physician's history-taking and certainly in physical examination and the presence of a scribe of either gender will intensify and not diminish any modesty present. It is unreasonable to expect a scribe to pick up all the nuances and significances developed by the physician's history taking and physical examination. The keyboard and screen replaced by a scribe in the room is, in my opinion, no improvement in patient-doctor relationship.

So what is the solution for the keyboard-screen patient relationship handicap? The physician narrating the entire visit via a clip-on microphone and recorded for later input as text into a computer system either by the computer program itself or some human. And what is valuable for the patient by listening to the physician verbally recording the notes is to be comfortable that the physician understands what the patient says as part of the history-taking and also is aware of concluding descriptions, the extent of thoroughness and attention the physician is paying to the patient's body in the physical exam.

I vote for NO medical scribes but other approaches such as more verbal communication from the physician to be heard by the patient. ..Maurice.

 
At Thursday, February 20, 2014 2:23:00 PM, Blogger Maurice Bernstein, M.D. said...

And, how about undergraduate college students learning to work as scribes and then being employed as such. "Working as a scribe is better pre-med experience than simply shadowing a single physician"

Here is a link to a university program for teaching and placing undergraduate student scribes.

..Maurice.

 
At Thursday, February 20, 2014 7:07:00 PM, Anonymous Anonymous said...

Why do undergrads need to get involved in medical care? Can't they get a job working in the medical office (interacting with patients, but not delivering care) or volunteer at a hospital?

I'm 100% uncomfortable with any kind of observer to my care.

(Unless it's a blood draw, send the students to prick me I'm so unafraid of needles)

-JR

 
At Thursday, February 20, 2014 7:19:00 PM, Blogger Maurice Bernstein, M.D. said...

JR, the rationale is to have some way of introducing the student who may want to become a doctor to see what the profession is all about from the doctor's side of the desk. Though the idea seems of benefit for the student's occupational education, I seriously wonder of what benefit it becomes for the patient. Once the student is already in medical school and on the way to the goal of caring for and treating patients, direct interaction with the patient (but first with the patient's approval and consent) is essential. ..Maurice

 
At Thursday, February 20, 2014 7:37:00 PM, Anonymous Anonymous said...

In one regard scribes increase the efficiency of
physicians. I see no reason why a scribe needs
to be in the examining room during the exam
process. It appears that a scribe violates the
reccomendations set forth for chaperones by
the AMA in that a scribe acts as a chaperone
while being privy to conversation between
patient and physician, which should be private.
I have seen scribes observing intimate exams
for which there presence was not needed.

PT

 
At Thursday, February 20, 2014 7:38:00 PM, Anonymous Paul said...

Are we going to have scribes when we see psychologists about personal private issues as well. I don't think I would be comfortable with that. Why would I be comfortable with somebody scribing my appointment during a physical exam.

If the patient is ok with it then it's ok, but I'm sure like other procedures if enough people don't bother to refuse, it too will become the norm. Then once again you will have to look like the nuisance patient when you protest.

 
At Thursday, February 20, 2014 11:58:00 PM, Anonymous Anonymous said...

Misty wrote on 14Feb:
1.) Given Imaging gets FDA clearance for colon camera pill - This is very interesting. I never knew that there was a pill camera. This has been used on patients who had incomplete colonoscopies.

I hope you are not encouraging people to forgo colonoscopies in favor of a pill camera. You cannot "back-up" a pill camera when some anomaly is present. With a colonoscopy, one can. Gerald

 
At Friday, February 21, 2014 12:02:00 AM, Anonymous Anonymous said...

I would want neither a scribe nor a chaperone when I visit a physician.

I found it very interesting to read "...which the scribe takes with him or her throughout the shift." This person would never be a "him." Most physicians hire almost exclusively female staff (about 95% by my personal observation). Gerald

 
At Friday, February 21, 2014 6:29:00 AM, Anonymous Anonymous said...

I believe that the use of medical scribes is yet one more violation of patient privacy and modesty perpetrated by medical professionals for their own convenience.
I would also speculate that it will create yet another double standard that will disadvantage men. I doubt very much that many male physicians will ever use male scribes because when they see female patients there would be two men in the room which would make many women uncomfortable and make physicians feel more vulnerable to charges of misconduct. As a result, if a man sees a male doctor who uses a scribe he can be almost certain that person will be a woman but of course we are supposed to be fine with that because as we all know men aren’t modest anyway.
One of the ironies here is that the use of scribes is simply not necessary. There exists computer voice recognition programs that could perform the same task at a fraction of the cost. Or if a physician is not comfortable with that method he or she could use a microphone to speak to a scribe located in another room with the patient identified only by number thus preserving his or her modesty and privacy.
It is up to us to resist by refusing to ever allow the presence of a scribe in the examining room and to spread the word to all our acquaintances that they have every right to refuse to have any additional personnel in the examining room without their express permission.
MG

 
At Friday, February 21, 2014 10:27:00 AM, Anonymous Anonymous said...

MODESTT ......is a big deal to me, as a patient. I have had my share of doctors; mostly outstanding and respectful to me. I did have one female doctor that made a negative-slang term about my private area. She hurt me so bed mentally, by her comment that I have not had a female exam since then. I reported it to the nurse Manager and nothing was done. I also don't like it when doctors are rough during the exam. I have many times gone home bleeding from the female examination. MODESTY should play a big part in the EDUCATION of ALL doctors. It is very hard to expose yourself to somebody that is a total stranger. I often wonder what doctors talk about to other doctors, in private. I know many doctors have issue's with obese patients...and that too is a delicate area they should approach carefully. Most obese patients are aware they need to lose weight. Some doctors blame everything on obesity, to the point they may overlook certain tests or bloodwork. All in all, doctors are human and make errors or social blunders...just like the rest of us. I have had my fair share ! Did I say "fair" !!!
Candace

 
At Friday, February 21, 2014 12:27:00 PM, Anonymous Medical Patient Modesty said...

Candace,

Welcome to this blog! Thank you for sharing your excellent insights! I am sorry to hear about your bad experience with that female doctor.

I am the founder of Medical Patient Modesty, a non-profit organization that works to educate patients about how to stand up for their wishes for modesty in medical settings. I encourage you to check out some articles about female patient modesty. Make sure you look at the bottom of that page.

You also may be interested in checking out another forum that deals with unnecessary pap smears and pelvic exams, For Women Eyes Only . This forum was developed by another woman, Sue. I comment there from time to time.

Misty

 
At Friday, February 21, 2014 8:15:00 PM, Anonymous Anonymous said...

Candace

Did you think for one minute the nurse manager would stand up for you, the patient. They stand up for their nurses not the patient, while you are labeled difficult. This is war and your first act should have been to throw the nurse manager and the physician under the bus. Never complain to the nurse manager,never. Patients never get a chance for
rebuttal.
Write a complaint to the chief medical officer,
and the CEO. State that you wrote a letter of concern
to the nurse manager but that he/she never responded. Complain to your insurance company, that
the physician was physically and verbally abusive, I
did say this is war, didn't I ? Write a letter to the system that the facility uses as feedback, Press Ganey, etc. Then file a complaint with the state
medical board. Go online to Yahoo and give the
facility a negative review and do the same for the
physician, ie health grades or Yelp. Capice?

PT


 
At Saturday, February 22, 2014 3:41:00 PM, Anonymous Anonymous said...

Patient modesty should be defined as avoidance of unnecessary exposure but it should not be extended as a religious edict that demands same gender care for all people even those that prefer opposite gender care. If a person asks for same gender care, the medical profession should do all it can to accommodate the request within reason. Likewise, if a person requests opposite gender care, the medical profession should also take reasonable measures to provide this.

Understanding this is a forum with some or most of the posters preferring same gender care, and the fact that lots of people prefer same gender care, there are also lots of people that prefer opposite gender care especially men. An example of this is men getting checked for prostate cancer by a team of female urologists. There was a 250% increase from the year before. The following link is the source:

http://jamaica-gleaner.com/gleaner/20131016/health/health2.html

The point that I am making is that when trying to accommodate same gender care, opposite gender care should not be prohibited or obstructed in the process for those who choose it.

Here is an example of a posting that wants to criminalize cross gender care:

http://bioethicsdiscussion.blogspot.ca/2013/12/patient-modesty-volume61.html#c7263919085990018252

and supported by this posting:

http://bioethicsdiscussion.blogspot.ca/2013/12/patient-modesty-volume-61.html#c602329091506601476

BD

 
At Saturday, February 22, 2014 6:40:00 PM, Blogger Maurice Bernstein, M.D. said...

For your information:

BD's second link has an error. The full contents of the second link is referred by Misty in the 3rd link. ..Maurice.

 
At Saturday, February 22, 2014 10:42:00 PM, Anonymous Anonymous said...

In an earlier post somebody said something about people from all over the worlds reading these posts. I was just curious if somebody is keeping track of the volume of people reading this stuff. How many is it?

I find this very interesting to read and would like to know how many people share our interest. Thanks.

 
At Sunday, February 23, 2014 4:05:00 PM, Blogger Patty M said...

Dear Misty,
THANK YOU so much for your support and understanding. I do apologize to you and the bloggers for my delayed response.
The reason for my delay was to ensure I was giving honest feedback from us (hubby and I) with direct interactions from staff.

I asked my husband to help me be honest and provide the detailed scenarios: To answer your 1st question… Do you have any idea why she reacted that way? No idea why…. We arrived and one of the two nurses came in and took vitals which we of course we know is common. Once done, my husband asked/remindered her that he has asked for an all MALE staff for the entire procedure. That’s when her “Eyebrows raised”. She walked away and did not reply at all. So, to be sure my husbands wishes were executed, I walked out to the nursing station to her and the following transpired:
I asked: My husband asked for the staff to be “All Male”. She replied: There are only two of us and we are both female. I said: We understand when it comes to vitals. I asked: are any Female staff needing to view any of his “private parts” (hernia surgery). She said NO. Quite Firmly. OK, Got It! THANKS!
I asked: Is ANYONE female for his pre-operative prep? She said nothing, I pushed further (mind you I know I had to be kind and calm as we are at their mercy), and asked, IS ANYONE “female” during the surgery and/or for Post operative surgery and recovery? She just looked at me, hesitated and that is when I said…. His notes specifically state and ALL MALE STAFF requested a month ago.. She then looks me in the eyes and says: I believe so. I said, the chart specifically states it “HAS TO BE” an ALL MALE STAFF”. She looks at me again and says, OH YES the, chart did state that. Still being calm outside (inside not so much) I said WHY did you not affirm this right away? She had no answer. So I pressed a little bit more and told the nurse, you are telling me this but please provide me with the names of “ALL” who will all be attending the entire procedure from this moment forward and we want to meet everyone before the surgery.
Guess what… It was done and the meetings of the staff began…..
Misty your 2nd question was:
Can you tell us the role of each male medical personnel that was involved in your husband’s surgery? Did they put him under general anesthesia?

The anesthelogiost came in and was a male. He said. “I usually do not work past these hours BUT I WILL stay to accommidate your needs”. He did say. “The female” anesthesologist sits behind a curain and would not see “very” much. BUT HE stated also he understood how we felt and wanted to be the anesthesiologist to do the procedure for us. And, he did.
The Two operative nurses that escorted my husband into surgery introduced themselves as well. Our surgeon came in, checked my hubby to ensure the correct side of the hernia (right not left) was being performed and had the surgical MALE nurse come in to introduce HIMSELF. At this point ONLY this male nurse would be caring for my husband once the surgery was completed.

One other HUGE factor patients need to know…. YOU have the RIGHT to CROSS OUT BEFORE ANY procedure with your surgeon/medical staff (i.e. breast exam, procedure etc..) some of the many following privacy factors you SIGN for RIGHT before a PROCEDURE….
1. PARTIAL OR FULL PHOTOGRAPHING OF THE PROCEDURE FOR EDUCATIONAL, RESEARCH, ETC….
2. STUDENT/STUDENTS MEDICAL OR NOT TO VIEW THE PROCEDURE while it is being performed or viewed later.
3. SOCIAL SECURITY NUMBER ASSOCIATED WITH AND/OR FOR USE OF PATHOLOGICAL STUDIES FOR FUTURE RESEARCH.

These are only a FEW of the items listed before you SIGN For consent. If you do not take the time to read it if or do not care, GREAT! We DO care and CROSS IT OFF.

To everyone…any comments about what I have posted? I DO NOT mean to offend the UMTEEM PHYSICIANS and MEDICAL STAFF that go above and beyond!!!!! I am a medical staff member and want to go above and beyond to help in the right way.

Thank you for your time.
Scorpian

 
At Sunday, February 23, 2014 6:58:00 PM, Anonymous Medical Patient Modesty said...

Scorpian,

It is wonderful that your husband and you took all steps to ensure that his wishes for an all-male team were honored. Sadly, many patients feel intimidated and do not feel they can speak up. I wonder if the female advocate would have reacted differently if a woman who was facing a gynecological surgery asked for an all-female team. It is sad, but it seems like our society and the medical system think that male patient modesty is less important than female patient modesty.

It does not matter how medical professionals feel. Patients’ wishes should always be priority number 1. Your wishes for modesty and same gender intimate care are more likely to be violated in operating room while you are under anesthesia than in a doctor’s office.

I hope to expand Medical Patient Modesty’s web site to include more information about how surgery patients can get maximum amount of modesty and same gender intimate care if they wish. I do have several articles for certain types of surgeries and procedures at http://patientmodesty.org/modestyforprocedures.aspx. Especially check out the one about gallbladder. It is possible for male patients to never have any of their private parts exposed for gallbladder removal surgery.

Thank you for your excellent tips about what to look for in a form and what to cross out! Many patients are rushed to sign forms. Some patients do not read surgery forms carefully.

We really need to educate as many people as possible about steps they need to take if they care about their modesty before they submit to surgery.

What kind of medical staff member are you? Are you a nurse?

Misty

 
At Sunday, February 23, 2014 9:10:00 PM, Blogger Maurice Bernstein, M.D. said...

"It does not matter how medical professionals feel. Patients’ wishes should always be priority number 1"

Misty, yes, patient's wishes should be given primary attention. However, how the medical professional evaluates the "wish" is going to be based on a number of considerations including practicality and some of which has to do with patient safety and efficacy and the professional standards to promote such safety with effectively completing the task. And there are some considerations by physicians which has to do with how they "feel", as a human (and they are humans and not robots). For example, the patient may "wish" for an abortion but this request may be violating the physician's religious or moral beliefs and the physician, him-herself need not follow that "wish" as long as the physician doesn't abandon the patient but attempts to refer to another physician to accomplish the patient's "wish".

In the doctor-patient relationship, both are humans, interacting with each other and "feelings" do matter on both sides of this relationship and should be recognized and understood by both parties. ..Maurice.

 
At Monday, February 24, 2014 6:32:00 AM, Anonymous Anonymous said...

I'm imagining a Jehovah's witness surgeon or emergency room worker who refuses to do blood transfusions.

Of course, JWs believe the end is coming any day now and many believe college is a waste of time, but that is slowly changing. We may have JW doctors some day.

Wouldn't it make sense for a JW doctor to work in a field where they won't need to give transfusions, if they have a moral objection to it?

That's my feeling on religious exemptions: someone with a religious objection to any form of medical care should find a job where they won't have that conflict.

-RJ

 
At Monday, February 24, 2014 7:02:00 AM, Anonymous Anonymous said...

Maurice,
Would you agree that a patient who has had a past experience with sexual abuse in a hospital,(coming to the hospital at a future date0 presenting with stroke symptoms
should be accommodated as a safety issue for same gender care due to the medical and psychological ramifications if not accommodated?
belinda

 
At Monday, February 24, 2014 10:12:00 AM, Anonymous Medical Patient Modesty said...

Dr. Bernstein,

I was ONLY talking about patient modesty when I made the below statement:

"It does not matter how medical professionals feel. Patients’ wishes should always be priority number 1"

Many medical professionals get offended or feel inconvenienced when they find out that patients do not want them to perform intimate procedures on them because they are not the same gender as the patients. I received an email from a female medical professional over a year ago who said that she was offended when a male patient declined to have her work with him because he was a Christian man who wanted to protect the intimacy in his marriage. The male patient requested a male medical professional who had much less experience than the female medical professional to do his procedure. The female medical professional said that she finally came to realize that patients have the rights to same gender care if they wish.

Think about how some urologists claim that it would cost them too much to hire male nurses or assistants for male patients who are modest. Those urologists are too focused on what works best for them rather than accommodating patients who are modest. Many men avoid healthcare because they know that their wishes for no female nurses won’t be honored.

Check out some articles that state that patients’ wishes for modesty should be number 1 priority.

1.) Tips For Nurses

2.) Tips For Hospitals

Misty

 
At Monday, February 24, 2014 10:22:00 AM, Blogger Maurice Bernstein, M.D. said...

I have nothing against same gender care if the patient desires same gender care. Now that we all agree, let's get about to change the medical system so that this possibility can be realized in every case. What is the next step? ..Maurice.

 
At Monday, February 24, 2014 10:37:00 AM, Anonymous Anonymous said...

