Patient Modesty: Volume 69
As we continue on communicating about all the issues of
patient modesty, I find that I may have been suggesting a wrong approach for my
visitors to help resolve these issues: "speaking up" to physicians and the medical system.
"Up" suggests that the patient is somehow less significant and is
inferior in the patient-doctor/medical system relationship. And I don't believe this is true. Even though the
patient may be the one who is ill, to meet the medical system's professional responsibilities,
the system cannot act alone and must give equal attention to the patient as to
their own personal and operational interests.
So, as we move forward on this blog thread, working out ways
to communicate the needs of those who write here, let's change the suggestion
to "speak to..." as part of a more level "speaking field"
rather than the wrong view of "speaking up".
But as we begin Volume 69, let's remember that we have had 9
years and 68 volumes to "moan and groan" about the painful issues
that are seen but now is the time to change the discourse to one of presenting
a positive approach to attaining the needed relief by showing how the
participants here plan and have already started to change the system to meet
their goals.
..Maurice.
Graphic: From Google Images and modified by me with ArtRage.
NOTICE: AS OF TODAY NOVEMBER 14, 2014
"PATIENT MODESTY: VOLUME 69 WILL BE CLOSED FOR FURTHER COMMENTS. YOU CAN
CONTINUE POSTING COMMENTS ON VOLUME 70.
posted by Maurice Bernstein, M.D. @ 6:24:00 PM
177 comments
177 Comments:
Don,"Normal" context would need to be established by sociologists, psychologists, and others who work in healthcare and mental health. What's normal would be aligned to existing social norms with sensitivity to being unclothed in front of strangers and the (by lack of medical disclosure on informed consent forms). There should be an opt out section for those who require restrictions without punitive or forced to disclose previous traumatic sexual experience.
What would determine the protocol would be patient oriented for a healthy interaction to benefit the
patient without compromising medical interventions.
It is not a subjective issue; it's
patient driven with focus on eliminating psychological trauma when the medical industry directs their agenda instead of ours without telling us. This is the crux of a majority of the problem.
The way the medical industry is working at this time is unethical.
Working with mental health professionals, not only recommend advising patients on what to expect, but to dictates how disclosure, when disclosure regarding observers, gender of observers, level of exposure and informed consent that is properly executed is required.
belinda
"mental health professionals, not only recommend advising patients on what to expect, but to dictates how disclosure, when disclosure regarding observers, gender of observers, level of exposure and informed consent that is properly executed is required."
This shouldn't be a recommendation, it should be a legal requirement. Full disclosure AND APPROVAL from the patient of all of the above with severe legal penalties for all involved if breached.
Lets face it... no committee of doctors, shrinks, or any combination thereof could possibly know what MY level of "modesty comfort" is, so without full disclosure and approval before hand, lines ARE going to be crossed when staff makes assumptions based on what THEY think I should accept or what they feel like doing.
Jason
don, belinda, jason,
Here are some good references. The last 2 sources are excellent references for providers. Perhaps in keeping with Maurice's challenge to change in Patient Modesty: Volume 69, Speak To, we can use these sources to help educate about the problem.
As I stated before, I am in the process of composing a letter that I am going to send. I am not the most eloquent writer, so it is not just type it out and send. I will keep everyone apprised of what happens.
Doctor Addresses Prevalence of Medical Trauma
Medical Trauma: When A Procedure Goes Wrong. Source: Psychology Today
PTSD After Surgery
Pediatric Medical Traumatic Stress Toolkit for Health Care Providers This is an excellent resource for parents and healthcare providers: there are guides and pocket cards to help identify PTSD
It also says: Up to 80% of pediatric patients and their families report experiencing some traumatic stress following illness, injury, hospitalization, or painful medical procedures.
Finally here is a publication from the Veterans' Administration on how to recognize patients with PTSD:
PTSD implications for primary care
--Banterings
Banterings, Great articles and will read them at length. I found an old "friend" on one of them. Peter Levine. He wrote a book called "Waking the Tiger". It's about how your mind may forget a traumatic incident but your body will react and keep the information and compares our reaction to fight, flight and fear to the animal kingdom.
There is a very effective therapy called IMDR that focuses on releasing traumatic event by relaxing the mind.
While PTSD is prevalent in all kinds of trauma, one kind is harder treat than all the rest.
Causes include: accidents, fire, natural disasters, war, but
ramifications from sexual assault are in a category alone. They are harder to treat, have the lowest success rate.
I mention this because medical procedures where your clothing is removed from you is a sexual assault if you did not give permission in the setting you expected.
Also, I recommend Dr. Van de Kolk's book on PTSD - excellent read!
belinda
It's interesting that those trauma / PTSD links all talk about injury and fears of needles / blood / failed anesthesia, but I didn't see one mention of modesty concerns.
Jason
Correction....It's called EMDR.
Jason, the reason you saw nothing regarding modesty on those reports is that they were focusing on medical reasons for trauma.
Modesty issues belong in the sexual abuse area if exposed without your consent or knowledge (that is the same as being against your will).
The main difference between sexual abuse and other causes of PTSD is that modesty violations have more to do with extreme humiliation.
Cruel and degrading treatment/torture abuses you psychologically. Public stripping is their first mode of application.
The argument can be made that if a patient is unaware of what's to come, if privacy is not a concern to the practitioner, and the event is unexpected and especially if you cannot move, is akin to cruel and degrading treatment.
The medical profession can hide behind their "dressings" but when it comes down to it, without informed consent, without total disclosure of who is present and what state of undress, you did not and cannot, give informed consent.
Without consent, it can be considered sexual battery...and that's the law.
Next time something happens, try calling the cops.
belinda
Belinda, I am not sure the criteria you have presented are consistent with the legal definition of "sexual battery" at least under California law. ..Maurice.
Jason,
It can be difficult to distinguish between health care and sexual abuse when routine examinations involve genitals. Physicians are able to perform exams such as genital/rectal/breast exams when they are medically unnecessary, and to then defend their actions by claiming they were being “thorough”.
It can be very difficult to prove otherwise except in rare instances. For example, Dr. Stanley Chung was brought before the College of Physicians and Surgeons on allegations of frequent and unnecessary rectal and genital exams on patients, some of whom were virgins.
Further proof is the fact that no charges have been filed in the case of Dr. Stanley Chung or Dr. Nikita Levy (Johns Hopkins).
In Memory and suggestibility in the forensic interview (M. L. Eisen, J. A. Quas and G. S. Goodman) studied children having gone through medical procedures:
"...the procedure involves painful, forced genital contact, and thus presents a physical approximation to sexual assault..."
Research is lacking, yet the internet is filled with testimonials. Here is another source that validates this: Psychological Harms of Pelvic Exams.
The question is how many is too many? The answer is "1!"
People who suffer this opt out of healthcare. Providers assume they have moved, seeing a different provider, lost insurance, etc. Nobody tracks what happens.
It is similar to some issues with the homeless and their health/psychological issues. The difference is that these people may be functioning in society and hide among the uninsured or those assumed to be healthy. If they become dysfunctional, the proximate cause is usually hidden by some other social issue like homelessness, PTSD, or mental illness.
Many people who have a phobia about medical care may not know why they are afraid. I have never seen a survey that accepted "I don't know" as an answer. They say, "are you afraid of needles," seems logical.
Consider the case of: Richard Rosenthal beat his wife to death and then impaled her heart and lungs on a backyard stake, because she burnt the pasta. The burned pasta was not the reason, but the trigger.
Consider Maurice's 2010 post: Clitoral Sensitivity Study in Children; you would have to be insane to believe that these children have NOT suffered any emotional trauma.
The question becomes was the trauma from the "birth defects" (that was corrected with surgery), the surgery itself, (I'm sure that present were) med students learning from this rare surgery, from what seemed like a very adult sexual experience of having their clitoris stimulated with a vibrator with chaperones, med students, nurses, parents, etc. in the room, and so on...
It probably was a combination of the entire experience and very difficult to pinpoint the "trigger."
--Banterings
Dr B.,
I guess I question the semantics of "speak up" vs. "speak to" in the title of this volume.
By definition as it is used in the context of this discussion, "speak up" means to state one's beliefs, objections, etc, bravely and firmly.
There's nothing there that implies speaking from a position of inferiority.
That said, there is clearly a perceived power differential in the patient/physician relationship - you'll notice that I said "patient/physician" and not "physician/ patient" - that nuance was deliberate.
Patients need to understand that the physician/facility is a professional resource that is being consulted for the benefit of their knowledge and experience. When push comes to shove, the only power or authority that a provider or medical facility has is that which the patient chooses to give them.
If it takes using "speak to" instead of "speak up" to get patients to wake up to the fact that they are the ultimate decision maker and should be in control of the interaction, then I'm all for it.
Hex
Maurice said...
***
Belinda, I am not sure the criteria you have presented are consistent with the legal definition of "sexual battery" at least under California law. ..Maurice.
***
That link says...
***
"Felony penalties may apply if the alleged victim:... was unaware of the nature of the act because s/he was fraudulently convinced that the touching was for professional purposes (like, for example, medical or therapeutic purposes),
***
So... what I get out of that is that any "intimate contact" should be treated as sexual battery unless the provider can prove it was necessary... I guess catheters aren't used all that often in Cali, since the staff can simply clean any spilled urine off the table floor, making the catheter not "necessary".
and cases like that guy who was getting a colon scope done, and left his phone on... discovered a nurse had touched his penis... that (in Cali) would be sexual battery.
Makes me wonder why more medical folks aren't getting charged.
Jason
Maurice, Here's the answer to your question of Ca. Law Sexual Battery & Sexual Assault Penal Code 243.4. PC
Under 1. Legal Definition of sexual Battery in Ca. please direct to section 1.3 Against the will of the other person. Also, Section 1.4
www.shouselaw.com
belinda
Jason,
The big problem with sexual battery is that it must be:
"for the specific purpose of EITHER sexual arousal, sexual gratification, or sexual abuse"
It is hard to show the intent was anything other than therapeutic when in a medical setting.
--Banterings
"The big problem with sexual battery is that it must be:
"for the specific purpose of EITHER sexual arousal, sexual gratification, or sexual abuse""
interesting... since none of those 3 are an actual physical thing (shy of the slim to non-existent chance it was a male aggressor and there's video of him getting an erection while doing it).... so... the only way (almost) anyone can be found guilty of that is if they admit it?
Not just the medical setting, but in any context...
Jason
Here is Belinda's full link regarding the legal definition of sexual battery. ..Maurice.
It is too bad that some patients want to turn or better "twist" the issue of the medical systems reaction or responses to patient modesty issue into sexual assault or sexual battery. If those of us who have become physicians was aware that all of our potential patients had these criminal behaviors in the back of the patient's minds and that each patient was anticipating that some criminal act was about to happen to them, I doubt most of us would have decided upon a different occupation to avoid serious life-changing consequences if accused of such behaviors. Sorry, patients.. no more doctors to examine, make a diagnosis and treat. Feel safe..be comfortable.. have your husband and wife examine you..let them Google a possible diagnosis. Oh.. I forgot, a sexual assault is even possible between married couples. Oh well.. just then go ahead and examine yourself but do it carefully and not to masturbate!
I hope you understand the ridiculousness of generalizing the issue of sexual criminality into potentially every doctor-patient relationship.
Think of what I wrote. Now.. let's get on how to begin changing the system to meet your needs. ..Maurice.
Just so that my previous comment doesn't get disregarded as "moaning and groaning" - it had a point.
My solutions:
1. We need to start having frank and open conversations about consent in medical care. Implied consent is an outdated notion. Its congruent with the idea that if you stay the night at a girl's house, you have implied consent to have sex and don't need to discuss it.
Medical procedures, even simple ones like having your heart and lungs listened too, need to be explained as what will be done and consent obtained. Yes, this takes more time and we need to structure our system to allow this.
Anyone who goes to have a test in the hospital needs to know what will happen ahead of time - what drugs or contrast will be used, what measure of nudity will be needed, how many people will be involved, and an explanation of exactly what is happening. No woman should show up for an ultrasound and be stuck with a frustrated tech having to tell them it's a vaginal ultrasound and they are wasting time let's get this done.
2. We need to look beyond the medical impact of actions, and onto the emotional and mental impact of medical care. Acute Stress Reactions or even PTSD are common following medical care. More knowledge about prevention is needed. Prevention is much more effective than treatment!
One study had those hospitalized keep a daily journal about what was happening, and the medical personnel did too - afterwards, those that had access to those diaries had an easier time processing what happened to them and adjusting to the experiences. (That may have been in one the links provided - great set of links about PTSD!)
-JR
Maurice - it would mostly all be fixed if patients would be allowed to bring our own chaperones with cameras.
Assaults would pretty much go away... especially if there were a series of videos online of "proper procedures" for exams etc performed on mannequins, with an explanation of what conditions would warrant such an exam. Then people could compare what their doc did to what they "should be doing". If it doesn't match up, then authorities can be contacted.
It would also pretty much solve the consent issues. (especially while the patient is unconscious in the OR and someone decides to lead a field trip through) If the doc knows he's being filmed, he's not going to bring med students in to "play" with the knocked out patient, nor will they do anything else blatantly wrong.
