Patient Modesty: Volume 65
And the discussion continues.
From Paul writing to Volume 64:
I wonder what women in general, as well as female nurses
,female techs, and other female providers would think if the gender numbers
were reversed?
Imagine you go in for a routine exam with your female doctor because you don't want a male doctor. A male chaperone or student is brought in to the room to observe.
You either ask for him to leave or because you were blind sided by it you say nothing and go through it. Only to be angry about it later.
During your exam the doctor finds something and recommends a vaginal ultrasound. You ask for a female but there is only male sonographers that work there. You can say no or swallow your pride and do it. Another male will be assisting you find out at the last minute.
Time for a visit now to a gyn/urologist for a more invasive exam and a cytoscopy. Once again you choose a female doctor but when you arrive all the assistants will be male.
You are found to need an operation. When you arrive a male will be prepping you and another male catheterizing you. By this time you hate the medical system for having to go through all these embarrassing procedures with so many males involved. You say nothing because you are told all the men have seen it all before and your body is nothing special. They have seen it all before so it is silly and immature of you to feel this way.
This is what almost every male has to deal with when we go into the health system. They wonder why men do not go in for their exams. I wonder how many women would hesitate to go if this is what it was like for them?
Oh wait. I think there was something called affirmative action. Now they have female choice for doctors and a support staff of 95 percent women.
I sympathize with the issues of women posting to this site but being a male is even worse.
Imagine you go in for a routine exam with your female doctor because you don't want a male doctor. A male chaperone or student is brought in to the room to observe.
You either ask for him to leave or because you were blind sided by it you say nothing and go through it. Only to be angry about it later.
During your exam the doctor finds something and recommends a vaginal ultrasound. You ask for a female but there is only male sonographers that work there. You can say no or swallow your pride and do it. Another male will be assisting you find out at the last minute.
Time for a visit now to a gyn/urologist for a more invasive exam and a cytoscopy. Once again you choose a female doctor but when you arrive all the assistants will be male.
You are found to need an operation. When you arrive a male will be prepping you and another male catheterizing you. By this time you hate the medical system for having to go through all these embarrassing procedures with so many males involved. You say nothing because you are told all the men have seen it all before and your body is nothing special. They have seen it all before so it is silly and immature of you to feel this way.
This is what almost every male has to deal with when we go into the health system. They wonder why men do not go in for their exams. I wonder how many women would hesitate to go if this is what it was like for them?
Oh wait. I think there was something called affirmative action. Now they have female choice for doctors and a support staff of 95 percent women.
I sympathize with the issues of women posting to this site but being a male is even worse.
Which hand of a healthcare provider do you want touching you
and whose eyes looking at you, male or female? Do you believe that gender is more
important than skill or personality.
..Maurice.
Graphics: From Google Images.
NOTICE: AS OF TODAY JUNE 9, 2014 "PATIENT MODESTY: VOLUME 65 WILL BE CLOSED FOR FURTHER COMMENTS. YOU CAN CONTINUE POSTING COMMENTS ON VOLUME 66.
NOTICE: AS OF TODAY JUNE 9, 2014 "PATIENT MODESTY: VOLUME 65 WILL BE CLOSED FOR FURTHER COMMENTS. YOU CAN CONTINUE POSTING COMMENTS ON VOLUME 66.
posted by Maurice Bernstein, M.D. @ 9:18:00 PM
181 comments
181 Comments:
From PT writing to Volume 64 at the time of closure. ..Maurice.
Paul
You forgot to mention mass school physicals
and sports physicals that males have endured
not to mention unnecessary female observers
during military induction physicals. This is all
before males actually enter the health care
system with real medical problems.
PT
It is sad about how male patient modesty is often disregarded. It seems like the medical industry respects women’s modesty better than men’s modesty at times. Many patients feel gender is more important than experience and skills. Many women who do not want a male gynecologist under any circumstances would prefer to have a female medical student who has only helped to deliver a few babies deliver their baby than a male gynecologist who has delivered 9,000 babies. One man on this blog shared that he would prefer a male assistant who had very little experience than a female nurse who had 30 years of experience participate in his intimate procedure.
I thought you all would be interested in reading this article: Why are there so many young, male gynecologists on TV when there are so few in real life?.
Misty
Paul could have preceded the other fiction by stating how the woman had to call the doctor's office and spoke with a male receptionist. When she arrived at the office, she would have been greeted by a male receptionist who asked her when her last pap smear was.
Gerald
Misty, male patient modesty is not simply "often disregarded." It is the rare exception when male patient modesty is regarded.
Gerald
Believe it or not, there are Ob-gyn practices (sadly, included State owned facilities) where hey hired male receptionists and assistants because they thought would make he practices feel more "modern" and progressive.
Maria,
I know some all-female ob/gyn practices listed on this online directory on MPM’s web site has male office managers. But many of them are husbands of one of the female doctors. Many of those office managers help to administer the practices. They do not ask women personal questions such as when their last pap smear was though.
Can you please email me privately through this link to let me know of some practices that have hired male assistants and receptionists? I heard of a female gyn who hired a male ultrasound technician at her practice. He even does transvaginal ultrasounds.
It is possible for receptionists to refrain from asking patients personal questions. I personally think that personal questions about intimate health issues should be dealt with in the doctor’s examining room. I know many men are upset when female receptionists ask them such personal questions and men should simply say I am not going to answer your question and I will discuss this with my doctor.
Misty
The provider gender issue that is being discussed here is from the emotional point of view of the patient. If we all want to equalize the provider gender population for the benefit of all patients of either gender, we should also look at the emotional impact which the gender issue on the providers themselves.
In this regard, writing to a Sept 11 2013 thread on the values of "eye to eye communication and the laying on of hands" a visitor RDW who is a male CNA but would have wanted to study to become a physician assistant (PA) but is finding to be inhibited by his experience already attending to female patients as a CNA. So the emotional distress is not just one sided affecting only the patient.
You might be interested to go to the thread and read the concerns of RDW. ..Maurice.
Interesting read Dr. Bernstein but go back and count how many times references were made to how it was inconvenient for him, it disrupted his productivity or pattern. I have brought this to the table before, and while in part it is about him being uncomfortable, it is as much directed to the problems it causes him as to him being uncomfortable doing it because of modesty concerns for him or the patient.
Let me present a quote from Art Stumps book "It's all to easy for casual interlopers, and perhaps for some seasoned healthcare professionals as well, to fail to appreciate the degree to which modesty and privacy foster a sense of identity and security in most people. In this culture the surrender of one's clothing is a dramatic reversal of a basic norm." So while providers may feel some sense of being uncomfortable it is quite different than that of the patient. I am sure there are some who feel empathy for the patient and this creates some of those feelings. I would however refer back to the post again and ask to note how much of it was self directed, he was afraid to be called a pervert, he didn't want to have to deal with it, getting a same gender provider was a pain and disruptive of HIS and the PROVIDERS schedules....quite different from a patient with their legs in stirrups in front of members of the opposite gender....don
Maurice, We really don't have to look at this issue from both sides.
The law says we have a right to privacy. We are the paying customer. It's up to the medical community to seek out those patients who would want to participate.
Perhaps if the medical community can't round up enough patients of the opposite gender, then that student might want to consider other options.
Why is it a patient's problem or responsibility to give up their privacy, suffer emotional trauma to benefit some student?
I would bet if presented to a patient with the idea of participating in the advance of medical education, you'd probably get plenty of people who wouldn't care. It's the arrogance, and lack of communication that creates both emotional trauma and the unwillingness of patients to cooperate.
belinda
How disappointing.....
We are told to speak up/let our concerns be known/ask for what we want/ and what happens?
Here is a perfect example of someone who is getting the message from patients regarding gender preference for care. It's not as if they are silent...in fact they are so clear that he is now uncomfortable. That's Good!
Isn't that sending the message to providers yet?
He could admit the problem healthcare has. He could see the need to make it better. He could say " how can I make a difference". But instead, he seems to be angry that patients can be inconvienient in their needs. Perhaps dissappointed that these needs will follow him even with a "P.A" beside his name.
It seems that even when they get it..they don't get it.
How much clearer can we be?? And this person is looking for ways to avoid the issue instead of taking the opportunity to make the difference that (unlike many) he actually see's and acknowledges.
How sad. Someone who does see the need for change, and asks instead how to make it go away.
Hopefully we can see this new hurdle coming and send the message "you can't".
"a visitor RDW who is a male CNA but would have wanted to study to become a physician assistant (PA) but is finding to be inhibited by his experience already attending to female patients as a CNA."
I am sorry, but I see this as progress. Maybe it's time to make female CNA'S "uncomfortable" as well.
Suzy
Suzy, are you talking about Dr. Bernstein?
belinda
Nope. Sorry if I did not make that clear with the reference at the end. It was a refernce to the post from RDW, and his post in "eye to eye communication and the laying on of hands". I apologize.
Suzy
Dr. Bernstein:
Did you ever find out if "RDW" continued on in the healthcare field? Or if rather..the idea of patients right to gender choice changed his career path?
I would like to think that he used his knowledge to help patients with gender preference receive that dignified and respectful care they deserve. One can hope!
Suzy
Suzy, I have no idea since I have not found any followup posts elsewhere on my blog and received no e-mail from him. ..Maurice.
Suzy,
Are you the same woman who started this blog at http://patientmodestysolutions.blogspot.com/. If so, I really enjoyed your great insights and articles. Please let me know.
Misty
Suzy, good to have you with us again. And what a great observation. The comments have been patients need to speak up, to make their desires known,,,and here you have the reaction that we patients expect. Now it may be unfair to say this is representative of the profession as a whole. But it is a glimspe of why patients do not speak up, they antcipate this reaction. ....don
It occurred to me that this issue has so many dimensions and here's one that I don't think we've talked about.
Isn't is issue of empowerment to "speak up" really taking back our power and taking it away from the medical professionals? In order to perform medical duties, medical protocols have crossed into areas that are stepping all over our feelings, rights, privacy and autonomy (when information has been withheld), and our mental health.
It is the reason I'm so adamant about what I want, what I will and won't do, and what I say and my feelings about the medical professionals who treat me.
After experiencing horrific treatment, what else could a mentally healthy person do other than take back their power, and refuse to become a victim?
I choose them, they do not choose me. I do my part, cooperate, inter-active, express my needs, etc. I also fire them when I don't get what I need.
The most important part is bringing up this issue while scheduling every appointment, when I'm at the appointment, after I've gone to the appointment--always discussing how the experience went, why or why not it didn't go well.
Unfortunately, we are not all alike, we have not had the same experiences and unless you've had something so egregious happen, most people dummy up or really don't understand if you haven't had an extreme experience in a medical setting.
It's the same as reading in the history books about the death of President Kennedy and being there, feeling the blanket of death envelop a nation for the first time in modern history. It's the difference between reading about rape, and being raped. Unless it's happened to you, you can have feelings and empathy about the issue, but they won't be the same as those who've experienced it.
Most of us on this blog have had something happen that drew us here; some have not.
The funny thing is it didn't take years for me to take back my power. I did it when it happened. While I didn't understand at the time the ramifications of what happened (and wouldn't for more than 20 years), I knew what I had to do. No matter how uncomfortable it might be, it pales in comparison to the experience I was forced to endure under the guise of medicine.
The medical industry should support a patient's right to bodily privacy as a psychologically healthy thing to do. They know what happens when your privacy is eroded.
So, if you can, take back your power. Refuse if you're uncomfortable beyond your emotional tolerance and by all means, speak up, reject appointments with physicians who don't recognize your right to privacy. How long would it take for them to change if they saw it in their pocketbooks?
belinda
I hope the practice of medicine to diagnose and treat the patient and to be diagnosed and treated by the doctor never becomes a fight over power. Unless you have had the opportunity to diagnose and treat patients, you will know that this activity is not one that requires superiority of one party over the other. It requires instead, except under emergent conditions when the patient is unconscious, the equal cooperation between the doctor and the patient to make a diagnosis and have effective treatment carried out. Each party has the practical and ethical and even legal right to "speak up" to each other. And the potential benefit of an encounter beyond the physician's "pocketbook" is also the regaining health of the patient.
Yes, a patient going into a doctor's office may feel there is a power differential in favor of the doctor. It is the patient who is sick. But also, yes, a doctor accepting a patient acquires a personal responsibility for the patient's health that depends much on the cooperation of the patient.
With regard to the matter of bodily privacy, it requires education on both sides of the patient-doctor relationship. The patient should be educated by the doctor regarding the specific necessity of undress and the doctor should be educated by the patient regarding limits set by the patient's modesty concerns.
The goal of our discussion here should be understanding the necessity for the education of both parties and consideration of ways to carry this goal. ..Maurice.
Bravo Maurice! I couldn't have said it better myself. Yet, in the realistic world, things don't always go the way you speak. I will say, that progress has been made in a positive direction.
It's funny, but in medical disclosure, it's idiot proof, telling what can and might go wrong. The psycho social issues don't exist. What's needed is the same attention to detail in this regard. Maurice, any ideas of how to get the medical community on board with proper disclosure? Then, it's up to the patient to share what's needed BEFORE a personal negative experience.
belinda
NPR did a story on medical scribes today, which I thought you all might find interesting. They make a brief mention of the privacy issue, but not much.
There are a lot of comments already, and the number keeps growing. Here is the story.
This has all of the elements of this thread. Do you think after sitting in on 2-300 exams the scribe will care or remember you paticular body?" "We are trained professionals", etc etc The scribe making minimum wage is now also a professional since they done scrubs...I agree with you Dr. Bernstein, both sides need to communicate but the history of the profession has only recently changed. it will take awhile before patients feel empowered to do so. Excusing the profession from their responsibility in recognizing and changing to accomodate that is like excusing the sexist or racist because they didn't know better....while that is extreme, it doesn't make it acceptable, for those who have historically held the power and perpetrated the system, a special level of responsiblity falls....don
Regarding constructive ways to educate hospital administrators about some patient's needs for physical modesty: I am a medi-caid patient and have to use a county hospital which is NOT a teaching hospital. Last year I had an spinal MRI scheduled and requested a female tech, I was given a male. I finally got a female after MUCH objection from the male tech. I was in tears he was so hard on me. I later called the manager of the dept (I actually emailed Dr. Maurice about this as I was proud of myself for doing something constructive.) The manager was not very understanding and I was terrified of being marked as a difficult patient. Fast forward to this year when I needed another MRI. I got the same female and was told, "We have a volunteer today who will be watching the procedure."Because of my past traumatic medical experiences, I need to feel in at least some control of my medical care. Also, who is this "volunteer" who is going to watch my imaging? So I asked the tech to excuse this girl from watching. She was too afraid, she called her manager. They put me in a little room to wait..I felt like a criminal, I could hear them whispering. I had now made them all uncomfortable. The asst manager of imaging walked in escorted by security guards! This is how they now viewed me! Now, it is a county hospital so they have inmates going there, but still! When she saw that I was a small woman she laughed. I tried to explain that I needed my privacy and finally she excused the student/volunteer. It was a hostile conversation Though. Later, mindful of what Maurice says about education, I asked to speak to the asst. manager again. She met me in an exam room, she would not even let me in her office. I tried to explain that if she had ASKED my permission, I might have allowed the student volunteer. She just didn't get it. Finally, in desperation, I said what if I had been Muslum. This is San Francisco and Muslums are given everything special. I told her I was Christian and very modest, which I am. But that was a mistake because then it became about religion and she STILL didn't get that some patients like privacy and their privacy rights. I tell this story to illustrate how difficult it is to communicate to hospital administrators. This lady considered me a problem no matter what I said. Very frustrating. Thank you, Anne
A visitor to the 2007 then closed version of this thread attempted to post the following there. ..Maurice.