Maurice,
A post was made my me within the last couple of weeks hat talked about a protocol based on identifying the problem whether it be from negligence, mistake, misconduct.

In order to fix the system, the causes must be identified. Then a protocol on how to track violations and who made them, and finally, the solutions to best fit what's needed. This makes sense and is the only way it can be cone because if you don't identify the problem in all of it's dimensions, then it cannot be fixed.
belinda

 
At Monday, February 24, 2014 11:06:00 AM, Blogger Maurice Bernstein, M.D. said...

Belinda, it may be the system that needs rehabilitation and not any individual healthcare providers "negligence, mistake or misconduct."So tracking "violations" may be inappropriate if it is the system itself that needs attention. If there is inattention by the system to every and all the issues regarding patient modesty or if the system, at this time, cannot provide uniform same-gender care, it is these issues which need to be considered for rehabilitation and not start with "tracking violations". ..Maurice.

 
At Monday, February 24, 2014 11:06:00 AM, Blogger Maurice Bernstein, M.D. said...

Belinda, it may be the system that needs rehabilitation and not any individual healthcare providers "negligence, mistake or misconduct."So tracking "violations" may be inappropriate if it is the system itself that needs attention. If there is inattention by the system to every and all the issues regarding patient modesty or if the system, at this time, cannot provide uniform same-gender care, it is these issues which need to be considered for rehabilitation and not start with "tracking violations". ..Maurice.

 
At Monday, February 24, 2014 5:16:00 PM, Anonymous Anonymous said...

BD I support your position 100% that to mandate same gender care is just as wrong as ignoring wishes for same gender care by some. I have said before some people don;t care and some prefer opposite gender. To say they do not have the right is just as wrong. I do however have to say qouting a 250% increase with all female care for prostate should be qualified for two reasons, first the sample size was so small, and second the reason given was because of homophobic fears. While this is an internationally read thread. I don't know that one could apply this to a wide segment of society. No doubt there are some who have homophobic concerns, but not sure you could draw any sweeping conclusions from a small sample group at a Rotary meeting in Jamacia....don

 
At Monday, February 24, 2014 8:23:00 PM, Blogger Patty M said...

Dr. Bernstein, Misty and other bloggers…. I am a Nurse and have been for 27 years. MY research has NOTHING to do with me and my husband’s personal requests for patient privacy. I just want to make that clear. I just feel this is the only site/blog that many of you support our private feeling and concerns and we are grateful. Plus, I can learn a lot based on your feedback which I as an abused individual and feel this blog is invaluable. Truly, I believe I learn something new everyday. 

My attention to a patient’s needs and concerns may encounter complex situations and take time but they are NEVER invaluable requests. Fear is fear. NO matter what age, sex, religion or anything. We are ALL individuals with concerns, fears and wanting the best care with the least amount of stress possible. I guess that is where I feel I come in, 1 patient at a time and help by providing my patients the “LEAST STRESSED EXPERIENCE as POSSIBLE”. I want to treat YOU the way I want to be treated.

Example: I had a woman which I thought had originally been scared to death of an antecubital blood draw due to needles but as we spoke for 20 minutes, I found out (based on her Hindu religion) she did not want to raise and expose her sleeve for a draw. So, once I realized her true fear, I suggested a hand vein draw so her arm would not need to be exposed. Now, it is a little more painful but a heck of lot less pain for her emotionally and I did the draw and she and her husband were ecstatic. It’s amazing what a little consoling and conversation can bring out and most importantly, alleviate her fear and still get the Doctor the blood draw she needed to find out what was making this patient so ill. A valuable win-win is where I as a medical professional follow the request and guidelines as well as find a balance and respect the physician’s instructions to a tee. It does not take too much extra time to identify each and every patients request to make it the least stressful when possible. Open your ears and LISTEN!

One specific concern I complete and BEG on surveys at medical facilities to ask is: Do you as a patient care if you are being seen by a male or female staff? SAY YES if you OR YOUR LOVED one feels this way. Believe it or not, over 77% DO NOT CARE. Facilities can only staff for this WHEN they know you have to have it. They WILL make arrangements for you if you have a preference.

Routine appointments: Patients most of the time did their homework. Many of these appointments are made for routine/advance exams and they KNOW as a patient if the Dr. is male or female before the appointment is made. ASK if you are not sure based on the name of the Dr. your appointment is with but be prepared IF a Drs office has multiple “back-up’s” with doctors. It’s NOT a bait and switch – the Drs office did not know you cared one way or another. TELL THEM! Now, those that are not embarrassed to ask… delve deeper and ask the question if a male/female is included in the exam while the physician is doing the exam and so on…

At another time I would be glad to list several major questions to ask the Dr., his staff, and specially a facility that will be doing an invasive and/or surgical procedure such as hernia repair, vaginal ultrasound etc….

People do not know what they do not know. But, what happens when we ask????

Thank you all,
Scorpian

 
At Tuesday, February 25, 2014 11:46:00 AM, Anonymous Anonymous said...

Scorpian:
Since you are a nurse I would be very interested if your fellow workers know how you feel about this matter and if so how do they feel about it? If you have not spoken to them about it, why not? It has been very difficult to get medical personnel to comment here so your postings are very appreciated. I also find it very encouraging that you feel every request is worth hearing and meeting if at all possible and it speaks volumes that you find it takes little extra time to do so. That is quite contrary to what we normally hear: that trying to accommodate patient requests for same gender care and/or serious attention to modesty throws a monkey wrench in the whole schedule. Any thoughts you can share about what others in your workplace feel about this modesty issue would be interesting. Thanks for commenting and thanks for understanding. Jean

 
At Tuesday, February 25, 2014 4:55:00 PM, Anonymous Anonymous said...

Thought readers might find this study interesting. It compared doctor's reports of their patients response to treatment vs patients self-reports.

http://www.medpagetoday.com/MeetingCoverage/MHNCS/44439

The magnitude of disconnect between patient and physician assessments was one of the more surprising findings in the study.

"I don't think it's unique to head and neck cancer. I don't think it's unique to our study. I don't think it's unique to medicine," Vainshtein said. "I think physicians tend to underestimate the effect of their treatment -- whatever it is -- on our patients."


-RJ

 
At Tuesday, February 25, 2014 6:12:00 PM, Blogger Maurice Bernstein, M.D. said...

RJ, thanks for the link and posing this contrast between evaluations of patients vs the treating physicians. I can easily see it extended to multiple other outcomes and conditions. Subjectively, it is only the patient that can truly evaluate the patient's outcome or the patient's view of the results of the doctor-patient relationship. And certainly how patient modesty is characterized and its longer lasting effect can only be made by the patient. ..Maurice.

 
At Tuesday, February 25, 2014 6:33:00 PM, Blogger Maurice Bernstein, M.D. said...

As I have written, patient physical modesty is not simply a "Western" issue and its management by medical systems is not necessarily how it has been described so far on this blog thread. We have had input over the years from visitors in U.S.,Canada, Great Britain and Australia. But, we do get visitors to this thread from other countries and their perhaps different cultures. I therefore encourage visitors from these other countries and cultures to write here patient modesty issues in their country and how they are handled in their medical systems. ..Maurice.

 
At Wednesday, February 26, 2014 5:13:00 PM, Anonymous Anonymous said...

Scorpian,welcome and glad to have a provider to share. You made the comment 77% don't care about the gender of their provider. I am curious where the number came from. I have never been asked either on an intake or other form or in person if the gender of my provider matters. While some say providers assume we don't care I would say they don't ask for fear or perhaps knowledge a significant number do care. I and a number of others have said I do not care about the gender of my provider UNLESS it requires exposure, colds, stitches, flu, whatever as long as I stay clothed I don't care. I have had so many conversations with people expressing being uncomfortable and embaressed by various procedures with opposite gender I would think the number higher, but I would guess the number that actually speak up to be lower. don

 
At Wednesday, February 26, 2014 6:55:00 PM, Anonymous Medical Patient Modesty said...

Don,

The points you made below:

While some say providers assume we don't care I would say they don't ask for fear or perhaps knowledge a significant number do care. I and a number of others have said I do not care about the gender of my provider UNLESS it requires exposure, colds, stitches, flu, whatever as long as I stay clothed I don't care. I have had so many conversations with people expressing being uncomfortable and embaressed by various procedures with opposite gender I would think the number higher, but I would guess the number that actually speak up to be lower. are excellent.

I agree with you that many medical providers assume that most people do not care about modesty because they are afraid that they will find out that many people do care. Many men actually avoid going to the doctor for male intimate issues until later in life. I do not think we can get a good survey for men because many men actually avoid the doctor. I’m sure that one of the top reasons men avoid doctors is due to modesty concerns.

You are right that most people do not care about the gender of their doctors and nurses for non-intimate health issues. I have never heard of a man complaining that he did not want a female nurse to give him a flu shot in the arm. Also, many people would not care about the gender of their doctors and nurses for certain surgeries such as knee, nose, hand, etc., as long as they were able to wear at least their underwear and surgery shorts and no private parts were exposed at all.

Look at the studies in Dr. Sherman’s article: Patient Gender Preferences in HealthCare about the high percentages of patients preferring same gender intimate care especially women. Dr. Sherman made the following points that are very important: Most men are loathe to admit that they are embarrassed by receiving care from women. They are frequently made to feel humiliated if they do. Women can have this same problem but it is far more acceptable for a woman to be modest than it is for a man. A man is likely to accused of sexism or suspected of homoerotic tendencies if he refuses opposite gender care whereas a woman will just be considered modest. It is much easier for a man just to avoid receiving any medical care which men do in far higher numbers than women who are forced into entering the healthcare system early in their lives for contraception and obstetrical care

Misty

 
At Wednesday, February 26, 2014 10:13:00 PM, Blogger Maurice Bernstein, M.D. said...

It is all the doctor's fault.. or is it?

I came to clinic at 9.15 am the other day. I was held up in the wards and was fifteen minutes late. My patient, a 40 year old housewife with poorly controlled diabetes was fidgeting outside my room. She was unhappy. I could tell. She entered my room and started berating me for my seeming lack of consideration for her time. By the time she was done, I had apologized a dozen times. We started with the consultation and to my chagrin, she forgot to bring her home sugar monitoring chart. Her blood sugar control was abysmal and her kidneys were starting to leak protein. She was obese and still gorges on fast food despite being counseled by a dietician. She has defaulted her appointment to the eye doctor because she felt ’her eyes are just fine’. She has not been taking her medication for the past week as she was visiting her sister and forgot to bring it along.

Before walking out of the room she had the temerity to say this: “ If only you could spend more time with me, you could have treated my diabetes better. You just had to be late.”

My years of training in medicine kicked in: “I’m sorry. It’s my fault. It won’t happen again”

She walks out. The next patient walks in. And the cycle repeats itself…


Read the physician's full story at the above link. Is all the blame with regard to patient physical modesty to be applied only to the healthcare provider? ..Maurice.

 
At Thursday, February 27, 2014 5:52:00 AM, Anonymous Anonymous said...

Don:
Excellent points. I wonder also where Scorpion got the percentage number for those who don't care about the gender of their provider. I also agree that many do care (when it comes to exams or procedures involving exposure) but do not speak up for one reason or the other. Also, many have already stated their preference by choosing a doctor of their preferred gender when it does matter to them. It's unspoken in that regard. Of course it's all the ancillary personnel that may impact that choice in a negative way. I honestly think that more people would be willing to voice this concern but they have come to accept that medical care is somehow different and that we should accept either gender in our care: that's just the way it's always been and most have gone along. Doesn't mean they wouldn't be more comfortable if they had more choice. It just means they will not make waves and speak up or they have just decided that's part of the deal and have basically sucked it up. And Maurice I do not believe that it is only the medical profession who should take the "blame" on the modesty issue but I do think they have more power to fix or change it. Jean

 
At Thursday, February 27, 2014 12:10:00 PM, Anonymous Medical Patient Modesty said...

Dr. Bernstein,

The article about the obese patient who has diabetes does not mention physical patient modesty. I can understand how it could apply. But I wanted to comment on how I feel about patients who refuse to follow advice to take medicine and change their unhealthy habits.

In the case of the diabetic patient, I personally feel that almost all of the blame rests on the patient because she won’t change her diet or take medication in the right way. Sometimes, doctors just cannot help that they are late because they have a backlog of patients. Even if the doctor had been on time for the appointment, it honestly would not have made a difference in the patient’s management of diabetes if she was unwilling to follow doctor’s advice and work on her diet. I really admire doctors who have to put up with difficult patients who won’t do important things to improve their health. I am sure that you, Dr. Bernstein has had to deal with very difficult patients who had health problems because they refuse to give up things that were harmful to themselves. Obesity is a big problem in America today because many people have unhealthy eating habits and won’t exercise. There are some people who do have poor metabolisms of course. There are some people who are not overweight who have unhealthy habits that could contribute to high blood pressure and heart disease. Sometimes, genes do cause health problems and it cannot be helped.

I am not sure if you watch My 600-LB Life. I watch that show on a regular basis and I am amazed at how Dr. Nowzaradan, the surgeon who specializes in operating on patients who are morbidly obese is willing to work with very difficult patients who do not want to change their diets and exercise. I really appreciate his bluntness with his patients when they do not lose weight like they are supposed to. He often has patients who get angry at him. I think one patient slammed the door in his face. Dr. Nowzaradan has helped to save many lives.

As for physical patient modesty, there are times it could be the patient’s fault. I know that this may cause some disagreement here. Let me share one example. Let’s say that a man who knows he does not want a female ultrasound technician to do his scrotal ultrasound for sure has already shared that he wants a male ultrasound technician and the medical facility said ok. But when he arrives to the medical facility, they inform him that the male ultrasound technician is out sick today and that he has the option of rescheduling the appt. until another day or that he can go ahead and have his scrotal ultrasound by a female technician today. The male patient decides he does not want to wait and just to go ahead with the ultrasound even though he does not want any female intimate medical care. In this case, the medical facility let the man know his options and that he can reschedule the appt. to have a male ultrasound technician. This is not an emergency situation.

Doctors and nurses should never use time as an excuse to not accommodate patients’ wishes for modesty.

Misty

 
At Thursday, February 27, 2014 2:00:00 PM, Anonymous Anonymous said...

Maurice,
I agree that the system is broken.
Are you suggesting that some easy fixes might take place such as:

providing adequate staff to accommodate gender issues for intimate care

tightening the rules about knocking, waiting for a response before entering

Consent form adaption for modesty issues and clarifying who will be in the room and for what reason

If so, this sounds like a great start. The system as of now is not willing to recognize it's broken even though there's enough evidence that men avoid intimate healthcare, patients are traumatized by inhumane treatment that degrades them and the lack of keeping track of offenders.

If this isn't what you're thinking, than how do you fix a broken system that neither recognizes that it is broken, nor knows why it is broken?

All we known that all of this is to the detriment of the public and the benefit of the system. Why would this system want to fix itself?

Documenting what has been happening gives purpose for the need to fix the sytstem, and indications where to start.
belinda

 
At Thursday, February 27, 2014 5:20:00 PM, Anonymous Medical Patient Modesty said...

Jean: You made many excellent points. Why do we have so many all-female ob/gyn practices today? Many doctors are actually aware that many women are more comfortable with a female doctor. It is obvious that many women especially younger women do not want a male gynecologist. About 80% to 90% of ob/gyn residents today are female. Survey results vary with age groups and areas. There could be one area where many patients do not really care about the gender of their doctor and nurse for intimate procedures.

Dr. Sherman’s article, Patient Gender Preferences in Healthcare was a very well-done article about the subject of gender preferences.

Many people are embarrassed to speak up about how they really feel. Patient modesty is a sensitive and embarrassing issue. Patient modesty is often a difficult issue for many people.

Misty

 
At Thursday, February 27, 2014 5:26:00 PM, Anonymous Anonymous said...

Jean I agree 100%, patients have been condictioned for so long that they should see medical staff as gender nuetral we have come to believe if we don't agree, there must be something wrong with us. We are the one with the problem, not the provider. While the comptetive nature of medicine is changing that to a degree, the stigma remains.
Dr. Bernstein are providers fully to blame, no not completly. You have used parables to illistrate a point before. A couple have a child, they have a room they prohibit the child from entering. They constantly remind the child he is not allowed to enter the room and scold or mildly belittle the child everytime he tries to enter. One day they decide it is OK for the child to enter the room if they choose, but they don't tell them. Are the parents completely at fault for the child not entering the room? After all they aren't preventing him, and all he has to do is ask or just walk in. I love the saying "to whom much is given, much is expected". This is paticularly applicable to trust. We are expected to place a great deal of trust in providers, should we also not expect a great deal from them on this issue. The power dynamics are theirs. Should we not expect them to at least ask? Now, knowing they fail to live up to that expectation, if it is important to us, we need to stand up for ourselves....don

 
At Thursday, February 27, 2014 5:58:00 PM, Blogger Patty M said...

Hello everyone,
Thank you for your reply and questions… I have been so worried about expressing how I feel about patient modesty and thought you all would think I was an alien with 3 heads because I feel so strong about it. Yes, I have been a nurse for many years.