Most people should assume that they will not be treated right when in a hospital... all these "rare bad docs" we hear about... how many ancillary staff witnessed the bad behavior? (number of staff per surgery, how often if the staff rotated and new faces come in, multiplied by how many patients / surgeries over how many years? For every one "bad doc" there's many, many, many bad ancillary staff. Once something is done, there's no undoing it. It only makes sense to assume the worst.
Jason
Maurice, You mentioned in a previous post that certain issues would be not be considered sexual battery and the link I found says otherwise.
Part of the problem rests solely on the medical community for not disclosing intimate details of what to expect from an exam. I do not and I would not accuse someone of inappropriate behavior if it didn't exist
The article in the NY Times that talks about the breast cancer patient recuperating had to endure a room full of students looking at her naked body when her doctor stripped her in front of everyone for no medical reason. These things happen and when they don't happen with informed consent, then these lawsuits are filed.
Sometimes the lawsuits are warranted and sometimes they are not. From where I sit, it makes more sense for the medical community to fully disclose the nature of procedure to prevent a large amount of these lawsuits.
Patients and medical personnel have different perspectives on bodily exposure and it's important for everyone to be on the same side so that if there is a question of impropriety, a patient will have less to "go on" when they have been informed in clear language.
I'm not against you, Maurice, rather the opposite, because I feel that much can be done to eliminate liability for these kinds of issues but the main reason that these things happen if there is no communication and that rests on the medical community.
A patient may not know to ask how many people might be in the room for intimate care because it is out of their realm of thinking that a room full of people might be included in an intimate exam. Their belief system dictates that social norms are not congruent with what they unexpectedly faced in the hospital. Too bad that the patient is humiliated or traumatized. Most of these lawsuits evolve because all the patient wants is an apology that they don't get.
They can't ask questions that they wouldn't have thought of to begin with if they don't know or understand how a teaching hospital works and how the medical system ignores those privacy issues. JAMA or another publication published an article, "An Apology Goes a Long Way in Medicine".
I can also tell you when something does happen, the refusal of getting that apology from the system further traumatizes the patient into feelings of complete outrage. Those are the feelings that prompt lawsuits.
I never figure out how a populations of smart, intelligent people can get this issue so wrong. It boggles my mind.
belinda
This post will be in 2 parts, this is Part1
Maurice,
The point that Jason is making can be seen in the case of Dr. Stanley Bo-Shui Chung:
"...The now-retired physician is accused of conducting excessive and unneeded pelvic and breast exams on 19 of his former patients, including a developmentally delayed 15-year-old girl....During the cross-examination, Alice Cranker, counsel for the College, told Chung that Patient A had 18 pelvic and breast examinations in just over two years..."
Excessive? Absolutely. Criminal? How do we know what was going through his mind?
For the sake of my example, let's assume Dr. Chung's motives were sexual.
Dr.Chung (assuming sexual assault motives) is still cleared of criminal acts. (See link above.)
Yet school teachers are warned that if a child has a bathroom accident not to assist but rather call the parents so as not to be accused of sexual assault.
This speaks to Belinda's point; Providers are so "mechanical" that they fail to see the person. What is common sense to everyone they fail to see because they have been desensitized.
Chaperones are NOT the solution either!!!
Consider the case of Dr. Twana Sparks in the following 2 articles:
Doctor accused of inappropriate exam behavior to return to practice, with conditions
Is Dr. Mark Donnell lying to protect a sexual predator?
...After applying a dressing to the surgical site, Dr. Sparks, who was also the hospital chief of staff, reached inside the patient’s boxer shorts without wearing gloves, fished out his penis and pointed it at the ceiling. She observed fluid filled vesicles on the side of the shaft, indicating a sexually transmitted disease, and shouted “Oh Gross!” She then slapped the head of his penis three times, saying “Bad boy, bad boy, bad boy!” with each strike, as her all female operating team erupted in laughter...
The Medical Board had issued a notice of contemplated action against Sparks, a board-certified otolaryngologist (ear, nose and throat surgeon) who is on staff at Gila Regional Medical Center, in April that alleged:
"(A) For many years, up to and including at least July 17, 2007, Respondent performed genital exams on many of her Ear, Nose and Throat patients while they were under anesthesia without obtaining prior written, informed consent from the patients and did not refer to the exams in the patients' hospital records."
"(B) For many years while she was performing Ear, Nose and Throat surgeries at the Gila Regional Medical Center, Respondent wrote messages and created artistic images on the bodies of many of her patients while they were under anesthesia without obtaining the patients' prior written informed consent."
It was alleged that this behavior took place for many years and was the subject of many long running jokes in the hospital. It was well known among the staff that this was happening.
This case raises some very serious questions about Dr. Twana Sparks and Gila Regional Medical Center, and appears that much of it hinges on whether Dr. Mark Donnell is a liar.
His alleged statement, “Oh, wait, is Twana doing one of her exams again?” would be 100% consistent with operating room humor, and what is considered common knowledge in that hospital.
As I stated before about Dr. Chung: It is more frightening if his motives were therapeutic and NOT sexual. How is it that he could not see that this was excessive and abusive?
Here is a different way to look at sexual touch.
--Banterings
This is part 2 of a 2 part post...
Take this test from the patient's point of view:
A 19 year old girl was at a party. It was late and she was very tired. She had one alcoholic drink, but was not impaired. She had fallen asleep three times, and finally asked her friend to take her home. She describes what happened next...
I asked for a ride and she agreed, just as soon as she said her good byes. I started dozing off again. I awake to find myself on a bed. The light above me is bright and there are a bunch of people standing around me. They are taking my clothes off of me. I tell them to stop, but they do not. I try to fight back, but they are holding me down telling me not to resist and to stop fighting. They are touching me everywhere, I want them to stop. I can feel my self naked, being exposed makes me feel cold. I want to cover up, but they are holding my hands.
I can feel them inside me. I scream for them to stop and try to fight. but they have me tied down. Then they start putting things in me, I don't know what they are. This feels like a bad dream, I am so afraid, I feel light headed and pass out. I awake in a hospital bed. I want to leave. I do not want anyone to know what happened to me. I want to get a shower, wash away what happened. I can feel my self naked, being exposed makes me feel cold. I want to cover up, but they are holding my hands.
This is my fault. People are going to blame me for this. I should not have fallen asleep. I should not have gone. I should have just closed my eyes and pretended it was not happening. Maybe it would have been over faster if I did not fight back. I can't let anyone know, I will just say "I am fine and want to go home" if anyone asks.
I can't remember everything that happened, but all I want to do is to forget.
Question: What situation is this girl describing?
A:) She fell asleep waiting for a ride and a bunch of drunk people took her in to a bedroom and gang raped her?
B:) Her friend got in to a car accident, she awoke in the Emergency Department in the middle of a trauma exam?
C:) She was gang raped after falling asleep at the party then taken to a hospital after found by friends, having visible injuries.
Answer below..
The answer is: "DOES IT REALLY MATTER WHAT HAPPENED TO HER?"
Here is a person emotionally traumatized. Any answer than we need to get her the help to deal with this experience she endured is a sign for lack of concern with the well being of the patient and your egocentric view of healthcare.
As to Maurice's challenge: I have contacted about 10 physicians and advocates who have written books, had research published, etc. Many have touched on every issue of patient centered care except the modesty issue. I have not had any responses yet.
Maurice and any other providers,
Please comment on the Dr. Chung news story. I know that you don't have ALL the facts for each patient and so on, but isn't there a point when you say enough is enough? At what point is the cure worse than the disease?
If you can defend this, I would ask that you attempt. I also ask ALL OTHER POSTERS to be RESPECTFUL of any defenses of Dr. Chung!!!
I, my self can see some REMOTE defenses such as for one reason or another, perhaps expertise in persistent, chronic issues with female organs was his speciality, these were cases no other physician wanted to tackle because of the intimate nature, or these patients were "wards of the state" which he handled.
What I can't get past is that common sense says it looks excessive, there were too many patients that he did this to, this is in Canada (socialized medicine), and he had been warned about this previously.
Any takers?
--Banterings
Banterings, Well said. Oh, the medical personnel will find a way to
to defend but that doesn't matter.
What does matter and needs to be addressed by the medical community that there is a problem that needs to be fixed. They can't fix what they don't recognize.
I actually had a doctor's wife call me on the telephone after filing a complaint that her husband wasn't deviant. Her experience was that he was a kind, loving person and would never do such a thing that he was accused.
My experience with this person was quite different mainly because there was no medical reason for him to be in my operating room, when he was there. He made no attempt to give me the common courtesy to averting his glance, even though I was awake without any sedation, did nothing to correct the situation and it was he, who cause me to realize at first that something was terribly wrong.
Improprieties happen all the time because they can. This must be recognized, employees need to be identified when it does. Then, they need to be watched.
Banterings had a point with his rape scenario and that point is one's experience is subjective to one's reaction to it. The hospital is such a scary place that every effort should be made for the people who are paying them. It is not and it is not recognized that there is a problem to fixed. It's just ridiculous.
belinda
*** "It was alleged that this behavior took place for many years and was the subject of many long running jokes in the hospital. It was well known among the staff that this was happening."***
Perfect example... "one bad doc", but the ENTIRE HOSPITAL was part of it.
Jason
I wanted to share with everyone about this disturbing story of a 16 year old high school girl being forced to shave pubic hair of a boy she had a crush on. She was in a student nursing program and went to help nurses at the hospital. She was very uncomfortable with the idea, but a head nurse pushed her to do it. This female head nurse is apparently not sensitive to male patient modesty. This high school girl had no experience and could have caused serious injuries to the boy’s private parts. Check out this article about dangers of shaving surgery patients at http://www.nytimes.com/1983/06/21/science/the-doctor-s-world-shaving-area-of-operation-now-seems-dangerous.html .
I am sure that this boy felt so vulnerable. It is obvious he was not asked if he was comfortable with the high school girl participating in shaving him. He was probably not offered an option of a male nurse. The truth is he could have been given instructions about how to shave himself.
PT: If you still look at this blog, can you please respond to this? I am sure this disturbs you greatly. It is unbelievable that female head nurses would be so insensitive to male patient modesty and force high school girls to do intimate procedures on male patients. I really value your insights about male patient modesty and I hope you will come back here to contribute your thoughts.
Misty
Misty, I was tempted NOT to publish your link to "thatsembarrasing.com" since it contributes NOTHING factual to an ethical discussion of patient modesty. It is not worthy of reading since no date is given and the writer is not identified nor is the "local hospital" and the entire story anyone could make up and put up on that website. And the website itself is oriented to "stories" that are designed to make the reader blush. I published your link only as an example of "resource" NOT to be repeated.
Misty, on the other hand the link to the New York Times article is of value since it does point out an area of modesty concerns which may involve a generally accepted procedure which may not be in the patient's best medical, if not, emotional/modesty interests. And then, as you recall, a clearly named and identified physician revealed some personal self-disclosure of the matter which is certainly more pertinent to the issue under discussion than the story written by somebody on a website to embarrass.
Yes, people have been, over the years, telling "their personal stories and experiences" here without definitive identification of themselves and who knows how much is really true. We assume that those writing here are honest in what they write. But who really knows? But to link to a story by an unidentified someone who is not part of our "blog thread family" in the future will not be accepted. We want FACTS and not made-up stories to guide our actions. ..Maurice.
Maurice,
I agree with you about the web site. Assuming that the story is true, I am sure that the story has been embellished.
This website also highlights another aspect of the patient modesty issue: the fetishization and sexualization of medical procedures.
Please indulge me here and try to follow my line of thinking on this:
I use the term sexual to mean any bodily areas associated with Freud's Stages of Psychosexual Development are involved.
"Sexual" means involvement of the breasts, genitals, anus/rectum, and to some extent the mouth (of the patient).
There are NO motives, no sexual gratification, not doing a medical exam, simply describing an action. In this case touching or looking at the breasts, genitals, and anus/rectum.
You can see an in depth explanation on my blog here:
The fact that medical procedures have a sexual aspect (explanation above) to them, they can feel sexual to the patient. Some people have fetishized medical procedures. (Search the internet for "medical fetish.")
The central themes in medical fetish are submission and humiliation. For these reasons, even though done professionally a patient may feel (and actually be) humiliated. It is also impossible to tell if a provider is doing such things for therapeutic reasons, sexual gratification, or both.
This is also one of the reasons that the traditional nurse's uniform was replaced by scrubs. The uniform was sexualized and promoted harassment of females. A more practical reason for its abandonment is usually cited, and that is more men entering the nursing profession. Look at the nurse halloween costumes.
--Banterings
Maurice,
Can you (or anyone else) clarify something for me. I have always contended that any "Patient's Bill of Rights" is nonbinding, mean nothing, are not enforceable, and are little more than a marketing ploy.
I was having a conversation with a friend on "Patient's Bill of Rights" and he says that these were enacted by law. I said that only what the law requires as "Patient Rights" is what a patient is entitled to.
He says that anything included in a "Patient's Bill of Rights" become binding.
Also they include "Patient Responsibilities" (which always conflict with the Rights), which I contend is only an excuse to berate the patient.