I am 53 and have a woman doctor. I've never been fully naked-always have the open back gown. I am always placed in stirrups for a prostate exam because she told me my prostate is higher than usual. There is no issue of modesty there. Your legs are in the air and spread. You're facing the doctor as she places a finger in you. It is humiliating due to the position. The doctor and assistant have always been very professional. You're in a doctor's office so you expect clothing to be off.
Don't really see the relevance of the 2007 posting. This patient does not have any issue with gender and the procedure described.
We are all aware that the modesty issue does not bother everybody. Some people pose nude for drawing classes, go to nude beaches and some just like being nude in front of people cause they are exhibitionists.
Some have no issues with nudity or gender regarding medical procedures, we all no that.
I thought this thread was about patients that do have problems with modesty and gender?
I am always a little curious and a little amused that people think what is right for them should be right for tou. this is on both side of this issue. The man CHOSE a female MD so obviously he has a different level of concern than some of the others here. Good for him but that has nothing to do how I feel. Conversely just because you do not want a male gyn does not mean others do not or care one way or the other. The crux of the problem is we are all different yet the medical community chooses to use the one size fits all approach rather than simply asking. The other side, if you have been on this thread and haven't figured out the key to your comfort is you standing up and stating what you want and will accept...look in the mirror for the problem. Should they ask, I think they should, will they? not likely so make them. I have started emailing prior, I am looking for a facility that will conduct the following exam/procedure and I want a male tech/provider for this part of it. Will you be able to accomodate me and who do I need to contact to make sure. If you get an affirmative prinit it and take it just in case you need confirmation. It is so much easier to address like this and you have printred proof of what was promised....don
Anonymous from 3:41pm today: The individual noted wrote today to the closed "volume". Since this is a "discussion" blog, I think it is appropriate to a discussion to allow entry of a view that is not necessarily "in step" with the majority of those written here. I wish there were more visitors here to explain how they can tolerate experiences as a patient which to others seems to be "intolerable". Isn't that a necessary part of a discussion regarding "patient modesty"? ..Maurice.
And Don you wrote "I am always a little curious and a little amused that people think what is right for them should be right for tou. this is on both side of this issue." How right you are about the bilateral nature of how "people think".
I hope that individual who wrote that comment today on the closed for publication thread would find this "Volume 65" and come and defend his view here. "It's Open!" both for publication but also for an alternative view. ..Maurice.
3:41 pm guy here. You are right Dr. Bernstein. It always makes a democracy when we can hear all points of view. I guess hearing all points of view will ultimately come to a conclusion. We are all different and how do we make the medical community address this issue. As Don says its like the medical community uses a one size fits all and it does not work. There are people avoiding exams and this is most likely causing deaths in society. Educated medical staff must know this?
There is a thread on Allnurses under general
discussion titled " would you deliver your baby
at your place of employment". Very interesting
comments!
PT
The posting on Tuesday, April 22 by the 53 year old man with the female physician illustrates the complexity surrounding modesty issues in medical care. The writer states that “I am always placed in stirrups for a prostate exam because she told me my prostate is higher than usual. There is no issue of modesty there.” Yet three sentences later he goes on to write that” It is humiliating due to the position.” I’m not quite sure why he would believe that there is no modesty issue involved when in fact he admits to feeling humiliated. I would suggest switching to a different, more respectful physician, perhaps a male, who might be able to do the exam, without an assistant present, while the patient is lying on his side, therefore involving less exposure and less humiliation.
The medical industry should not be responsible for everyone's level of comfort in the sense of thinking they can cover every situation.
They are responsible for disclosure of what to expect in the realm of attendance during a procedure/operation/exam, state of undress one can expect, and whether the facility is a teaching institution.
Don, with respect to written s requests, while it's nice to have, it's not going to happen due to liability, however, you can get the name of who you spoke to for validation of your concerns and then...on the day of the interaction, re-confirm and if they can't accommodate you, just leave. It's the best way to let them know you mean business.
A relative needed an operation and was told that normally, the patient would go home the same day. Due to multiple medical problems and the one plus hour drive to get to the hospital, the doctor consented (prior to operation day) to have him spend the night. The day of the procedure comes and they won't guarantee he can stay overnight.
The patient kept the OR waiting and refused to sign the consent form. Guess how fast the doctor showed up? The patient recalled their conversation and the accommodation was met.
The bottom line is they are not going to let you just walk out when they've slotted time just for you.
Ask questions. State concerns. Have the person repeat your concerns. Then ask if they are authorized to approve your request and if not, who is? That should do it. Works for me every time or I just have to leave (and that has only happened once).
With regard to the blogger who wanted to know why some procedures are tolerable to some and the same procedure not to another--it's based on feelings, past experience and that's different for everyone.
belinda
I have to disagree Belinda, I have on several ocassions emailed various requests and concerns and on every ocassion recieved a response in writing. From my experience they will respond. In that thread Dr. Bernstein is correct, right or wrong if you don't ask, you aren't likely to receive. don
Here is a frank, demeaning, and troubling account illustrating how medical students lose their humanity and empathy, apparently sanctioned and encouraged by the institution.
Ed
The link actually helps; my apologies!
http://www.kevinmd.com/blog/2014/04/watch-spectacle-share-guilt-create.html
Ed
Some people here may have a hard time finding the forum that PT referred to so I wanted to post the link here. There were some very interesting comments.
Would you deliver your baby at your place of employment?
Misty
I personally think it would be easier if everyone who posted here could use initials or name because it is hard to keep up with which anonymous posts. I think Dr. Bernstein’s request that people who post here use their names or initials is a good idea.
I wanted to respond to the below comments:
The posting on Tuesday, April 22 by the 53 year old man with the female physician illustrates the complexity surrounding modesty issues in medical care. The writer states that “I am always placed in stirrups for a prostate exam because she told me my prostate is higher than usual. There is no issue of modesty there.” Yet three sentences later he goes on to write that” It is humiliating due to the position.” I’m not quite sure why he would believe that there is no modesty issue involved when in fact he admits to feeling humiliated. I would suggest switching to a different, more respectful physician, perhaps a male, who might be able to do the exam, without an assistant present, while the patient is lying on his side, therefore involving less exposure and less humiliation.
I thought you made excellent points and observations.
I also found it strange that the 53 year old man stated that he had no modesty issues, but then talked about how humiliated he was. It is clear that he is at least a little uncomfortable with the female doctor and the way she does his prostate exams.
Many people will deny that they have modesty issues in medical settings, but then they share some of the things that make them uncomfortable. Many patients are trained by the medical industry to give up their modesty in the name of medicine. Also, many patients prefer to pretend that they were not exposed as much as they were. For example, some surgery patients do not want to admit that they could have been naked while they were under anesthesia.
Patient modesty is an uncomfortable issue for many people so that’s why you do not hear much about this issue in public.
Misty
The description of the behavior of former college students who have been thrust into a gross anatomy lab in their literally first days of medical school which you can read from Ed's link to kevinmd website is worth reading. The later consideration of the dead body as a former real person with a life is a common metamorphosis which regularly occurs in the later days of the course.
Another excellent description of the same developed humanistic consideration was written by Dr. Steven Miles, physician ethicist which I used for my blog thread "Humanism and Pathology: The Anatomy Lesson". You might be interested in reading that description also. ..Maurice.
To Misty and others commenting on the "53 year old man". I would suggest that his humiliation might not be related to physical modesty or the doctor's gender as much as having to be examined in a way pelvic exams are performed on women.
However, in terms of a statistical analysis of 120 patients undergoing digital rectal examination (DRE) http://www.sciencedirect.com/science/article/pii/S1875974212001048
between "cross-leg lithotomy" (CL) vs lying on the exam table on the left side (LL) the results:
Men found DRE uncomfortable [LL (81.7%), CL (85.0%)] and embarrassing [LL: (81.7%), CL (78.3%)] in both the positions. DRE was painful [LL (11.7%), CL (8.3%)] with a mean pain score of 1.92 and 1.85 respectively. Patient apprehension regarding pain was significantly higher [LL (62.5%) vs. CL (21.7%), p < 0.001] in LL position. Overall, men preferred CL to LL position [CL (78.3%), LL (21.75%), p < 0.001] for DRE. From urologist perspective, the extent of prostate felt in CL position was significantly higher (CL: 11.15 ± 1.96/12 vs. LL: 9.25 ± 2.50/12, p < 0.001). Withdrawal response was significantly higher in LL and urologist had to sit down to perform DRE in LL position.
Interesting. ..Maurice.
The link that Ed provided is very disturbing. Some medical schools desensitize medical students to lose their empathy for patients. I believe this is exactly why we have so many patient modesty violation cases. A number of medical students were reluctant to do non-consensual pelvic, genital, and rectal exams on patients under anesthesia without their consent, but they felt intimidated by professors to say no.
Misty
I have interacted with a number of people who were modest, but they felt they had to give it up in medical settings because they were told it was necessary for the sake of their health. Some doctors do not tell patients the truth about their risks. For example, so many pap smears, Digital Rectal exams, and pelvic exams are unnecessary. For example, a virgin woman who has never engaged in any type of sexual activity really does not need a pap smear according to this article.
I have to say that most patients who feel humiliated when they have invasive exams are at least a little modest.
I cannot help, but wonder if this 53 year old man was given enough information about DRE to help him to determine if it was really necessary for him.
It is true that DRE, Pelvic exams, and pap smears are necessary at times, but too many of them are done unnecessarily. I am tired of the one fits size approach that doctors use. Not everyone has the same risk factors.
Some of the research I have done shows that DRE is not really necessary for asymptomatic men. I personally knew a man who had prostate cancer. He had some symptoms that were concerning so he first got a blood PSA test.
Here are some articles I wanted to share with you all that I thought you would be interested in researching:
1.) Great News For Guys: No More Invasive Prostate Exams!
2.) Are Annual Prostate Cancer Screenings Necessary?
3.) Prostate Self-Examination; Prostate Self-Exam At Home
Misty
Dr. Bernstein could you explain CL to me. The two exams i was aware of was LL and bending over the exam table...that one is definatley uncomfortable emotionally...don
Don, I was not previously aware of that positioning (cross leg lithotomy) of a patient and on researching I could not find a graphic to illustrate the positioning. However, I would assume it would be as with a pelvic exam in a woman, the patient is lying on his back with the lower extremities elevated but unlike the womans' positioning with the lower legs abducted (positioned laterally from the midline)and feet in their stirrups, the male would have the legs adducted (brought and crossed at the midline) with the feet in stirrups. I don't understand the practicality of the cross-leg positioning. If anyone has a better description please report it. The prostate which lies on the anterior aspect of the rectum is superior to the anus. In the standing or lying on the left side positioning the prostate would be felt relative to the examiner's position, inferiorly on standing and left laterally in the LL position. In the CL, the prostate would appear superiorly to the examiner. I am not sure the explanation of better access to a more superior positioning of the prostate in which the examining finger in the other positions might not reach the entire prostate. ..Maurice.
Yesterday I went shopping--something I detest, but when there is need, I do it. I'd rather go to the dentist.
My observations and this blog collided. I know why I'm skittish in a small shop, removing clothing and worried that an unwanted salesperson will pop in unannounced, a flimsy "too small" curtain separating me from the public area.
Yet, I go to the gynecologist, and have no qualms about my state of undress, the position I'm in, etc.
What did that say to me? After carefully thinking about it, I came to realize that the unexpected, and the clash of private and public areas so close, caused anxiety because of my experience all those years ago. It wasn't about vanity, it was about privacy.
The examining room at the gynecologist's office is a safe place for me. I trust both my doctor and her nurse. The door is positioned when open to have a view of the back of my head only. It is a safe place. I know why I'm there and what to expect. There is no embarrassment or feelings of being uncomfortable.
Dressed in street clothing minus underthings, there is no reason or cause for any kind of anxiety at all.
Sometimes, positioning, and the degree of nakedness only increases patient humiliation in an operating room/ER. Couple that with intruders and observing eyes that are unexpected is just traumatic. It's the nature of the beast.
I'm not sure the medical community gives the same consideration to the living patient as much as Dr. Miller did in his piece about the cadaver he was working with.
Maurice, how do you feel that the medical community can improve itself to recognize vulnerability, humiliation and humanity and put that at the forefront of every medical situation, even an emergency.
Protocols to limit observers and
examination of an victim in pieces doesn't take more time, it takes protocols in advance to recognize there is a human being involved with feelings.
So often, people leave the hospital and what do they remember? They remember the humiliation they had to endure to get their medical care.
belinda
I wanted to share an article that was in Outpatient Surgery Magazine today: Patient Says He Was Defamed During Colonoscopy.
This is exactly why patients should opt for local or regional anesthesia without Versed or any types of sedation that would impair their ability to speak up for many procedures. It is possible to be alert during colonoscopy. Check out the colonoscopy article I wrote last year.
Also, it is prudent for a patient to have a personal advocate present. I believe that we would see cases similar to this one decrease if patients were alert during procedures and had personal advocates.
Misty
Here is a rather disturbing story, concerning doctors mocking an anesthetized patient, during a colonoscopy. Here is the
link, and another here. The patient found out about the comments, since he left his cellphone on during the procedure. Apparently, he wanted to record what the doctor told him in recovery. Not a bad idea, really. I never remember meeting with my doctor after a colonoscopy, let alone do I have a clue what he told me!
Some of the comments made included an accusation that the patient has an STD, which
he does not, and that the doctor "wanted to punch you in the face and man you up a little bit".
More disturbing is the fact that a medical assistant was permitted to touch the man's penis during the procedure. Something that is certainly not necessary for a colonoscopy. In fact, there
is really no reason for his genitals to be exposed.
I hate to be paranoid, but I can't help but wonder if this is one of the reasons that
they always give me Versed, which causes amnesia, when I have a colonoscopy. Since I am never fully sedated during the procedure, it might be "inconvenient" were I to remember all that occurred.
Also, Dr. Bernstein, I sent a link to a picture of the CL position, but it looks like you
may not have received that comment. You can find the picture
here.
I saw that story too, Misty. In fact, I submitted a comment on the topic, but it appears that Dr. Bernstein did not receive it.