The 77% is ONLY an average (NONE of my patients I encounter are asked as it would be unprofessional in my eyes). It is of me asking family, friends, neighbors, their friends and so on for about the last 6-8 years. Mind you, all of them (family/friends) know me VERY well and know I will ask new friends….
I start out by waiting to get to know them (of course), I ask them if they would participate in private research and I ask a question and start by letting them know I am obtaining/gathering information that is “totally and completely” confidential and their names will NEVER be used. I am only looking for answers to personal/intimate questions. If they say NO… NO Is NO!!!!

My questions start out:
1. Do you prefer a specific gender for intimate care? If yes, why? If no why? (this is a “yes” and “no” repeat after each question).
2. Does your spouse care for a specific gender for your care?
3. If the facility you are going to would offer it before you scheduled an appointment would that make a difference in your selection?
And so on….. As the conversation either ends at this point OR some people want to help others and ask “how” they can help and what to do with Dr’s offices, hospitals and so on….
At this point, many people do not “seem” to care which round about is 75%-77% give or take usually 3 out of 4 but NOW the last year to 2 years are changing to “YES”. I DO CARE! (Maybe it is just me paying more attention). DO not want to lie.
So, I probe a little more depending upon the conversation, how well I think I got to know them OR because family and friends tell them ahead of time.. Yes, they tell them…… I have this friend that “truly” is during research for a fear she has… I NEVER demand, only ask and thank them for talking to me. I usually get strange looks but it is amazing how curiosity gets the best of some. Okay I have now realized many more people ask “me” more about my study. How about we step away with you and your spouse or me and them with my friend or hubby (you get the message). DO NOT want to sound like I am a swinger and I make that CRYSTAL clear. I just want to get information ONLY to help individuals like me that ONLY accept “same gender staffing for intimate care. I insist upon a 3rd party for consent/witness for asking questions. Again, not wanting send the wrong message and re-stating my actual intent for research.

Please let me know if I can answer anything.
Thank you all for you care and concern….

Scorpian

 
At Thursday, February 27, 2014 6:25:00 PM, Anonymous Anonymous said...

Hi I'm a new blogger and found this an interesting topic and fully support this. I am a male that has recently had some procedures that have concerned me when it comes to what happens when a patient is under sedation. I feel vulnerable knowing that I have no control over what happens in the operating room at those times. Is there a better way to control the behavior of those that are in the profession and consider themselves to have a devine right to take liberties on an unconscious patient?
MT

 
At Thursday, February 27, 2014 9:34:00 PM, Anonymous Medical Patient Modesty said...

MT: Welcome to this blog! I am the founder of Medical Patient Modesty. I can certainly understand your concerns about operating room. Patients are most likely to have their wishes for modesty ignored once they are sedated or under anesthesia.

Can you share what happened to you?

The truth is the only way you can be 100% guaranteed that your wishes for modesty are not ignored in operating room is to have an advocate not employed by the hospital present for your surgery such as spouse.

Scorpian: Thank you for clarifying about the survey! You will always get different survey results. There is a certain group of women that I know who go to a certain practice with male gynecologists.

I am just curious. What are your thoughts about patients taking their spouses, friends, etc. to be present during their surgeries to ensure that their wishes are not ignored? Did you ever think about being present for your husband’s surgery?

Everyone Else: I saw a very interesting article in Outpatient Surgery today: OR Crowd Control . It is true that operating rooms do get crowded with many people. It is ridiculous about how many medical facilities have policies prohibiting family members or friends being present for patients’ surgeries and use the excuse, “We cannot let you in because of germs”, but then let as many people as possible in the operating room. Think about how those people may have a lot more germs than the patient’s advocate.

Misty

 
At Friday, February 28, 2014 9:27:00 AM, Anonymous Medical Patient Modesty said...

I just learned about a very disturbing incident at a hospital in United Kingdom. Check out this article: Visitors catch sight of surgeons operating on a 'naked patient' after blinds were left open at a hospital. It is so sad about how this patient’s modesty was not protected during surgery.

Also, I learned about this photographer who took pictures of patients who were naked for surgeries: http://vichinterlangphotojournalist.wordpress.com/2010/06/28/hopital-st-louis. One man had hernia surgery. The other man had arm surgery. It is ridiculous about how the man with the arm surgery was not allowed to wear underwear and surgery shorts. Check out the picture of the man with arm surgery. You will notice that a gown covers his private parts. I cannot help, but wonder if this photographer really had the permission from the patients to photograph them. Patients should always be allowed to wear underwear and surgery shorts for surgeries that do not involve their genitals.

This is exactly why every patient needs an advocate not employed by the medical facility to be present for their surgeries.

Misty

 
At Friday, February 28, 2014 11:58:00 AM, Blogger Maurice Bernstein, M.D. said...

Misty, why take pictures and then publish them and our blog thread provide links to them if the pictures are insensitive to the modesty of the patients and since we have no assurance the picture taking and universal, literally world-wide, distribution was permitted by the patient.

Degrees of nudity occur in most major surgeries but the exposure does not last long (with prompt covering) and during surgery the patient is fully covered. Yes, you might say it is unfortunate that a major artery and vein access to the body is located in either groin "within the genital area" and wouldn't you know that the groin which can be dirty with bacteria needs to be scrubbed with antiseptic before the area is covered. Misty, I saw nothing in the pictures presented which represent an unnecessary or degrading a patient's modesty during a needed surgery.

I would caution those who are unsophisticated in an operating room environment such as a family member as an "advocate" to be present during the patient's surgery since a vaso-vagal reaction such as fainting from observing what was going on will cause them to become a "second patient" needing attention or provide, by making verbal complaints at the time, perhaps a disruption to what should be a routine procedure. Anyway, these are my cautions to your post. ..Maurice.

 
At Friday, February 28, 2014 12:20:00 PM, Anonymous Medical Patient Modesty said...

Dr. Bernstein,

You cannot see the private parts of the male patient who had arm surgery because they took his gown off and put it on his private parts. I am uncomfortable with sharing pictures that show patients’ private parts fully . The point here is that at least several medical professionals saw this man’s genitals before they put the gown / clothing on his private parts. This was completely unnecessary for arm surgery. Arm is not connected to the groin.

The photographer has no pictures of the hernia surgery patient’s private parts, but he described what he saw. I’m sure the photographer has some pictures that were too revealing that he chose to not put on the web site.

Let me respond to your statement:


Degrees of nudity occur in most major surgeries but the exposure does not last long (with prompt covering) and during surgery the patient is fully covered. Yes, you might say it is unfortunate that a major artery and vein access to the body is located in either groin "within the genital area" and wouldn't you know that the groin which can be dirty with bacteria needs to be scrubbed with antiseptic before the area is covered.



Even a minute of exposure matters to many patients who are modest. Many patients do not want to be exposed even for a few seconds period. There are some surgeries that do require exposure of genitals such as hernia, gynecological, etc. But there is absolutely no reason for patients to be required to take off underwear for many surgeries. In fact, some hospitals have started allowing patients to wear 100% cotton underwear for certain surgeries. I did research and found some hospitals that did. It is very rare that a patient would need access to the groin for many surgeries. If that happened, underwear could easily be removed in a few seconds. I saw on one hospital’s web site that they suggest that patients take a shower and wash themselves with antibacterial soap before surgery.


Let me respond to your second statement:



I would caution those who are unsophisticated in an operating room environment such as a family member as an "advocate" to be present during the patient's surgery since a vaso-vagal reaction such as fainting from observing what was going on will cause them to become a "second patient" needing attention or provide, by making verbal complaints at the time, perhaps a disruption to what should be a routine procedure.



I understand your concerns. There are some family members who can handle blood and surgery. I believe the patient can find that information out and determine who would be a good personal advocate. For example, if a husband does not handle blood well, it probably would be best for the lady to look at having her friend who can handle blood well to be her advocate instead of her husband. It is very important to have advocates present for surgeries to make sure the patient’s wishes are honored. Patients who are sedated or under anesthesia cannot speak up and advocate for themselves.

Misty

 
At Friday, February 28, 2014 4:24:00 PM, Anonymous Medical Patient Modesty said...

I found out that patients can actually scrub their groin with antiseptic before surgery. In many surgeries, the groin will never need to be accessed. Patient should be able to do as much as possible to prepare for surgery so they do not have to worry about their modesty.

Here are some links I found:

Pre-Surgery Showers

Preparing the Skin at Home Before Surgery

Misty

 
At Friday, February 28, 2014 4:39:00 PM, Anonymous Anonymous said...

Hello everyone,

Misty in reply to your question below:
I am just curious. What are your thoughts about patients taking their spouses, friends, etc. to be present during their surgeries to ensure that their wishes are not ignored? Did you ever think about being present for your husband’s surgery?

Great minds think alike Misty! I would attend and want to be the observer for his surgeries. I’d do it in a heartbeat every time and he wants me to. I just asked my spouse and he said he especially would do it for me due to support my privacy respected. With that being said… please know that I “Do NOT want” ANY exposure nor is there a need for it especially if it is for a non-invasive procedure. Dr and others that know better please verify…. The only impact I am aware of is for the monitoring with EKG leads and the gown is loosely covering the chest (unsnapped) while undergoing certain procedures. NO reason boxers/panties need to be removed at all! Even if it is all women I do not want to be exposed AT ALL. I do understand things go wrong (02 level drops, EKG readings are concerning and so on. My personal experiences with me and hubby is that “some of the surgical and/or procedural staff” just toss your modesty out the window because they know you, the patient will NEVER know. I look at it this way…. If I were to be recorded every second of the day, don’t you think I would be the model citizen, wife, employee etc…. I use this as a way to measure myself to make sure I do the best I can as a person with family/friends as well as a nurse everyday.

Dr. Bernstein
I understand what you are saying but….. Medical students “think” they can handle watching the procedure as well as photographers and research technicians. Some of these candidates selected cannot stomach it one way or another, much to their dismay. The opportunity for spouse, family and/or friend to be an observer should under go the same criteria as the medical student/researcher etc…. If the staff knows they are being watched, I really think everyone would be one their toes.

Scorpian

 
At Friday, February 28, 2014 7:15:00 PM, Anonymous Medical Patient Modesty said...

Scorpian,

It is encouraging to me that you agree that patients have the right to have a personal advocate present for their surgeries. I am glad that you are a nurse who thinks that patients have the rights to maximum amount of modesty and same gender intimate care if they want. Medical professionals cannot deceive you if you have a personal advocate present to make sure your wishes are honored. I believe we also would see a decrease in deaths and injuries and infections if every patient had an advocate present.

I am not sure if you had the chance to read the story of Maggie from Utah who had the hysterectomy at http://patientmodesty.org/Case.aspx?GID=1. She had asked for an all-female team, but she was deceived and ended up with some males in the operating room. They gave her Versed so she could not speak up.

I think you would make an excellent patient advocate for women who want to be guaranteed all-female team for gynecological surgeries. Some husbands are not able to handle blood.

You are correct that family members / friends should be put in the same criteria as everyone else. I think it is so strange that they have a policy prohibiting family members in the operating room, but that they allow pretty much anyone else in the operating room.

Most bras especially underwire bras would not work on female surgery patients. A lady who recently had eardrum surgery was able to wear sports bra without any metals. Have you ever heard of this special bra, Digni Bra that was designed by two nurses in UK? I believe this kind of bra allows EKG leads.

Misty

 
At Friday, February 28, 2014 8:40:00 PM, Anonymous Anonymous said...

Scorpian, the fact that the people you polled knew you were a nurse could affect their responses. Likewise small samples without controls can give varied results but I applaud the effort.
So Dr. Bernstein, you are showering for work thinking no one is home. You get out of the shower to find out you forgot a towel, walk out naked to get one and low and behold there sits your female neighbor whom has come to see your wife, You make a hasty retreat to the bathroom. Does the brevity of your exposure make it not embarassing not uncomfortable? There are so many justificaitons, it is brief, we are professionals, we are used to it, it is no different than an arm to us. None of which ask the two important questions: Is it absolutely required? and more importantly Does it matter to the patient? We have had this duscussion before, the practice of forcing a patient to be naked for cateract surgery, for wrist for the minute possibilty they will have an unexpected event, and even smaller chance that the time it would take to remove shorts would materially affect the outcome. The medical community has decided it we are not allowed to make those choices on our own so they don't offer us the chance to make the informed decision. Once again the issue becomes providers thinking they have the right to make decisions for us rather then give us the right to make these decisions for oursleves,,,,don

 
At Friday, February 28, 2014 9:22:00 PM, Anonymous Anonymous said...

Misty and bloggers…..
I encountered recently though ….LIMITED scenarios where women “within the United States” may now wear an overly large white tee-shirt so women can get a mammogram done without having to expose breasts on the plates. Only caveat is that their Dr. needs to be on board. Which some of the Dr’s I work with are willing but MUST HAVE certain criteria met before they will even read the mammogram. But SOME opened minded Dr’s are on board. The NURSES have been causing a total UPROAR about it’s too much work and too hard to straighten the shirt and you name it… Blah Blah Blah… I can only imagine how many MORE women would be willing to get this done if their privacy could be respected. Talk about saving LIVES! The slightest deviance found would/could have a Dr. reading this result to identify an abnormality that NEVER would have been found since FEW FEW FEW Nurses and/Dr’s are willing to go this modest route.

So….. I over the last 4 months asked, 6 out of the 7 nurses… When was YOUR last mammogram? Answer…. I NEVER had one as I am below the age of 40. REALLY? Big Smile on me. Ok. And how many women have been asking about this NEW technique? Ah.. .A few out of a few hundred. OK, Fair enough as I asked the question. Now, two Dr’s willing to do it “mind you if more care/radiology is needed it is part of the agreement which exposure MAY be needed”). AKA.. .Full blown Mammography…. Ok.. I am still checking the results for this method… BUT, does not hurt ALL females to ASK for this method so all fellow females could get possible early breast detection identified with the ability to face the “Horrorifing and Painful Breast Squash Machine” and MOST, MANY women DO NOT OPT for a mammogram. EVER!

6 out of 7 nurses said huh? Ok, my turn….Since you are a mammogram technician/mammographer, I would suggest YOU GET one done and NOT just see it on “YOU-TUBE” or on-line. Put YOUR breasts (not just one, gotta experience what YOUR patients are experiencing) and let’s see what your responses will be. NO TAKERS… HUH… Wonder WHY?????? After months of being “so called friends” of these staff members” I just think I made a few enemies. Tough!

Misty, what research information about this “White Light Large Shirt On During A Mammogram” can you help us with? ANYTHING would be beneficial.

Thanks,
Scorpian

 
At Saturday, March 01, 2014 12:17:00 PM, Anonymous Medical Patient Modesty said...

Don:

I appreciate your excellent points. I really like your example about a man getting out of shower and realizing he forgot a towel so he went to another room where a female neighbor was present to see his wife. I’m sure that many men in this situation would be so embarrassed and leave the room as quickly as possible. The fact that it was just brief does not change the way many men would feel if they accidentally walked in a room naked with a female neighbor. It is frustrating about how the medical profession often cannot see that patients value their modesty even in medical settings.

It is ridiculous for patients to be required to take their underwear off for many surgeries that have nothing to do with the genitals. I received a very disturbing case of a lady who had surgery on her finger who woke up nude. They had taken her gown off. This lady was actually a nurse who had complained to the hospital about how she thought they exposed patients unnecessarily. You can see her story at http://patientmodesty.org/Case.aspx?GID=1. The truth is she could have easily had local anesthesia or nerve block on her finger and worn her street clothes (as long as there were no metal pieces). I have found some surgery policies on several hospitals’ web sites that state that patients can wear underwear for surgeries, but that they must be 100% cotton.

I saw this important information the other day:

Why do I have to take my underwear off before surgery?

During your procedure at ECSC, your surgeon may use an electrocautery device (Bovie) that allows rapid control of bleeding and tissue biopsies. This device uses electricity that, if it conducts through your nylon underwear or metallic underwire bra, may cause a burn. For this reason, we ask that you remove your underwear or wear only 100% cotton underwear without any metal pieces.

We know most patients would rather to wear 100% cotton underwear than no underwear.

I am so tired of hearing the excuses by medical professionals about why patients cannot wear underwear for many surgeries that have nothing to do with the genitals such as hand, cataract, etc. There is only a small risk that the groin would need to be accessed. I would say probably only 1% chance.

Scorpian:

I actually have never heard of “White Light Large Shirt On During A Mammogram” before. I believe that there might be some mammogram gowns or robes that protect your modesty as much as possible. Do you have any articles about this type of shirt that you have found that you can share here?

Misty

 
At Sunday, March 02, 2014 5:55:00 AM, Anonymous Anonymous said...

I've never needed to remove my bra or underwear for an x-ray, and they've gone right through the hospital gown without exposing the body part being x-rayed.

It makes sense... why would you need to go topless for a mammogram? It's an X-ray right?

-RJ

 
At Sunday, March 02, 2014 4:42:00 PM, Blogger Maurice Bernstein, M.D. said...

From DB this afternoon. ..Maurice.