The main conflict is that Rights include the patient involved in deciding the course of treatment. Responsibilities say that the patient follows the physicians orders. This allows the patient to be penalized if the physician disregards the patient input.
There are many other examples I would really to have a legal answer.
--Banterings
Here are two comments to my "feedback" thread that are appropriate for presentation here on Patient Modesty. Today's commentary follows in the next posting. ..Maurice.
At Monday, June 24, 2013 1:21:00 PM, Anonymous Anonymous said...
Your article on "gawking" was very poignant. Thank you for writing it. I happen to be one of those patient's who has been gawked at since I was a child. And, it has not stopped. I was born with two deformities, the left hand with finger mutations and the right leg with a foot deformity which was amputated at the age of 4. I am now 48 years old. As a child I adapted quickly to my prosthesis and I was constantly in medical school auditoriums in my undergarments walking on stage showing the medical students what a "great walker" I was and how well adjusted a child I had become. Gawking is an understatement. No one ever asked if I wanted to do this. I was mortified, ashamed, and utterly embarrassed. This continued well into my teenage years until I said no and it finally came to a stop. Fast forward to adult life. My hand became a fascination to international medical residents to the point where they would have their camera phones and take pictures and videos of my hand despite my saying no. The amazing thing is that the local doctors did not stop this invasion of privacy despite my very vocal disapproval. I will add this happened in major university medical centers ... not some little town in nowhere USA. I agree that informed consent should be obtained before all the gawking begins but in instances where the person specifically says no ... then it should stop no matter how interesting it may be to photograph the deformity and take home to show someone else. To quote the elephant man (I think), "I am still a person not an animal". I am a professional woman with two masters degrees one of which is in bioethics ... needless to say your article hit home. Thank you again for writing it. [MM]
Here is the commentary sent to "feedback" thread today. ..Maurice.
At Saturday, September 13, 2014 12:56:00 PM, Anonymous Anonymous said...
While working as an RN in a trauma room were seriously injured people are taken for treatment I witnessed this scenario of the double standard of modesty for male patient many times. The first thing the medical staff would do is cut all the patients clothes off to examine their entire body. A digital rectal exam is performed to see if there is blood in their rectum and then the patient would be catheterized to obtain a sample of their urine to analyse and detect the presence of blood. This is done to all patients. Many trauma's were a result of car accident's or crime victims etc so the police would normally be involved. The police would routinely walk in the trauma room and were allowed to stand around and watch as patients, that is male patients were put through this necessary but extremely embarrassing ordeal . If the patient was a female the curtains would be immediately closed and kept closed until the entire trauma procedure was complete. If the patient was a male the curtains were always left open and the police officers which often included female officers were allowed to watch as the patient was stripped naked, under went the rectal exam and catheterized. Allowing the police especially female police officers to watch this is blatant patient abuse. I think this double standard of modesty for male patients is an extreme violation of medical ethics and standards of decency that are supposed to apply to all patients. If the police have a reason to enter the trauma room which they often do the curtains should be closed for male patients as well. Police should not be allowed to enter the trauma room in the first place without permission or be allowed to " hang out " there while patients are being treated. Quite often female patients in the trauma room are naked and will be seen by the police officers before the staff has a chance to close the curtains so this is a violation of their modesty as well. Curtains stop you from seeing but not hearing everything that's going on behind them so this is also a violation of the privacy and confidentiality of both male and female patients. The police presence in the room amounts to a combination voyeurism and morbid curiosity.
I know for a fact that the police are too friendly with the ED staff.
--Banterings
Makes one wonder why the hospital staff allows the police back in the first place... I'm sure they'd stop the average person off the street from wondering in to "hang out" while a woman is being stripped and "examined".... so why not the cops?
It should be the hospital / hospital staffs legal responsibility to ensure no unnecessary people are anywhere near patients. (including other hospital staff)
But nothing will change until the hospital staff themselves (not just the hospital entity itself) are legally liable for what goes on under their watch.
Jason K
Not wishing to stray to far from the main subject as I have experienced several of the scenarios described, but now that a typical medical practice has become more of a business, shouldn't it be treated as one? Namely, the patient is not only a patient, he or she is a client or a customer. That being the case, customer satisfaction now has to be considered. That should include how said customer's modesty is treated and whether or not they are satisfied. Any good business should recognize that but it has been my experience that many practices do not.My advice is to complain directly to the business you are dealing with. Am I wrong?
Ed T
The post from Anonymous Anonymous (AA) illustrates the enormous double standard that is rampant in the medical establishment, from the routine (e.g., school physicals and doctor visits) all the way to the extreme (e.g., trauma centers and ICUs), a difference in treatment that arguably keeps many if not most men from seeking the preventative care that would avoid the more acute conditions down the road.
AA’s post, decrying the double standard, is precisely the elephant-in-the-room issue that several volumes ago would have brought charges of “gender warfare” and insistence that our discussion not pit the sexes against one another--which IMO was a straw argument for not addressing the problem. (Analogous to a gender-neutral discourse on breast cancer, deferring to the 1% of men with the ailment.) At which point the thread would segue, amid long walls of text, to either a more general topic like informed consent or backless gowns, or to a more gynocentric one like ER pelvic exams or the emotionally fragile state of [female] sexual assault victims (the “abuse excuse” for ignoring males).
Like myself, PT probably was/is frustrated by a medical modesty blog whose posters would downplay the victims of by far the greatest number of violations, systematic not episodic violations. Of course the problem is gendered: 90-95% of the support staff is female, the nursing culture is female and largely autonomous; the doctors are only a problem in their acquiescence. To emphasize this fact is neither anti-woman nor warfare of any stripe. When PT used to expound on this and other matters, he was not indulging in some gender-warrior polemic; rather, much like the RN above, he was sharing his considerable lived experience. Truth be told, if we dismantle the scourge of the privacy double standard, all the other modesty intrusions will likewise fall. PT’s posts, unlike many of the other subjects herein discussed, were scrupulously on topic: this is, after all, Medical Modesty.
---rsl
P.S.: Finally just recently got normal computer access, but can’t say I’ll be coming back to the discussion either.
The sad but true reason that the police are allowed free run is so that staff can become familiar with them. If they are seen as an "ally" helping in their investigations, there is a professional courtesy extended to hospital staff if they get stopped speeding.
For the police, beyond making their investigations easier, is the knowledge that if they are ever injured they will be taken care of by their familiarity with hospital staff.
You can't blame a police officer for wanting to have friends in the ED, and you can't blame hospital workers for wanting to have familiarity with police.
Even I am guilty of having familia rite with police officers, and YES it has helped me in certain situations.
One might say that the police officer's familiarity wiyh me gave him an insight to my intent and that my infraction was "accidental," unintentional, an most likely not to occur again (good community relations is less harm than a traffic citation), and NOT a "quid pro quo."
True, but that familiarity gave me that advantage. That is just human nature. In relation to patient dignity we hear the term "professionalism." That professionalism needs to be applied equally, consistently, and at all times.
That is one of the biggest issues for the healthcare system, the lack of consistancy.
--Banterings
Then where is the line drawn for familiarity?
Standing around while the patient is stripped... then what? let the cop give a shot / perform a DRE?
And why stop at cops.... I've seen ED staff have pizza delivered, so why not let the pizza guy take a peek? Might result in extra toppings / faster delivery for the ED folks... (if anyone thinks the comparison is ridiculous, by all means explain the difference between letting " Non-medical person Scott" in, and "Non-medical person Brad" in.... neither one has any right or business being in there)
I get what you're saying, but I still believe it should be considered illegal behavior on both the hospital staffs part AND the tourists part, be it a cop, drug rep, doctor who isn't part of that case or what ever.
And yeah, I know a lot of folks here think I'm a tad extreme with my opinions from time to time.... but like the old saying goes... "you can't un-pee in the pool"... once something is done, it's done... a privacy violation isn't like knocking over a chair... it simply can't be undone. No apology will ever fix it. Lawsuits and jail time however WILL make the person responsible think twice before deliberately or "accidentally" doing it again.
Jason K
rsl, First contact me direct. My email here:
Second you said:
Truth be told, if we dismantle the scourge of the privacy double standard, all the other modesty intrusions will likewise fall.
Not true! The underlying problem is healthcare's entitlement to a body that is NOT theirs! Fix this issue and all other issues will fall.
The problem with the gender choice is that providers do not respect the patient's dignity. First ask "Can I expose your body?"
"No, would you prefer same gender, better draping... what can I do to make you feel comfortable?"
That is the solution!
Again, please contact me rsl
But if the double standard was eliminated and females were experiencing the same and the same frequency it would change as women have demanded and recieved more consideration' Men are not seen as victims and not given much concern. if they speak up it is different than when women do, so I understand the statement that addressing the double standard will impact the issue. While i don't know that it will eliminate it, it would force changes.
If the police and providers want to be buddies, go for pizza and a beer after they get off work. Someone being in a truama center is not match makers, they are there for themselves not for the benefit of providers and police. I don't blame them for wanting to be friends, just for compromising the patients privacy, that I blame them for....don
Don, Is what your saying is let's punish women for speaking up and start abusing them in order for the men to get what they want?
Almost 100% of the time, living in a big city, men are assigned to all procedures whether the be a technician, nurse etc.
It's up to patient.
I've already paid my dues, no students, no extra personnel and no men if I'm undressed.
While men and women are equal they are not the same. If men choose not to speak up, what does that say?
Time for everyone to accountable and I don't think by setting women back so far after they've worked so hard to get what they need is going to help men get what they need. You're going in the wrong direction.
It's almost akin to this birth control/abortion issue. Why should someone's religious beliefs infringe on the rights of someone else.
Some genetic diseases aren't discovered until after the 20th week.
Also, want to get rid of birth control? Then let's get rid of vasectomy, prophylactics, viagra and women, keep your legs together. See how fast the laws would change then.
They also don't say what society would do with all the children both healthy and genetically damaged after they are born. Forcing a rape victim to carry a baby is abusive. Someday, if these laws do change, one woman who was raped will have the inclination to jump off a building, killing both of them. Then, will society be happy?
I know I've strayed off the point a bit, but the bottom line is that we all have a right to decide how and what we want to do with our bodies. I am not a supporter of abortion and often wondered how parents back in my day, didn't offer support to help their daughters for a few years, helping them to get their education and prepare them instead of the adoption option that carries many regrets as well as abortion, although illegal at that time.
Medical issues are no different.
belinda
"While men and women are equal they are not the same. If men choose not to speak up, what does that say?"
Well, for one thing, it says that you are fond of making assumptions. How do you know that men do not speak up? As it happens, some of us do. But, when we do, we get little support from society, or even from family and friends.
Most of the time, a woman doesn't even have to complain. Someone will jump in and protect her modesty, even if she was unwilling to do so herself.
For a man, even if he does complain, he's called a whiner. If he adamantly complains, he's called belligerent.
You give women far too much credit, and men far too little. The fact is, the medical community is far more responsive to a complaint from a woman, because they know it will be taken seriously. So much so that they seek to avoid any such complaints in the first place. For men, it's just the opposite.
To blame all men for their mistreatment, or to credit all women for their favored treatment, is simply wrong. The medical community was predisposed to react differently to each before ever a complaint was filed.
Here is a perfect example of the double standard;
The Medical Process for Candidates Applying for Entry into the Australian Defence Force (PDF document).
It starts out:
Why is a Medical Examination required?
Medical standards in the ADF need to be of the highest level to allow the successful completion of all military duties. These are often performed in isolated and stressful circumstances where there is no ready access to medical care.
The medical process will assess your suitability to perform military specific duties, and your ability to adapt to different living conditions. The medical process aims to ensure that you do not have a pre-existing medical condition requiring uninterrupted access to medication, medical care or special diets.
OK, fair enough. Here are the other section headings...
What are the processes of the Medical screening?
Your Opportunities Unlimited (YOU) Session
What is involved in the Preliminary Examinations?
What is involved in the Medical Examination?
Now it gets good....
...During this examination you will be required to undress down to your underwear (both males and females will be provided with a gown to wear, if requested)...
--Looking and feeling for any abnormalities around the abdomen and anal regions. A rectal examination is not performed. Males will have the external genitals examined for abnormalities.
--Gynaecological examination will not be performed on females. If the Doctor deems a gynaecological examination necessary to determine your fitness you will be referred back to your own Doctor.
--Females are not required to have their breasts examined. If there is a problem identified in the medical history questionnaire, you will be referred to your own Doctor for further follow up.
Why do males need their external genitals examined for abnormalities Are they that important to the defense of Australia?
I have to assume from this that the country of Australia expects that if you don't have a weapon and you are under attack that you will have to pull out your penis and stab the enemy...
--Banterings
In response to Banterings last question
"Why do males need their external genitals examined for abnormalities." The appropriate answer would be to check for inguinal hernias, present and perhaps as yet undetected by the potential male soldier. With the abdominal straining associated with physical exercise and other activities, a frank asymptomatic hernia becoming symptomatic would be a major handicap in training and not uncommon. Better, discover it early. Other than that I can't see a reason. Checking for a testicular cancer in this group of younger men would be appropriate but provide only a rare positive finding. ..Maurice.