The most troubling item in the article that I read concerned the medical assistant touching the patient's penis during the procedure. Apparently, this was in conjunction with the "doctor" falsely stating that he had an STD.
Pretty disgusting, and exactly why I intend to refuse Versed during my next colonoscopy. I am never fully anesthetized during the procedure, and even with Versed I usually have images and disjointed memories. I would much rather have a clear recollection of what has occurred. Especially if this sort of nonsense is possible.
So once again we have another "isolated incident".
How many of these "isolated incidents" is it going to take before the medical system realizes they have a serious problem and address it.
There need to be automatic penalties for these type of actions and they need to be severe and zero tolerance - first offense, automatic suspension of license for minimum of 30 days - 2nd offense, automatic termination and suspension of license for 1 year - 3rd offense, permanent revocation of license to practice.
Some may think this a little on the draconian side, but consider the situation: there are some professions, such as police officers and physicians, who, because of their implied position of trust, need to be held to a higher standard of conduct.
I firmly believe that incidents like this contribute significantly to the erosion of trust in the medical profession we see doctors complain about.
Physicians complain that they weren't the ones that behaved this way so why should they suffer from the loos of trust. To that, my response would be that if they aren't part of the solution, they are part of the problem.
This is my challenge to physicians, the vast majority of whom I am sure are truly caring and concerned about their patients: Clean up your profession. Proactively and publicly get rid of those who commit these type of acts, and the public will see that you have earned their trust. On the other hand, do nothing and the public's trust in your profession will continue to erode.
Hex
Misty
Thank you for sharing this article, sadly this
kind of behavior is rampant at ALL medical
facilities. I have heard my share of derogatory
comments directed to patients or behind their
backs. I could write countless comments on
this blog about this subject and I believe this
patient will be successful in his lawsuit.
For patients who want to avoid the risk
associated with colonoscopy there is a
test in Cat scan called virtual colonoscopy
which allows for successful visualization of
the colon. If abnormalities are seen it would
call for further evaluation.
PT
which
Thanks to Staying Fit for the link to the picture of crossed leg lithotomy positioning for rectal exam. It is consistent with my understanding and description and it brings the examiner "face to face" with the patient's anus. However, I am not sure I understand how the prostate is more easily palpable in that position. I intend to ask a urologist friend of mine. By the way, he wrote one response on a previous Volume some time ago and was "turned off" by the response of my visitors and is disinclined to write again. Unfortunately, to make changes in the medical system that our visitors hope for does require a certain amount of attention to courtesy despite the lack of courtesy you may find within the medical system itself. Correct? ..Maurice.
Why don't you tell us why he was "turned off" on the oft chance we won't repeat the mistake?
Ed
Perhaps he dosen't agree with the subject
matter and commentary on this blog, yet
it is from his perspective that all providers
are absolute professionals.
He commented on KevinMD how distasteful
it is the way male patients are joked about and
portrayed on television and the media. Sad he
can't seem to grasp how those behaviors are
extrapolated in real life.
He argues against hiring male assistants in his
urology practice and states that " if you have
some concerns, let us know what those conerns
are " to that effect. Would a female urologist hire
a male assistant for all of her female patients?
The continual theme of course by offsetting blame
which instead should be to fix their own problems,
hold themselves accountable and advocate for ALL
of their patients instead of just one gender!
PT
Maurice
Incorrect. The definition of discrimination is
" the unjust or prejudicial treatment of different
categories of people or things, especially on the
grounds of race,age or SEX.
Then there is the subject of ethical treatment
which when factored into the equation takes the
subject to an entirely different level. What does
courtesy have to do with any of this. If he is
not turned on, great! He can be " turned off"
and tuned out. I much rather he be turned off
that turned on.
Do you think blacks, Asians, Jews or any
one else for that matter should handle
discrimination with courtesy. Would you please
show me where that is written.
PT
StayingFit: The link you provided about different positions was very helpful. I appreciate that no genitals were exposed on this web page.
You are right that there was no reason for this man’s genitals to be exposed. He should have been able to wear colonoscopy shorts or boxer shorts that only exposed his rear.
Versed should never be used for colonoscopies period. I think they should make Versed illegal. I do not know if you had the chance to read the Versed article I helped to write last year.
Many people are unaware that Versed is also known as Midazolam. The truth is a colonoscopy really does not need an anesthesiologist anyway. Look at this article on KevinMD.com: Colonoscopies don’t need anesthesiologists.
PT: Most medical professionals would not make derogatory comments in front of patients or if they were alert & awake. Imagine how many derogatory comments are made behind patients’ backs without them ever finding out.
Dr. Bernstein: Can you please ask your urologist friend a question? As you know, patients can wear colonoscopy shorts or boxer shorts for colonoscopies to protect their modesty. Can you ask him his thoughts about patients wearing boxer shorts backwards for Digital Rectal Exams? Let him know about colonoscopy shorts. I am sure many men would appreciate being able to wear boxer shorts backwards or colonoscopy shorts for DREs if possible.
Misty
PT, you wrote "He.." and "He.." Which "He" (urologist) are you referring to. If you are aware where my urologist friend had commented on this blog, please let me know since I am been searching without discovery. Are you inferring that my urology friend also wrote to KevinMD.. did I know he did that?? Thanks for any refreshing of my memory. ..Maurice.
I encourage you all to check out another article I found about the colonoscopy patient: Colonoscopy Patient Sues Doctors for Making Fun of Him While He Was Unconscious.
The truth is if this man’s cell phone had not accidentally recorded the doctors’ conversations, he would have never found out about those derogatory comments they made. I hate to say this, but medical professionals making inappropriate comments about patients behind their backs happens more than we wish to admit. This is exactly why patients need to be educated about how to protect themselves. Sedation and general anesthesia should be avoided as much as possible. I cannot help, but wonder if this man was informed of choices to be alert during colonoscopy.
The comments especially from medical professionals at the bottom of this article are very disturbing.
Let me share one disturbing comment from one medical professional:
Apparently, you never worked a 10, 12 hour or longer shift in the medical field before, I do and have been doing just that for over 20 years. Working in the medical field you are under constant stress with lives in your hands, from the minute you clock in, to the minute you leave for the day. Use of humor is a must in the medical field, if you want to survive in it long term. I have said to my coworkers, the day i lose my sense of humor, is the day I need to leave the medical field.
I find it disturbing that she thinks that what happened to the colonoscopy patient was okay and that this kind of humor is okay. It is certainly not right to mock a patient’s private parts in the name of humor.
Misty
I encourage you all to check out this article: Mom Says School Physical Exam Crosses the Line.
It is terrible that New York State Department of Health requires Tanner Staging as a part of a complete physical exam. It is ridiculous for medical professionals to be required to check a child’s level of sexual maturation in New York. This has nothing to do with the health of a teenager.
It is encouraging that this woman’s daughter refused the test. I wish we could educate all parents and teenagers that Tanner staging exam is unnecessary. It’s simply an invasion of patient privacy and modesty. Think about the emotional damage this could do to teenagers.
Misty
Misty
Great post! As I have mentioned I have
heard countless negative comments about
patients behind their backs. One comment
I will share here regarding a surgeon who
learned that his patient whom he just completed
surgery on was an attorney. The surgeon said
to the PACU nurse " oh he is an attorney, we
won't give him pain meds when he wakes up"
Not sure what 10 or 12 hour shifts has to
with people losing their ethical or professional
behavior. When I was in the military during the
Vietnam conflict I never slept once for three
days. I then got 5 hours sleep and then I went
for another 2 days without.
Most of these medical crybabys wouldn't
know what real stress is. If it's not whining about
money it's complaining about anything else so
related to how so important they claim they are.
PT
PT,
Thank you for your perspective from your military experience! There is no excuse for anyone to do unethical things when they are under stress. People who served in military who did wrong things were usually punished. There are so many good things that medical professionals can do if they are under stress. Stress is not an excuse to make fun of patients’ genitals or treat them badly.
I really appreciate you serving in the military to fight for freedom in America. So many wonderful soldiers fought for our freedom despite high levels of stress.
I get the impression you’ve worked at regular hospitals. I have learned that modesty violations seem to be worse at Veterans Hospitals. In fact, it seems like some female nurses at VA hospitals treat men who wish to only have male nurses for intimate procedures terribly. In fact, I have corresponded with a man who had bladder cancer who was very upset with the way he was treated at a VA hospital when he expressed he did not want any females to be involved in his intimate care. One of the doctors there labeled him as bipolar.
Do you know much about modesty at VA hospitals? Some VA hospitals do ghost surgeries (this means that they allow medical students to do surgeries instead of the doctor who was assigned to do the surgery without the patient’s consent).
Misty
My article on medical scribes and patient privacy has been published on KevinMD. Please take a look and follow any comments.
Reading thru this thread it occurs to me that another difference between the lithotomy position for women and men is that women are always fully draped. Now I've seen no statistics for men but I doubt that it is always true for men, obviously increasing the potential embarrassment.
The link noted by Dr, Sherman to KevinMD is in error. Here is the correct link. ..Maurice.
Dr. Bernstein, thanks for posting the comment that I thought I had lost. I'm not sure what I was doing wrong, except maybe trying to post things before I was fully awake!
Misty, thanks for the link, concerning Versed. That is some very interesting information! I have been given Versed 6 times (3 colonoscopies and 3 surgeries), and every time I was told that the anesthesia would cause amnesia. However, they neglected to mention that this was intentional. I honestly thought it was an unavoidable side-effect of anesthesia. When I learned the truth, I was not happy. To me, withholding that information is misleading, at best, and even somewhat deceitful.
StayingFit,
I personally think the way they give Versed is deceitful in many situations.
You would not believe how many people do not know about Versed. I received a very disturbing case from a lady who had a hysterectomy. She had requested an all-female team, but was lied to. In fact, a male anesthesiologist gave her Versed before she was being prepped so she could not complain about the males involved in her surgery.
I wish all patients knew the truth about Versed. Based on the tracker for Medical Patient Modesty's web site, many people have visited the Versed article . It looks like some people just typed in other keywords that did not involve patient modesty to find that article.
Misty
Great post Dr. Sherman informative and fair. Thanks for the effort.
I don't know what kind of MD you all have been seeing but I have had versed several times by several differnt MD's and they all explained exactly what it was for, so i would not remember the experience and would not have to have more risky anesthethia. For me that was fine, what happened or did not happen doesn't bother me that much. I trust them, i just don't want to experience it so I have memories of it...but that is my personal feelings not right for everyone, just me...don
Don, I understand what you are saying, and I probably would have agreed to the Versed at the time, especially since I was not aware of most of the issues that we discuss here when these instances occurred. Lest you think I simply had one bad doctor, please understand that I had 3 different surgeons, who practice at 3 entirely different surgical centers. I also had 2 different gastroenterologists, practicing at 2 different facilities.
In all cases, my doctors never discussed any details, concerning the sedation that I would receive. I would first hear about this at the time of the procedure, and even then I would be told that I was being given something to keep me calm, and that amnesia would follow.
I appreciate that you are comfortable with receiving this drug, and I can see the benefit in not remembering the procedure. Personally, I really don't like amnesia, especially the partial kind that I seem to have after colonoscopies. I find the disjointed images disturbing, and I usually spend the next couple of weeks trying to make sense of them. Also, as I said previously, I find it troubling that no one ever told me that the memory loss is intentional.
Dr. Bernstein asked this question at the top of this blog:
Which hand of a healthcare provider do you want touching you and whose eyes looking at you, male or female? Do you believe that gender is more important than skill or personality. ..Maurice.
A lady made some very points at the bottom of this article that are relevant to the question Dr. Bernstein asked: Reverse Sexism in OB/GYN
Alice April 23, 2014 at 8:50 PM
The issue in question isn't whether or not male OBGYN's are compassionate , competent, sincere or otherwise. The issue is simply this , he's a man treating a woman for problems & conditions in connection with her sexual organs. No thank you. Pure & simple.
Many people who value their modesty even in medical settings will not even consider opposite sex medical professionals for intimate procedures even if they are compassionate and competent. One man commented here that he would prefer to have a male medical student than a female nurse who had 30 years of experience.
Misty
I thought you might be interested to the Comment I just wrote to Dr. Sherman's piece on KevinMD regarding scribes and my suggestion how to avoid the need and costs and the privacy issue of scribes. What I wrote is reproduced below. ..Maurice. p.s.- I too am try to spread the word regarding patient modesty!
Why not a clip on microphone for the physician to input his/her comments as the history and physical exam proceeds? The spoken text is then immediately translated into written text by the same wonderful translation apps on everyone's cell phone and the history and exam proceeds smoothly. As far as later review is concerned, the physician must take time later to do that for the same rationale that the physician must review and correct even the scribe's work-- for accuracy and completeness.
With a spoken narration, the physician's eyes are always directed to the patient and the patient gets to make corrections to the narration of history or importantly ask questions and thus be educated about points in the description of the physical exam findings. This technique will hardly cost an office or ER the price of a scribe and for the patient: privacy. ..Maurice.
Dr B, bear in mind that the justification for using scribes is ultimately to input the info into an EMR, so someone has to type or click the narrative into the EMR. There are multiple chances for error which are hard to eliminate.
My article on Kevin MD has aroused much comment. I'm sure a significant part of it is coming from readers here. That is one very important way you can all show that the concern over your personal privacy is an important issue. We still need to convince many providers and institutions of this. Keep it up and thank you.
Joel, I can't believe that at this stage of computer science, there is no way to provide direct entry of text from speech directly into the EMR file itself. ..Maurice.
I don't know Maurice, but I doubt that it's easy to do given all the different programs and ever changing Federal mandates.
Dr. Bernstein,
I really like your great idea about how doctors can avoid scribes. They do violate patient’s privacy and modesty. Also, more patients might avoid medical care if they know scribes will be present. It would also save money if doctors could resort to using a microphone to input his/her comments to be translated immediately into text.
Perhaps, Dr. Sherman and you could do some research about this. We should check with some programmers who have helped with voice recognition. I agree with Dr. Bernstein that there should be a way to provide direct entry of text from speech directly into the EMR file.
Misty
"Which hand of a healthcare provider do you want touching you and whose eyes looking at you, male or female? Do you believe that gender is more important than skill or personality. ..Maurice."
I believe that in emergency situations obviously most people will be in shock and not thinking about gender preferences. Or if you are dying and an opposite gender doctor or personnel are the only ones qualified to do the procedure you will probably say yes.
My problem comes with routine or exploratory exams. If I need a testicle or prostate ultrasound I don't like the idea that most of the time you are stuck with a female. If I go to a urologist for a vasectomy, I don't like having a female there to just basically watch. I don't like opposite gender care period. I know they are just as well qualified but i don't care.
Society conditions us to be segregated as genders regarding nudity our whole lives. We have our own bathrooms,change rooms, even jail cells . In fact if I were to walk naked in front of my female coworker I could go to jail.