I recently had surgery at . My problem was a hernia in the scrotum area. By the way I was amazed to find that all but one of the student doctors were female. During my stay in the hospital room I found that there was little modesty in front of the female nurses and doctors. Ecept for one older nurse I was always completely naked while my incision was being examined. It was located over my colon area and not having anything to do with my genitalia.
My care was given by a team of resident female doctors. One day in the door came 7 doctors in a class I suppose. They were doing my release examination. When it came time to look at my incision of coarse there I was naked again in front of the whole class. On the way out of my room the head female doctor made a comment that caused the whole class to snicker. It was a bit embarrassing also for the female nurse to remove my Catheter. Well at least it wasn't in front of a whole class.
I won't complain about anything like this formally. My over all care was very good!! Being a guy the whole situation had me laughing it off. However could you imagine if this situation was reversed. A female patient in front of a whole class of male doctors. OMG!!! They could of maybe mentioned a head of time what was going to happen. It is a teaching hospital so what can I say!! DB

 
At Sunday, March 02, 2014 5:05:00 PM, Anonymous Medical Patient Modesty said...

I learned about a disturbing column, Don't Let Modesty Make You Sick that was responded by Annie to this 22 year old woman who did not want a male nurse to remove her catheter after surgery because she strongly believed that no man except for her husband should have access to her private parts. This male nurse actually went to high school with the 22 year old woman. I have included the 22 year old woman’s comments and Annie’s response below. I was very disturbed by many of the comments people made at the bottom of this article. It is so sad that many people think you must give up your modesty in medical settings. Make sure you all read lefteddie’s excellent comments at the end.

Dear Annie: I'm 22 years old and recently needed an operation in the only hospital in our area. I am an extremely shy and modest female and would never go to a male doctor except in an emergency. Luckily, I was able to arrange for a female surgeon and an all-female surgery team.
However, while I was in the recovery room, a young male nurse — a guy with whom I had gone to high school — came into the room and told me he was there to remove my catheter. I was stunned. I told him there was no way I would allow him to do that. He tried to convince me, saying, "I'm a nurse. It's OK," but I wouldn't back down. He finally found a female nurse after I threatened to sue him if he came any closer.
Am I wrong to feel that a young male my age, especially someone I know, should not have access to the most intimate and private parts of my body, especially since removing a catheter is not an emergency?
I made a pact with my boyfriend that no male will see me undressed until I marry, and then only my husband. When I told my boyfriend about this nurse, he was ready to knock the guy's block off.
The idea that this nurse believes he has the right to violate me in such a way is keeping me from going back in for a follow-up operation. Do I have the right to forbid a male nurse from attending me? I was told that since female nurses can examine male patients, a male nurse should be able to do the same with females. The anxiety is killing me just thinking about it. What should I do? — Modest in Iowa


Annie’s Response:

Dear Modest: Most health professionals have no prurient interest in their patients. A nurse, male or female, who removes a catheter is acting solely in a medical capacity. He was not "violating" you. However, you are entitled to request only female nurses if the hospital can provide them. Please don't let your anxiety keep you from follow-up treatment.

Talk to your doctor about your concerns.

Annie


Misty

 
At Sunday, March 02, 2014 7:16:00 PM, Anonymous Anonymous said...

DB, a common misconception is that patients lose the right to choose who participates in their healthcare in teaching hospitals; nothing could be further from the truth!

Ed

 
At Sunday, March 02, 2014 10:17:00 PM, Blogger Maurice Bernstein, M.D. said...

"Most health professionals have no prurient interest in their patients."

I agree. Their interest is to complete their task of attending to the diagnosis, treatment, care and management of the patient's clinical condition without causing a delay or harm and then move on to the next waiting patient. Those who fear the medical profession should have joined it and observe and perform what goes on day by day. Yes, there obviously is physical modesty of varying degrees in patients but there is much more going on in the doctors, nurses and techs mind than intending to deliberately violate that patient's modesty for the caregivers' personal pleasure. If you can't accept my word on this matter, you know, you can always enter the professional activities to observe and help by becoming a hospital volunteer. It's that simple. Attend on the wards and in the emergency room and then you will readily see what is going on day in and day out and not just depend on hearsay comments on the websites, newspapers and elsewhere. Become a hospital volunteer and contribute to the care of patients but also educate yourself about what the medical activity is really all about. And it is not all about prurient interest by the practitioners. ..Maurice.



 
At Monday, March 03, 2014 5:45:00 AM, Anonymous Anonymous said...

Maurice,
I am disappointed that you did not respond to my last post.

It really doesn't matter whether a violation is intentional. It's the same as friendly fire. While there is no intent does the soldier not get shot? Same with this issue and that's why it's important to find out what is causing this problem.
It is a complex issue and needs to be analyzed to fix the problem.
belinda

 
At Monday, March 03, 2014 1:44:00 PM, Anonymous Medical Patient Modesty said...

I feel that Annie’s s response to the 22 year old woman was very insensitive. It does not matter if a medical professional is able to do intimate procedures without having prurient interest in their patients. It is pretty obvious that Annie has not done much research on sexual abuse in medical settings.

This 22 year old woman would not have felt any differently if she could be guaranteed that this male nurse would not have any lustful thoughts about her. She simply did not want any man who was not her husband to touch and see her private parts. The male nurse was very insensitive to her feelings when he made those comments: ”I’m a nurse. It is Ok” after she said no way. He should have simply said ok, I will get you a female nurse. It is obvious the male nurse was focused on his expertise as a nurse rather than how the lady felt.

One man here on this blog expressed that he would rather to have a young male nurse with a little experience than a female nurse with 30 years of experience. It is not about skills of doctors or nurses. Many patients just do not want opposite sex intimate care because they care about their modesty.

Misty

 
At Monday, March 03, 2014 9:45:00 PM, Blogger Maurice Bernstein, M.D. said...


Belinda and Misty, to achieve the goals of absolute adherence to the modesty and gender-selection desires of each and every patient and since there is agreement that the problem is not due to widespread sexual misbehavior of healthcare providers, then the approach should be to make changes in the medical system and its gender distribution of healthcare providers.

For example, no nurse should be required to attend to a patient for any activity as set by a schedule or the nursing supervisor but is simply set by each and every patient.

Education and active procurement by clinics and hospitals of male nurses should be encouraged and supported.

Surgery protocol and various medical procedures should be reviewed and changed to attend to each and every modesty concern and still provide effective and safe procedures.

Without these changes, I expect nothing will happen and the complaints described on this thread will never ever end. ..Maurice.

 
At Tuesday, March 04, 2014 8:56:00 AM, Anonymous Anonymous said...

In response to DB'reeletis post of March 2nd regarding being examined by a number of female nurses and students while he was completely naked, I would offer the following:
1. Even in teaching hospitals, one has the right to refuse to be observed or examined by students.
2. Since you say the incision had nothing to do with your genitalia, it is unconscionable that you were completely naked during examinations when you should have been draped so that only the incision needing to be examined was covered.
3. You say you won’t formally complain about this treatment. My question is why not? If men who are put in a situation like yours do not complain, these violations will happen again and again. Unnecessary exposure and snickering students are incredibly unprofessional and I hope for the sake of all future patients that you do file formal complaints regarding the manner in which you were treated.

 
At Tuesday, March 04, 2014 7:13:00 PM, Anonymous Medical Patient Modesty said...

Anonymous on March 4, 2014: I appreciate your excellent advice. You are right that patients have the right to refuse medical students to be a part of their medical care. I agree with you that it is important for patients to complain when they have been mistreated. I believe it is much harder for men to speak up or complain when they feel violated in medical settings.

DB emailed me the other day and I have replied to his email with some suggestions about how he can complain. I noticed that Dr. Bernstein chose to cut out the hospital name that DB had this experience at so I won’t mention the hospital here. But I can say that it is a hospital in Texas that was in the newspaper about a year ago. There were many sexual abuse cases at that hospital.

Misty

 
At Tuesday, March 04, 2014 9:31:00 PM, Blogger Maurice Bernstein, M.D. said...

Maybe part of the modesty problem in the doctor-patient relationship has more to do with the tendency of the doctor to maintain a "professional distance" from the patient. You may be interested in reading my 2012 thread on the topic of "professional distance" . Perhaps we should be quicker to ask "are you upset?" What do you think? ..Maurice.

 
At Wednesday, March 05, 2014 5:19:00 AM, Anonymous Anonymous said...

Maurice,

I agree with you. I'm referring to a post I made a couple of weeks ago about an example protocol of sweeping changes that would not only identify the problem but also put muscle behind it.

Until some changes occur, we patients have no choice other than make the demands and requests required for our health.

Please look at the protocol and give us your opinion.

I also agree that outright deviance is in the minority even though I was subjected to it.

There are some in healthcare that use their position to exploit the
vulnerability of the patient and use their power to be punitive or humiliate. This is an issue, will not go away until these people are singled out and put on notice.

Ignoring this part of the problem is paramount to negligence and doing harm to patients.
belinda


 
At Friday, March 07, 2014 4:31:00 PM, Anonymous Anonymous said...

While browsing the internet I came across a website that I found very thought-provoking. Some will agree, some will disagree, but none will forget about the subject. The wed address is www.modestyxxx.com I would be interested in your thoughts.

 
At Friday, March 07, 2014 8:10:00 PM, Anonymous Anonymous said...

To be honest I don't see a lot of problem with the response. I do not think providers go out of their way to humiliate patients for their own benefit, I do think it is just a matter of having their needs (time and efficiency) at a higher priority than their patients needs (modesty) I don't think they are doing it for kicks, and she is right, she does have the right to ask for same gender care. Not sure where the answer was that off or insensitive...just my opinion. Now for the guy with the hernia, not challenging double standards which in this case equates to sexism..supports and promotes it. don't suck it up, speak up or nothing changes...don

 
At Friday, March 07, 2014 9:04:00 PM, Blogger Maurice Bernstein, M.D. said...

I agree with Don and perhaps Don agrees with me in this:

Let's throw away from this discussion here on "Patient Modesty" that the medical profession in all its forms is as primary intent to "humiliate patients". And discard from this discussion that those who practice medicine are out to sexually attack patients for the practitioners own sexual benefit. And attributing such motivations to the entire profession because of the publicized and suspected behavior of some misfits is unfair to all doctors and nurses and unfair even to me and really does not identify the problem.

Yes, beyond our nominal teaching of the importance of attending to modesty issues of the patient to our medical students, obviously the teaching of the variation and magnitude and the consequences of inattention to patient modesty is missing and most students finally becoming doctors and nurses and going out into the practice don't seem to become fully aware and attentive about this issue.

We, professionals, despite whatever physical modesty we personally carry with us, do have an ongoing misconception that to an ill and suffering patient what is most important to that patient is to have the suffering resolved and the cause cured and that physical modesty is set aside for completion of those goals. And that is how it is..nothing more and nothing less.

So what is necessary is not to pick at and base changes on some professional perverts but attempt to change the misconceptions and inattention of doctors and nurses and their hospitals and clinics with what I previously described. If you suspect a pervert nurse, doctor or tech and have suffered an assault or battery from them, just go ahead and first notify the police in your community. That is the way to get things started to get rid of them.

So let's alter the approach to the discussion here to a more realistic understanding of what is the problem and approaches to make changes. We want the education regarding the true extent of patient modesty which I received over the years reading this thread to be now transmitted to others in the system. The goal now is to present realistic approaches to achieve that education and to see that the medical system makes the necessary changes based on that education. ..Maurice.


 
At Saturday, March 08, 2014 5:45:00 AM, Anonymous Anonymous said...

Maurice and Don,

I agree that the primary focus and result of healthcare is to take care of patients and not to do anything that would cause harm.

However, unless it's happened to you or you've investigated, you have no knowledge.

I work with a ph.D in psychology who specializes in healthcare. You would be astounded by the amount of complaints and the content of complaints. Some who work in healthcare like PT recognize and admit that there's a problem.

So, unless you are willing to look at the entire problem, not only are you digging your head in the sand, you are achieving nothing.

I have nothing further to say on this matter and find this blog has turned into a narrow minded view of what really goes on behind those closed doors. Don, how fast would you change your tune if something outrageous happened to you?

I speak from more than thirty years of my own experience, examining the way people are treated. The health psychologist speaks of many issues that will go unrecognized. It's almost the same way racism is handled, ignore it and it doesn't exist.
belinda

 
At Saturday, March 08, 2014 8:11:00 AM, Anonymous Anonymous said...

Freud was very interested in Hysteria, so he interviewed hysterical women and had a breakthrough:

Every women he interviewed with hysteria had been sexual assaulted during their childhood. He even published a paper stating so.

But then, other educated men scoffed. "Think of how many hysterical women there are! You really think that most men are deviants who rape children! How dare you suggest that!"

Freud then realized all these women were LIARS. They concocted these stories because of an innate desire of all children to have sex with their parents.

Thus, investigations into childhood sexual abuse were derailed for 100 years.

-RJ

 
At Saturday, March 08, 2014 9:19:00 AM, Blogger Maurice Bernstein, M.D. said...

Sexual assault or battery within a hospital, clinic or medical office should be reported to the local police as such just as sexual assault should likewise be reported if on the street.

I can't believe that patient modesty issues primarily arise out of physician or nurse behavior. Isn't there any evidence that people have their physical modesty developed from what they observe and taught by their parents when a child?

I think for this thread to have any merit and value, we must discuss approaches and methods to educate the medical system regarding the significant role patient modesty plays in medical/surgical patient care and the willingness of patients to be examined and have procedures when modesty issues as presented here are not considered or attended to by that system. If the lack of education by medical professionals about patient modesty is responsible for what appears to the patient as actions which sexually humiliate the patient then educate.

Don't obstruct this goal by repeatedly discussing frankly criminal acts which can be handled directly by report to law enforcement. ..Maurice.

 
At Saturday, March 08, 2014 1:22:00 PM, Anonymous Anonymous said...

Maurice


The first step in recovery for alcoholics
and drug abusers is accepting that they have
a problem. The medical industry has a lack
of acceptance and continually refuses to
acknowledge it, even you often side step the
issue just in your last several posts.

In one post you mentioned that although
not your exact words you said that the medical
community would never use nudity to coerce
patients to comply. Joel Sherman says otherwise
( military induction exams) and yet, I have seen
this scenario played out many times in healthcare.

The end result when one physician disagrees
with another physician, he said,he said. The
patient is the one who suffers in the final analysis
and often a lawsuit ensues. When will the medical
community come out and say, yes there is a
problem?
Furthermore, you say that most health care
professionals have no prurient interest in their
patients, I disagree! A thorough review of every
state medical board, nursing board, google
search of medical misconduct would quickly
debunk your suggestion.

For the many readers of this thread I will be
reaching out to all of you in hopes that we all can
through a series of calculated steps get the
message out there.


PT


 
At Saturday, March 08, 2014 1:50:00 PM, Blogger Maurice Bernstein, M.D. said...

PT, you are right on the ball when you write "we all can
through a series of calculated steps get the message out there." And is exactly what should happen here:
1. Define the message.
2. Decide how to get the message out to all of the medical system.

That is exactly what I want to see written here. Everything else has been repeated and repeated and repeated during the 8 1/2 years and probably thousands of postings. So now, let's get going on the message and how to deliver it. ..Maurice.

 
At Saturday, March 08, 2014 7:26:00 PM, Anonymous Anonymous said...

Dr. Bernstein, we are obviously on the same page with the roll sexual assualt, rape, etc play in this discussion. I agree that to a degree the focus on the physical aspects can cause other issues such as modesty to be lost on providers. However, I would like you to wiegh in on my theory on this. I believe that modesty is as much a victim of the desire, perhaps need for providers to make a profit as concern for the medical aspects. Attempting to accomodate modesty of every patient would be very inefficient and add labor and expense so providers must find a way to deal with it as efficently as possible. Adopting the mantra of gender nuetrality is part of the solution. The issue becomes a little more obvious when providers defend accomodating their own modesty in nursing/medical schools, and in care with excuses such as we know each other. Further I believe providers have adpoted the position they have risen above scrutiny because they are professionals and this makes them and the situation different. I believe this is both self defense for doing something they may know deep down is traumatic for the patient and conflicts with their desire to do no harm...and to some degree arogancy in their position and profession elevates them and the challenge is somewhat offensive...don

 
At Saturday, March 08, 2014 10:35:00 PM, Blogger Maurice Bernstein, M.D. said...

Don, I would disagree that providers know "deep down" that the way they handle the patient modesty issue (with the routine cautions since medical school) is traumatic for the patient. They are just like me before I got educated by this thread and never realized that just because patients were not complaining about how their modesty issues were being handled by their doctors and nurses, that patients understood medical standards and necessities required for safe and effective diagnosis and treatment of their symptoms. If the medical professionals and the managers of the medical system would only come and read my blog, they too would become educated. It is about their ignorance and not their lack of care for the patient or any arrogance associated with being a doctor or nurse. Trust me.. it all has to do with ignorance. That is why "speaking up to your doctor and nurse" is essential to educate (one on one) but, of course, more needs to be done to educate the system and make the necessary changes so that requiring each patient to "speak up" will be substituted with standards and protocols to see that modesty with gender selection if requested will be routinely attended to. ..Maurice.

 
At Sunday, March 09, 2014 6:24:00 PM, Anonymous Anonymous said...