"USPSTF Testicular Cancer recommendation: Do not screen. Grade D. There is inadequate evidence that screening asymptomatic patients by means of self-examination or clinician examination has greater yield or accuracy for detecting testicular cancer at more curable stages. Management of testicular cancer consists of orchiectomy and may include other surgery, radiation therapy, or chemotherapy, depending on stage and tumor type. Regardless of disease stage, over 90% of all newly diagnosed cases of testicular cancer will be cured. Screening by self-examination or clinician examination is unlikely to offer meaningful health benefits, given the very low incidence and high cure rate of even advanced testicular cancer. Potential harms include false-positive results, anxiety, and harms from diagnostic tests or procedures.
And the USPSTF makes no recommendation for hernia or pubertal development and other disorders. How many must be screened and at what cost to identify these relatively rare disorders. It's sort of like PSA testing for prostate cancer, something like 700 plus to save one life to say nothing about those treated for cancer, the side effects, while the vast majority likely wouldn't have died from the cancer anyway. It's one thing to actually discuss the risks with the patient and then let them make an informed decision but you know that's not happening. Lifetime hernia risk for males of one to five percent seems pretty low odds to require annual genital exams. These exams should be "offered" after discussing the associated risk factors unique to each patient while clearly be given the opportunity to decline; you know that pesky informed consent requirement. If they elect the exam, I would have no problem with them as long as they were conducted privately without a chaperon unless the patient requested one, and then only if the chaperon was the gender the patient was comfortable with. Instead, we're told to drop our shorts and and deal with it!
Ed
I have followed this blog for a number of years but only began commenting recently. Instead of straying from the main topic, in this case "Speak To",can we address this topic? Who exactly do we speak to?
I have tried speaking to my doctors both in letter form and in person but little change has taken place. There is still no posted information on Medical Chaperones in the office, patient ambush is still commonplace and there has been no noticeable improvement in balanced staffing in the office or the Operating Room. In short, the problem seems to be getting worse as clinics try to force more volume through the office funnel.
The general policy seems to be "Don't tell, don't ask" as in don't tell the patient what is about to happen and certainly don't ask permission. Implied consent is still the norm.
Is it time to go to the media for attention and possibly take advantage of the Dr. Ozs and Phil types out there? This might be the shortest distance between two points.
Ed T
Ed,
You ask, "Who exactly do we speak to?"
The answer I found in this The Fiduciary Obligation of Physicians to “Just Say No” if an “Informed” Patient Demands Services that Are Not Medically Indicated. On the 9th page it states:
...“Patients began to voice the ethical proposition, founded on the autonomy principle, that they, rather than the doctors, should have the ultimate authority to decide the course of their medical treatment.” In an attempt to secure this newfound “ultimate authority,” patients turned to the American court system.
It seems that this is the only way to make changes to the healthcare industrial complex.
I also have one other suggestion; There are some physicians who feel that patients have an obligation to participate in training the next generation of physicians.
Note: I totally disagree with this notion. Ethically it is the current members of the (any) profession that have certain obligations to their profession. These ethical obligations create the "professionalism" of the chosen "trade." Some of these ethical obligations include continuing education, self policing, advancing the profession, honesty, mentoring (training) new members, etc.
I would argue that the ethics of the (any) profession require that all physicians act as training subjects BEFORE the real patients.
If healthcare holds the position that patients ARE obligated to teach, then patients need to take their seat at the table. Patients need to help develop the protocols, need to be part of the grading, etc.
I have seen some hospital consent forms that say this, so hold them to it. Of course patients may again have to turn to the American court system.
--Banterings
BTW, If anyone knows rsl who posts on here, please ask him to contact me (my email address here: Thanx!
Belinda,
Some of the comments you made on Monday were confusing and I was wondering if you could please clarify some of the points you made.
"They also don't say what society would do with all the children both healthy and genetically damaged after they are born. Forcing a rape victim to carry a baby is abusive. Someday, if these laws do change, one woman who was raped will have the inclination to jump off a building, killing both of them. Then, will society be happy?"
Do you mean that you believe that rape victims should be able to abort their baby without restrictions?
"I know I've strayed off the point a bit, but the bottom line is that we all have a right to decide how and what we want to do with our bodies. I am not a supporter of abortion and often wondered how parents back in my day, didn't offer support to help their daughters for a few years, helping them to get their education and prepare them instead of the adoption option that carries many regrets as well as abortion, although illegal at that time."
This part is confusing because you said that you were not a supporter of abortion. Do you mean that you would not consider having abortion yourself even if you were raped or had a baby who had a severe disability? Don’t you support a woman’s right to have an abortion? It seems to be in conflict with your statement: “I am not a supporter of abortion”. I am curious. Why do you think adoption carries many regrets as abortion? What is your opinion of unborn babies’ rights to live? What is your opinion on euthansia?
Anonymous reader
Belinda, my point was the argument about the difference in how the different treatment males get compared to females is relevant. It is relevant because society treats women with more respect in this arena and if they were forced to treat them the same there would be improvement. Is this really different than how civil rights for African Americans or equal rights for women were addressed. Demanding all be treated the same to elevate treatment for all?
You missed the point Dr. Bernstien. why would your logic not be equally applicable for pelvic or breast exams for females entering the service. Wouldn't those screenings also protect females entering the military as the genitalia exams for males? ...don
Don, I have no idea the rationality of these regional physical exams except what I already stated in terms of interference with armed force training program.
Also, I don't understand why a documented physical exam could not be performed by the patient's own private physician but paid for by the government. By the way, the urologist who wrote his comment here a while back has taken on the duty of performing induction physical exams on candidates at a military exam center. I will check with him and find out what really constitutes a military exam and the explanation of what is done for male vs female candidates. And whether he is observing "gang stripping". ..Maurice.
Anonymous, My statements were clear.
If you are confused, I would suggest you do some reading about the emotional devastation that rape causes and what a forced pregnancy could do to the fragile psyche of a victim.
Secondly, I would recommend you do some reading about genetic diseases that have catestrophic outcomes that cannot be diagnosed until the 20th week of pregnancy.
This is a personal decision that thankfully I have not had to make, therefore cannot comment on what I would do.
Abortion is a permanent decision and one that needs to be thought about carefully. So does giving your baby up for adoption.
If birth control were no longer an option, what happens to women who have autoimmune diseases with clotting issues that could cause stroke or death if they got pregnant? They would be relegated to a life of celebacy to protect their health. Additionally, these patients cannot take "the pill" and must depend upon an IUD, condoms etc.
I support a women's right to choose and birth control.
Every situation is different and should be a decision between a woman and their family and doctor.
I had a family member give birth to a baby born without a brain fifty years ago. There was no technoloy at the time to determine this defect. The baby could not live and was still born. I was very young but remember my mother, who was an RN, talking about how the baby's brain stopped right above the eyes.
This is a terrible story and for those of you who know me on this blog, know that it's bad enough that it happened, that I don't need to make it up because these birth defects can and do exist.
Now I ask you, Anonymous, how could you support the pain and suffering for all under circumstances like this?
belinda
Don, I never said your points weren't valid. I have supported rights for all. I don't support taking away benefit from one group as an action plan to fix the other group.
When you are the patient, regardless of your gender, you deserve the same rights as everyone.
belinda
Ah but Belinda, I did not mean reducing the considerations afforded women to even it out. When institutions were forced to treat people the same regardless of race or gender, the inequity was resolved by elevating the treatment of those discriminated against, not by lowering what was provided the majority. That is the way things work, taking something away from someone who has become accustomed to it is much harder. So the intent of demanding equal treatment is not to reduce or deny those that have it, it is to provide for those who do not. Men did not lose rights during the sufferage movement...women gained them.
Consider this, recently the requirement for the physical abilities, in particular push ups and pull ups was modified to allow a greater number of females to pass hurdles for advancement in the military, particularly to qualify for combat. Yet if the exam for male induction to the military is to detect something that would compromise performance. It would appear the dynamics of what drives this is more than just physical. I remember taking my kids to a water park, we changed to go home and my daughters talking about how gross the changing stalls were...changing stalls? We guys had one big open room to change. I would imagine this double standard still plays into something as important as military induction physicals though likely cloaked in other rationale. Would not a bladder prolapse or weakness of structure that supports the bladder and appears to be a problem is some women also not be a concern? ....don
This time, I am deviating a it from the "theme du jour" to comment o something that I've found deeply disturbing. The actress Joan Rivers (of the Fashion Police) died recently, and it turned
out that while she was anesthetized,her doctor took an unauthorized selfie with
her seconds before she went into the cardiac arrest that killed her!!!!
Firefighters attempted to deal with the whole thing, to no avail. A question to Dr. Berstein. She was 81, isn't it dangerous for a person that old to be put under? Isn't that beyond unethical? And I thought fame and money could keep you safe...
http://www.jpost.com/Not-Just-News/Report-Doctor-took-selfie-with-Joan-Rivers-during-procedure-before-her-death-375603
There's a lot that's wrong there: unauthorized biopsy, unauthorized selfie... I initially learned about the whole thing in the Daily Mail (UK). Read the comments, and the Britons seemed to think it was all highly unprofessional!
Well, Majo, in a way what you wrote does fit the theme du jour" in that the ethical issue is about "speaking to.." Joan Rivers apparently had no opportunity to speak to her physician providing permission to the taking a "selfie". The performing a biopsy of the vocal cords when considered clinically essential in an elderly patient where allowing the patient to come out of anesthesia to get informed and give permission and then re-anesthetized may pose a greater risk to the patient. So it depends on what was found (eg. ?cancer), how it may have contributed to the patient's original symptoms leading to the endoscopy, the expected risks of the procedure and the risks, alternately, of re-anesthetizing the patient. Thus the ENT doctor might have a reasonable explanation. But the "selfie" without permission fits what has been described repeatedly over the years on this thread regarding violation of patient modesty. ..Maurice.
Banterings... Good link, very informative. It also struck me that from a legal standpoint, chaperones are in the room to protect the doctors but may in fact make the doctor more liable by traumatizing the patient. Certainly food for thought.
The key elements that i gleaned from the paper are Medical Paternalism, Patient Autonomy and Shared Responsibility. Although this was treated as an evolutionary account, in practice Medical Paternalism seems to still dominate in terms of patient modesty needs. Shared Responsibility would indicate the need for "Informed Consent" which just isn't happening in the office or anywhere else.
Again, the paper referenced was excellent but I did note that it was written in 2009 and here we are 5 years later in the same boat. This additional information will make that boat easier to rock. Thanks again.
Ed T
Just a question of identification: is Ed and Ed T the same visitor? Thanks for any clarification. ..Maurice.
Unless I'm an undiagnosed schizophrenic no!
Ed
Ed, I presume you are referring the schizophrenic diagnosis to yourself and not Ed T. ..Maurice.
Dr, Bernstein, ED T is indeed a different person. Thanks.
ED T
Ed T, Thank you.
I ask everybody to bear with the following cynicism of mine...
In response to Ed T on chaperones and Misty on pap smears:
There is one purpose and one purpose only: to gain and maintain total control over you.
I am not going to comment on the intent. It may be to keep the patient alive and healthy, it may be to keep the patient a repeat customer, it may be some self serving narcissistic purpose, or it may be a combination.
I just did a post on my blog examining domestic violence and abuse (link here).
One may ask why somebody would stay with a partner who beats the. I applied this to the doctor-patient relationship where abuse, under the guise of healthcare, would be extremely difficult to detect. This may also explain why patients fail to speak up to their physician if they feel they are being abused (either real or perceived).
If patients don't speak up, and return, the physician may assume that all is fine.
Getting to my point, if U.S. healthcare was truly putting the patient first, they would offer women self administered pap smear tests like they do in Europe. Note: This article is from 2000!!!
Chaperones would also be tasked with building trust with the patient, not just being called in to the room. Patients would be encouraged to bring their own chaperone whom they may feel MORE comfortable with.
I have never seen any recommendation that chaperones also build a trusting relationship with the patient, anywhere!!! Correct me if I am wrong, I would love to see something on this.
Then physicians wonder why patients refuse chaperones even if the physician has a good relationship with the patient.
Even more disturbing is the fact that physician groups encourage physicians to build a trusting relationship with their patients, but yet call in the nearest, most convenient stranger for the most delicate and intimate parts of the exam.
Things like this that seem so obvious only reinforce the belief in the self serving double standard that exists in healthcare.
Couple this with things such as 33% of providers requiring annual pelvic exams for birth control prescriptions when it says right on the packaging none are required. How does one justify these behaviors as something other than perverse?
The good providers are tainted by the bad because the system allows the bad to "hide" in it virtually undetected.
--Banterings
I hope so!
Ed
Don, thanks for clarifying.
Belinda
Yes, fittingly, the whole thing
(in the Joan Rivers death case) was found out because an employee spoke
out and uncovered the mess.
Even worse, the doctor was unlicensed to work in the facility at all. And no, there was no authorization for the biopsy, exactly because at her age, it might endanger her life, which is what happened.