Now if your sick and in a vulnerable situation here comes the health care system that throws opposite gender care at you and says it's different now! We have seen it all before so you have nothing to be worried about.
What is being professional with regards to exposure in front of opposite genders. Acting concerned and serious about the exam and not letting on that you are disgusted or aroused by the patient? We expect that.
When I hear medical personnel say that they look at body parts without any normal human judgment it makes me angry. Everybody judges...it is human nature. Thats like saying I see so many peoples faces everyday that I don't notice who is not attractive and who is.I service cars all day so I don't notice the difference between a Pinto and a Ferrari. You and everything is being judged every time someone sees it. It is called human nature. So if the medical community can do a good enough acting job to fool you into "We have seen it all before" they are "Professional"?
Don't get me wrong. I know we need medical people and most of them do a great job but there is a lot of us who don't like being told "We see it all the time" or "It's no big deal". We are not stupid and we know human nature. Medical staff are no different than regular people. If they have seen it all before and it is no big deal then why is sex the biggest seller in entertainment?
Oh right."Its not sex, its health care". We are robots.
Give us some dignity at least before we go in for the big one(procedure).
Bob,
I appreciate your excellent points. You are right that medical professionals are humans like others.
Misty
I would like to go back to the subject of scribes just a bit. If you go to the article Dr. Sherman wrote on Kevin MD and read the comments it is quite obvious to me that most of the doctors commenting there read the whole issue as one of concern over privacy of medical information and not one of bodily (modesty) privacy. They just don't get the whole concept of patients not being comfortable with exposing themselves to multiple individuals especially of opposite gender. Or, again, they just don't want to acknowledge it. One commenter basically just says that when they go to a doctor they just know and accept that others besides the doctor are going to "view" their disrobed body. To me most of the comments from doctors were complaining about the mandate for EMRs (for those accepting/billing Medicare patients) and giving that as the reason to justify using a scribe. Little concern about the issue of patients having to bare their body to yet another additional (clerical!) person. I really appreciated Dr. Bernstein's suggestion about the microphone but it seems to me that there is always an argument about that: that somehow it doesn't meet the requirement of the "checklist" design of EMRs. So in essence it appears that doctors/medical offices may just want to take the easiest route to streamline their practice regardless of the level of comfort to their patients.
I don't know how common medical scribes may eventually become (in private practice not emergency care) but it seems like with all the new regulations/mandates, etc. we may be seeing more of them and generally experience a lessening of our privacy. I am not too optimistic about this whole issue being addressed system-wide but I am still prepared to speak up and put my foot down if necessary to get the respect and privacy I need. Thanks so much, however, to doctors like Sherman and Bernstein who are willing to listen and understand. I am a little more optimistic that there are others out there like them and if we do indeed speak up we may all be able to find them! Jean
At many medical facilities once purchase is made
of EMR and implemented the federal government
will reimburse that medical facility. Emergency
room scribes are not employees of the hospital,
they are employed by the emergency room
physicians group. The fact that they are not
hospital employees in my opinion gives you the
patient more say in refusing their presence.
To my knowledge hospitalists do not use
scribes and it is my take that ER physicians use
them to improve efficiency. The truth is scribes
type in very little information about the patients
history and symptoms. Each patient that presents
to the emergency will have an already pre-made
medical record that resembles their symptoms.
The scribes simple fill in a few blanks, something
the physician could easily do. The use of scribes
from what I have seen merely is a tool to further
document specifics of the patients visit, thus
reducing lawsuits. I have reviewed these EMR
records of many ER patients and most of this
pre-made data does not even apply to them.
All of this computer implementation and staff is
now passed on to you the patient in an ever
upward spiraling out of control of healthcare
costs. For many years Radiologists use a dictation
system and newer use a voice recognition software
that easily could record and transfer data to the
patients record. That alone should alert the casual
viewer that this is really about money, equipment
and reducing lawsuits and nothing to do with
efficiency and quality for the patient.
PT
Three points: Can anybody tell me why scribes are needed when there are computer programs that write for you as you speak?
Second, a medical facility that specializes in ED made a radio commercial in our area. It describes their services so I decided to call.
Everyone from the receptionist, techs, nurses and doctors are all male! I was so pleased and mentioned that they should advertise that they are an all male facility. Guys, it looks like your time is NOW!
Third, Maurice, you asked the question whether gender preference is more important than personality or skills. The answer is simple. If you have a situation when a patient refuses opposite gender care, isn't it better to see a doctor rather than see no one?
I really don't care about a doctor's personality. It's only when they are disrespectful that I have a problem. I love all my doctors, both male and female.
My neurologist said, " I have no idea what's wrong with you". I quipped, "What good are you?" I was joking as he's the only doctor who actually gave me medications that helped my situation. I apologized for teasing him (he looked horrified) and told him how much I appreciated his hard work. He referred me to a nationally famous top hospital for an evaluation. Now off to that adventure. That's just how I look at it. It's always a little challenging but I find most to be so empathetic, and staff really makes an effort when you treat them with a friendly attitude and what your needs are and why.
belinda
The whole point of scribes is to enter data into EMRs to satisfy federal mandates. It would not help to transfer spoken speech to typed comments unless it can fit the EMR form. And as this is constantly changing, I'm not hopeful that the process can be done without a person entering data. Even if it could the doctor could not talk freely but would have to tailor his comments to the requirement of the EMR.
Voice recognition integration with a number of EMRs already exists and it works - just "google" it and you will find numerous examples....
Hex
Belinda said " Guys, it looks like your time is now"
With all due respect Belinda, I don't think so. It's
the same old song and dance and that is female
nurses it seems just can't wait to either shove a
tube down someones penis or walk in while we
are changing.
PT
Thanks Hwx, I Googled and by golly I see that it is quite possible that Dr.Sherman's pessimism may be unwarranted. The ads (mainly ads) sound very optimistic as far as the current ability to work with EMR even in all specialties and the variations of physician's voice.
The question then arises as to who is overstating the need and value of their services: scribe vs the voice recognition companies.
..Maurice.
See my comment on KevinMD.
My experience with voice recognition software is very limited. But I disabled Siri on my iPhone as being worse than useless.
If Stephen Hawking can communicates via a computer, so can doctors. Instead of speaking, it's writing.
Siri is not the program for transcribing. Siri's function is to interpret and give back information.
By the way, I've had students take a history on me and sometimes Siri is more accurate. Sad to say, but true.
belinda
On KevinMD, today, Dr. Sherman wrote the following followup comment regarding voice to EMR files systems:
I'd like to hear from providers who have actually used these systems. Are they ready for prime time? That is can they really be error free enough to avoid substantial corrections having to be made by the provider thereby undoing the reason for getting them in the first place? Most of what we see are ads by companies who lease scribes or who sell software. Medical societies such as the AMA need to evaluate the actual performance of these entities.
I responded today with the following:
And added to such evaluations of the methods of EMR recording, the medical societies and of course also the government should consider in addition to the importance of statistical documentation, which may not have any immediate value to the patient, the added factors of patient autonomy and privacy. These direct and immediate interests of the patient should have equal consideration. ..Maurice.
Staying Fit, You and i are on the same page here. What is right and comfortable for you, and me may be different, we recognize that, I wish everyone on both sides understood that. Now that you mentioned it, I do not recall if i was told before or at the time of the proceedure what versed was about. I think it may have been a mixture, I know for my endoscopy my MD explained prior, can't be sure about the other times....
Bob you summed up my thoughts in one post that i have tried to express over 7 years....right to the point.....don
When I needed emergency surgery I was too sick to care about modesty, I think there must have been 4 people with me when I was stripped, and a male nurse I remember held a sheet over me to not expose my naked body to everyone in ER.
But I learned the hard way after having several colorectal surgeries when my surgeon became strange and began to touch me around my waist and hit me with my own chart, he told me he wanted to be more like me, then he began to be even more strange, finding me on my runs, I started to fear him. Long story, but laying LL position for DRE while he blocked the closed door, hasseling me about not acknowleging him on the road, I felt so vulnerable. 7 surgeries with his face and hands in my vagina and rectum, yes, I learned not to trust. I now have PTSD, my psy reported him once I told what was happening, by law he had to. Now I wont allow my new colorectal to follow me out, or touch me even a pat on the back is a trigger.
So to answer the question, life saving I didn't have anxiety about people seeing my naked body, but intimate exams I still shake on exam table
Female patients who require a pelvic exam in the
emergency room apparently are exempt from scribes
during the exam process. If a provider can remember
any physical findings from a pelvic exam then why
can't they remember physical findings from the rest
of the emergency room patients.
PT
But not for male genital/rectal exams! Imagine that?
Ed
I still love the comment by Bob, I notice people whether they are attractive or not and see them everyday....it puts a new question on the contention that seeing people naked...exposed becomes routine and context makes it different. Simple but profound Bob....don
PT,
I am not sure if you read my posting on April 26th. I would love to hear your thoughts about Veterans Hospitals. I am very concerned about how some VA hospitals treat male patients when they express desires for modesty and no female medical professionals to be involved in their care.
Please let me know.
Misty
Misty
I don't have any experience with VA hospitals,
military hospitals nor nursing homes. I will say that
as with any institution there is always to some
degree of abuse in some form or another. Of
course I have heard stories from military but
nothing I have seen or that I can verify.
Remember that abuse comes in many forms
and currently there are a number of VA facilities
at this moment across the country that are under
investigation. Personally, VA and military hospitals
should be managed perfectly as they are truly
non-profit institutions if you compare them to the
civilian counterparts. They have plenty of staff and
a hugh budget, yet mismanagement is rampant
at many of these government facilities.
PT
Misty
Let me if I may present my opinion from a
different perspective. I think it's irrespective of
whatever the institution but rather the mindset.
Nurses simply hate their jobs and I believe
that as a whole there exists more job
satisfaction among professional hit men, bus
drivers and pimps than the nursing industry.
This hate mentality is well ingrained in their
nursing culture. Nurses eat their young,they
often claim they " know more than the doctors"
and my biggest pet pieve, they are quick to
ridicule anyone who earns more than they do,
especially teachers and for that matter anyone
who works in acedemia.
PT
I ( male, 50s)was told to lie on the examination table for a urological procedure. Theater was busy with about a dozen staff-more female than male. Then without a word my gown was pulled up to my neck and I was bare from shoulders down to all.Urolgist came and examination was completed , still visible nude on table. Staff all looked me over openly and unconcerned.And not bothered that I saw them looking.No attempt to cover me at any time. Just treated like a piece of public property.
Remember "At Friday, May 09, 2014 2:39:00 AM, Anonymous said... I ( male, 50s)was told to lie on the examination table..." that it's not about you. You are the object to be processed so that the administrators can bill the government and/or health insurance companies that allows the profit.
BJTNT
Anonymous, I am sorry that you had that experience. I have had an experience that changed my life and gave me the opportunity to research the issues that are mentally unhealthy to patients in the .
I've been blogging on here for a long time and would be interested in learning about your feelings and how those feelings have effected your attitude about future medical care.
If you are interested in speaking with me, please contact Dr. Bernstein and he will provide you with my e mail address.
Thank you for your consideration.
belinda
To anonymous on the exam table nude, while I can certainly understand your reaction because I've been there and silently endured the humiliation too, the only way to deal with this is forthrightly and directly. "Excuse me, but exactly why are you all here? You, you, and yes you, you're all excused or I'm leaving. Do you mind but it's actually cold in here and I'm not a slab of meat on display in a butcher shop." To my layman's knowledge, there are few if any urology procedures in an outpatient setting requiring anyone other than the urologist. Take control of your medical care since you're actually paying for it and demand it be administered in an acceptable manner or go elsewhere. If the physician actually believes you're leaving with the resulting hit to his bottom-line, they'll bend over backwards for you. Come on guys, start acting like men! Women generally get their modesty, dignity, and privacy concerns adequately met simply because they've insisted upon it and we must do the same!
Ed
The urologymatch.com forum discussion, "How do men feel about seeing a urologist who is female" has been deleted without explanation. Seems very similar to those allnurses.com posts where entire discussions were deleted when patients had the audacity to question or object to the status quo we are routinely expected to submit to when receiving medical care. I emailed the following:
Why has the forum post "How do men feel about seeing a urologist who is female" been deleted? With all due respect, was your decision to delete this post attributable to objections by female providers who feel their practice may be threatened when men have the audacity to question or object to who participates in their healthcare? Alternatively, might it have been male urologists who fear their bottom-line might be negatively affected when men elect to walk when faced with the nearly universal female staff their faced with?
If you're interested in commenting, email collectingsystem@urologymatch.com.
Ed
I'm not so sure women get heir modesty concerns addressed or even respected.
B tw, I'd like to comment an experience,
I had surgery recently. It was an eyelid op, for which they didn't use (and never do) general anesthetic.
THey gave me an injection that left me just the right amount of drowsy and that was that. Yes, I was aware of what happened all the time, apparently over here OR conversation has to do with holiday resorts (also OK with me, they were doing their jobs and silent 90% of the time)
Comment: my surgical attire was a gown that tied on the sides, undies that fasten the same way, a cap (OK, guess you also need to keep that hair out of the way). I wasn't allowed to wear any bra, that bothered me. Not to mention that in the rush of getting ready, (and figuring out what must be fastened where) I kept my real undies under the surgical ones, something that according to protocols, I shouldn't have done.
There are two ORs in the same clinic, all in the same floor, right next to the other. I distinctively remember taking the lift there, and walking all the way from the prep room (that doubles as as recovery room) wearing nothing but the booties on my feet. Then you climb by your own means to the rather high operating table. So I can't wear a bra but I am made to walk barefoot all over the floor? Btw, that being a plastic surgery clinic, it can also get embarrassing if you happen to bump into someone you know who is having work done in the next room.
They admitted that's not unheard of, since there are times of the year in which they're really busy and working to full capacity.
Yup- we should be more assertive.But the other staff were nothing to do with my gang- just unqualified assistants clearing up an earlier procedure.Point is no one person was in charge of the room.So the clearers were bold as brass.
Apologies for not signing first post.cbee.
"But the other staff were nothing to do with my gang- just unqualified assistants clearing up an earlier procedure."
Which illustrates exactly how much they cared about your privacy, dignity, and modesty! Personally, I would be filing formal complaints with the physician, insurance, state medical board, and Office of Civil Rights (HIPAA).
They get away with this crap because we let them!
Ed
I agree with Ed, often when this stuff happens it catches us by surprise at our most vulnerable time. After the event we tend to blame ourselves for not stopping it. Don't do that, challenge them, they work for you. Write letters, email, call and do not stop until you get an answer. What happened to you was not your fault, if you accept it, if you just let them get away with it...that will be your fault...don
Unnecessary exposure, inadequate draping is
considered unprofessional misconduct by state
nursing boards and falls under guidelines of
sexual impropriety.
PT
Misty
You may have read that there is now a nation
wide investigation into all VA hospitals stemming from
the recent incident at the Phoenix VA hospital. Are you
surprised, I'm not!