Perhaps traumatic is a bit strong in general. For some it is definately traumatic but for many more at a minimum it is uncomfortable. I understand your position that providers take silence as consent and can see that as being valid to a large degree. However, when we see the effort to accomodate, as PT indicated male mamograghpers are pretty much non existent, etc there is obviously some recognition at some level. I do believe that over time providers come to believe we are OK with what they are doing because we don't resist, but given their own discomfort when they are asked to partcipate in their education, when they are patients, etc I struggle to believe there is no recognition the patient is uncomfortable. There appears to be some recognition that females may be uncomfortbale with males but little of the reverse. Sometimes knowing, and admitting to ourselves are two different things. The second part of this is the efficiency, why did male orderlies disapear? Because of cost, there was a recognition of the value of same gender to comfort at one time. As institutions recognized they could get away with not providing what was comfortable, they stopped. I think the issue is parts of all 3, ignorance, denial, & efficiency. What the proportions are, is up for debate,...don

 
At Monday, March 10, 2014 2:12:00 PM, Anonymous Medical Patient Modesty said...

Belinda:

I really appreciate your excellent points on Saturday, March 8th. Please do not quit commenting on this blog. Since I started Medical Patient Modesty a few years ago, I have found out sexual abuse in medical settings is far more common than we can imagine. I wish that sexual abuse in medical settings rarely existed or did not exist. I heard from one lady a few years ago who was sexually abused by a male gynecologist. She shared that her psychologist told her that sexual abuse by doctors was pretty common.

I just recently finished reading a book, A Medical Affair a fiction book about a patient who was “coerced” to have an affair with her doctor. The author, Anne Straus has a special interest in victims’ rights. There were some excellent points in the book. The doctor also had affairs with other women, but they would not report him because they were afraid that it would ruin their marriages.

This author made some very important points. I wanted to share one important point about why sexual misconduct by medical professionals is underreported.

” The process of bringing an abuser to justice can be horribly revictimizing. That’s one reason nearly all victims of sexual misconduct fail to report it. Fewer than two percent even consult an attorney”.

I agree with Dr. Bernstein’s statement: Sexual assault or battery within a hospital, clinic or medical office should be reported to the local police as such just as sexual assault should likewise be reported if on the street. But it is much harder for patients to report medical professionals because they have so much power. It is very hard to get medical professionals in trouble. Plus, look at the above paragraph about why it is hard for victims to report sexual abuse. Also, patients should report to state medical boards and the hospital.

Misty

 
At Monday, March 10, 2014 2:33:00 PM, Anonymous Medical Patient Modesty said...

Don:

I was also concerned about this statement you made;


I do not think providers go out of their way to humiliate patients for their own benefit, I do think it is just a matter of having their needs (time and efficiency) at a higher priority than their patients needs (modesty).



While it is true that there are some great doctors and nurses who do not humiliate patients, there are many who have crossed the lines. We have seen so many examples on this blog. PT has encountered some nurses who humiliated patients.

Here are some examples to look at:

1.) Discussion about how his friend’s wife made fun of male patients’ private parts on February 16th

2.) LKT who had a conversation with a female CNA who told her that she could not wait until she could shove a catheter in man on September 5, 2013.

3.) PT shared about how some female nurses talked about men’s penises on Facebook on September 29, 2013. LKT made some excellent points the next day. What she said is very true. Many female nurses may make fun of male patients with their nurse friends or other people behind the scenes. One law student shared with me about how his ex-girlfriend who was a trauma nurse made fun of unconscious male patients’ genitals.

PT: I am glad to see you back on this blog. You have made many excellent points. It is strange that medical professionals are not held to the same standards to other people. The medical industry often denies that some of their medical professionals have problems. You should email me through Medical Patient Modesty’s web site. I’d like for you to share some of things you’ve researched.

The article about military induction exams by Dr. Sherman can be found at http://patientprivacyreview.blogspot.com/2010/11/military-medical-humiliation-german.html.

Misty

 
At Monday, March 10, 2014 3:16:00 PM, Blogger Maurice Bernstein, M.D. said...

Do we still have to discuss more frank sexual abuse, sexual assault and battery as the most essential activity that gives rise to current issues in patient physical modesty?

I can't believe that criminal activity in the medical profession is behind any or all individual patient's concern about how their own wish to avoid exposure of their "private parts" to anyone beyond their husband or wife. To me, claiming that this activity is the basis for modesty in general is ridiculous.

What I think is not ridiculous is to consider that physical modesty to whatever degree is a learned experience over the years and varies in degree from person to person and that most doctors or those running medical systems are ignorant regarding the patient's importance of maintaining their particular degree of modesty despite and irrespective of the medical examinations or procedures necessary for the patient's diagnosis and treatment. Period. ..Maurice.

 
At Monday, March 10, 2014 4:55:00 PM, Anonymous Anonymous said...

I was watching this video about objectification.

http://www.youtube.com/watch?v=kMS4VJKekW8

It's a great video that really explains what objectification is.

And I couldn't help but think that this model of "subject who acts upon object" is exactly how the doctor/patient relationship is seen in medicine.

The patient is the object being acted upon by the medical personnel.

When there is a direct patient/provider relationship, you can have some semblance of a partnership. Add an onlooker - a student, scribe, a shadower - and that illusion of partnership goes out the door and you're left with the patient as an object.

Watch the video, and then think "how are patients objectified?"

-RJ

 
At Monday, March 10, 2014 6:00:00 PM, Anonymous Anonymous said...

I have absolutely no concern that providers are evil, abusers, are going to molest me, or any thing close. I do have modesty concerns, and they have nothing to do with illegal or criminal activities. Dr. Bernstein I hope you don't take my challenges as meaning I think you are not being truthful. When we operate inside a closed community such as providers we tend to assume the mores of that community. Those beliefs and actions become the norm and to a degree reality within that community. We then apply that to those outside the community. I doubt there is a person on this blog who has not heard a provider joke about exposure of patients. In it's simplist for take the infamous gown. Go to all nurses or many other sites, go to a card shop, there are numerous references to the embarassment of patients wearing the I-C-U gowns (i see you). The recognition is there in numerous areas, the acknowledgement is not. There have been numerous articles, interviews, and controveries over females in locker rooms. Have you ever seen one where the reporter acknowledges the athelete is or may be uncomfortable? I haven't. Does this mean the reporters are completely ignorant that some might be uncomfortable? I have seen players complain on their own but never from the reporter. I see a lot in common with the way the two handle these situations. It is to their benefit to claim ignorance, even to themselves. Sometimes we believe what we need to believe. I mean this in all sincerity Dr. Bernstein, I am trying to understand this...how do you explain what appears to be recognition of the issue (i.e. mamography) and yet, at the same time claim ignorance? The vast majority of new ob/gyn will be female...how does the medical community reconcile that and claim complete ignorance? How does recognition in one area not transfer to others. I have no imperical evidence to back this, but I still suspect it is more a issue of acknowledgement, both to self and outside, rather than ignornance....don

 
At Monday, March 10, 2014 7:43:00 PM, Anonymous Anonymous said...

Do I think there are some bad providers, yes, have I seen the posts and debated nurse on allnurses about their lack of respect on their posts, yes. Do I think the majority of providers are doing things with malice, NO I DO NOT. You can see all sorts of bad things SOME soldiers did in Viet Nam, does that mean Viet Nam Vets are mainly bad, deserved the lack of respect they endured, and should be judged by that measuring stick, NO I DO NOT, lets toss Cops in there, do a majority of cops get involved in corruption or brutality? NO I DO NOT believe that. If you choose to view providers as mainly evil, out to do harm, that is your decision and I cannot do anything about it. I am troubled by the fact that some of you choose to judge and cast the many good people in the field like this. I just finished reviewing applications for a medical scholarship we sponsor. Among the section they fill out school disciplinary history, 12 apps no violations, GPA & SAT's high to very high, community involvement & vol. activities, exceptional. These are not bad people Are there bad people in the field, of course there are, but I refuse to believe that is the rule or a significant number. Believe what you want, my experience is the opposite...even the experiences that were so troubling, were not done from malice and they were very respectful, still was troubling, but not because they were evil.......don

 
At Tuesday, March 11, 2014 10:49:00 AM, Anonymous Medical Patient Modesty said...

Don,

I think it is wonderful that you help to provide scholarships to male nursing school students. This is a good way to encourage more males to become nurses so they can help to accommodate male patients who are modest. I have some questions I’d like to ask you about the scholarships you provide.

1.) Do you provide scholarships just for the closest nursing school to your hometown?

2.) Do you have any interactions with the nursing school you provide scholarships to? If so, what kind? Have you explained to them how important it is to increase male nurses because of patient modesty?

3.) Do all of the male nursing applicants you award scholarships to know that you have a special interest in improving male patient modesty?

4.) Do you keep up with the male nursing students who you have awarded scholarships to after they graduate from nursing schools? Do you know where they ended up getting jobs at?

Misty

 
At Tuesday, March 11, 2014 6:06:00 PM, Anonymous Anonymous said...

The scholarship is given each year with some preferences, (1) males entering nursing (2) improving diversity (3) returning to the county (4) a medical need i.e. imaging, PT, identified by the local hospital. Last year it went to female PT student, no male nursing students applied. This year same scenerio. The 2nd part of this is we just started a program to promote the scholarship targeting males in an attempt to get them into some of the pre nursing programs such as shadowing that are almost exclusively female at this time. I am on the selection committee, present it, but beyond that am not involved. I think the key is getting more young men to understand this is a good profession for males. The scholarship is as much to make them think as much as funding...don

 
At Tuesday, March 11, 2014 6:59:00 PM, Anonymous Anonymous said...

I am also concerned about modesty. I'm more concerned about the criminal angle than I am about being coy, shy, or believing that one's spouse should be the only person who sees one's body. While MOST providers do not do anything out of malice, there are a significant number of prosecutions and convictions of healthcare providers from everything from taking and publishing nude photographs of their unconsenting patients to exposure, fondling, to outright rape. Even more frequent is performing procedures without consent of the patient.

All healthcare providers are human beings. Humans have sexual interests. That cannot be trained out by any amount of medical training. One person may be more or less uncomfortable with that than another. That is precisely the reason that we have separate mens and womens restrooms. Even though there is not much exposure in a women's restroom, women are just not comfortable with a co-ed restroom.

Some percentage of providers abuse their patients. I hope it's small, but reporting is mostly confidential. There are some who are convicted of assaulting and abusing their patients - sexually or otherwise. Now, it puts one in a much more compromised position if one has gotten naked in front of the provider. That may set off a healthcare provider who really is a sexual predator.

Really, there is no way to tell if the provider you are seeing is a sexual predator or not. IMnsHO, it is better to be safe than sorry. Just as I would not be alone in a secluded area with a man I do not know, I choose to not bare my body in front of a man I barely know, giving him access and visual stimulation which could lead that direction.

 
At Tuesday, March 11, 2014 9:06:00 PM, Anonymous Anonymous said...

Dear Dr. Maurice,

I think you have an extremely common sickness which plagues many doctors, we call it the "narrowed mind", this is when your thoughts are what is true and the reality is ignored.
The fact to the matter is that while you may want to make your quick buck, undressing and diagnosing all naked men, women, children as possible, it would be more prudent to direct them to a more appropriate doctor for their needs and someone who would show such respect.
Criminal behavior in the medical profession is all too common and just saying that it does not exist is not solving anything, calling it ridiculous does not either. For me, personally, I am very scared of how I have been treated before and will not go to a doctor who would speak like this, with complete disregard for the people you should be treating. You should be helping them, not objectifying them and claiming that the procedures are more important than your ability to respect people.
Why can't we be respected in the doctor's office? The almighty dollar should always take a back seat to Personal Modesty and you should learn that patients are people too.

 
At Tuesday, March 11, 2014 9:46:00 PM, Blogger Maurice Bernstein, M.D. said...

Anonymous from 9:06pm today, when you write attributing the following to me:
"The fact to the matter is that while you may want to make your quick buck, undressing and diagnosing all naked men, women, children as possible, it would be more prudent to direct them to a more appropriate doctor for their needs and someone who would show such respect." There is no "quick buck" for the most of the physicians which certainly includes me. I deny that I have ever undressed or examined any "all naked" patients or either gender or age. There would be no rational medical standard for me to do so. I practiced as I now teach students "serial specifically appropriate undraping" during the physical examination. And as I have noted many times on this thread, NO patient EVER told me I was abusing their modesty.

I concede there are miscreants in all professions (and religions) including medicine and you will read about them in the news and noted repeatedly on this thread. It is, however, an insult to all the hard working, ethical and considerate physicians to lump every doctor into the same barrel with those other "rotten apples".

Ad hominem accusations about one participating in a discussion is not acceptable. Worthy discussions are about topics and not participants. ..Maurice.


 
At Tuesday, March 11, 2014 10:00:00 PM, Blogger Maurice Bernstein, M.D. said...

A postscript to Anonymous from 9:06 pm today: Notice that all my postings here are with my full legal name, nothing hidden with "anonymous" or with a pseudonym. This is in contrast with the majority of those writing to this blog. While I am not against publishing comments from those writing anonymously, I think those of us who fully identify ourselves adds something which I might classify as "responsibility" for the comments we make. And "responsibility" does add some element of worthiness to what is written which is more questionable in those who write anonymously.
..Maurice.
p.s.-Actually this would be a great topic for another thread: "The Ethics of What is Written Anonymously".

 
At Tuesday, March 11, 2014 10:38:00 PM, Anonymous Anonymous said...

We often refer to modesty and privacy violations
on this blog and others but I would like to point out
something that we haven't considered before, issues
of quality. Despite having the most expensive health
care system, the United States ranks last overall
compared to six other industrialized nations.

On measures of health system performance in five
areas such as quality, efficiency , access to care,
equity and the ability to lead long healthy productive
lives we do very poorly. Reading through these
comments over the years I am not surprised.

PT

 
At Tuesday, March 11, 2014 11:00:00 PM, Anonymous Medical Patient Modesty said...

Anonymous at 6:59 PM On March 11, 2014:

I am the founder of Medical Patient Modesty, a non-profit organization that works to educate patients about how to stand up for their rights to modesty in medical settings. You should check out our web site.

You made many excellent points. It is important to take precautions to prevent sexual abuse in medical settings. This is exactly why Medical Patient Modesty encourages women to avoid male doctors for intimate procedures. Check out the article.

You are correct that medical professionals are human beings. You never know which ones might be sexual predators. You are wise in avoiding a male doctor for intimate female health issues.

I would love to talk to you some about your insights. You should email me through this link.

Misty

 
At Wednesday, March 12, 2014 4:49:00 PM, Anonymous Anonymous said...

9:06 your attack on Dr. Bernstein is unwarrented and sympomatic of what is wrong with this discussion. Never has Dr. Bernstein denied abuse happens in medicine, nor has he downplayed its impact. What he has said is (1) it is not the rule, norm, or representive of providers in general (2) this discussion is about modesty not abuse. (3) abuse is criminal and should be prosecuted to its fullest. I disagree with Dr. Bernstein on several fronts, paticular the role ignorance, denial, and institutional efficiency (the almighty dollar) plays in the issue of modesty violations. I disagree with him that providers do not hold themselves to a different standard when they are patients or providers (ie student nurses), However I could not agree more that modesty violations and abuse are seperate issues. While I disagree strongly with Misty she is respectful, your personal attack on the host of a blog that is there far more form our benefit than his or providers is ridiculous. Unless you are intimately acquainted with Dr. Bernstein, and I doubt you are..you speak without knowing what you are talking about....where I am from, that usually requires an apology...don

 
At Wednesday, March 12, 2014 5:35:00 PM, Anonymous Anonymous said...

"I think the issue is parts of all 3, ignorance, denial, & efficiency. What the proportions are, is up for debate,...don" [March 9,6:24 PM, 2014].
Ignorance: Our campaign to speak up to medical personnel and tell others to speak up will address ignorance.
Efficiency: If MDs want to be a profession they can't use "it costs time and money" whenever they don't have a reason
for accommodating patients. Occupations use "time and money" as a reason, but true professions would have difficulty with that excuse.
Denial: I would add my own three parts to the equation: power, control, and condescending arrogance. Until the medical industry enforces a policy that has it's employees relinquish unnecessary power and control over patients, it will a difficult slough for us to change things. SATs and paperwork often don't provide sufficient information. I have witnessed too many individuals over a long time who became MDs to hope for much change in the condescending arrogance of older MDs. I agree the younger generation may well be superior to older generation when it comes to condescending arrogance.
BJTNT

 
At Wednesday, March 12, 2014 6:58:00 PM, Blogger Maurice Bernstein, M.D. said...

BJTNT, I agree that there occurs "condescending arrogance" toward patients in medical practice because doctors and nurses can be "jerks"..and why can we be "jerks" is because we are human. This is wonderfully expressed by Dr. Val Jones (though I thin with some "tongue in cheek" in Better Health website in an article titled "In Defense of Doctors:We Act Like Jerks, And How to Handle Us" From the article (and I encourage you to read the details for each notation):
Here are the primary reasons doctors are jerks:
1. We are afraid
2. We are hen pecked
3. We are exhausted
4, We are probably jerks to begin with


And then what do you do as a patient or family working with a jerk?