However, what's really disturbing is the time spent taking the selfie could really have been put to better use in trying and save her life. Not to mention how many violations go undetected because nobody dares to name unethical colleagues?
Many of us know that it is very rare to hear of men being abused by female doctors and nurses. I believe it is mainly because many men do not feel that they would be taken seriously if they reported the abuse.
I wanted to share an article,
”Senior citizen complains about nurse sex” about a gentleman who was in the hospital, awaiting a heart transplant, needing to "take it easy", and 33-year-old nurse comes in and forces herself on him.
The nurse was fired, and the hospital is being sued for $200,000. According to his suit, the hospital knew that this nurse had a tendency to do this with patients - and took no action to stop it.
I find this sentence interesting:
There are apparently a long line of patients, according to testimony, who’ve been schtupped by Shaper, but only Cantone has been the man brave enough to speak up about it.
This confirms what many of us know. Many patients especially men feel intimidated by the medical industry to not report abuse they experience.
PT: If you are still around, can you please comment on this case?
Misty
I am probably going to "get a lot of flack" for this, but I question the validity of the sexual assault.
I do not condone assault or battery (sexual or not) in any form, abuse of power, or infraction's of one's human dignity. One of the things that I do for a living is forensic investigations. I have looked at people, events, documents, even management and leadership in my investigations. I look for inconsistencies, and I see many in this case.
My biggest issue with patient modesty (patient dignity) is consent and the entitlement to a patient's body healthcare assumes.
Note: I am not blaming the victim. I am questioning the accuracy of the alleged events.
First, the article is sensationalizing this case. The title is "Senior citizen complains about nurse sex."
This is what I think of when I hear "senior citizen." This is John Cantone, in his Corvette. Source: John Cantone's Facebook page. Again, even a "play'a" can be a victim.
Next; " Cantone was in the care of the registered nurse in the cardiac intensive care unit of the hospital, located in West Chicago, awaiting a heart transplant at the time of the alleged abuse, according to The Smoking Gun.
Cantone was reportedly medicated with ‘various drugs and was under electronic monitoring’ at the time. " Source:
One of the leading causes of erectile dysfunction are heart problems and medications for other chronic conditions. It did not say if he was able to perform or not, but I have do assume that he did. "John Cantone says that Rachel Shaper had sexual intercourse with him while he lay in 'compromised health' in her care." Source:
How could he if he had a bad heart and was on meds? He is also not suing for rape. He is suing because she initiated unwanted sexual advances. After that, he consented to the act of intercourse.
" The complaint states that as a result of Shaper’s sexual battery, Cantone ‘suffered injury and damages of a personal and pecuniary nature.’
Cantone’s wife, Laura, a co-plaintiff in the lawsuit reiterated that the nurse’s conduct caused ‘damage to the marital relationship including damage to the society, companionship, and sexual relationship with her husband.’ "Source:
This says that because he consented to cheat (as a result of the unwanted advances), it damaged the relationship he had with his wife.
Copy of the lawsuit here:
I am not giving the nurse a free pass here, but there seems to be too many inconsistencies in this case.
--Banterings
I started fainting about 6 months ago. It became more and more frequent so I went to see my regular doc, doc says go to the ER. The ER is busy this day, all the exams rooms are full, so they have me sit on a gurney in the hallway in the ER. The ER is layed out like a large U. Nurse’s station in the center, exam rooms all along the outside of the U. Docs, nurses, techs, other patients and family members are continually walking right past me. I’m feeling fine so I don’t really mind being in the hallway. I’m there for 20 minutes or so and the ER doc finally comes over, introduces himself, asks me why I’m here and I tell him I’ve been fainting lately. Doc notices I’m still in my street clothes so he says to a nurse nearby “Why isn’t he in a gown?” Doc leaves, nurse leaves, nurse comes back and places a gown at the foot of the bed and leaves without saying a word. Holy cow, they expected me to change into a gown right there in the hallway of the ER! There was no way a woman would be required to change into a gown in the hallway. The docs and nurses don’t change from street clothes to scrubs in the hallways. So I refused to be treated any less than anyone else and I let the gown stay right where it was. I decided I would see what happened if I didn’t put on the gown. Guess what, nothing happened. I ended up getting admitted, did have to change into a gown but it was in my room with my dignity intact. I ended up being diagnosed with bradycardia and had to get a pacemaker.
Oliver
Oliver, congratulations (not for your diagnosis but your appropriate behavior). I see no other approach by a patient with mental capacity to the situation as it was described. ..Maurice.
Maurice, Would you agree that being asked to changed in public is ridiculous? I would.
What's scary to me is that if this is the mindset of medical personnel, that signifies a greater problem. And, it's not difficult to imagine how privacy infractions can be traumatic to patients when personnel behaviors are ridiculous especially when there is no medical need, and no respect.
Those are the things that have many of us upset on this blog.
If this behavior occurs, why is it a stretch to realize that these kinds of infractions happen all the time?
Are we outliers, or is the system is so broken that what appears to be outliers are just regular folks who are fed up with being treated in such poor fashion and that what you are seeing is the reaction to poor behavior, at best.
belinda
Being asked as a patient to change to a gown in public is more than ridiculous, it is professionally wrong. Think of this: Federal HIPAA regulations prevent the patient's medical history from being displayed in public. Certainly, if that is the law, one would assume that society must also agree that exposure of the patient's physical body in presence of the public would also be prevented. If there is no law like HIPAA then it becomes the responsibility of the patient to refuse. ..Maurice.
My most recent blog post (here) deals with abuse by physicians and providers. It compares these abuses to domestic abuse. My post also references a National Institute of Health article. The following two excerpts are from that article:
"...use of harmful medical interventions to outright verbal, physical, and even sexual assault. Furthermore, the more extreme examples are not aberrations but merely the far end of the spectrum. Abuse, moreover, results from factors inherent to the system, which increases the difficulties of implementing reforms."
"During residency, doctors trained in authoritarian systems are likely to internalize as normative a model of interaction with underlings and patients that desensitizes them to problem behaviors if not converts them into outright abusers themselves."
It also examines factors that allow this to occur. I think that there is insight to be gained here.
Banterings, in case I missed it, there is no mention of using humiliation as a tool to punish and make patients submissive. Do you have any info on that subject?
Thanks .
Belinda
I never ever confronted medical personnel and wish I did. Al least
you're in a situation in which they
might be fired or seek justice on other ways. It's also unfathomable being asked to change in public.
You still can . It's not too late. I work with patients for advocacy support and would be happy to assist at no charge. If interested, please contact Dr. B for my e mail.
Belinda
Ed not sure if I read the same post you referenced, but I found the one I read for several reasons, it was written by a clinical RN, a female RN working at a "busy prostate clinic". Employing a female, to talk to males about their choices and side effects of prostate cancer treatment. Now that makes all the sense in the world, and before we go down the "well would you rather have good advice or same gender" road, lets just assume for the sake of argument there might be somewhere on this planet an equally qualified male with the same knowledge and ability. This is such an emotional, embarrassing and truamatic experience for men, the choice of a female to discuss this with to me really goes to the point that the provider, not the patient is the focus of the medical community. Would anyone really expect to find a male counselor discussing mastecomies in a breast clinic. Would we not expect the argument that women can identify better with what these women are going through?
The conversation is controlled by the provider so naturally her take is most men don't shut down with me as a woman so it must be OK. What more can you say, employing a woman to discuss erectile dysfunction, urinary incontinence, dry orgasims, with men....why would that be an issue....like these guys have a choice, catch them at their most vulnerable moment when they are over whelmed and just assume since you are a professional they are fine..don
Don, completely agree! Make those comments on KevinMD because the majority of the readers there are actually healthcare "professionals."
Ed
Don, I have been seeing the same male Urologist for years normally for routine matters, either before or after passing a kidney stone. Recently had one get stuck requiring urteroscopy, laser and removal. Requested an all male surgical team but of course that didn't happen. It was when I was scheduled back into his office for a stent removal a few days later that I finally noticed that his entire staff was female. Can you guess who was scheduled to remove the stent?
I ended up doing it myself at home, thankfully with no ill effects. Why would a male Urologist who deals mainly with males not have any on his staff? It makes no staff but when questioned about it, he thought that it was not unusual.
Ed T
Ed
I could not find the right site to comment on Kevin, I googled it but will go back and try to use your link
My urologist is male as well and has an all female staff. I have related here before how I had to have a scrotal ultra sound and requested they schedule me with the male tech on staff at the hospital. They looked at me like I wanted to have it done on Mars but complied. Not sure how I will react to something like you had. I would hope I would discuss it and seek help other places if not satisfied with the answer but not sure until it happens. One of my employees had complications with his kidney stone removal, had to have some sort of drain left in place. When it came time to have it removed like you a two female nurses did it, one simply held his penis while the other "yanked" it out. He said they lead him back, told him to remove everything waist down while they stood there then did it. Doubt that would happen to a female, but then doubt they would allow it so both parties culpable.
What did they say when you left and did not let them do it? don
I am sorry to say this, but this is as obvious as the problem with a urologist that deals with men having an all female staff: The number of malpractice lawsuits against physicians should be no surprise.
If they can not figure some as simple as this out, what else are they missing?
How could someone so smart be so dumb?
I think that providers with complaints of inappropriate behavior filed against them, instead of taking some ethics or other course, should have to participate as a training subject for medical students.
This would solve the problem. No one can disagree with that.
Don, if you haven't already commented go the article, click on reply to whichever comment you want to respond to, and then establish log on credentials with Disqus by simply providing an email and password. To be clear, I don't have prostate cancer but I can't imagine a newly diagnosed patient is expected to share such intimate details of their lives with a female nurse, PhD or not. I've had negative experiences with female staff at a urologists office so I freely admit I'm sensitive to the issue.
Ed
I did reply Ed, thanks. I was referring to comments about removing the stints for kidney stones but I see that was Ed T. I would be interested in what the reaction was to refusing care and pulling the stintsyourself. Can't imagine how that felt pulling the stints or how it felt walking out.
I didn't need to walk out, I called to verify the appointment and asked if the doctor would be doing the procedure. I was told no, one of his "assistants" would handle it. Since all of his assistants are female, I decided to handle it myself. After reading up on several techniques, I picked one that fit my degree of bravery and proceeded. It went well and was much more humane than your "two nurses" method sounded.
His office was shocked when I called, cancelled the appointment and told them that I did it myself. I sent the doctor a letter later explaining the whole scenario. Not sure if he got it but at least I tried to explain things to him including that silence doesn't always mean consent.
It was well worth not facing the alternative.
Ed T
Ed T,
I'm pleased that you took matters ibto your own hands but it might have been better for you to go to your primary care doctor, explain tge situation. If that didn't work, I would have done what you did. It would have pointed out to all concerned how important your privacy meant, an opportunity to advise another office of the problem. And... Hopefully, there won't be any complications. Good job!
Belinda
Belinda,
I did consider contacting my GP but would have had to explain the situation to the receptionist first. She would have set me up with the PA who is also a female as the doctor usually requires scheduling well in advance. I just didn't feel like wading through all of that embarrassing discourse. I was also physically very uncomfortable at the time and just wanted to get the job done. It is unfortunate that this scenario is very common and a barrier when it comes to any male seeking a little dignity regarding intimate care. Intellectually, it should be a simple concept for any doctor or clinic to grasp but in practice it is evidently not so simple.
Ed T
Here is a question for the group, are there any big groups that are fighting for patient dignity (like the aclu, amnesty international, etc.) that you are aware of?
--banterings
Banterings, to my knowledge no but I've always thought the right case would be great for the ACLU. That said, I'm not sure they would even accept one considering the gynocentric society we live in.
Ed
Banterings, I don't think any big groups would be interested until the topic gains a higher profile in the media.
As a test, I have submitted the topic via the web to a number of medical talk shows this morning. I don't know how often they really look at suggestions but they do solicit them on their websites. Maybe if more of us did this, their curiosity might be engaged. In any event, it couldn't hurt.
I will report back if I get any responses.
Ed T
belinda, there is information about humiliation, but far and few between. i am gathering it up and creating a post about it on my blog complete with references. i will post a ling here when completed.
Another allnurses post about male modesty and the double standard and of course all the female nurses defend it!
http://allnurses.com/nurse-colleague-patient/male-modesty-double-947659.html
Ed
Maurice et al,
I read Ed's link to allnurses. It made me ill. I had to comment:
It seems first of all that everyone acknowledges the double standard between male and female but just brush it off. sure it is no big deal, but then again you are the one wearing clothes.
I also want to pose this theory:
Do you believe the "mistreatment" of patients in regards to modesty (and other issues), may be a contributing factor in depression, burnout, suicide, etc. that physicians (and all providers) suffer, because subconsciously they know that this treatment is undignified, mentally/emotionally harmful (to the patient), morally and ethically wrong, and when they try to justify it as "saving a life," conducted professionally, the way I was taught, etc. it (subconsciously creates a conflict that can not be resolved?
This is only a theory, but "unresolved conflict" has been the basis of many psycho-pathologies.
There are similar mental/emotional traumas experienced by people who find out their assumptions about their whole life was false. Think children who were abducted as babies and raised (lovingly) by their abductors as their own.