PT
Ed, I can only partially agree when you stated "Come on guys, start acting like men! Women generally get their modesty, dignity, and privacy concerns adequately met simply because they've insisted upon it and we must do the same!"
Let's be honest. Some women complain, but most don't, as is evidenced by the comments that they have posted on this and similar blogs. But, when some few women do have the presence of mind to complain, they are taken seriously. The medical staff consider their concerns and at least make a show of taking appropriate actions.
Most men don't complain, because they have been socialized not to do so. If a few men manage to act contrary to their upbringing and object, they are belittled, both by the medical community and even by their fellow patients and family.
I refuse to accept this "blame the victim" mentality, as it absolves the medical community of responsibility. The onus lies with them, both to anticipate the needs of their patients, and to react when those needs are violated. I will not chastise someone who is in a vulnerable position, who is taken by surprise and is naked in front of a room full of strangers, for not being more assertive. It's easy to be strong, to take control, when commenting on a blog, but much more difficult to do so in real life.
To encourage men, and women, to complain is fine. We are of one mind in that. But, I cannot blame someone for their own abuse, simply because they were not able to prevent it.
StayingFit, I truly appreciate the feedback but I think you're reading way too close between the lines. I generally agree with everything you've said except the "blame the victim" and the "onus of responsibility" comments. I was making a straightforward and accurate observation IMO that when we find ourselves being disrespected and taken advantage of, the only recourse we've got is to put a stop to it, forcefully if necessary. I wasn't blaming anyone! I've been in very similar circumstances as those cited by CBEE and my response was exactly the same. To this day I'm pissed about the way I was treated and have resolved never to be a victim again! In a perfect world, medical providers would accept responsibility and make proactive changes to prevent these egregious violations but that's not going to happen in our lifetime. If correct, then our only recourse is the actions we take to prevent it. I'll never walk into a physician's exam room or hospital expecting to be treated with empathy and basic human dignity ever again. This attitude is what will ensure I receive medical care that respects my dignity, modesty, and privacy! I'll never roll the dice expecting providers do it for me.
I think StayingFit made some excellent points. It is true that many patients do not complain.
I believe that the reason we have an increase in all-female practices is because so many women request female doctors. For example, look at this all-female ob/gyn practice’s web site. Look at the top picture caption that says, “I feel more comfortable with a woman doctor”. However, many rural or small towns still have no female gynecologists. If a woman wants to be guaranteed a female gyn for the birth of her child, she must choose an all-female ob/gyn practice that does not rotate with other practices that have male doctors.
I believe that urology practices in smaller towns are less likely to have male nurses or assistants. For men on this blog who prefer male intimate care, have you noticed if urology practices in bigger cities are more likely to have at least one male nurse or assistant on staff than urology practices in smaller towns? I believe that if more men spoke up and made it clear that they will not accept female nurses or assistants in urology practices that urologists would start hiring more male nurses and assistants.
I have a question for men on this blog who prefer male intimate care. If you were very ill and you could not take a bath or shower, would you prefer a male nurse or your wife to give you bath? Based on my observations, many married men prefer that their wives give them bath than a nurse (even if a male one is available). Most women can easily give their husbands bath especially in the bed.
Misty
I won a trip to an exclusive resort that was presented this week. My wife and I went, part of the package was a massage. I got a female, she got a male. That was interesting, but as we talked about it the differences started surfacing. In the men' locker rooms we were given lockers to store our clothing which was a wall of lockers, benches, and a lot of open space...women were provided lockers and enclosed changing areas. When I was returning to the locker room there was a male and a female staff member working on a laptop right next to the locker room, when they opened the door for me to enter a man was standing there near naked changing, clearly visable to both staff members. While we have debated this before there is just less concern for male modesty throughout society....that said, the challenge is universal but the barriers may be a bit different...I could not help but think about this thread as I got my massage, laying there naked under a sheet, I actually trusted the massuse to respect my modesty more than the medical community, these moderately paid people have never tried to justify violating my modesty.....don
Hi Misty. Speaking only for myself my first choice would be my wife with a male nurse being my second. After that just leave me dirty until I get released.
Some will say that having your spouse do it is not a option. I showered my wife when she was hospitalized under going a stem cell transplant so I know it's possible. She just told the nurses that I would do it and they brought extra towels. Al
Misty, this is a no-brainer; most definitely my wife. A male nurse a very distant second and there is absolutely no third option ever. Showering in the locker room is one thing but a stranger (even male) actually administering a bath/shower would be intensely uncomfortable!
Ed
I would most definetely prefer my wife bath me if I were in a hospital. I dont know if this is commonly permited and if not why? I know when my wifes fathers brother was in the hospital with terminal cancer he bathed his brother. That was only because he wasnt being properly being cleaned and one day heard two female staff arguing about who would have two do it. I guess they didnt have the stomach to bath a patient in that bad of condition. This infuriated my father in law who told them he would be doing it. He took care of that part of his brothers care for a couple of weeks until his brother passed.
Misty, I live in a large metropolitan area and have not found a single urology clinic with even one male receptionist or assistant. Also, I am sure that your "survey" about very ill men is flawed from the start. You are soliciting opinions from a very small subset of men.
Gerald
"Which hand of a healthcare provider do you want touching you and whose eyes looking at you, male or female? Do you believe that gender is more important than skill or personality."
How are patients supposed to objectively judge skill or personality for a comprehensive physical exam or urology appointment with a provider they've never seen before? IMO, the guys here aren't complaining about physicians but the nearly universal female ancillary staff. Generally, we get to choose the physician and know beforehand whether they're male or female. Furthermore, I think it's reasonable to assume physicians in private practice are fully qualified and medicine expects us to assume the same for everyone we encounter during a outpatient appointment or hospitalization. In that case, I'm choosing male.
Ed
It is not surprising that men who are modest prefer that their wives give them a bath instead of a male nurse or assistant. I think hospitals should have forms asking patients who they prefer to give them bath if they are too ill. I find it strange that some hospitals do not like for spouses to give their spouses who are patients a bath because it helps to lighten their work load some. Some hospitals may fear that they will face a lawsuit if the patient gets injured during bath.
Based on my observations, men are more likely to be bathed by their wives than women being bathed by their husbands if they are ill. It’s much more common for a female nurse or assistant to give female patients a bath than their husbands. Does anyone here have some insights on why men are more likely to be bathed by their wives than women being bathed by their husbands when they are too ill? It is interesting, but many women who do not mind going to a male gynecologist are upset at the thought of a male nurse bathing them.
Ed made this interesting point: Showering in the locker room is one thing but a stranger (even male) actually administering a bath/shower would be intensely uncomfortable! Many more men feel this way.
AL: It’s great that you helped to shower your wife. I am sure that she felt very blessed to have you assist her in showering.
I had the privilege of meeting Robin Lenhart of Dignity Resource Council last month. She makes personal garments for bathing and assistance. I recommend you all check out the web site. She gave me some personal garments and I was very impressed with how they protect a patient’s modesty. I think that every nursing home should consider having them on hand for patients. Many elderly patients are not able to have their spouses help them with bath because their spouses may have some physical limitations due to age.
Misty
I encourage you all to check out this discussion: Can We have patient modesty? that was started by a man who had an urological procedure. He was upset that there were about 9 women present for this procedure. When he expressed his concerns about patient modesty, one of the ladies replied by saying, “We’ve seen it all”. It is pretty common for medical professionals to say, “We’ve seen it all” when patients express concerns about patient modesty. We all know that medical professionals have seen many private parts, but that does not change many patients’ wishes about modesty.
I encourage some of you to consider replying to this man’s concerns. I commented under Patient Modesty.
Misty
Misty
His story is fetish fodder and notice he
says about 9. Now I don't know of anyone who
has that kind of staff for just one room let alone
a large OR suite. Did he say he followed the
recommendations we suggested and what were
those results.
Did he say he followed up with complaints
that myself and others had suggested and do
we see the feedback from him. No. Sadly, in
these kinds of forums whereby we often post
concerns and descriptions of scenarios these
blogs become breeding grounds for those who
in particular from the voy forums. Don't believe
everything you read.
PT
@Misty (5/24/12:02) "It is interesting, but many women who do not mind going to a male gynecologist are upset at the thought of a male nurse bathing them."
This merely highlights how the degree of patient cross-gender modesty is related to the level of the professional. Many people who are tolerant of a different gender doctor are justifiably uncomfortable with someone at the level of nurse or below. This is especially a problem with males because support staff is overwhelmingly female. Despite the absence of complaint, I think it would be bizarre for anyone to feel comfortable with opposite sex intimate care from someone who might have been flipping burgers just six months before.
--rsl
There is a big difference between having your opposite gender doctor, that you selected, and having a stranger who happens to be a nurse or someone else of opposite gender, see you under intimate circumstances. This has nothing to do with level of medical expertise; but rather control of whom sees you unclothed.
I would also note that any imbalance of who bathes what gender may have more to do with men who are sometimes homophobic and don't want a male caretaker, don't want a female caretaker for modesty reasons, but a spouse who they are comfortable with, is the best way to handle the situation with the least amount of discomfort.
On the other hand, women are probably just as comfortable with a female caretaker and maybe even more comfortable with a female caretaker, rather than being seen as less than capable by their husbands.
belinda
The compulsion to repeat the trauma via
re-enactment and revictimization. Many
traumatized people expose themselves.
One third of men arrested for sexual
offenses in the U.S are exhibitionists
and 20% to one half of all those
caught will re-offend and get arrested
again at a later date. In the UK the
ratio is 4 to 2, men to women.
Many men in their young impressionable
years develop these various fetishes from
medical exams and procedures whereby
female staff are present. We have the
female dominated healthcare industry to
thank for this as many men admit this was
the case for them.
The compulsion to repeat the trauma and
re-enact the experience takes on many
forms ranging from exposing themselves to
children or other adults, voyeurism and
other illegal sexual activity. I knew of one
young male patient who required a scrotal
ultrasound.
This patient had this procedure performed
7 times in one day at different facilities.He
went to different medical facilities and would
call to ensure the technologist was female.
With a script ( physicians order) no individual
facility can verify the exam was done at
another facility. It is only when his insurance
company was billed for a scrotal ultrasound
from 7 different facilities on the same day
that his behavior came to light.
What is being done at medical facilities and
at the provider level to circumvent these
types of behaviors or at the very least recognize
what promotes these fetishes from forming.
PT
PT said:
Many men in their young impressionable
years develop these various fetishes from
medical exams and procedures whereby
female staff are present.
PT, I believe that is correct but I have never seen any studies. Do you have any references?
Belinda i disagree, while there may be some men who are homophobic about care to say that it significantly changes the discussion here is just throwing a personal opinion out there with no support. You have often shown strong opinions against males and downplayed the issues they face, I would suggest it is a pattern that plays out in the medical community as well.
Go to the Indianaurology or perhaps urologyindiana and look at the subtle differences. they list MD's, but when you click on women's they list the MD's specifically treating women, click on the men's tab, no such listing. Click on the physicians assistance tab, and notice all are young women except 1. Men are just assumed to be OK with things. Think if this were a OB/GYN site and the page was all young men except 1 female....anyone here think that would be OK?....don
@PT: Once again you knocked it out the park. A couple years ago I had a similar discussion on the origin of the prevalence of male fetishes. (I went a little further back, mentioning the tendency of mothers to ignore their sons' modesty--public urination, changing them on a public beach, etc.--while scrupulously protecting that of their daughters.)But your discourse on the compulsion to repeat trauma nailed it! (That compulsion is probably a subconscious attempt to finally overcome, hence, master the trauma.)
@don: On my visits to the site, I have noticed a disturbing gynocentricism in the post of both Belinda and Misty. And yes, Belinda has consistently downplayed the modesty problems men face in the medical arena. It's almost as I, a male, went to breast cancer survivor site and harped on the 1% of men with breast cancer. Yes, women have modesty concerns in medicine, but they are outliers.
--rsl
During the Memorial Day weekend, my wife was suffering from a prolonged and severe migraine headache and because of the holiday we brought her to a different hospital than usual because only they had a neurologist available.
As my wife’s representative, I was asked to sign a consent form which gave the hospital permission to provide her with treatment. I was dismayed to see that the form included the following:
• A paragraph granting permission for students, residents and others to take part in in and/or observe her treatment
• A paragraph granting blanket permission for the hospital to videotape or take photos of patient treatment.
The hospital’s own web site delineates among others the following patient rights which are based directly on the State Patient Bill of Rights. These include:
• The right to refuse to be examined, observed, or treated by students or any other facility staffed without jeopardizing access to psychiatric or other medical care.
• The right to privacy during medical treatment or other rendering of care within the capacity of the facility;
Obviously, the hospital, in using this consent form, is attempting to coerce patients into signing away rights already guaranteed to them by the State and the health care facility. I cannot consider this anything but an underhanded attempt to deliberately deceive patients.
Thanks, in part, to the information I have learned from following this site, I simply crossed out and initialed these two paragraphs. After several hours in the ER, my wife was admitted to the neurological floor for observation. Within an hour, a resident, and two students came to the room to speak with my wife. When I asked if they had read the consent formed they seemed baffled by the question so obviously the thought had never occurred to them that someone might not agree to their presence. As I ushered them out of the room. I politely suggested that in the future they might actually read the signed form before assuming that consent had been granted.
Because I have been educated about the medical system’s lack of concern for patient rights, I knew how to handle the situation but many patients are too naïve, too trusting, too ill, or perhaps not literate enough to read the consent document fully before signing it and subsequently may be subjected to privacy and modesty violations that they are unaware that they have agreed to in writing.
I believe the use of this form is deliberately deceptive and unprofessional and provides one more example of why there is a continuing erosion of trust between patients and the medical community.
MG
MG, you did precisely the right thing..you took the correct action. Congratulations!
What you should do next before too much time has elapsed is bring a copy of the signed form and your personal experience with the students to the hospital administrator and explain your concerns, frustrations and what you suggest must be done to prevent an event like this again with some other family.
As I have noted here previously, I teach my medical students to personally obtain permission from the patient or even from the close relative in the room to be present and to communicate or examine the patient. The permissions given in the admitting papers may be overlooked by the patient or surrogate and that is why it is essential that the student ask the patient directly and before anything further is carried out.
You can tell the administrator that the admission papers are totally worthless if they are not examined, read and understood by the hospital staff before there is an attempt to violate what was consented to by the patient. ..Maurice.
In those cases where you're incapable of reading/signing admission documents like MG related, here is an idea I think we should all consider. Having recently moved, my wife and I recently updated our wills, POA, and advance directive. We added the following bullet statements to preclude to mitigate these exact issues:
No photography, filming, or video recording of my health-care (any type or format) is permitted without explicit advanced informed consent.
No urinary catheterization of any type is permitted without explicit advanced informed consent.
Upon request, the full names and qualifications of all providers who administer (ed) / participate (d) in my health-care must be made immediately available.