DON'T
1. Bring your doctor more trivia
2. Threaten your doctor with legal action or allusions to your “friend the lawyer"
3. Attack your doctor’s judgment directly
4. Fight fire with fire

DO

1.Be prepared for your visit.
2.Be understanding of our lateness.
3.Be a “compliant” patient.
4.Find another doctor if you need to.


Read the entire article.

Teaching medical students, I am doing everything I can in my teaching to defuse the "jerkiness" which they bear with them but when they face the real (not academic) world in a few years, I can't say they will be absolutely "cured". ..Maurice.

 
At Thursday, March 13, 2014 9:14:00 PM, Anonymous Medical Patient Modesty said...

I wanted to share a disturbing case about a male nurse anesthetist student who sexually abused a woman who was in labor. Check out this link: Nurse sentenced after admitting to inappropriate sexual contact with woman in labor at Fairview Hospital. This man actually admitted that he had sexual contact with this lady.

It first started out as patient modesty violation. There is no reason for an anesthesiologist or nurse anesthetist to see a laboring woman’s private parts or even touch them. They can easily administer epidural in the back without ever exposing or touching private parts.

It is heartbreaking that this special day turned in a horrible day for the mother who was joyously awaiting the birth of her baby.

Look at the positive comments that family, pastor, and a friend made about Mr. Lewis below:


They said he was a good husband, father and a "rock" for his family. Friends and a pastor said despite growing up in a tough neighborhood, he was kind, compassionate and a role model for others --even paying tuition for other poor students to attend private school.


Even good and compassionate medical professionals could turn out to be sexual predators. I agree that there many good medical professionals who will never sexually abuse patients. I feel that many sexual abuse cases in medical settings start out with patient modesty violations.

I believe that gender neutrality at all levels of medical training and practice is the root of all of the modesty and abuse issues.

Misty

 
At Thursday, March 13, 2014 9:45:00 PM, Blogger Maurice Bernstein, M.D. said...

Misty, picking out isolated criminal activity to scare or warn potential patients that essentially "this might happen to you" is not in any way a constructive method for helping to educate the medical system itself about the need to pay more attention to a whole spectrum of patient modesty concerns which have been written about on this thread. And this education of the medical system should be what we should be devising now in preparation of moving forward with this goal.

Finally, I am not sure what you mean by "gender neutrality" when you write "gender neutrality at all levels of medical training and practice is the root of all of the modesty and abuse issues." In no way are medical student taught that gender is "neutral" or that it makes no difference whether the patient is a man or a woman. We also teach that a person is not a disease but each patient is a person and nothing about the patient is "neutral". I have never heard that a physician in practice ignores the patient's gender. And the concept of "gender neutrality" is certainly not the basis of patient modesty. In the case of rare sexual abuse, which you are repeatedly describing within the medical profession, sexual behavior either upon a man or woman by a professional of either gender cannot be described as an act independent of attention to gender. The only gender neutral application I can think of is to refer to a hermaphrodite who has both male and female sex organs. ..Maurice.

 
At Thursday, March 13, 2014 10:19:00 PM, Anonymous Anonymous said...

Maurice

I think choosing isolated criminal activity might
not be the best choice of words. Just how do we
know these incidents are not isolated. They appear
to be isolated when we hear about them and
we certainly ought to remember that these are
the ones who were caught. We only hear about
the ones who are caught, the ones who make
it to the news, not the ones who do this on a
continual basis.
The medical community as a whole seems
ashamed when abnormal behaviors are brought
to light. The suggestion is they are rare and that
patients should not ever worry and that patients
should trust all providers, nurses and all other
medical staff. Spend some time in the trenches
of many large medical centers and I assure you
there is plenty of abnormal behavior.

PT

 
At Friday, March 14, 2014 9:14:00 AM, Anonymous Medical Patient Modesty said...

Dr. Bernstein: Sexual abuse in medical settings is much more common than we want to admit. I wish it was very rare. PT made excellent points: They appear to be isolated when we hear about them and we certainly ought to remember that these are the ones who were caught. We only hear about the ones who are caught, the ones who make it to the news, not the ones who do this on a continual basis. The medical community as a whole seems ashamed when abnormal behaviors are brought to light. The suggestion is they are rare and that patients should not ever worry and that patients should trust all providers, nurses and all other medical staff. Articles about incidents help to raise awareness about how patients can protect themselves. There is no way that we will ever be able to change the whole medical system. There are some good medical facilities that have taken precautions to protect patients. I personally see much more hope in patient education / advocacy efforts than trying to change the whole medical system. This reminds me of the tips that women are given about how to protect themselves in other non-medical settings. For example, many women are encouraged to not walk alone in a park at night because of “few” incidents where women were raped. Most men in a community will not hurt women, but they should not take the risk that a few men could hurt them. I’ve had some women who were sexually abused in medical settings who contacted me expressing that they want me to spread awareness about how women can protect themselves in medical settings.

The male patients who Dr. Sparks abused should have been allowed to wear both 100% cotton underwear and surgery shorts for their surgeries. Dr. Sparks was only supposed to access their noses, ears, and throats and not genitals. It’s a patient modesty violation when a patient is required to take his / her underwear off unnecessarily. There are some surgeries that require no underwear of course.

PT has talked about how nurses will talk about patients’ genitals behind scenes. They may have maintained a professional composure in front of the patients and their families, but they are different behind scenes. Those nurses are definitely never disciplined. For example, the nurses who posted some comments on Facebook were apparently not disciplined.

Gender neutrality is certainly a basis for patient modesty violations. Many nurses respond to patients who express concerns about patient modesty and not wanting opposite sex intimate care by saying something like this: “Don’t worry. I am a nurse. I’ve seen everything”. Many people are shocked & upset when I tell them that it is pretty common for male nurses to give women in hospitals. Many nursing departments are gender neutral because they just assign opposite sex nurses to patients without considering the fact they may not want opposite sex intimate care. Look at an article I wrote about risks of gender neutral nursing assignments at http://patientmodesty.org/genderneutralrisks.aspx . Dr. Sherman talks about how medicine is gender neutral in his article, Patient gender preferences for medical care.

PT: Thank you for your excellent points! You should email me through Medical Patient Modesty’s web site. I am sure you have tons of stories you could share with me to educate patients about how to protect themselves.

Misty

 
At Friday, March 14, 2014 12:00:00 PM, Blogger Maurice Bernstein, M.D. said...

Misty, I don't agree that physical modesty which everyone of both genders bear with them throughout most of their lives to one degree or another has anything to do with fear of being sexually attacked. Fear of being sexually attacked is one thing and modesty is totally another. Think about those who are naturists. Do you think that though they have very little concern about being nude with others have less concern about being sexually attacked when dressed and walking in the park? I doubt it. Don't mix modesty (in the case of displaying female breasts or genitals of both genders to inappropriate others) with fear of criminal attack. ..Maurice.

 
At Friday, March 14, 2014 5:06:00 PM, Anonymous Anonymous said...

OH GREAT, now I can never get on a 777 because it might disapear from the face of the earth. It did happen, and then their were other planes that crashed...I am never flying again...I am driving everywhere...wait people die in cars everyday...I am never driving again...

I am modest, I have absolutely no fear of being molested under medical care. None, nada, zero.

Dr. Bernstein, I do think you are missing a connection on the gender nuetral. We are told not to view our nurses as female or male, they are medical professionals and we should be willing to accept either gender for our care...that is preaching gender nuetral. We are told nurses view a penis and an arm the same...that is gender nuetral. I think it is BS, but we are pushed to accept this. I believe you when you say providers are not taught that patients are gender nuetral, I would suspect a large part of that is physical treatment oriented vs modesty oriented. But, it is almost impossible to push patients should be equally comfortable/accepting of both gender of providers when exposed without taking the provider is not male or female, they are providers....don

 
At Friday, March 14, 2014 5:44:00 PM, Blogger Maurice Bernstein, M.D. said...

Of course it is BS to believe that a nurse finds the patient gender neutral so that the arm and penis "are the same". The nurse will know the difference between putting in a urethral catheter into the penis and inserting a intravenous catheter into an arm and will know that the modesty differential between the two anatomic structures. And in no way am I suggesting that patients don't have the right to select the caregiver's gender. They do but whether they get it or not still depends on the medical system. Hopefully, your encouragement to the production of more male nurses will help patients to attain care by the male gender if they desire.
..Maurice.

 
At Friday, March 14, 2014 5:45:00 PM, Anonymous Medical Patient Modesty said...

Dr. Bernstein,

Patient modesty and sexual abuse in medical settings are separate issues many times. There are times that doctors and nurses do not actually sexually abuse patients who had their modesty violated in the beginning. But addressing and improving patient modesty will help to reduce sexual abuse. The case of Dr. Sparks doing unnecessary genital exams is a good example. She had absolutely no business doing those genitals on those male patients because she was supposed to only deal with ears, nose, and throat.

It is true that many people who are modest do not fear being sexually abused by doctors. For example, many spouses do not want their spouses’ private parts to be exposed to the opposite sex even if they could be guaranteed that the medical providers would not sexually abuse or have lustful thoughts. Many men in the How Husbands Feel Group have shared that they do not want their wives to have intimate medical care by male medical professionals because they want to protect the special bond in their marriages. Also, many wives do not want their husbands’ private parts to be exposed to female medical professionals because they wish to be the only women to access and touch their private parts. Many spouses feel that they should be the only person of the opposite sex to access and see their spouses’ private parts in all settings including medical.

I am sure that most naturists do not care about their modesty in medical settings.

Misty

 
At Friday, March 14, 2014 6:24:00 PM, Anonymous Anonymous said...

I never did believe nurses saw a penis and a arm in the same light, but there were many posts and claims to that. I beleive they were well intentioned, intended to make the patient more comfortable. While I know, you know, we all know...nurses did not see them the same, most of us at one time or another have heard or read this statement or one similar to it. The myth of providers being "gender nuetral" in treatment, and not seeing gender as an issue in treating patients has lead us to where we are today. I don't know if the message had been more honest " We know this is uncomfortable for you but for the sake of your health I will do my best to make it as comfortable as possible and I hope that will be enough to make it tolerable" would have changed the feelings expressed here, but the message of gender not being a issue was definately promoted and has contributed to a distrust as patients began to question numerous aspects of their care........don

 
At Friday, March 14, 2014 6:43:00 PM, Anonymous Anonymous said...

I don't fly anymore because I don't want to go through scanners, and I don't want to be patted down.

I am disappointed there aren't more men going into nursing. I know some men who would be great at it.

-RJ

 
At Saturday, March 15, 2014 12:17:00 AM, Anonymous Anonymous said...

I once worked at a major hospital that had
a reputation for neurosurgery. It also had a
reputation for more sexual activity than the no
tell motel located three quarters of a mile away.

Late one night a neuro icu nurse and a 2nd
year neurosurgery resident were caught on the top
floor of the parking garage by security having
sex, they were both fired. Instances like this
occurred often there as this facility recieved about
300 new medical residents( physicians) each year.

In another instance a cardiologist and a
respiratory tech were caught in the stairwell
having sex. I don't know the outcome but the
cardiologist was female and her radiologist
husband caught wind of it and divorced her.

That no tell motel heard about the activities
at this hospital and for weeks had an advertise-
ment on their sign that read " welcome blank
blank hospital employees" as a financial
incentive to encourage employees to come
there for their activities.

PT


 
At Saturday, March 15, 2014 12:33:00 AM, Anonymous Anonymous said...

Don said " I have absolutely no fear of being
molested under medical care".


Miamiherald.typepade.com/gaysouthflorida/2008/05/
hospital-worker.HTML

A sedated hospital patient woke up to find a hospital
employee giving him oral sex. The employee was
fired and arrested.

PT

 
At Saturday, March 15, 2014 7:55:00 AM, Blogger Maurice Bernstein, M.D. said...

This thread is about the ethical issues (autonomy, beneficence,justice) involved in patient modesty. The modesty is not created out of knowledge about the consensual sex by others. Patient modesty is not created by news stories of sexual misbehavior by healthcare providers.
Modesty is a separate issue as compared with regard to fear of criminal sexual attack. Of course, caregivers who are sexual perverts deserve to be removed from offices, clinics and hospitals and subjected to the law for their criminal acts.

Modesty of ones body represents degrees of shyness to exposure to the eyes or touch of others and the issue on this thread should be how the healthcare system can be aware of the magnitude and significance of this shyness and devise ways to manage the patient's shyness within the need to provide medical care which the patient would be unable to get elsewhere. That is what this thread is all about and it is definitely not about criminal behavior in medicine or in other settings. On this blog, we are in no position to stop criminal behavior in any medical environment but we can devise approaches to educate the medical system about the need for more attention to the modesty needs of each and every patient. ..Maurice.

 
At Saturday, March 15, 2014 8:25:00 AM, Anonymous Anonymous said...

Have you seen this article?

http://www.kevinmd.com/blog/2014/03/confessions-medical-scribe.html

It's about a scribe who is falsifying records at the demand of the doctors employing the scribe. The scribe is a pre-med student. They've already been socialized that if they speak out about misconduct, it will ruin their future career.

Read the comments from doctors on there. "Don't speak out! You're powerless! Yes this happens everyday!"

Unless we can make it safe for medical providers to speak out about patient abuse, we'll never be able to stop it.

The commonality between these very public cases is that there HAD to be a large number of people knowing that there was a problem, and they do nothing. They aren't held accountable.

I know legal reform keeps getting thrown around... but from my perspective, it seems that medical providers can pretty much do ANYTHING and not be held accountable for it, unless it gets to the point where hundreds of patients rise up to protest and it becomes an embarrassment.

-RJ

 
At Saturday, March 15, 2014 9:30:00 AM, Anonymous Medical Patient Modesty said...

PT,

I do not know if you knew this, but I developed a web site about Sexual Misconduct By Doctors, a separate web site from Medical Patient Modesty a few years ago. I developed a separate web site because some people who contacted Medical Patient Modesty were also concerned about sexual abuse in medical settings. This educational web site includes tips about how patients can prevent sexual abuse in medical settings and links to articles about doctors who have been accused of sexual abuse in medical settings. I would like to expand this web site to include news articles about other medical professionals in the future.

It is very clear that you have done a lot of research on sexual abuse in medical settings. I would like to suggest that you email me through Medical Patient Modesty this link so we can talk some about the research you’ve done. You can send me articles you have found. I am particularly interested in raising awareness about how male patients can be abused too. Many men who are abused will never report abuse.

Misty

 
At Saturday, March 15, 2014 12:18:00 PM, Anonymous Anonymous said...

Dr B, I just want to assure you that not all women (even those who are modest) fear sexual misconduct from male doctors. You have been unbelievably patient & tolerant of some of the posters here who want to harp about nothing else. Why not post a disclaimer at the top of the page that states this blog is intended for discussion of modesty issues, not criminal activity of providers ?

 
At Saturday, March 15, 2014 1:11:00 PM, Anonymous Anonymous said...

Misty

I have not done a lot of research on
sexual abuse of patients in medical settings. I
actually have done zero research on the subject,
but I have seen much of it with my own eyes and
know of it happening in the hospitals that I have
worked at over 35 years. I do plan to e-mail you
soon as I want to get our plan rolling on what we
need to do about all of this.

PT

 
At Saturday, March 15, 2014 2:02:00 PM, Anonymous Anonymous said...

I am not afraid of being assualted while under medical care because I trust them. Does abuse happen yes, people get struck by lightening, but I leave my house during storms. People are mugged and shot everyday, but I still go out. There have been several shootings in theaters, I still go to movies. If you want to make this about illegal activities rather than modesty, your choice. But it stops the conversation that this thread was started for, it curtails any discussion that might lead to a solution or progress, and I do not believe it is characteristic of the medical community. Even if you believe it is frequent, even if you can somehow make some thin correlation to the topic of modesty...what are you accomplishing by repeating these offenses over and over? Nothing said here is going to stop you from citing these illegal events, if it makes you feel better by comparing the sexual preditor with a provider who has done nothing illegal and is doing what they were trained to do, though misguided in my opinion..go ahead. But it wastes time and space on this thread. If you are that passionate about it, do as Dr. Berstein suggested, start a new thread....don

 
At Saturday, March 15, 2014 3:37:00 PM, Blogger Maurice Bernstein, M.D. said...

To Anonymous (from 12:18pm today) and also Don, it appears that Misty already has a blog topic on this very subject regarding sexual misconduct activity of healthcare providers. Those visitors here who find this as the primary concern promoting the expression of individual modesty discomfort and fear should go and participate there.
To All My Visitors:
With this post of mine, we are at the 141 comment and so we are approaching the number of comments which I have set to move on to the next Volume. (Remember I am limiting the number of postings in each Volume since previous experience has shown the Blogger.com system seems not to tolerate high numbers of comments for each post and also because less comments make scanning and reading easier.)

So now,in keeping with the suggestion which I agree, I will, as Moderator, reject for publication on this thread beginning with Volume 64 any comment which includes descriptions or examples of healthcare provider criminal behavior, sexual abuse or sexual misconduct attributed to patient physical modesty development or aggravation of modesty already present. It is not necessary to repeat all that. We know such misbehavior exists and it must be eliminated by attention of superiors and legal prosecution. But this is not what patient modesty issues and gender requests should be focused upon.