I personally know a person who's mother was only 14 when she gave birth, so the paternal grandmother raised her "granddaughter" as her "daughter."
Even though she was wanted, loved, and raised in a family, later on when she found out the truth, she had conflict (with abandonment issues) that she had to go to therapy for.
She functions "normally" now (or as close to it as she can get), I still see the emotional scars.
The way this applies to providers is "what if you discovered that everything you were taught about patient exposure, dignity, gender choice, etc. was WRONG???"
Note: Perhaps I should say what you were taught was correct, what you practice is incorrect, OR what you were NOT taught....
One of the issues that the perpetrators of domestic violence (the batterers) deal with in therapy is the unresolved conflict of knowing "in the back of their mind" that beating someone that you love is wrong, but having been taught (or justified) that it is acceptable.
Despite it seeming so obvious, many perpetrators do not know that it is wrong, but it does not "feel right." See my blog post about domestic violence here:
Any thoughts?
--Banterings
You know, maybe if differences in gender at a cellular level are investigated as the following description of a "White Paper" suggests, it might be carried through to clinical applications which include better equality of care and attention to modesty for both men and women. ..Maurice.
Preclinical Medical Studies Get “Blueprint for Change” from Leading Women’s Health Organization
Biological Sex Essential for Study in Basic Research Funded by the NIH
Washington, DC – The Society for Women’s Health Research (SWHR®), the nation’s leading voice on the study of biological differences between women and men, has released a white paper about the new National Institutes of Health (NIH) policies requiring investigators to address sex and gender issues in the design and conduct of NIH-funded preclinical studies. For nearly 25 years, SWHR has been advocating for research on sex differences in preclinical and clinical research. Download the SWHR white paper at SWHR.org.
The white paper, written by SWHR Vice President of Scientific Affairs Dr. Christine Carter and Jessica Backus, is intended to advise the NIH on the development of new policies, training and initiatives related to accounting for the sex of cells and animals in basic research. It covers the history of the study of sex differences, SWHR’s recommendations for NIH-funded preclinical research, and examples of studies that emphasize the importance of sex differences. In addition, the white paper includes a recommended mock-up of the requirements the NIH should apply to researchers who seek funding.
“For too long, women’s health has not been given the priority it deserves in the health care community. The Society for Women’s Health Research believes that analysis of biological sex differences should become the norm in medical research that examines diseases and conditions affecting both men and women,” said SWHR President and CEO Phyllis Greenberger. “This white paper offers a blueprint for change for NIH-funded preclinical studies. SWHR will remain vigilant in ensuring that sex differences are appropriately prioritized in medical research.”
“It seems like common sense but we need to acknowledge this simple truth: Sex is the most basic variable in human biology and medical research needs to begin with that simple distinction. Including sex in basic research on cells and animals will lead to new discoveries, safe and cost-effective medications, and better treatments for women,” said Dr. Carter. “The proposals outlined in SWHR’s white paper can guide the NIH as they work on their new preclinical research policies. By studying sex differences at the basic level, we can ultimately improve the health of all Americans.”
For more about research into biological sex differences and women’s health, visit www.SWHR.org.
I quit reading that tripe on all nurses when I hit page 2 and read
"Male patients that are involved in trauma tend to have a higher incidence of violence against the staff AND a danger that whatever caused the conflict that the person who shot them comes to finish it off in the ED. Curtains are left open most of the time to ensure the patients and staff safety."
That's a nurse openly admitting they deliberately expose male patients for the world and anyone walking past to see for no other reason than they're male and that they can.
Jason
Read on Jason and and provide your usual insightful comments. While I appreciate and enjoy the sarcasm you occasionally utilize, refrain from using it there or they'll shut you or the thread down in a heartbeat.
Ed
Maurice, I haven't read the study yet but wondering if it goes into the different psyches of men and women thereby having different sensibilities and interpret humiliation and modesty differently due to different levels of male and female hormones.
Belinda
Kinda disappointed in the lack of comments from the regular posters here on the allnurses post; don't have to be nurse to comment! I'll never willingly go to the ER based upon the accepted standard of care they practice.
Ed
Ed, is it just me or does there seem to be a hatred of men there?
Let me quote from the allnurses thread:
Women have had no choices in their healthcare for many years as women were NOT admitted to medical schools and still face discrimination in medical schools from the "good ole boys" club. We are accustomed to being given little to no choice...because we are women. Women are constantly minimized and marginalized because we are woman and therefor any "vague" complaint is discarded because we are...women.
it gets better....
In the United States, men are much more likely to be incarcerated than women. Nearly 9 times as many men (5,037,000) as women (581,000) had ever at one time been incarcerated in a State or Federal prison at year end 2001.
Murder and Gender In 2011, the United States Department of Justice compiled homicide statistics in the United States between 1980 and 2008. That study showed the following:
Offenders
Males committed the vast majority of homicides in the United States at that time, representing 90% of the total number of offenders.
Young adult black males had the highest homicide offending rate compared to offenders in other racial and sex categories.
White females of all ages had the lowest offending rates of any racial or age groups.
The overall offending rates for both males and females have declined since 1990.
Of children under age 5 killed by a parent, the rate for biological fathers was slightly higher than for biological mothers.
However, of children under 5 killed by someone other than their parent, 80% were killed by males.
and the best:
One poster dispensing medical advice and the moderator not calling it out....
I urge you to seek professional help. Obviously you are coping with some self perceived trauma related to female nurses and sexuality. By the massive amount of time and research you have put into this, I imagine this obsession interferes with other aspects of your personal and work life. This is not healthy. Seek out a male counselor, PCP, or psychiatrist, please. I think you would be a happier person if this obsession wasn't consuming you.
Throw in to the mix constant contradictions. Perhaps there is an agenda on allnurses.....
Banterings, completely agree! We live in a society where racial profiling is illegal and reprehensible but gender profiling in the ER is completely acceptable. Every male patient is treated as potentially violent and therefore it's okay to sacrifice our dignity and privacy so the staff and the rest of the entourage can keep an eye on us; that attitude is sickening. If the public only knew. I've already contacted my attorney to update my advance directive to spell out clearly what ER staff can and cannot do. That's our only recourse unless someone has a better idea. You need to log a TOS protest for what it's worth. The paternalistic attitude that their gods and we're some lower life form is far from dead.
Ed
It was an intersting thread and to be honest I am surprised they have not shut it down yet. Some take aways, from the provider side, as they pointed out there are many things going on that some, in the post a EMT in training, do not know that affect what is going on and why. I learned that from artiger as well. Sometimes when you get their side of it, especially the why looks a little different. Thoughts of malice, don't care, self serving become a little blurred with self protection, following policy and protocol, to safety. Now, not saying it justifys or makes things right, but it does make things a little easier to understand.
One thing I noticed is a common tendency of female nurses to bring history into the discussion. The fact that women historically were discriminated against was brought into the present numerous times. While I would argue what happened to women in previous generations does not have anything to do with how you treat men today,,,we are a product of our environment, and if the women in these nurses families faced that discrimination and shared their experience and resentment, one could assume it would have some influence on how these female nurses feel and deal with things. You could sense the hostility and resentment in some of their responses when there was any hint of pointing out the double standard and discrimination toward men. It was a mix of women have dealt with it for ever, there is no double standard, and ultimately it is justified.
I found that paticularly troubling as it shows the depth of denial in recognizing the issue much less addressing it. One nurse whom was really one of the more rational flat out said the policy when the patient was a suspect in a crime, DUI, etc was female they called for a female officer, when the patient a suspect and male they got whoever and stated, it is what it is. She at least admitted there was a double standard but indicated it was justified. Not sure if she was the same who said curtains were left open when the patient was male or not for protection of the staff but that was indicated as well. They used the stat that most assualts are committed by males. When I stated that society had determined profiling was not acceptable for any reason including middle easterners on planes and extra scrutiny of Black Males inspite of statistics indicating a disporportiante number of offenses, it went right by unrecognized. When i further pointed out it safety was truely the issue, a male whom was physically stornger would be a better choice for both genders to restrain patients and protect staff.....to be continued...don
It was pretty obvious there is a lot of resentment toward the way women have historically been treated and applying it today, The double standard and the history of women being held out of beind MD's in the past was a real issue, but the double standard against men in this case was justified and when asked about the lack of divesity in nursing for males it was largely dismissed or ignored. Pretty obvious there is a feeling of persecution and lack of respect in the field of nursing in general. That feeling toward men is even larger. Don't take me wrong, I don't think they are men haters or intentionally mistreat men. i do think the psyhic is very defensive and antil malewhen it comes tor things like double standards and male modesty. When confronted with things that went against their point it was avoided. When challenged with OK I get the need for a police officer for safety, but why is the policy a female patient/suspect gets a female officer but a male patient/suspect gets whoever including female officers not a double standard and wrong? they went off to it is for the safety of the staff, when challenged well then why would not a male due to strength be a better choice, it was ignored. They used the gender dispairity of nurses to justify not accomodating males but ignored that the dispairity in police was just as lopsided but they still accomodated females, the crickets chirping was the response.
Another thing that struck me was how they threw the we are professionals out there and expanded it to cover police. Lets see, when it comes to not respecting male modesty all medical staff including17 year old CNA's are respectable, as are police from the town cop up, and of course reporters, camera people, etc in locker rooms who don't even have to have an education. All and all I found it a little disturbing, there was no attempt at all to recognize that applying a double standard to males was just as wrong as applying it to women. However I do not feel it was a concious effort to pay back males for the past, nor was it uncaring. Does not make it right but don't think it was malicous....don
don,
I agree with you. I did find one point interesting, the one nurse use to be in law enforcement and left to take nursing as a second career.
Law enforcement is generally a good job with automatic raises, excellent benefits, and a pension (as opposed to nursing). There are 3 reasons (generally) that someone leaves law enforcement:
They become seriously injured (gunshot, MVA), they get disability and a settlement and retire. I guess killed or suicide fall into this category too.
They become fully vested in their pension and leave before getting killed and not be able to enjoy their pension. They usually go into some form of security work/private investigation, because with their experience and connections they command a very high salary.
Then there is option #3. They get caught doing something VERY wrong. Normally the unions can even keep someone like Mark Fuhrman on the force. You have to do something like the cop who shot the unarmed guy for not wearing a seatbelt. Trafficking drugs or corruption (taking bribes). Then...
Warning, you may find the following police dash cam video disturbing. There is NO nudity, just the actions of the officer....
Note: The officer uses the SAME glove.
Another thing that can get someone removed from the force is being caught on camera doing something morally reprehensible like a roadside body cavity search.
I am not saying that all cops are bad and I am not saying this nurse did anything wrong, but the choice of nursing is very interesting.
Some may think that burn out, depression, substance abuse, etc. are a reason. These happen at a high rate among law enforcement, but (usually) nobody says I am burned out, depressed, etc. and quits, one of the 3 main reasons occur and they leave. Again, these are generalizations based on statistics.
Finally I also wonder if the types of personalities that are attracted to law enforcement might be attracted to nursing. Both professions have similar qualities: the power over people, the uniform, saving lives/hero, respect in society.
Just my thoughts.
--Banterings
While the basis of the thread was the double standard against males, I think there is some food for thought there in general. The double standard was obvious, at times even admitted, but was justified. The providers generally felt unappreciated, disrespected, and discriminated against as women. Could it be possible this attitude manifests itself in general in the medical community? Could it be they ignore or deny modesty in the medical setting is an issue because they feel disresepected. One poster lamented over the wrong of lack of dispairity in the past for MD's but ignored it in nursing. Could part of the issue be I don't feel sorry for you because you don't feel sorry for me or because you don't appreciate how hard it is for me as a nurse. The lack of recognition of what is obviously a double standard, and the dismissal or justification by those that did was truely amazing. We recognize these things all over, but not here among "professionals". truely puzzling...don
don,
Even worse, they all adamantly claim that they care for their patients, despite admitting that. They justify it with the montra "we are professionals" and "it happens" ( similar to the way we have always done it maybe).
It seems borderline sadistic to say "I care" then to (for lack of better words) "abuse."
Then again, there has been much talk about the culture of learning and residency (especially for physicians). Healthcare had such an abusive nature laterally, the Joint Commission came out with a code of conduct in 2009 ( I think that is the correct year).
This mainly was due to physician behavior toward the nursing staff. Looking at dysfunctional families, it is well documented that abusive behaviors are learned and passed on. That is where the saying "the abused has become the abuser" comes from.
Let me play devil's advocate here and explore this possibility: Is it possible, that although not appropriate, the abusive behavior by physicians towards nurses is a result of the nurses' attitudes and actions witnessed by the physicians?
I wonder how these nurses treat physicians? Are they treated in an abusive manner? Just as with the issue of physician suicide, physicians being "taught not to ask for help," I can see where a physician would not "report" a nurse, but deal with it themselves.
There may be some credence to this because it seems that most of the complaints of physician abuse are males directed at female nurses.
don... I can appreciate what you are saying when a hospital setting is involved but I do not see it as an excuse for the day to day practices in a doctor's office setting.