No "students" can participate in or administer in any way my health-care without explicit advanced informed consent. In the absence of such consent, all providers (physician, PA, NP, nurse, CNA, tech, assistant, etc.) must be either board certified and/or fully qualified to perform requisite medical care IAW all federal/state/local/hospital/practice statues, regulations, policies, and procedures. Specifically, boilerplate signed physician practice or hospital admission documents do not supersede this requirement.
My HIPAA protected health-care information/data, even if de-identified, cannot be shared for any marketing or research purposes without my explicit advanced written consent.
I specifically did not address the gender issue for the following reason. If I'm in the ER and unable to advocate for myself, I don't want provider gender to impede necessary healthcare.
Ed
MG,
I am so glad to hear about how you took steps to cross out certain sections on consent form. It is true that using hospitals often use consent forms to attempt to coerce patients into signing away rights already guaranteed to them by the State and the health care facility. Sadly, many patients or their family members are rushed into signing consent forms without really reading the form.
I agree with Dr. Bernstein’s suggestion that you should take a copy of the signed form and share your personal experience with the students with the hospital administrator to help future patients.
I bet that those students were not used to being rejected by a patient to be a part of their care.
Misty
It is very obvious people on this discussion have different opinions about why men and women value their modesty.
Don made a good point. Most men who prefer that their wives give them a bath are not homophobic. Many men who prefer a male nurse for intimate male procedures are much more comfortable with their wives giving them a bath than a male nurse because they have no shame about their wives seeing them nude. Many men who value their modesty are even a little embarrassed about being seen naked by another man even though it is much better than another woman who is not their wife. Bathing is something that can be easily done by a wife is physically able.
I believe there are a number of reasons why some women may be more comfortable with a female caretaker giving them a bath than their husband. This only applies to some women. I know one lady who will not go to a male gynecologist at all does not like for her husband to see her naked when she is dirty. She is very vain about her body and prefers that he only sees her when she is clean.
I strongly believe male patient modesty is as important as female patient modesty.
It is interesting that PT brings up the issue of medical fetishes that some men have. I remember one boy in middle school over 20 years ago who shared that he enjoyed being examined by a female doctor and that he got aroused. I am not sure how often this happens. I would be interested in seeing some studies.
Misty
I am wondering here but to me looking at things like men are homophobic in their approach to care because they prefer their wives for exposure during things like bathing, those who have fetishes about medical care, etc. is about the same as saying women flirt with and seduce their male caregivers have a significant place in this conversation or women who prefer husbands to female nurses must be homophobic is pure conjecture. What are outliers and what is the norm, after all providers, including Dr. Bernstein seem to feel those of us with modesty concerns like this are outliers. The problem is there really doesn't seem to be a lot of data to draw a baseline of normal. That said, as per MG's efforts, stepping up and speaking out will cause providers to look at what is the norm from a more individualistic basis if enough people do it....don
Don, RSL,
I don't where you are coming from. I have explained over and over again this not a gender war. It's for the rights of EVERYONE to obtain medical treatment and privacy.
I have spoken to, and spoken out whenever given the opportunity, especially to urology practices about hiring same gender care and how they are losing business by not having a male staff on hand.
I have interviewed hundreds of women and men about their preferences in my research and many men have said that they don't like the idea of a male caregiver for intimate care. This has been my experience and is the opinion of some men.
Never have I said that the rights of one gender are more important.
What I have said is that there are gender differences and those needs need to be met, while equal, they might be a little different.
I don't need to defend myself but I refuse to have those of you who are doing selective reading about my posts, to go back and read again.
While it is easier for women's needs to be met in the exam room, or nursing staff, once you get to the OR, ER, we are on an equal playing field.
Yes, more male nurses need to be hired. Yes, more sensitivity to all to preserve the mental health of patients is extremely important.
What I have said is that there are more male sex offenders than female based on national statistics. What I have said is that perversions occur in healthcare as in the general public. PT feels more female nurses are at fault with issues, and this may be true based on the amount of female nurses outnumber male nurses.
Whatever selective reading you're doing, you're taking comments out of context.
I have never said, or will say that one gender's need are less important than the other. I stand for equal rights for men and women on this issue. I hope I've made myself clear.
belinda
@rsl: First of all your statement that some women have medical modesty concerns but that they are "outliers" is ridiculous. I can assure that as a woman (who knows many other women) our modesty concerns are just as real as those of men. And I think your criticism of Belinda and Misty is unjustified. They have both repeatedly said that men deserve as much respect and concern for modesty as women do.
Although I will continue to read this blog I do become very discouraged when the discussion keeps returning to the debate on who has it worse: men or women. Let's just establish once and for all that both sexes have concerns and both deserve equal respect and thoughtful treatment. And I agree with Don: while homophobia and fetishism may play a part in a few men's medical preferences I think those are the true "outliers".
Dr. Bernstein has proposed many times in the past that we get over the "moaning" and do something proactive to address our concerns and I think that is the way this blog should head. If nothing else, even just to suggest and promote ways individuals can advocate for themselves versus a system wide change. MG's experience is an example. He was empowered to act in his wife's behalf after following this blog and that may be the best tool we have right now. I know reading this and other blogs has given me more confidence to speak up for myself in medical settings. Let's work together to try and change the system in this way, as slowly as it may be. Jean
Let me step in a moment to support Jean's comment and to put my views in perspective and also to make a suggestion to those who are reading and writing here.
I do believe that those males and females who find that their physical modesty issues have been so disregarded or previously or currently mistreated that they would even sacrifice their health to avoid medical care..those specific folks who have and would avoid necessary medical care (diagnosis and treatment) are statistical outliers. It is my observation after years of clinical practice that even though I suspect that most patients have various degrees of modesty, as I do too, they would not sacrifice their health and well-being out of fear of being modesty or sexually mistreated by a healthcare provider. So this is my concept of which group of patients are the statistical outliers. When I became aware and learned about these outliers (and only by reading the responses to this blog thread over the years) I certainly have made no attempt to disregard their concerns and have repeatedly attempted to encourage ways to mitigate their concerns beyond simply "giving up with anger". So again, let us stop the bickering as to which gender is the most hurt or disregarded or whatever in this modesty issue. Both genders appear to be affected. Let's turn the conversation to ways of changing the medical system either directly for the individual patient or generally for all patients.
Finally, I want to remind you that there are alternate medical ethical issues, which threads I have put up in the last month, that in ways have emotional and physical impact on the patient population and their relationship to their physician.
What words should a doctor use to begin a professional relationship to a patient?
Should all doctors be randomly screened for drugs and alcohol for the patient's "peace of mind"?
Are you happy if your doctor starts and ends a visit by shaking your hand or should another way of introduction if there is a worry about transmission of infection?
and finally, if you end up in an emergency room with a life-threatening emergent condition, should the doctor there ignore your request against beginning emergent life-support treatment such as inserting a tube into your lungs to begin resuscitation?
These, too, are personal questions as a patient that deserve your expressed views. ..Maurice.
Maurice,
Maurice,
You pose some interesting thoughts. While you might consider me to be in your group of outliers, perhaps I'm not, because I found a way to work with the medical system that works for me.
That being said, I wonder what the percentage of outliers refuse care based on cruel, degrading treatment (and an outlier sexually deviant doctor). I would bet that within the group, those who would except today's "standard of care" would be the
outliers of that goup.
Thanks for your comments about the gender wars! I have and always will support your position on that issue.
I would strongly recommend that for those that this issue is paramount, wear a medical ID bracelet and state your needs and your medical history.
My feeling is if I'm out do what you must, however, if I'm awake,
serious detrimental damage would ensue if my needs and wishes were ignored. Make sure your family members know your feelings and support them. Carry with you what I call living directives so that your wishes are there, like a living will with instructions.
I live in a major city and new directives are being instituted that are patient centered. While the modesty issue is not directly addressed, it is in the broader context of goals of the facility to have a positive, supportive experience during your hospital stay.
Personally, I use every encounter to address these issues whether they come up or not when visiting a new practice, whether the practitioner is male or female.
Everyone should be doing it. I think the social consciousness has risen regarding this issue and with enough pressure, the medical industry will try harder and harder to comply.
belinda
"...I would note that any imbalance has more to do with men who are sometimes homophobic...." I agree gender wars and who have it worse are not productive, that was not my point. I would put forth addressing myths and stereotypes that contribute to the problem is. There have been numerous posts here and other sites inferring a significant number of males don't want female providers because they are homophobic. Two points, have you EVER heard that comment made toward female patients, and it contributes to the justification of the lack of diversty in nursing.
Dr. Bernstein, while I understand your comments if we were to go back to the begining of this thread I think we will see a transformation of all of our thinking. On your part I believe you used to defend the medical professions lack of attention to modesty much more vehemently. Those early discussions were not narrowly applied to those who avoid care. they were much more broadly applied to modesty in general, context made exposure to opposite gender not only different, it was logical. There were discussions of professionalism trumping gender etc.. Are those who avoid care at all costs outliers? I would guess so. Are those who delay or postphone due to concerns outliers...I would bet much less so but the degree may vary. Are those who have significant concerns outliers, I would bet not. Are those who have concerns I would say definately not. That is my point, medical people tend to use the exception to justify the rule. They use life and death in the ER to justify routine in the exam room. They use the extreme of avoiding medical care as being outliers to discuss the topic. I truely appreciate your efforts here and your encouraging people to speak up. that is definately where we need to head, but your current position and that of providers in general have a lot of space between them. There are still two sides in this discussion, and two mentalities, providers and patients....don
I'd need an answer to my last post.
The thing is, for the very first
time, I'm going to complain, but
while you might not need to be 100%
knowdledgeable, you do have to know
what to complain about.
I do have some degree of trust in
my surgeon, but not sure some po_ licies were even appropriate.
To make a long story short, (and so as not to repeat what I've already stated in my post). I was told that under no circumstances was I allowed
to wear a bra, but was made to walk
with nothing but cloth surgery booties on the floor. Is that even
OK,?
Maria,
I saw your post originally, but need clarification that they " made you" walk down a public hallway in the nude?
If that is the case, no it's not okay and remember....you are in charge. You won't turn into a pumpkin if you refuse. When you hold your control close, you'll feel more comfortable and relaxed.
Don't consent to anything if you are uncomfortable.
If you would like some private advice on how to handle this situation at no charge to you, please advise Dr. Bernstein and he will forward my email to you.
All the best.
belinda
I wanted to let you all know that I got an encouraging case from a man who refused to give in to a doctor who wanted his medical students to examine his private parts after inguinal hernia. It’s terrible that this doctor labeled the man as immature. It is nice that the man's surgeon supported his wishes to not have his genitals examined by medical students. Patients who speak up about their wishes are mature. This case is at the top of this page about standing up for your rights.
I was a patient recovering form inguinal hernia surgery, when a Doctor I had never seen before came in with five interns. Three males and two women. The doctor started to pull my blanket down, but I stopped him with a question as to what was going on. He explained that we were in a teaching hospital and he wanted the students to see what a lower abdominal incision looks like, one day after surgery. I told him that the incision was sutured and somewhat red but was covered with a bandage that I didn`t want removed. I further told him that under the covers I was essentially naked, so that if the six of them removed all their clothes we would all be equally dressed and then they could have a look. The Doctor replied that I was very immature. I responded that perhaps I was, but not as immature as he to think that he had the status to have complete and utter control of my body. I later told my surgeon who responded: good for you. The doctor was wrong...he should have asked me for the OK to approach you and then given you a chance to decline the show and tell.
- Joel A. ( Male ) From Boston
Misty
Misty
At Saturday, May 31, 2014 2:14:00 PM, Blogger Maurice Bernstein, M.D. said...
Misty, ..and what did that doctor do after saying that the patient was "immature"? Did he and his troops quickly leave without inspecting the wound?
You know, I am a bit unsettled reading patient narratives like those on your page where there is only the writer's description of events which may or may not be a valid and objective description of events. (Of course, I know it is subjective and can be "flowered up" by the writer to make a point but as readers we will never know since there appears no back and forth communication by readers and the writer. On our thread here, at least myself or other readers have the opportunity to challenge the writer or clarify points which seem unclear or ambiguous.
Yes, I know that if a patient feels they have been abused they are unlikely to simply present un-modified facts, yet that is where the potential for repeated conversations with the writer by the readers is important.
In the case presented, beyond what that doctor did after calling the patient "immature". I would like to know whether the patient's surgeon identified that doctor and said "I will talk to him and advise him the proper way to handle this matter." Otherwise, how would this incident contribute to any even minute change in the understanding and behavior of the medical system? ..Maurice.
Dear Belinda, I am not sure if you were responding to me earlier this month, you mentioned having a life changing event and researching things that are mentally unhealthy to patients. I wrote about being diagnosed with ptsd after issues with my surgeon. If it is me you would like to talk I can answer your questions, somehow I feel you must have gone through similar situation, no one really understands the true cost of losing trust in someone you have handed the keys to your life, I never considrred it until faced with it myself; it is devastating. I look at the entire world differently now. JM
Dr. Berstein
I agree with your assessment that sometimes accounts are perhaps embellished to make a point. Something I would ask of you, why do we never see other medical providers joining this conversation? You have as i recall suggested your students might join, yet we seldom see providers join, Unfortunately when they have we have seen them attacked and they left. Why do you think other providers do not join in the discussion? So we have providers use the extreme, ER to justify the routine, patients embellish, but why do providers not join in the conversation?.....don
Don, of course I don't know if and when a physician comes and reads this Patient Modesty thread and with a very modest 60-70 visitors coming to this Volume 65 most days and 10 or so more apparently only reading the earlier Volumes, I can't believe that there are many physicians. And the one I know about, a urologist, who wrote relatively recently, was as I may have mentioned before "scared off" to further communication here because of the responses he read.
I will try to locate his writing and the location of the comments by others.
As some of you may have recalled, I had written 2 articles (one with Doug Capra) to the AMA News (physician newspaper) which contained a link to a Patient Modesty Volume but I don't know if there was any doctors directed from those articles.
You know, you visitors here should send your doctors a link to this thread and encourage them to participate. It might just work and would be a worthy attempt to "spread the word" (educate the system). But be courteous (as you would want them to be to you). ..Maurice.
I found where the urologist wrote. It was a year ago on May 19 2013 at 4:23 pm which is followed by a series of responses. ..Maurice.
Maurice
The urologist comments that he is in private
practice and he further states that it is not possible
in private offices to have assistants of each gender
assist in each procedure. Why? Is there a law that
prevents this. The opposite of private practice is
that he would have to work for a hospital or some
medical facility whereby he is an employee. Nothing
changes in that regards as far as staffing is
concerned.
I get the feeling he is not a urologist and perhaps
not a physician at all. Furthermore he comments
that fears of the patient can be eliminated and the
patient issues regarding control could be further
contained provided the assistant first has a face
to face meeting with the patient if female. Notice
he dosen't comment about if this is a male patient
and in that regards male patients are ambushed if
you read his ( maybe it's a her) comments. If this
poster is scared off then perhaps they should not
have blogged here in the first place.