Future Volumes will be directed to ways of educating all those participating in healthcare (patients, physicians, nurses, techs and the healthcare system administrators themselves about the various aspects of patient modesty and gender selection (patient consent, gawkers, privacy unnecessary undressing and so on} which has been amply described on these Volumes since the thread "Naked" started it all 8 plus years ago.

So, everyone, take care in preparing your commentary to those issues and send all the criminal behavior discussion to Misty. ..Maurice.

 
At Saturday, March 15, 2014 4:22:00 PM, Anonymous Medical Patient Modesty said...

PT,

I also want to hear from you about comments you have heard nurses making about patients. I am particularly concerned about how female nurses make fun of male patients' genitals behind scenes.

Please also share more of your observations about how medical facilities won't hire male nurses for male patients. We all know that medical facilities are less sensitive to male patient modesty than female patient modesty.

Misty

 
At Saturday, March 15, 2014 11:59:00 PM, Blogger Hexanchus said...

Dr. Bernstein,

I agree with Don and others in that I do not fear being the victim of a sexual assault in the medical setting. Your repeated and very reasonable requests to drop the "provider sexual assault" focused posts and to instead focus on the modesty issues and potential solutions have been largely ignored, and I agree with your proposed action to limit future posts to the topic at hand. As you pointed out, there are other blogs where those interested can post their assault related concerns.

So back to the topic at hand, how do we improve the recognition of patients' potential modesty issues by medical providers? I thnk there are a number of things that need to be addressed:

1. As I have said in the past, patients need to speak up and make their desires known, so I won't further belabor that here.

2. I believe another underlying causative factor is a wide spread objectification of the patient, s evidenced by a lack of respect on the part of the providers for the patient as a person first, with all the associated personal values, fears and uncertainties that we all have, not just a disease or condition. I know this for fact, because I have experienced it personally and know of quite a few others that have also experienced it at one time or another. There are a number of theories as to why it occurs, but the bottom line is that providers need to learn to first respect the patient as a person. As a medical educator, I'll throw it over to you as to why it occurs and how it might be addressed.

3. Providers need to be proactive in engaging the patient and uncovering these issues. When doing an exam or procedure that may involve intimate exposure, explain first exactly what they are going to do and why, and ASK the patient if they are comfortable with that. If the patient objects or seems hesitant, STOP and discuss it with them before you do anything.

4. The provider should never mislead or withhold information about what is involved in a test, treatment or procedure from the patient. Tell them what is going to happen and get their acceptance ahead of time, don't blindside them.

Just a little common sense goes a long way......

Hex

 
At Sunday, March 16, 2014 8:15:00 AM, Anonymous Anonymous said...

Hex touched on a point that led me in a bit of a different direction. Trisha Torres does a blog on patient advocacy. I has included related threads to patient modesty, largely sparked by the outrage expressed when she posted a "suck it up men" post. I think several participants from this site went back at her hard on the issue of men should not have to just suck it up when it came to their modesty. The obvious take away from this, she is an RN and while she defended on the front of it, came to realize it was and issue and these "patients" felt strongly and were not backing down. While I don't think she agreed 100% I do think it made her rethink her position. That is the approach we need to take whenever the opportunity presents itself. There are opportunities to plant that seed and we should not be embarrassed by it.
The thing that Hex mentioned was the depersonalization. Trisha just did a post on what should providers call patients. While I am not big on all this PC name change game..there is something to it. On allnurses the topic came up when a hospital wanted to change what nurses called patients, the wanted them called guests or clients. The push back was very telling. Some were very belligerent with the basis being "They are here to get healed physically, if they want to be coddled go to a hotel". It is a version of what Dr. Bernstein has said often, providers focus on the physical and do not see the emotional. It also shows the resentment of some providers when the "I know what is best"..."I am a professional and important so do as I say"..and how dare you bother me with the trivial.
We may not be able to change that mentality, but we can affect how we allow it to be applied to us....and I think that has to start before you walk in the office or put on the gown...don

 
At Sunday, March 16, 2014 11:11:00 AM, Anonymous Anonymous said...

How one is treated is in the "eye of the beholder". There are many practices that are mentally unhealthy to the patient that would not be deemed as illegal, sexual assault nor cruel and degrading practices that are standards of practice in medicine today and need to be re-visited. These practices leave a loop hole for those who have an ulterior motive.

Taking the blog in this direction is more damaging to the issue than doing nothing. The naive on here are being "hosed".

Dr. B has chosen to bury his head in the sand with all those outliers here who believe that everyone has a good heart and is only in the medicine to help and to heal when the research says otherwise.
belinda

 
At Sunday, March 16, 2014 12:49:00 PM, Blogger Maurice Bernstein, M.D. said...

Belinda, I agree that not every single provider in medicine has a sterling silver good heart but obviously since society over the many, many years has found value in the medical profession, there must still be enough "good hearted" doctors and nurses to explain society's continuing support the medical profession with actions only permitted and allowed to the medical profession and society's continued support and participation in the profession as its patients.

In view of this, if dealing with unwarrented accusations of widespread criminal behavior or even more simple unprofessional acts within the profession, maybe it is the ethically right thing to do so as not to frighten potential patients is to "bury ones head" from such accusations rather than "sticking ones neck out" and promoting unwarrented accusations and thus frightening and impairing necessary medical attention for the patients.

Don, I also want to stress that at no time do we teach medical students to look at the patient as a physical finding or a disease but to look at the patient as a whole human being, a person not some object and never to think or express the identification of the patient as "that gall bladder in Room 208". Also, truly the paternalistic professionalism within medicine of years past when "I know what is best" was at its prime is fading as patient autonomy has become the ethical keywords. ..Maurice.

 
At Sunday, March 16, 2014 12:56:00 PM, Blogger Hexanchus said...

Belinda,

No one has said that sexual abuse within the medical system doesn't occur. That said, the frequency and nature of these instances need to be put in proper perspective. Blowing it out of proportion in respect to reality fosters unwarranted paranoia and detracts from the focus of this blog, which is how do we change the system to foster respect for those patients with modesty concerns. Repeatedly rehashing references to situations of abuse does nothing constructive and detracts from the focus - as Dr. B. has repeatedly pointed out, there are other blogs that focus on abuse, and that is where those discussions should be taken.

Several years ago, in conjunction with my experience in various forms of martial arts, I was asked by a psychologist to work with her in developing a self defense program for battered women. The underlying focus was to help these women regain their self respect and help them develop the basic skills and self confidence they need to stop acting like a victim.

Some basics that apply across the board in almost any situation:
1. Trust no one unconditionally at face value. Trust is something that needs to develop over time. This is just as true with respect to doctors and other medical caregivers as anyone else.
2. Be alert and ready to speak up for yourself - if someone says or does something that doesn't feel right or seems out of place, speak up and question it immediately.
3. Be assertive in standing up for yourself.

It's the same thing we teach our kids - be wary of strangers, and if someone does something that feels wrong, yell, scream and run to find a trusted adult.

The best way to not become a victim of abuse or assault is to not act like a victim in the first place. Predators prey on the weak, so don't be weak.

These same principles apply to protecting a patient's modesty - when the patient is uncomfortable with something, they need to speak up.

Hex

 
At Sunday, March 16, 2014 1:53:00 PM, Anonymous Medical Patient Modesty said...

I support Belinda’s concerns. Again, I believe there are many good medical professionals who would never harm patients. But we cannot deny that sexual abuse in medical settings is pretty common and more common than we can imagine.

Many patient modesty violation cases do not end up in sexual abuse. But they do have the potential to end up as sexual abuse.

Dr. Bernstein: I am very concerned about this statement you made: maybe it is the ethically right thing to do so as not to frighten potential patients is to "bury ones head" from such accusations rather than "sticking ones neck out" and promoting unwarrented accusations and thus frightening and impairing necessary medical attention for the patients.

Over the past few years, I have received emails from women who were sexually abused who wanted me to do whatever I can do to raise awareness about how patients can protect themselves.

For example, think about this disturbing incident in a small town: A male doctor who did sports physical exams on girls did unnecessary breast exams on girls whose mothers were not present. I talked to a good pediatrician about this case and she thought it was horrible. This doctor got away and is still practicing. Those girls will have emotional scars for the rest of their lives. I am sure those girls would be hurt by this blog.

I personally think you should start a separate blog about how addressing and improving patient modesty will reduce sexual abuse and other issues Belinda mentioned. You have so many topics on your blog.

Hex:

Your statement: The best way to not become a victim of abuse or assault is to not act like a victim in the first place. Predators prey on the weak, so don't be weak. bothered me because some strong people have become victims. People should be as strong as possible, but there is no guarantee that they will never be hurt.

Misty

 
At Sunday, March 16, 2014 2:56:00 PM, Anonymous Anonymous said...

Dr. Bernstein I believe you when you say providers are not taught to view patients as "the gall bladder in 202". As is often the case what is taught in an institutional setting gets diluted or revised in the real world. One has to think over time the stress of the day to day dealing with death, and sickness, and dealing with people who are scared, in pain, possibly dying takes a toll. If one becomes "dulled" over time, and the older providers mentor the younger, and the older are in power positions, it is easy to see how this may be somewhat a natural progression. A focus on the physical becomes THE focus. I believe a portion of what we are seeing here is providers finding ways to cope. If they admit this is causing emotional pain, they have to admit they are causing or a part of inflicting that pain so they find ways to avoid that admission even to themselves. It makes it very difficult for providers to admit they see it or perhaps hard to admit it. You stated the other day that of course it is BS that providers don't view treating a penis any differnt than an arm. you indicated nurses/providers know this...yet yesterday I read a blog from 2009 written by a female provider in training who was commenting how amazed she was by how easily people would expose themselves just because she was wearing scrubs...she justified this as her being a professional...and she was becoming so used to it...it was no different than...the very thing we were discussing the other day. So yes I believe what you say, however it is still part of the medical culture. Why is a more complicated question. Dr. Berstein you have expressed some of this in your posts. I believe it has been so ingrained in the medical culture it goes unquestioned and is accepted as fact. You stated you know it is bs, but have you ever heard providers stating this, maybe not in person, but in print or otherwise. Have your heard providers take the "I am a professional" line and thereby putting themselves above the normal thoughts and emotions treatng a "naked" (i am using this broadly for exposed) patient which inturn makes the patient OK with it. These are common lines providers have stated over and over. While these are fading, they are still in the culture and while better concealed they appear to me to influence how providers approach modesty. The inconsistencies...providers are unaware of this..of course providers know the the difference in treating a penis and an arm including the emotion for a patient...providers were never told, I have never been told...yet as indicated before the profession accomodates in certain ways indicating the know...female mammographers, the proliferation of new female OB/GYN's....would indicate at some level they know...what is said, taught, and acknowledged appears to some degree in some cases to conflict with what is practiced...that is my point here.
And the paternalistic approach, I agree it is changing, and while there has been big progress on how it is presented, it will take time to go away if ever. And it can still be seen to a degree in practices such as requiring a patient to be naked except those stupid gowns for caterat surgery. Providers know patients hate being naked in those gowns..so rather than give the patient a choice..they know best so they justify it....now, the question is how do get them to see it, get them to acknowledge it, and most important of all, get them to change to accomodate it.....don

 
At Sunday, March 16, 2014 3:38:00 PM, Blogger Maurice Bernstein, M.D. said...

And Don, that last sentence you wrote is exactly what I want the ongoing Volumes of this thread to provide: how to get the medical profession to "see it","acknowledge" it and "change" it. ..Maurice.

 
At Sunday, March 16, 2014 3:46:00 PM, Anonymous Medical Patient Modesty said...

Don,

Can you please include a link to the blog you referred to in this statement: yesterday I read a blog from 2009 written by a female provider in training who was commenting how amazed she was by how easily people would expose themselves just because she was wearing scrubs...she justified this as her being a professional...and she was becoming so used to it...it was no different than...the very thing we were discussing the other day. ?

I would love to view this blog and I know many others here would like to view it as well.

By the way, I agree with you that it is ridiculous for patients to be required to be nude under gowns for many surgeries.

Misty

 
At Sunday, March 16, 2014 4:02:00 PM, Anonymous Anonymous said...

"Be wary of strangers"

Actually, be wary of people you know. Strangers do a tiny percentage of rape and kidnappings.

"Do not act like a victim".

Most predators groom their victims. Most people don't know what grooming is, or how to spot it, or how to prevent it. People who "act like victims" don't know they are being "tested".

For those who are interested, I really recommend they read up on Jerry Sandusky, as his tactics are very typical.

http://www.newyorker.com/arts/critics/atlarge/2012/09/24/120924crat_atlarge_gladwell

I agree that educating patients on what to expect at the doctor's office and what is inappropriate behavior is critical to catching and stopping the bad eggs out there.

Right now, so many patients still just do whatever their doctor says without question, simply because doctors are an authority figure.

That's why I object to ignoring the issue - doctors are already on an "untouchable" pedestal.

-RJ

 
At Sunday, March 16, 2014 6:44:00 PM, Anonymous Medical Patient Modesty said...

RJ,

You made some excellent points. It is so important to educate people especially teenagers about how to protect themselves in medical settings. I wish that those girls in the small town who had unnecessary breast exams by the male doctor had been educated to refuse to submit to breast exams. There was no reason for them to have breast exams for sports physicals period. This also fell into the category of patient modesty. That male doctor is very well respected in the community.

Sadly, many patients think they have to submit to everything the doctor tells them to. You are right that many predators “groom” their victims.

Here’s an important statement to consider: Issues of modesty have turned into issues of deception, voyeurism, sexual abuse and molestation all in the guise of medical care so we cannot say that issues of patient modesty never turn into other issues.

Misty

 
At Sunday, March 16, 2014 6:45:00 PM, Blogger Maurice Bernstein, M.D. said...

RJ, when I put up the new Volume 64 and from then on.. no more references to sexual assault, battery or misbehavior within the medical profession or references to other newsworthy examples of sexual misbehavior and crimes such as Sandusky.

Doctors are not untouchable. Touch them with the law if you are subjected to abuse. It is done all the time with malpractice and if you are sexually attacked just call the police and they will be soon touched by the law. Patients are NOT powerless in this regard.

And if you find that your doctor demonstrates everything you have wanted as your physician then touch him or her with a smile or a hug (unless you find the latter to be too "sexual"}. ..Maurice.

 
At Sunday, March 16, 2014 6:57:00 PM, Anonymous Medical Patient Modesty said...

RJ,

Can you please contact me through Medical Patient Modesty's web site at this link. We could really use some of your research for our other web site, Sexual Misconduct By Doctors. I am also considering starting a blog on this topic.

Misty

 
At Sunday, March 16, 2014 8:45:00 PM, Anonymous Anonymous said...

In one staff bathroom of a MICU ( medical
intensive care unit) nurses had used full nude
male foldouts from playgirl magazine as
wallpaper. At this point though I have never
seen just photos of arms in these bathrooms
and I doubt ever will.

PT

 
At Sunday, March 16, 2014 11:15:00 PM, Anonymous Anonymous said...

Hey Mindy,

I sent you a message. This is my first contribution:

http://www.oprah.com/oprahshow/Child-Sexual-Abuse-6-Stages-of-Grooming

This is how you teach your children to ACTUALLY be protected. And yeah it's Oprah, I know, but this article presents the information in such a short, easy to read way, no need to read entire books.

PS I think it's funny that whenever I typo my name Maurice respects me, but whenever I use RJ he either ignores me or insults me.

-RJ

 
At Sunday, March 16, 2014 11:46:00 PM, Anonymous Medical Patient Modesty said...

RJ,

I did not receive any emails from you. It is possible I was having problems with receiving emails at that time.

Misty

 
At Monday, March 17, 2014 1:06:00 PM, Anonymous Anonymous said...

Maurice,

Keeping members of the community from knowing and understanding what can and does happen is propagating psychological trauma because the element of the unexpected must be present in order to be traumatized.

Would you not share how dangerous strangers can be to your children as to not frighten them? What makes this any different?

Knowledge is power.

It is my true belief that taking this blog down the road you are headed is just another attempt to sweep the dirt under the rug.

Standard of care practices often do not have the "milk of human kindness" with regard to dignity. Just because it's standard of care does that make it right? Is it fair to traumatize and humiliate people because they can?

Look at the beautiful example Art Stump uses in his book. It was just an observer and it created a horrendous situation due to the intimate nature of his situation.

Respect must be earned and the direction of this blog does not earn any respect from me or others who share the knowledge of what goes on behind those closed doors.

PT and I have been at odds so many times but now we are aligned with the same focus, that improprieties do occur on a regular basis, nobody is held accountable, and both genders deserve to have their dignity preserved. Without a system of checks and balances, this situation will never change and your followers now become your sheep filling your shallow agenda.
belinda

 
At Monday, March 17, 2014 2:48:00 PM, Blogger Maurice Bernstein, M.D. said...

Knowledge should be based on facts not simply stories and any defensive responses with that knowledge should be based proportionally on the known risk. It would appear from the news stories of events in movie theaters or schools that we should never go to a movie if we want to be safe or send our children to school. Taking in account the stories we also shouldn't be out walking or driving. Should we also feel safe at home if we understand by what is going on with home invasions throughout the country.