My visits to my Urologist were fairly routine until recently when I had to explore additional services and noted for the first time (shame on me) that everyone on his office staff from top to bottom (no pun intended) was female. As noted on previous posts, when comprehension finally dawned, I took matters into my own hands (pun intended).
So why, in the 21st Century, is it that difficult to have a mixed gender staff and finally accommodate female and male patient modesty preferences. This doesn't involve lengthy research or health grants from large pharmaceutical companies. It just involves common sense and caring enough to ask the patient ahead of time and to keep them informed. At the very least send out a survey that asks the real questions and provides a space for comment.
Rant concluded.Thanks for listening.
Ed T
Banterings, do not disagree. I do not always express myself clearly. It seems to me that we as humans look to pass "pain" down. If we are mistreated, we look for someone to mistreat to deal with it. I think you have something, nurses are "absued" by MD's, so they don't see the problem passing this down. I for the life of me don't have any other explaination for how a female nurse would could not see the discrimination in a female police officer is called for females, males get who ever. She stated this openly and then justified it with a really lame excuse. It is so obvious, no logic would change it, These are not stupid people, so how does this make sense. It makes sense from a evening the score basis.
Ed T I understand and agree. There is no :"silver bullet" to explain this. There was an exchange in the threat where the nurses brought up the dispairty from the past where MD's were mainly male. Yet skirted the discussion on the obvious dispairity nursing. While ultimately the answer is a universal respect for patient modesty, regardless of gender, from the personal perspective of the patient, until that happens males will fight this battle not only of logistics, but of attitude....don
Here is the "link to the American Academy of Pediatrics Policy Statement from 2011 regarding inappropriate or criminal sexual behavior toward their pediatric patients. The policy is speaking to physicians, patients and family and the medical institutions. ..Maurice.
Here are some take aways from the publication that Maurice posted (my comments in italics):
- The medical literature on the frequency
of sexual abuse of pediatric patients
by providers is sparse compared
with what is known about abuse
of adult patients. The fox watching the hen house perhaps?
Fifty-six percent of these
physicians indicated that they had
never received training in providerpatient
sexual boundaries. ...but have been taught that it is acceptable AND expected to examine the genitals of any patient.
Among the general literature about health or counseling care provider sexual misconduct with clients is a study of patients who sought psychiatric or counseling care secondary to
previous provider sexual acts. 51% of the offending providers were clergy, and 49% were health care professionals. This number is most likely low. Would you go to a clergy member for counseling if molested by clergy? How many avoid psychological counseling because it is part of healthcare? What is the first thing they do? A complete physical.
Bright Futures, which describes preventive care that is to be covered under the ACA of 2010, is a common source for guidance on age-appropriate examinations It recommends a genital examination at EVERY visit.
In these cases, normal examination practices may bemisinterpreted as assaultive. So a normal, professionally conducted exam can feel like a sexual assault?????? Very interesting.....
using nonfamily chaperones are the provider’s best protections. but feel free to abuse (or allow to feel abused) the patient
Grooming behavior includes perpetrator actions that increase the child’s trust and dependence on the perpetrator while gradually obtaining the child’s accommodation to sexual contacts Like recommending an annual exam of the genitals?
Institutions remain responsible for the future protection of patients from abuse. They should not pass problem providers along without appropriate notifications. Dr. Twana Sparks is a great ENT, despite all the genital exams she does. Is that good enough???
However,
even same-gender examinations can be misunderstood and can benefit from chaperoning. So what, use a female chaperone?
From Children's Hospital Seattle:
The patient or guardian should have the choice of the chaperone’s genderSHOULD have, does not mean you WILL have.
Medical trainees that are a part of the patient care team can be present as part of the normal care/training process. So we have a doctor, a chaperone, AND 8 medical students.
In such cases, the practitioner will make arrangements for subsequent evaluation of non-emergent issues or make an effort to transition patient care to another provider Not my problem any more if you refuse what I THINK IS BEST FOR YOU. What happened to joint decision making?
Why not try this, stop all the genital examining? Give the patient a choice, and if they chose NO, do not dismiss them as a patient, that is coercion.
If a physician does not gain the patient's trust, that is the fault of the physician. They just need to omit that part of the exam and move on. Otherwise, it may be misconstrued as predation.
Another point, you do not have be an abuse surviver or have mental or developmental issues to feel like an exam is assaultive. Physicians who hold medication hostage are guilty of assault (like pelvic exams for oral contraceptives).
Finally, nowhere does it say if the patient refuses, to just move on. It assumes a "my way or the highway" philosophy" which is paternalistic and detrimental to the care of the patient. A declination also takes the need of a chaperone and any possibility of sexual misconduct by the physician out of the equation.
--Banterings
Maurice, reading further statistics, the article says tha about87 per cent of abuse happens to adult women, perpetrated by men? I'm sure for opposite abuse to men is way under reported.
My question to you is that based on the article and the need for it, are we outliers or are we the start of a sweeping movement for the industry to clean up it's act?
Nobody who trusts medical personnel should have to suffer for the rest of their lives due to the inability and refusal to recognize that this type if treatment is abusive, does harm and thousands upon thousands of new outliers are "born" every day.
Now can you understand why we would rather refuse treatment than the possibility of abuse again. It 'a not if it will happen again, but when.
The industry should hang it 'a head in shame for creating an environment of mistrust and cruelty to people children and adults .
Belinda
This blog has discussed the issue of modesty and gender choice, some have justified it being overlooked in certain situations such as emergency, lack of gender diversity, etc. There are also situations that it is just ignored. As Maurice pointed out (when I first started posting) is the necessity of performing exams. The assumption has always been that the exams and procedures were necessary.
What about if they are not necessary?
I found this video disturbing because patients were needlessly subjected to admission, tests and procedures. "The Cost of Admission" which aired on "60 Minutes," Dec. 2, 2012. Health Management Associates HMA is the fourth largest for-profit hospital chain in the country with 2011 revenues of $5.8 billion. The hospital chain had a practice of pressuring emergency department physicians and hospital administrators to raise inpatient admission rates, regardless of medical necessity
After the story aired on 60 Minutes, the justice department began investigating HMA.
Former Health Management CEO Named in Kickback Lawsuit.
Former Health Management Associates (HMA) Executive Indicted for Obstruction-Related Offense
Community Health Systems acquiired HMA in January 2014.
I also question what has changed in the acquisition? Do they use the same software?
--Banterings
--Banterings,
Thanks to you and others for all your research and time spent informing us.
BJTNT
This post will be in 2 parts. this is part 1.
BJTNT,
One of the biggest problems that we face is the fact that (as stated on allnurses) is that providers consider themselves scientists. I reher both here and on my blog to healthcare as the "healing arts." I believe that is a more appropriate term.it is just as much and art and science.
Unfortunately people of science do not believe anything unless there has been a study done. (almost like dealing with the government. LOL)
I can see the sky is blue, but a scientist will not believe me unless there was a study done, despite the fact that we are both outside and I am pointing up.
The challenge is to find studies, however far and few between, that do show this happens.I remember Maurice telling me he could not believe people would avoid healthcare because of sheer or embarrassment.
I am sure that his mind (and others as well) changed when I referenced the study on the person refusing life saving bypass surgery due to a phobia.I just recently referenced a movement identifying PTSD in children as the result of medical procedures, and the last thing effects it has on their lives and how they view and seek healthcare as adults.
Do no harm has for reaching implications for both the seen (physical injury/illness) and unseen (psychological/emotional) according to the studies. Look at the allnurses thread and the last post. There is no rebuttle to this once presented as facts.
I have to give credit to the HMA physicians who fought the quotas and all the whistleblowers. But one has to wonder, how many physicians caved to the pressure? They cannot argue "in the patient's best interest" if there was any "coercion" in their decision making.
Should those physicians who caved in face any disciplinary actions? Will they argue this was protocol (a protocol written by accountants and not physicians)? It is too easy for them to say that all the tests and admissions were the physician "being thorough" to avoid any accusations of wrong doing.
How many will have the courage to stand up and say "I caved in" (even without any immunity from consequences)? Where does that leave the patients? Does "do no harm" apply to the finances of the patient too?
End part1
This post will be in 2 parts. this is part 2.
This blog deals with ethics, and what are the ethical implications of the admission of wrong doing? Note: There are legal AND ethical implications with some overlap.
Does a physician have an ethical obligation to admit mistakes even though legally there is a right not to self incriminate?
How about looking this issue in regards to pelvic (and other intimate) exams on anesthetized patients? Here is a physician who admits that this is how he was taught.
Again I ask, "What does he ow to his patients past and present?"
Here is the article on the ethical implications for physicians on "Beneficence vs. Nonmaleficence."
In regards to intimate exams on anesthetized patients (Beneficence vs. Nonmaleficence), the physician has gained experience (a benefit), but "do no harm" has eroded the trust in the healthcare system by patients.
Can you say that if the patient did not know explicitly that no harm was done? I argue that it does more harm because patients that were not subject to these exams (along with those who were) are left questioning if it happened to them and creates a feeling of mistrust of providers.
Going back to the question, and in the concept of justice I think that physicians should offer themselves up as standardized patients. This would be (I hate to use the term, but seems appropriate since Yom Kippur just past) "atonement" for a previously acceptable practice that was such a blatant violation of dignity that took public outrage after being exposed to end. I think the fact that this was a "hidden practice" (maybe in the fine print of consent forms) speaks to knowing it was unacceptable if not outright wrong.
It would add to the learning of both the physician and the medical student, would prove what patients are told about the acceptability of intimate exams, and work to restore the trust of patients in healthcare in "leading by example." No book or lecture can ever teach the patient's point of view to a physician, the closest that one can come to appreciating it is to become a patient.
I also have to ask why people like Dr. Edward E. Rosenbaum (his book titled, "A Taste of My Own Medicine: When the Doctor Is the Patient") are ignored? Here is one of many of healthcare's own sounding the alarm. Patients who raise these issues are told that "we are not professionals and don't understand" and are labelled outliers.
--Banterings
Re Banterings comments on intimate exams on anesthetized patients...
I personally don't think offering themselves up as standardized patients is a good enough atonement .... they're already doctors and well entrenched in their habits... It's the students that should be required to undergo this as part of their education. It's for their benefit after all. ( And I've yet to hear an argument against them doing it other than "they shouldn't have to"... but patients are expected to for some reason... it's weird...)
The doctors that did perform these exams... a good litmus test for what should happen to them would be to remove "doctor" (or "med student") title and hospital setting from the actions, and ask what the punishment should be.
Anyone care to guess what would happen to an average guy if he got a girl blacked out drunk, stripped her naked and he and his friends took turns putting their fingers in her vagina?
I somehow doubt it'd be community service....
Jason K
Jason,
I agree with that as well. Quite simply it would make them more empathetic as physicians and they would have the perspective of the patient before modesty is conditioned out of them. Besides, just as is recommended for all patients, undergoing invasive exams should be no problem when conducted professionally in a medical setting.
Peer physical examination (PPE) has been an acceptable method of training in medical and osteopathic curricula. Of course the students feel the same discomfort and embarrassment that patients do. When given the choice the student or patient as the subject of the exam, each will choose the other. Providers use this as justification to use patients as living cadavers,
Results from studies on PPE are similar to patient results: Findings suggest high levels of willingness to participate in PPE for low-sensitivity examinations of the kind employed in university teaching contexts. Nonetheless, gender effects appear more complex than previously described, and for some regions of the body, there are subtle preferences for particular examination types, in particular performing examinations, rather than being examined.
Here are some current articles regarding PPE. Note Australia is revisiting PPE.
Peer physical examination: time to revisit?
Evaluation of the acceptability of Peer Physical Examination (PPE) in medical and osteopathic students: a cross sectional survey
I feel that this should be a requirement for all medical students and they should get credit for it. It could only make them more empathetic and better physicians. Unfortunately there is an acceptable double standard to exclude med students, just as there is a acceptable double standard to gender care.
It is be fitting that the oath they take is called the " Hippocratic Oath" for a profession filled with such hypocrisy. But what do I know, after all I am the only one in the room NOT wearing any clothes.....
--Banterings
I do not agree that patient's and students share the same level of embarrassment for two reasons. First, there is the power differential and second, it's not the student who is baring all (perhaps without explicit informed consent).
What I do agree with is that the student 'a are exploited in the same way tge patients are in that these exams are perhaps not with their support and consent, but with the shared feeling with the patient that the situation is one of entrapment and helplessness.
Belinda
Peer examination should not be amongst people of their own class. It puts students who already have a professional relationship with each other into a position that is unequal to a patient dealing with strangers. What does make sense if two separate schools had a program where each school disclosed that there would be a shared requirement that the program for mutual exam exists and less likely that the students would know each other. Let's be fair and as closely as we can, compare apples to apples.
Belinda
Re: Belindas "student class cross over" idea... that doesn't really account for small towns where you DO know the people at the hospital.
That aside, nursing students, and any other kind of tech student who would be involved in the procedure should be required to be part of it too.
Also, if the students KNOW they're going to be seeing each other every day for the next couple years, they might keep that in mind and be more.... "inclinded"... to figure out how to do the procedure with as little exposure as possible.