PT
PT, the urologist is a urologist and he is a male. I know him personally for at least 3 years on a professional basis. In order to attempt to get physicians to write to this blog thread, a year ago, I personally invited him to come here and write. And he did. But now on talking with him, he was a bit perplexed about the responses he got and doesn't want to try it again. For me, I was not surprised regarding his response. (Think of it.. I have been reading each comment, EACH COMMENT, for virtually 9 years. So.. this is an answer to Don regarding having more physicians participate here. Maybe my colleague, the urologist, is demonstrating the response a physician gets who comes to look at our blog thread. He was scared away.
Has anyone ever thought that there may be elements of "modesty" (not physical but otherwise within the medical profession---and that the system doesn't want "everything to be shown" (like the inability to get a well-functioning staff of both genders available to each and every patient's request... like the inability when rushed (and they can be rushed) to anticipate every single patient modesty issue which is not previously disclosed to the doctor or staff... like the inability to understand how a patient can place his or her physical modesty above their physical well-being and life itself... and so on). Yes, doctors may be too modest to show off all those sensitive issues to their patients and the public just as the commenters here don't want to show off their own sensitive anatomic areas. It's simply modesty, modesty, modesty..and we all have it in one sense or another. ..Maurice.
This should stir you all up: Google Glass worn by folks in the operating room.. more "gawking"? and potential for distributing images outside the operating room? ..Maurice.
Maurice
Advocacy is the heart and soul of medicine
and perhaps you should suggest to your
urologist friend that if his office is dysfunctional
then he should hire another office manager. As
you say the inability to get a well functioning
staff of both genders available for his patients
needs. Physicians feel little need to understand
their own performance relative to that of their
peers. What is there on these blogs that would
warrant anyone to be perplexed regarding this
issue. Healthcare is a service industry and he
should ask himself, am I caring enough for my
patients, am I advocating enough for my patients
and if he is scared from what he reads on these
blogs than I too am perplexed by his inability
to comprehend. You admit, it's been a learning
tool for you, it should be a learning tool for him.
PT
It is not a hipaa violation as long as there is
no disclosed individual health information. The
problem will present itself and it always does
when abuse enters into the equation. You can
count on it.
PT
And you wonder why decent human beings want nothing to do with the healthcare system. The question really is, "Why would anyone who knows what's really going on want to subject themselves to conduct from unethical, irresponsible, arrogant and entitled medical personnel?
Video cameras without explicit consent is a morally unethical position, hippa violation, and despicable behavior.
Then everyone is to praise these people for performing a job, saving a life. Give me a break!
Dr. Bernstein I agree, I have been disappointed on several occassions when providers come to this site only to be attacked and scared off. I remember the young female MD who came to discuss the sports physcial and the anxiety it caused young males when she conducted the hernia exam, instead of siezing the opportunity to interact with someone who saw our side, she was attacked and scared off. However, I know on several occassions you have mentioned you encourage your students to visit the site, have any of them said they did so?...don
Don, I teach my group of 6 first year medical students and near the beginning of the school year in September, I gave them a project to look through my over 900 ethics threads a pick one to review, write and discuss in a group session. At the time they were aware of the popular Patient Modesty thread but none selected it as a topic for discussion. However, throughout the year, I have brought into our discussions the views of those who comment on this tread and suggested they write to the thread anonymously except to note they were a medical student. It appears that none have written. However, my student group was made aware of the elements of the discussion here, I will attempt to continue to "spread the word". ..Maurice.
Do you have any thoughts on why none of them pick this thread Dr. Bernstein? Are they more drawn to the more clinically oriented threads, in this paticular point of thier journey is this not on thier radar, or do they visit and feel intimidated? Realize this would just be conjecture on your part, but just curious,
I respect your choice to not censor, but to be honest at times I wish there was a way to control the attacking of the occasional provider who strays here, we really are missing an important part of the conversation without providers. it accomplishes nothing to vent on them and drive them away. ...don
I do not think we should censor comments to “please” medical professionals. We have to be blunt with medical professionals. I appreciated many of the responses to the urologist who shared that it was impossible to hire assistants of each gender. Medical professionals need to understand that patient modesty is important.
An urologist should always have male assistants / nurses available for male patients. I especially appreciated the comments of Ed, Don, Dr. Sherman, and LKT on the May 19th posting.
Misty
Don, to answer your question, though in advance all 6 students were aware of the long running thread regarding patient modesty, I did't compel any student to pick that thread topic. The ones that this years group selected were: "What kind of doctor would you Select to be your doctor: Engineer, Priest, Colleague or Contractor?", "What Patient Centered Should Mean?: Confessions of an Extremist", "What Role should Society play in the Regulation of Multiple Fetal Births?","Patient Medical History: Should the Description of Race and Ethnicity be forbidden?","Patient Refusal to Leave","Attempting Miracle Cures with Unproven Treatment; Should Doctors Do it?"
With regard to these students feeling intimidated by what was read on the modesty thread, I would doubt it since they, as first year students,are understanding of their own personal modesty concerns and they are not yet responsible for patient diagnosis and care and in situations where patient modesty demands might conflict with their clinical duties and responsibilities. I think it is this conflict between how patients would want to be treated or untreated in modesty terms and the goal and professional responsibilities of every physician where modesty is considered a trivial issue compared to making a diagnosis and proving effective treatment. These students are not at that point of responsibility.
With regard to scaring any physician attempting to read or write to this thread, it must be up to those regular patients writing their comments to be more constructive in what they write and les confrontational. I cannot do any more than to see that no spam, directed ad hominem remarks or material which is irrelevant or grossly poor taste to the thread is published. Beyond that, it is up to the writers. ..Maurice.
I agree with Misty and her comments regarding
censor as well as being blunt. Some people will
never get discrimination and that is why it will
exist in the hearts and minds of mankind.
PT
It is interesting to me that not one student chose this thread. Could it be that the gender neutral
mindset is cemented early on in medical education?
It would be safe to say that nearly
everyone has issues connected to dignity modesty.
It is also documented that a positive patient mindset aids in healing.
When you put the two together, it seems even more interesting that nobody wants to "touch" this subject.
belinda
I wanted to respond to Don’s statement below:
I remember the young female MD who came to discuss the sports physicals and the anxiety it caused young males when she conducted the hernia exam, instead of siezing the opportunity to interact with someone who saw our side, she was attacked and scared off.
I do not recall that one. Does anyone know when that young female doctor posted here? The truth is hernia exams are not necessary for sports physicals. I would have encouraged her to end hernia exams for sports physicals. We have plenty of evidence that there is no need for hernia exams for sports physicals. I am so tired of parents being blind that they must let doctors do anything to their children in the name of medicine. Check out the sports physical article that one of MPM’s board members and I did. We of course used Dr. Sherman’s article as a reference a lot.
It's sad about how teenagers and young people are forced to have unnecessary intimate examinations.
Misty
I wish that we had some medical professionals who were actually sensitive to patient modesty come to this blog to comment. Medical professionals like the male urologist who said that it was impossible to hire male assistants need to see examples of other medical professionals who are sensitive to patient modesty.
For example, I am very proud of the all-male urology clinic in San Antonio. If you look at their web site, you will see that they obviously understand men who do not want females to be involved in their care. I wish that every urologist who thought it was impossible to hire male assistants could be encouraged to look at this practice.
Misty
Just a comment about this all male urology team
in Texas that you list. It flat out says that it's an
all male team and you can see the list of male
providers, there are three of them. Yet, when you
click on womens services, the names of the three
male providers disappears.
PT
Misty I wish I remembered her name but I do not, she was a young female MD who was obviously disturbed by the anxiety her doing hernia exams on young males casued them. I originally saw her post on another site questioning was it really needed or if she could exclude it, or was there a way she could do this in a less embarassing way I recognized her when she came to this site. Instead of recognizing she was a concerned provider and possibly an asset in this discussion she was attacked on why would she do this, how dare she conduct exams like this. While I understand "blunt" and to the point discussions, when it is done in this manner we all lose a valuable opportunity to not only understand, but educate. I respect Dr. Bernstein's committment to not censor...but I have little confidence some of the partcipants here will ever tone it down to a discussion, dooming this to be a myoptic discussion of us, and perhaps as Dr. Bernstein has discussed moaning and groaning.....don
PT: I actually called the all-male urology clinic two times to confirm that they really had an all-male urology clinic. They said that the only female employee in the practice was female. This urology practice is in an office park with several other urology practices. You can call them to confirm that it is really true.
Don: I wish that the young female doctor could have found Dr. Sherman’s sports physical article. I am sure she would have found it very useful. Unfortunately, I think many medical students are not told the truth that hernia exams are not necessary for sports physicals.
I had a good experience talking to a female pediatrician at a conference that I had an exhibit table at over a year ago about sports physicals. I also had the privilege of talking to a female gynecologist at a baby expo who said she understood when I shared with her that many women did not want a male gynecologist. She shared that the practice she worked for only had female doctors and nurses.
I wish medical professionals who were sensitive to patient modesty would discuss it with other medical professionals and encourage them to be sensitive as well.
Misty
Belinda, I can assure you that first and second year medical students do not look at themselves nor do they look at patients as "gender neutral" if that expression, by your use, means devoid of sexual awareness or interest. However, I think that you are extending the connotation of "gender neutral" since it simply represents an expression or word such as naming an occupation which cannot be identified as either masculine or feminine such as "police officer" (gender neutral) in place of "policeman" (gender male). For medical students or any medical professional to look at themselves or a patient without gender identification can represent a harmful view of a patient simply as an object. An "object" is what mechanics repair but certainly not physicians. ..Maurice.
Maurice, Thanks for your post. What I meant by gender neutral is that the mindset of the education process is devoid of masculine/feminine presentation with regard to practitioner nor patient. Gender, does not exist in the realm.
It is something we all as individuals experience and understand but in the confines of medicine, the medical culture is professing that gender does not come into play for either party; the only thing that counts is supply and demand of medical care with a total disregard of gender.
If gender sensitivity was taught as part of the curriculum, then the mindset of the students would be encompassing elements of compassion, enveloping an understanding of the patient experience as it pertains to dignity and modesty. The do not.
This issue is not supported, nor recognized by the medical community. That is exactly why we have the difficulties we have.
Gender has been written out of the education process, thereby it doesn't exist in the mindset of students.
belinda
Belinda, biologic gender identity and gender identity preference of the patient is something all medical students learn as important in many ways both from making a diagnosis and procedural approaches to the modesty issues and sensitivity issues of the patient. If you would tell even a first year medical student what you just wrote they would tell you that you need to be more educated regarding the facts of their education and understanding.
Again, I want to emphasize to all visitors to this thread, physicians are fully aware of a patient's gender and I am sure that short of unprofessional pervert doctors, all consider and care with regard to patient modesty of their patient regardless of patient gender. What I never learned prior to reading here these past 9 years and what I think most doctors are unaware is that some patients weigh their modesty issues on a different scale where modesty issues may or will trump beneficent medical treatment and care whereas most patients understand that degrees of withholding certain modesty concerns may need to be withheld to allow for the diagnosis and treatment procedures by healthcare providers. This understanding followed by permission represents the patient's contribution to their personal diagnosis, treatment and care.
So it isn't about the medical profession from student to practitioner ignoring gender nor modesty but where the defect lies is the ignorance of the medical system and their practitioners regarding the degree of emotional upset of some patients relating necessary medical practice which to these practitioners appear not out of line with professional practices.
If these doctors were educated as I have been then they would take a moment to ask the patient about modesty concerns if the patient hasn't already spoken about them and then for the doctors to make definite efforts to mitigate the concerns or, if unable, to fully explain to the patient why a mitigation attempt could not be accomplished. ..Maurice.
Maurice,
How is it if student's are educated, that the gender issue for intimate exams as to who will be in the room, what gender will they be, how many and what to expect is not discussed with the patient?
Patients are anxious enough with a procedure in itself, added stress at the last minute does nothing to benefit the patient.
Perhaps they are educated about gender but how does their education play out in the way they practice.
I'm willing to admit that my analysis may have been incorrect, but it was based on observations of how people are treated especially during hospitalization. How does their education play out during practice?
By the way, thanks for your input!
belinda
Belinda, I can't, by experience, report how and what the students are taught in their clerkships when they are formally participating in clinical events with their ongoing patients. I am sure mainly by observation of their clinical superiors, they may find that for certain efficiency reasons or other practical reasons, the patient's modesty concerns may need to be of lesser import than the patients underlying medical challenge. This is all part of the "hidden curriculum" about which I personally have no input other than my issue raising and comments in faculty meetings. And, finally, as the student graduates into residency and beyond, again what we have taught them will be directed more on the side of practicalities they find necessary in medical practice. Unless one (like visitors to my blog thread) can find ways to permit both attention to the practicalities and all aspects of patient modesty, there will be no major changes in what the visitors are observing now. ..Maurice.
If you are an MD,DO, NP and you have to come to
a modesty site because you are concerned about
hernia exams that you are needlessly performing.I
really don't know what to tell you but I will tell you
this. I really do hope you are evaluating these young
folks for scoliosis at the very least and no, there is
absolutely nothing and I mean nothing I can expect
to learn, gain or glean from you. Historically, blacks
never held crumpet or tea parties so they could talk
to white folks about discrimination. Despite blacks
being nice, they still had to sit at the back of the
bus but then some people just like being told what
to do. Some like to be that little mouse in the corner
begging for cheese and happily accepting whatever
is thrown at them. At the conclusion of medical
school physicians take an oath," I will respect the
privacy of my patients." Nursing graduates are
taught to respect patients privacy but you really
can't expect them to do anything right. I am not on
this blog to educate those people how to do their
job, nor remind them of the oath they took. They
should already know all this yet those of us who
complain are considered outliers. There are 320
million people in this country alone who at any one
time require healthcare services and if we the
outliers represent only one out of every 320
people with the disposition that is representative
of those on this blog, that's 100 million people. Do
you still think we are the outliers.
PT
PT, Your best post to date! I, not only agree with it, but it's time that the medical system address "the hidden curriculum".
Hiding behind accountability, sexual impropriety, public stripping, mistreating patients because they can. Are these people the "outliers" of the medical profession? I don't think so and I would be interested to find out how many on here would agree based on their life experience.
I've been a patient, an educated one both medically and psychologically, to the effects of healthcare. During my life, I have had minimally, no less than ten experiences, that have ranged from inappropriate to deviant, to
outright cruel and degrading acts at the hands of medical personnel.
I don't think I'm special, and this is only a handful of experiences compared to the amount of medicalcare received over a lifetime.
However, it wasn't until my experience with cruel, degrading, deviant treatment that would constitute abuse that I started to pay attention.