To scare patients with stories about "some" but not every doctor and nurse and suspecting the possibility of bodily assault or battery for every visit will never be in the best interest for the vast majority of patients needing and entering into the medical system.


Let's face it. Society has accepted the medical profession as a needed resource and until there is some magical total substitution there will always be a medical profession for society to utilize.

That doesn't mean that society doesn't deserve something better in the treatment that is given to some patients especially with regard to the patient's modesty and their requirement for provider gender selection.

This should be our goal, to promote and help make changes in the system. One of the most immediate things which can be done is to encourage patients to "speak" to their healthcare provider regarding issues that are most important to them. (By the way, I think I will avoid using "speak up" since that already shows inequality.) Speaking to the provider will provide immediate education to that individual. And patients should demand a constructive response. Beyond that, techniques or actions should be discussed to educate larger swaths of the medical system. ..Maurice.

 
At Monday, March 17, 2014 4:35:00 PM, Anonymous Anonymous said...

Belinda, never once has Dr. Bernstein denied sexual assualt it not an extremely serious issue, I have never seen him deny it happens. He has said it is not representative of the medical community as a whole, and he has suggested numerous times that this thread is about modesty and encouraged others to take the lead on the seperate issue of assualt in the medical setting. Rather than attack the current effort to deal with modesty for not being involved in sexual assualt, use that energy to create one that is focused on sexual assualt. While Misty and I have significant differences I respect her for the effort she has put into this. I disagree Dr. Bernstein should or has any obligation to pick up the torch of assualt, but appreciate she is trying to do something. I would suggest that those who share the passion to stop sexual assualt join together, pool your talents, your resources, and yoru collective effort to do something about it rather than attack someone who is passionatley working on the issue of modesty. I like riding my Harley...should I condemn you for not joining abate and help protect my rights to ride as I see fit? Don't you know about the attack on my freedom to ride without a helmet, don't you know the saying loud pipes save lives...and what about the people that like to smoke pot, what are you doing to support their rights? And lets not even get started on gay marriage...if you have a passion for something, if you feel strongly, go after it, but don't condemn those who are doing something else for the benefit of others, condemn those who are doing nothing for the benefit of anyone....don

 
At Monday, March 17, 2014 4:52:00 PM, Anonymous Anonymous said...

Misty - just tried again in a different browser. I used chrome first, firefox this time. Hope you get it.

-RJ

 
At Monday, March 17, 2014 5:05:00 PM, Anonymous Medical Patient Modesty said...

Many patients who feel strongly about modesty would not change their minds about modesty in medical settings even if there was a 100% guarantee that medical providers of the opposite sex would not humiliate or sexually abuse them. I am sure that many men can agree here that there are some compassionate female nurses who would never humiliate or abuse them, but that does not change their feelings about only wanting male intimate care. Many women do not want “gentle” or compassionate male gynecologists either.

Belinda made many excellent points. I want to comment on some very important points she made.


Keeping members of the community from knowing and understanding what can and does happen is propagating psychological trauma because the element of the unexpected must be present in order to be traumatized.

Would you not share how dangerous strangers can be to your children as to not frighten them? What makes this any different?

Knowledge is power.



It is so strange about how the medical profession is held to different standards. Most strangers are people who would never hurt you. Should we stop telling kids to avoid strangers because most people in this world would never hurt kids?



Belinda is right that knowledge is power. I think it is important for people to be aware of what goes on behind closed doors in medical settings so they can protect themselves.

This does not mean that patients should avoid getting medical care. It simply means that they need to take precautions to protect themselves. For example, look at how two parents, Janet (a RN) and Peter commented on how they protected their children for sports physicals on the article one of my board members and I wrote at http://www.mercatornet.com/family_edge/view/11921. They allowed their children to have sports physicals, but they refused to let their children have unnecessary intimate procedures. Janet commented she thought the male doctor was pervert because he wanted her to leave and for her daughter to take all of her clothes off.

I think it is awesome that Belinda mentioned that PT and her were once at odds, but that they are now aligned with the same focus that improprieties do occur on a regular basis.

I have really appreciated PT bringing to our attention about how female nurses have humiliated and abused male patients. I believe that most men have no idea that some female nurses may make fun of them behind the scenes. This misbehavior is not considered criminal. We rarely hear about how female nurses and doctors have mistreated male patients because most men do not feel comfortable complaining because they know their complaints will probably not be taken seriously.

Our goal is not to scare patients to not ever get medical care. It is important for them to have tips about how to protect themselves.

Misty

 
At Tuesday, March 18, 2014 4:55:00 AM, Anonymous Anonymous said...

Don, Suppose there was a murder investigation and the police decided not to examine all the threads of the investigation because it was their belief that a particular thread was not germane to the investigation. Suppose that investigation took a wrong turn because of their lack of examination of the evidence and the wrong person was convicted. It happens often enough but probably constitutes a significant
part of the prison population as DNA evidence is now uncovering.

The same holds true in healthcare.
I have mentioned so many times that modesty violations in one form or another (at the time research was done) had a 40% rate of sexual impropriety and were reported to the Assigned Risk Department of this major city hospital.

That doesn't mean that 40% of healthcare workers went out of their way to purposefully humiliate or punish patients. And, sexual impropriety doesn't mean assault. However, the act of disrobing someone against their will (and that's what it amounts to if there are lots of people in the room or people who don't belong there, and the patient is not informed because of no prior experience).

So what I am saying, is without looking at the all the reasons (and that would include impropriety in any form), you are looking at a partial analysis that will be inaccurate and not fixable because it was never identified.

The statistic came from a VP of Risk Management of a major teaching hospital.

Closing one's eyes and pretending that there are enough people using their profession in ways that they shouldn't, by ignoring and refusing to make people accountable will result in much effort with little pay off and no result.

Now, what if you were victimized in such a way? Are you now willing to go with the sheep and ignore what is so prevalent and docymented along with abuse in nursing facilities, mental hospitals and sadly in our medical institutions and prisons? You think that medical institutions are separate in their make up? They are not.

So, with this said, I stand by my last post and my final comment on this matter...."ignorance is bliss".
belinda

 
At Tuesday, March 18, 2014 6:25:00 AM, Anonymous Anonymous said...

I agree with Dr. Bernstein and Don about this whole matter: sexual assault versus modesty in a medical setting. The only correlation I can see between the 2 is that, of course, violating someone's modesty may make it easier to commit a sexual crime. But for most of us the issue of modesty boils down to the feeling of embarrassment or humiliation (loss of control), especially in front of opposite gender, and that fact can make medical encounters extremely unpleasant, sometimes even traumatic. Maybe even to the point of avoiding them. For me medical modesty has nothing to do with fear of sexual misconduct. And I agree that we should start by speaking up about our concerns in our individual encounters. I also feel to some degree that the tendency of this blog to perpetuate the idea that sexual abuse in a medical setting is fairly commonplace has caused some of the contributors to leave. I remember a Ray Barrow providing some excellent insight here before the holidays but I have yet to see him return. Same for Doug Capra.
I also applaud Misty for her efforts but we do differ on many points. An example of Art Stump was given but his experience was not one of sexual abuse but rather one of being confronted with an unexpected situation (having a female student observe a very intimate procedure), causing him to "shut down" and essentially lose trust in those caring for him. I do agree that it is a lack of knowledge that causes those sorts of experiences: something is sprung on you that you do not expect. And, yes, this does go to the issue of "behind closed doors"; not being told ahead of time or giving consent with full disclosure. That is a big problem in my opinion and is probably the biggest cause of modesty violations. Jean

 
At Tuesday, March 18, 2014 2:38:00 PM, Blogger Maurice Bernstein, M.D. said...

I agree fully with Don and Jean with regard to defining patient physical modesty as degrees of discomfort in undress especially undress in front of unwelcome observers. Yes, some undress and medical palpation would be felt to be inappropriate by patients but that inappropriateness need not be defined in terms of criminality or even sexual abuse by the healthcare provider. It is simply a matter of education both from the education of the patient with regard to the methods and necessities of standard medical practice and education of the healthcare provider that despite such medical standards nevertheless, despite education, patients may still have strong and emotional concerns and opinions and that healthcare providers must be aware of this and to acknowledge and make attempts to mitigate those emotional concerns of their patient despite having those standards to follow. And perhaps there are circumstances when such medical standards should be modified. This is all that patient physical modesty is about..nothing less but nothing sinister.

And yes Jean, I am also disappointed that Ray and Doug have apparently left with their valuable views seemingly because of the crime and sex disfiguration of what started out as ways to look at and correct modesty itself concerns which had lead to practical and emotional conflicts.

I am about to start Volume 64 where postings describing news items, stories or inferring that patient physical modesty primarily involves known or suspected acts or behaviors of criminality including acts of sexual perversion or frank rape will not be permitted to be published.

Let's agree that everybody knows that physical modesty exists to varying degrees in everyone and that the standards of medical practice must be changed to accommodate this modesty and to allow a more comfortable and effective experience for all who enter into the system. ..Maurice.

 
At Tuesday, March 18, 2014 3:09:00 PM, Anonymous Medical Patient Modesty said...

Jean,

I agree with your statement: violating someone's modesty may make it easier to commit a sexual crime. I have received cases where someone’s modesty was first violated before they were sexually abused. You are right that many patients who are modest do not fear sexual abuse. I am very concerned about sexual abuse in medical settings because of the cases I have received and the research I’ve done. I had no idea that this issue was that serious when I first started Medical Patient Modesty.

I have been wondering what happened to Doug Capra too. He has written some great articles with Dr. Sherman.

Ray Barrow actually made some excellent points about how if we address & improve patient modesty that it would decrease sexual abuse. I still have his excellent points. I have bolded them below.



Dr. B., I submit that the act of sexual abuse committed by health care
providers can, indeed, be conceptualized in a manner that makes it an
"entirely different matter than patient modesty," but it cannot be conceived
in a manner that makes it an entirely different matter than the act by
health care providers of undermining patient modesty. Although they are
different matters in some ways, they are similar matters in at least three
ways.

First, sexual abuse committed in health care settings is likely to undermine
patient modesty. Witness, for example, the words of a woman whom I
interviewed for a research project conducted a few years ago: "I refuse to
go to the hospital; I don't want to be clinically raped." Indeed, research I
and my students completed suggested that those whose privacy and modesty
were violated in health care settings tended to experience the same feelings
and beliefs about themselves as those who were raped.

Second, sexual abuse and the act of undermining patient modesty are linked
theoretically and possibly empirically. More specifically, some social
psychological and structural theories of deviance and crime - e.g.,
differential association theory, neutralization theory, and social conflict
theory - can explain both sexual abuse in health care settings and the act
of undermining patient modesty.

Finally, 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. This hypothesis is derived from those
theories to which I allude in the last paragraph


Misty

 
At Tuesday, March 18, 2014 5:49:00 PM, Anonymous Anonymous said...

Belinda your analogy is a stretch but I will reply with "should I go down to my local PD and ask why they are not doing something about the missing jet? They are police after all. Police are paid to investigate crimes to the fullest. A MD taking his own time and effort to discuss and investigatge modesty is no where near the same. Would you expect the police to investigate whether all of the parties had proper table manners? Modesty and assualt have little in common.

Well said Jean, the events that brought me to this post had absolutely nothing to do with assualt or fear of assualt. Honestly it never crossed my mind nor does it now. My concern is exposure, paticularly to the opposite gender. My main problem(s) with the medical community is I feel the could do more but they choose not to. Further they employ various methods to first pretend the situation does not exist, next to claim they are unaware, and last justify it rather than be honest and deal with it. There is a great business book called The 5 dysfunctions of a team. The basis is what is left unsaid is more damaging and dangerous to a team than what is said, even if it creates conflict. The cornerstone of being able to have honest communication between parties is trust. If I do not trust you will be able to hear my opinion when it conflicts with you, and not hold it against me I will not feel comfortable expressing that opinion. We, I have read many posts by providers from providers that make me feel they do not accept my position. I have a distrust, not that providers will harm me, but will reject my feelings of concern for exposure to opposite gender..and I will have to deal with them, and depend on them for my care. Due in large to this & Dr. Sherman's thread I have at first challenged providers demanding consideration for my feelings and ready for a fight, only to find out when I asked, I actually recieved accomodation. Dr. Bernstein, just being honest, I don't think there is anything you can say that will change my mind that providers know, they know at some level exposure, is uncomfortable on different levels to many people. They have to know that opposite gender exposure it unnatural for most people and there for create additional discomfort. You have stated yourself that nurses do not view a penis and an arm the same and further acknowledged they know the different emotion involved for the patient. While I can agree some, perhaps many may not recognize the extent of emotion it causes some, they have to know it is uncomfortable for many. The statement 'dying from embaressment" is not that obscure. Even so, even if providers truely feel it is just uncomfortable, why in the world would you not strive to reduce that feeling of being uncomfortable as much as possible? I think the simple answer is it is self serving and efficient not to. While I still have doubts i will give you providers may not know the depth...no way they don't know it exists. I think we have beat this horse enough, I am going to try to focus more on what can we do...but, a certain part of that includes...identifying the why....don

 
At Tuesday, March 18, 2014 6:08:00 PM, Blogger Maurice Bernstein, M.D. said...

And let's do nothing to undermine patient modesty which itself appears to be a biologic and social human property which only needs tempering by education of the patients in such situations in which tempering modesty would be of value to the patient's general health. However also there should be the awareness of patient modesty and the need for consideration by the medical community as they attend to the patient's care. Otherwise, in non-clinical situations of life, an individual's degree of modesty should be acknowledged and accepted as it is. ..Maurice.

 
At Tuesday, March 18, 2014 6:56:00 PM, Anonymous Anonymous said...

The problem is Dr. Bernstein is who gets to decide what situations require tempering of the patients modesty? Providers or the patient? Providers have shown a disregard of what is requried and what is just convenient. They keep expanding the definition. Who gets to define that? That is going to be the difficult part. It is individualistic, and one that will be quite fluid. It appears there is going to be a lot of communication from patients...but that only matters if providers are willing to move, otherwise providers will continue to see this as just a matter of "educating the patient". Even though I am uncomfortable with opposite gender exposure...I think I could accept it if I felt it was really a matter of can't accomodate me rather than choose not to, and I do believe the later is the majority of the cases.....that said, interesting statement for debate...don

 
At Tuesday, March 18, 2014 7:03:00 PM, Anonymous Anonymous said...

Belinda

I absolutely agree with you and yes for
many ignorance is bliss,however, for those who
perpetuate any and all acts of unprofessional
behavior in healthcare I might add that they know
exactly what they are doing. I intend to go into
this in more detail on Maurice's next volume and
it will be at that time I will ask for help from every
one visiting this thread who wants to seek change.

PT

 
At Tuesday, March 18, 2014 9:15:00 PM, Blogger Maurice Bernstein, M.D. said...

PT, there is no need to go into more detail about "unprofessional behavior" if it amounts to describing prurient sexual interest and acts or frank sexual crimes by professionals. This behavior is clearly wrong for a physician or nurse behavior and requires notification of state professional boards in the United States and law enforcement as necessary. That is the solution for that behavior. To educate the patient to ask their provider "are you planning to manipulate my breast or genitals for your own pleasure or do you intend to rape me?" are ridiculous questions to ask at each medical exam or procedure. The way to feel confident in the behavior of the doctor you plan to visit is by getting recommendations from friends and neighbors and by visiting the state board website to see if there are any "bad marks" for that doctor. Also, if the patient can have the opportunity and afford (it certainly may be worth the expense) an introductory visit to talk with the doctor about his or her experiences and views (including religious) and at the start tell the doctor how you want to be treated in terms of your modesty issues but also in other regards. I am sure most patients will be able to size up this doctor and the doctor's environment and enter for an examination at another time with more confidence that the doctor has been "made aware".

What I want the next Volumes to be directed to is listing specific issues to educate and attempt to change the behaviors of the medical system to make the system aware of the need to incorporate programs of attention, mitigation or resolution of issues of patient modesty beyond current concerns about medical mistakes, preventable risks, patients' medical record privacy, ways to pay for patients' medical care and so on.

How do we do this beyond the one on one conversation with a doctor, nurse or medical tech? It is all this that we have to discuss. And where do we start? I believe I have previously mentioned for the United States: the Joint Commission that sets standards for patient care in hospitals and a hospital not passing the regular detailed surveys: no governmental Medicare or Medicaid payments.

In the next Volumes, instead of tearing down the medical system with accusations (and many may well be valid), let's go ahead and progress to "doing something" to meet the requirements for meeting the ethical principles of "justice", "beneficence", "autonomy" and finally "non-maleficence" for all patients of either gender and their own degrees of physical modesty. ..Maurice.

 
At Tuesday, March 18, 2014 9:40:00 PM, Blogger Maurice Bernstein, M.D. said...

NOTICE: AS OF TODAY MARCH 18 2014 "PATIENT MODESTY: VOLUME 63" WILL BE CLOSED FOR FURTHER COMMENTS. YOU CAN CONTINUE POSTING COMMENTS ON VOLUME 64

 

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