That one experience has clouded my feelings about medical care and those who provide it. It's the medical community who taught me how not to trust. It's the medical community who doesn't repect me, whose job it is to earn respect and trust from patients. It's the medical community that refuses to respect modesty and dignity, yet its #1 on patient's mind next to pain control. It's the medical community who, despite what Maurice says, who needs to teach that respect and dignity come before healthcare. It's the medical community that to change protocols to meet those medical demands and still maintain the bodily privacy of patients.
The medical community must stop hiding behind that veiled curtain. I don't know what they are teaching regarding this issue. Maurice, you have to agree that they are missing the boat.
Now, who, in that community will sign on to stand up and speak out against all the impropriety that happens in every hospital throughout the land? Who is it who will demand same sex care for those who desire it?
They don't care, they never will and it's they who are developing the attitudes on this blog and will one day result in complete dysfunction of the system when patients realize that to stand up and say, 'NO", ask the right questions BEFORE you're sick and set an example of dealing the with healthcare community in the spirit of what's healthy for all.
belinda
I appreciate Belinda and PT’s great points. I am so tired of medical professionals trying to push patients into giving up their modesty. Unnecessary invasive exams need to end. There should always be informed consent for all intimate examinations. Way too many intimate examinations are done.
On another subject, I wanted to let you all know that OMG EMT! on TLC Channel is airing tonight. You all will see some cases where patient modesty is an issue.
Misty
Here is a comment by Anne from this morning. I have edited her comment so as not to publish the name of the specific hospital she identified in view of the negative tone of the comment and the unlikely ability of the hospital to directly respond. Naming names in a negative context is OK if it is already in the public domain and the news source is identified. (Don, this is one example of my action to accomplish what you hoped for when you wrote "I respect your choice to not censor, but to be honest at times I wish there was a way to control the attacking of the occasional provider who strays here,"
..Maurice.
I just spoke to my friend who's husband is a patient right now on the hip replacement ward of [a major Canadian hospital]. I was appalled to hear that he is sharing the room with a woman patient, and that in Canada this is apparently the norm!
Anne
I have had the opportunity to verify the policy of my teaching hospital Los Angeles County-Univ. of So. California Medical Center. It does require the patient's "yes" or "no" informed consent regarding "the presence of an observer" in the operating room, which I think is the proper policy. ..Maurice.
Anne,
That is awful that the hospital will assign opposite sex patients who are strangers & not married to each other in the same room. In the US, many hospitals will provide private rooms for patients. I am afraid that this may become a trend in the US in the future. It is sad about how gender neutral hospitals have become. Are there any curtains separating them? What happens when one of them needs a bath? How does your friend feel about this?
I’d be interested in corresponding with you further about this. You can email me privately through this form on Medical Patient Modesty’s web site.
Misty
Mixed gender patient roms/wards in England is also standard practice.
I wonder how hospitals that have this policy protect themselves from
accusations of sexual assault or impropriety involving a roommate.
Maurice, thanks for checking on your hospital's policy regarding consent. All it needs is another tweek to tell the patient about their state of undress and the gender of the observer giving the
patient the tools to make the right decision for themselves. This is morally the right thing to do. How can someone consent when they don't have all the facts?
belinda
No, I wasn't made too walk in the nude.
Perhaps I should start by stating what kind of anesthesia was used: sedation, (I was really drowsy) which was administered in the OR itself, not before.
As for the attire, it was a gown with pressure hooks, booties (fastened with straps) and an undergarment that also fastened with straps. Your own underwear of any kind was strictly forbidden.
That bothered me, because I wasn't allowed to wear a bra, yet had to walk all the way there with nothing but the booties between my naked feet and the floor.
Belinda:
You made some interesting observations. Hospitals that put patients of opposite sex in the same rooms risk that sexual assaults could happen. Also, think about how many patients love having private rooms. It’s harder to recover when you have no privacy.
Maria:
Do you have any idea what kind of sedation they gave you? Was it done without your consent? Do you have any idea if it might have been Versed?
You should have been allowed to wear 100% cotton underwear unless the surgery involved your groin or genitals.
What kind of surgery did you have?
Misty
Operating room personnel leave the OR for lunch
to the cafeteria with their scrubs on and the same
underwear they left for work from their home. Now
something smells fishy here, no pun intended, but
it's apparent they just make up these rules as they
go along.
PT
PT,
It is ridiculous that OR personnel came up with the policy that patients cannot wear 100% cotton underwear or their own clothing that may be much more sterile than hospital gowns.
The OR personnel are much more likely to bring in germs than patients. Think about how many patients the OR personnel may have interacted. If they really followed strict rules about sterility, they would change their scrubs and take shower between patients. There are certainly a lot of germs in cafeteria and restroom that they can bring in OR.
I know you will find this article very interesting. This article revealed how some children got fungal infections from unsterile linens at the hospital.
How in the world does nakedness during surgery help to get rid of germs? Think about how the hospital gown might be laced with germs. Who touched the hospital gowns? The person who may have handled them may have not washed their hands at all.
I wanted to highlight two important paragraphs from this article:
When patients are in the dark, they may complain generally about something they think went wrong with their care. When they are brought into the information loop, their complaints can become more specific and more helpful. If parents had been told in 2009 that there were multiple children who had developed fungal infections from the linens at Children’s Hospital New Orleans, they could have talked with hospital staff about practices they had seen at the hospital that may have contributed to the problem.
If a parent, for example, saw a hospital orderly putting linens and trash together – as was alleged in a story by The Times-Picayune – they might be more likely to complain if they knew there was a fungus problem. If they noticed that the linens were dusty – the CDC found that they were being delivered uncovered to a loading dock with visible dust – they might have been more likely to complain.
Misty
As long as it's cotton. Use a little crazy glue at the top and they won't be able to remove without your knowing.
My daughter at 19 went for surgery and they told her she could keep her undies on if they were cotton; on the day of, not before.
They weren't and they were located more than a foot away from the surgical site. She looked at me helplessly and asked if she had to. I said it would have been nice if they had told her ahead of time. She did not remove her underthings nor did she get any kind of infection; a little common sense goes a long way.
belinda
Among the various fibers bacteria thrives most in
cotton as opposed to rayon or other man made
fibers. In surgery for the most part it's not so much
what you wear but rather how the surgical site is
prepared. The type of laminar flow used in the
surgical suite, if HEPA filters are used and if the
instruments have been properly sterilized as well
as proper surgical technique.
What's the point of removing your under clothing if
its kept in the surgical suite. Airflow over objects is
critical and this is where the or staff can make a
difference. Has the surgical suite recieved a terminal
clean after each case by evs( housekeeping).
Surgical suites are far far from being sterile. I have
seen anesthesiologists eating food during cases in
the surgical suite. I have seen orthopedic equipment
used on patients that were never sterilized. Why this
stupid big deal about patients underwear. It's just
redundant to say the least as there are so many
other factors that effect post-op infection.
In one surgical case an illegal immigrant who looked
as if he just crossed the soronan desert. He was
covered in dirt and dust as were his underclothing
and no one made an attempt to remove them. I have
never in decades seen any POLICY in any hospital
operating room that says a patients underwear needs
to be removed. The policies say only that a patient
needs to be in a hospital gown and realize that for
many inpatients they have been in the same gown
for a WEEK!
Naturally your underclothing will be removed if it
is covering an area designated for surgery. There
are many people who work in surgical suites who
have big egos and with nothing better to do than
create their own protocols that benefit their own
ego driven agendas. I would pay big money to
see the look on these nurses faces if patients
were to show up for surgery in an iron maiden
and state they can't find the key. I'm sure that
would just piss them off to the nth degree.
PT
As far as wearing underwear during surgery or any other time in a medical facility, they can create all the "rules" or policies they want, but they have no authority to force a patient to comply with them.
The patient has the final say - all you need to do is say "no" and stick to it. Sure they will probably try to browbeat you or coerce you to comply - don't put up with it. If they start, stop them and demand to speak with their supervisor - then make an immediate complaint about their abusive behavior.
As several posters here have experienced, when you threaten to cancel the procedure and leave, they almost always back down.
On a slightly different topic, one of my pet peeves are those consent forms with all the fine print. When handed one, the first thing I do is request a copy with larger print - at least 10pt but preferably 12pt minimum type size for ALL text.
Step two is to sit there in front of them and read the entire thing word for word, taking your time to read it thoroughly.
Step three is to line out and initial anything you don't agree with and add any additional restrictions or limitations you may have.
Some examples:
On most surgical consent forms you will find some language to the effect of consenting to that specific procedure and any other procedure the surgeon may deem necessary. I cross out and initial the last part, which limits them to only the specific procedure.
Most anesthesia consents are pretty vague and give them cart-Blanche to use whatever they want. I always cross out any general consent and add specific limitations. Depending on your preferences these can vary. Mine for example are:
I only consent to_______form of anesthesia as discussed with my provider.
I do NOT consent to and SPECIFICALLY PROHIBIT:
a. The use of general anesthesia under any circumstances for any reason.
b. The use of any medication known or suspected to have amnesic effects.
c. The use of any form of invasive airway support.
d. The use of any medication for sedation without my specific written consent.
e. The use of any medication at levels known or suspected to have sedative effect.
f. The use of a urinary catheter under any circumstances or for any reason.
g. The suspension of my POLST during any portion of the procedure. All provisions of my POLST shall remain in force at all times.
Wow! Are hospital administrators prepared for this? Hex, it looks like you are taking over management of the surgery away from the surgeon and anesthesiologist. I'm sure you must know that events or issues occur during surgery which requires changes in procedures and management. The staff may not be able to communicate with you during the surgery to obtain your permission for these changes. Oh! You are not under general anesthesia (really?) but do you have an endotracheal tube in place to ventilate you while your chest is open and thus unable to vocalize? It's becoming very complicated.
I understand, though, what you and the others are writing about. It all has to do with literally "uninformed consent" which is requested of every patient. The patient is "uninformed" because the surgeon and anesthesiologist has not sat down with the patient giving full attention to the patient and disclosing the plans, the options, the more likely complicating factors, if present, and the necessary acts to respond to the complications. Is this teaching the patient how to perform the operation? No. It just represents presenting the patient an opportunity to make a "fully informed consent" if the patient desires. Yea.. and ask the surgeon or anesthesiologist if they change their scrub suits, before returning, after they go out of the operating room for lunch. ..Maurice.
Dr. B,
My views may be somewhat on the extreme side, but they are right for me. I am not advocating them for anyone else - each person needs to decide on their own what is most important to them and act accordingly.
Actually, with the advances in regional anesthesia, even for major surgery, there should be much less need for general anesthesia. For example, while only a few have been done in the US, there is a facility in India that has done well over a thousand open heart procedures on awake, unsedated and non-intubated patients using thoracic epidural anesthesia.
As to communicating with me during a procedure, it shouldn't be a problem as included in my list (c, d & e) are the prohibition of both sedation and invasive airway support, which includes ET-intubation, LMA, etc.
I agree with you on the general failure of providers to have a meaningful informed consent discussion, and I find by taking the position I do, it forces them to do so. It's possible that after such a discussion I may relax some of those provisions, but so far, once I have explained why I take the position I do it hasn't been an issue.
With respect to prohibition of the suspension of my POLST during a procedure (g), that is not negotiable. My POLST provisions are pretty straightforward: DNR, DNI, No IV, Do not Transport, AND. I was a long term member of the original Hemlock Society, and my beliefs haven't changed.
I firmly believe that there some things that are worse than death, and a significant percentage of them are foisted on patients by the medical system's "do it because we can" attitude. I refuse to be a victim to that.
Hex
I think Hex has made excellent points about what to add on the consent form. While it is true that there are some surgeries that require general anesthesia, there are so many surgeries that do not require general anesthesia. There is no need for many surgery patients to have an endotracheal tube in place to ventilate them while their chest is open. For example, why is this necessary for a knee surgery patient? Patients should opt for local or regional anesthesia without Versed as a sedative as much as possible so they can stay alert and awake and in control. It would be harder for medical professionals to do things such as removing their underwear or inserting catheters if they were awake & alert.
Check out this helpful article on KevinMD.com: Is nerve block anesthesia better for surgery?
Also, check out Texas Statute Requires Anesthesia Informed Consent You will notice that this form discusses risks of each type of anesthesia. I wonder how often patients are informed about the risks of anesthesia before they are operated on.
I wanted to comment on Dr. Bernstein’s statement: Hex, it looks like you are taking over management of the surgery away from the surgeon and anesthesiologist.
I think it is good when patients are able to take over management of surgery away from the surgeon and anesthesiologist. Patients should be able to have complete control over what is done to them.
I agree with this great paragraph Hex mentioned and I wish more patients were aware of this truth.
The patient has the final say - all you need to do is say "no" and stick to it. Sure they will probably try to browbeat you or coerce you to comply - don't put up with it. If they start, stop them and demand to speak with their supervisor - then make an immediate complaint about their abusive behavior.
Misty
Misty,
Interesting comment on state requirements for anesthesia consent. In my state there are apparently no such requirements.
In my most recent encounter late last August, I incurred an injury to my hand that required a small (approx. 2.5 cm sq) skin graft. When I went to the plastic surgery clinic for the pre-procedure eval I was handed a one page consent form that covered everything.
The anesthesia portion essentially said I consented to whatever they decided they wanted to do. I crossed that out and wrote in "as I specifically direct".
Under the surgery section, I crossed out the "any other procedure deemed necessary" portion and wrote in "specific procedure only". I also crossed out and initialed the reference to allowing students or trainees to participate.
The clerk wasn't real happy, but that's not my problem. Their clear assumption was that the procedure would be done in an OR in the day surgery unit with sedation and they wanted to schedule it right then before I had even seen the surgeon. I told them to hold off and we could address it after my appointment.
Once I had a chance to talk with the plastic surgeon, she agreed with me that the day surgery route would be a collosal waste of resources. The procedure was done the next day in a procedure room in the clinic with a local anesthetic. The only people present were the surgeon and me - I was fully clothed and only my hand was draped. I got to watch the whole thing and she explained everything she was doing - it was actually quite interesting.
Hex,
It is wonderful you took the steps to ensure that your hand surgery was done under local anesthesia. I wish that all patients knew that they could easily have hand surgery with a local anesthesia. I heard about a lady who had general anesthesia for hand surgery who was stripped of her gown and underwear. Also, we got a case where a lady who had a simple finger surgery who woke up naked.
We have to stand up to medical professionals even if they do not respond favorably. We have to let them know that we are in control of what happens to our bodies period. Sadly, so many patients are so compliant. Also, many medical professionals keep a lot of things private from patients.
I am glad that your plastic surgeon was sensitive to your needs. If you have not have had a chance to do this, I encourage you to at least write her a letter of appreciation for honoring your wishes. Maybe you could also bring to her about patient modesty.
I encourage you to consider submitting a short version of your successful hand surgery to the list of successful patient modesty cases at http://patientmodesty.org/rights.aspx. Your case is a wonderful example of the importance of patients standing up for their rights no matter how medical professionals feel.
Misty
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