Jason K
Jason, if that's the case in a small town then the mindset would be completely different if the students were all local. Coming from a big city, the mindset is something else.
There are places and situations where fellow docs are friends and take care of each other 's wives and that brings them comfort instead as a source of embarrassment . Excellent spin, Jason.
Belinda
Part of the problem is that the healthcare system sees nothing wrong with violating our bodies in the interest of science. Consider the following event which occurred in 2000: Forced Genital Exams of Children--Nothing Strange or Unusual Here? (Source: The Rutherford Institute)
....entered the elementary schools were LPN nurses assigned to the schools to take blood samples and perform genital exams on behalf of the Head Start program that is associated with the schools.....
The nurses conducted their exams over the protests of the children, with some crying for their mothers. Still others, intimidated and filled with fear, even attempted to resist physically. Their parents did not know that the exams were scheduled and had not given their consent. So there was no way they could have known the terror their children were enduring during their school day.
The nurses stretched the children out on a floor mat, on top of a school desk, and forcibly removed their clothes. Although the nurses were not even wearing hygienic gloves, they pressed and probed the children's genitals and took blood samples. The exams were conducted en masse--the children endured these humiliations in front of one other, amidst the panic, crying and fear.
When confronted about the situation, the Head Start director responsible for the exams said that he didn't think there was anything strange or unusual about the physicals.
What is wrong with these people???? I know that Maurice has been good about informed consent, but what about the rest of the healthcare system? Where were these LPNs trained? The Josef Mengele School of Nursing?
These children were subject to a violent sexual assault.
It seems that there may be some psychopathology present in healthcare professionals where empathy has been conditioned out of them. What other possible explanation can there be?
--Banterings
Banterings,
I am familiar with this case. It is sad about how children were forced to have unnecessary genital exams. The truth is genital exams are not necessary for kids with no symptoms. I consider this to be sexual abuse.
This also reminds some me of the forced hernia / genital exams boys are required to have for sports physicals in many locations.
Misty
I hope that the school, the government program, the employees who administered the program were all prosecuted criminally. There is a fine line between cruel, degrading treatment and psychological torture. The only thing worse is being tried for murder.
These people should be publicly displayed for their infractions, stripped of their licensing and serve a long jailed sentence.
Anything other than that is not justice.
belinda
Even I couldn't read the link
about the forced exams on children
in full. I was seehting...
But they'll get a pat in the back,
and and probably even recommended
by other stupid parents.
And spare me the "it's for their own
good". That's a pretty worn shoe.
Maria,
If you are like most of us here, I hope that link did not hit any triggers and bring on a panic attack for you. I know that I need to take a break when reading these...
Anyway the recent issue with the 2nd nurse that developed ebola is another example of the us/them double standard that exists in healthcare.
I am sorry to be this brutally honest, but how can someone be so darn stupid???? Travel halfway across the US on a plane that recirculates the air???
But then again, she works at a hospital that turned away someone who was just in West Africa and had a fever.
I am just waiting for the CDC's overreaction that is coming from their complete incompetence in this matter that is going to force quarantine and exams is going to go over with providers?
("I need you to get completely undressed and put on this gown, don't worry about the video camera in your cubicle, nothing the CDC hasn't seen before. Gender choice, this is a national emergency, you are lucky you got a gown.")
I am not gloating, actually just the opposite; I am terrified. It is something like this that may cause our beloved government to impose forced exams on the population....
If that doesn't give you nightmares, this one will. Check out the CDC's web page for Zombie Preparedness.
The Zombie page first began as a tongue in cheek campaign to engage new audiences with preparedness messages has proven to be a very effective platform.
Finally:
I admit this one is questionable....
24 September, Monrovia, Liberia-based newspaper The New Dawn published an article regarding an unusual occurrence in Nimba County. According to the local news source, two deceased victims of Ebola had mysteriously come back to life just prior to their burials. The strange and sudden resurrection of two Ebola patients had naturally frightened local residents, all of whom are already living with the specter of a terrifying and deadly outbreak of the disease.
--Banterings
In the child abuse case, there was a lawsuit that was won, but no criminal charges (how?!). I think this is a good example of how our legal system protects abusive medical personel.
"Ruling against the Tulsa, Oklahoma affiliate of Head Start, the appeals court stated, "It is not the place of a Head Start agency to usurp the parental role." In their appeal of a lower court dismissal of the case, Rutherford Institute attorneys argued that the invasive, unauthorized examinations constituted unreasonable searches and seizures in violation of the Fourth Amendment and that the defendants' actions violated the parents' constitutional right to direct their children's medical treatment."
https://www.rutherford.org/publications_resources/on_the_front_lines/pr436
It has been stated that providers are unaware that procedures, even when conducted professionally and according to protocol can be a traumatic experience and lead to problems such as PTSD down the road. Here are some references for what is called “The Sanctuary Model.”
We first started calling our inpatient psychiatric program “The Sanctuary” around 1986 after reading a description of something termed “sanctuary trauma”. First described by Dr. Steven Silver in one of the first papers about the inpatient treatment of Vietnam War veterans, he defined “sanctuary trauma” as that which “occurs when an individual who suffered a severe stressor next encounters what was expected to be a supportive and protective environment and discovers only more trauma." Source: Center for Nonviolence & Social Justice at Drexel University, Philadelphia, PA
As of July, 2010, the Sanctuary Network is comprised of the following programs:
Here is a Power Point (PPT) presentation titled, "How systems of care can retraumatize."
Although this is applied mostly to mental health related programs, it does mention physical exams and medical procedures (see the PPT presentation referenced above) as a source of retraumitization because the actions mimic the initial traumatic assault and because these are traumatic in themselves as well.
I contend that if these procedures can retraumatize, then it is possible that someone not suffering any trauma, PTSD, etc. CAN be traumatized by those procedures.
--Banterings
What do you think would happen if children were taught to respect but not trust authority figures? What would happen if a child said if you touch me my parents will charge you with sexual battery and the police will be called (stated more simply for little ones). What if authority figures were taught to children with tge mindset that these people are strangers?
What would happen if the police were called by a first alert type system that a child wore inside tgeir shirt and could notify someone when they trusted their gut feelings? Would this help?
Belinda
Belinda,
Children should be taught NOT to BLINDLY trust authority. The Catholic church learned this the hard way. A child (as well as all patients) should be taught that if the provider earns their trust, and they feel comfortable, then they can allow that person to touch them. If it simply were the case that physicians have unfettered access to our bodies, then they can never commit assault (which is not the case).
I believe that there is a median ground: providers need to earn our trust. That is why we come to them. If a provider can't earn our trust, then it is the provider's fault.
If you think about it, oral birth control ONLY requires a heart and BP check (maybe cholesterol). yet many providers require a pelvic exam. That is not informed consent, that is coercion, extortion, and illegal.
So no we should not blindly trust them. We give them the chance to earn and keep our trust.
--Banterings
Actually, birth control pills should require a blood test to make sure there are no clotting issues. Autoimmune disease can be undetected and if you have a clotting issue, you should not be on the pill. Also, perhaps you shouldn't be pregnant either and taking away birth control could actually put these young girl's lives in danger.
belinda
Sunday, I returned from a 3 day convention of bioethics and humanities in San Diego and I want to note one session which I attended. It dealt with "libertarian paternalism" in which physician's "nudge" their patients who are making "autonomous" decisions to follow actions which the physician's think is in the patient's best interest. The "nudging" is done in a subtle manner so that the patient thinks the patient is making the final decision themselves.
Perhaps those letters to patient's or parents regarding the "essential need" for pelvic exams is such a "nudge". Perhaps it would, in keeping with the motif of this Volume 69 thread graphic is for the patient to provide each healthcare provider with a "nudge" regarding the patient's interest in modesty and gender selection. ..Maurice.
Belinda today wrote a Comment about nudging to this Patient Modesty thread today on the issue of nudging. However, since it dealt primarily with issues other than that usually discussed here, I published it on my blog thread titled "Nudge" started June 15, 2013. Nevertheless, our readers here may wish to read what Belinda wrote by going to that "Nudge" thread. ..Maurice.
I wanted to let everyone here know that we had a silent auction this past Thursday and we have a lot of items left over. We are doing an online silent auction to benefit Medical Patient Modesty now. Go to the home page of Medical Patient Modesty’s web site at http://patientmodesty.org and click on the green box at the top on the right side that says “Online Silent Auction”.
It’s very encouraging that we have gotten many in kind donations to support MPM. Silent auctions help to support MPM’s web site. This has also been a great opportunity to raise awareness about patient modesty.
Misty
And think of the doctors, too. Read this Atlantic article on why you may be treated the way you have been. Does this article help to explain anything? ..Maurice.
Ms. XYZ,
Based upon the recommendation of my PCP, I was scheduled for an esophageal endoscopy at XXXX 8 Oct 2014. My specific complaint follows:
During the registration process, I was told that if I didn’t sign a form consenting to a blanket authorization to release my medical information to anyone who inquired, the hospital could not discuss the care I received with my wife, whose presence was necessary to drive home. Needless to say, I refused while clearly stating that I expected my wife to be kept fully informed of my medical status. Why wasn’t I offered the opportunity to sign a limited release?
After being escorted back to the exam room, I was told to remove all my clothing and put on a hospital gown. Having received the exact same endoscope procedure at two different facilities in different states (2000 and 2008) where complete disrobing wasn’t required, I naturally refused. Completely nude for an endoscope of the throat, really? After much discussion where the staff attempted to convince me of the medical necessity, and my adamant refusal, they reluctantly agreed that I could leave my pants on.
Following the blood pressure and temperature checks, and not having seen the consent form, the nurse attempted to measure my neck. I immediately objected and asked why; she stated it was for a sleep apnea evaluation. I replied I’m not here for sleep apnea, no problems sleeping, and no one solicited my consent. Once again, another extended discussion apparently ensued while my wife and I remained in the exam room.
Finally, the “Informed Consent for Operation and Other Procedures” was presented for my signature. I specifically objected to the “performance of operations and procedures in addition to, or different from those now contemplated, whether or not arising from presently unforeseen conditions, which the above named doctor or his associates or assistants may consider necessary or advisable in the course of the operation.” That’s not informed consent, that’s a blank check! XXXX staff argued this was necessary for a medical emergency. In a true medical emergency where life or limb is at risk, physicians don’t need prior consent.
I also objected to the following:
“In the interest of education and research, I authorize the taking of photographs, movies or videotapes of the authorized procedure or medical service.” To be clear, I would have consented to this paragraph if the photography was used solely for my medical care. This is after all HIPAA protected information and patients get to choose, within the constraints of the law, how that information is shared.
“I authorize representatives of the company supplying any equipment, prosthetic device, or other device which may be used during my procedure to be present and observe the authorized procedure.”
“I understand that from time to time there may be nursing students, medical students, and other students present in the operating room. I give my permission for these individuals to be present.” I would have gladly allowed student participation in this particular case if the students in question would have personally introduced themselves while specifically asking to observe only.
The bottom-line is XXXX “Patient Rights and Responsibilities” clearly states that I have the right “To cross out and initial any part of the consent form that you do not want applied to your care” and “To refuse to participate in medical training programs and research projects.” Despite this, I was denied needed (still required) medical care because the physician with XXXX privileges disagreed. Those aren’t rights, they’re empty words. The physician attempted to dissuade me by arguing that I should simply trust him. That’s a huge leap of faith to blindly grant a blank check to someone I’ve never met before. Trust is earned and not simply granted with a signature.
Sincerely,
XX XXXXXXX
Ed
New commenter here. Thank you so much for bringing this subject out of the shadows. As a child and young man I experienced medical care that was probably not unusual for its time (1980s and 90s), but even today makes me sensitive to loss of modesty in a medical context.
Basically I had doctors with poor bedside manner who conducted intimate exams in a brusque and even rough manner. These exams were warranted, as at one point I was experiencing rectal bleeding that needed to be investigated. But I was a sensitive young man who was having difficulty in life, and these doctors seemed, in retrospect, completely oblivious to the emotional toll it takes to go to a strange man's office and allow him to examine one's private parts. There are much better ways to conduct a rectal exam than to have the patient bend over the exam table with his underwear around his ankles.
They also seemed oblivious to the mental health issues that, looking back now, were obviously what needed to be addressed. Once they determined that the blood was "just" from constipation they thought their job was done. Fortunately I have been able to address my mental health and have been able to reclaim some of my dignity in medical encounters, but it has taken a while.
- "Class of '94"
Class of 94, Welcome to the group.
Most of here because something inappropriate, insensitive, or unexpected happened in a healthcare setting that eroded our sense of safety and trust.
Claim all your dignity! You are in charge. When you need an intimate exam, you have the right to allow or not allow personnel to be in the room and how an exam should be conducted.
Wouldn't it make more sense to be asked to put on a gown, lay on your side for an examination. Women are never checked in the manner you had stated.
It's taking a very long time because the medical community would like us to think that they know nothing about the damage, harm and the erosion of their own system based on their behavior. Then they try to tell you that you're the problem.
Listen to yourself. You have all the power and that includes working with a doctor who respects you as an autonomous human being with a need to be treated with dignity and respect.
Why would they think anyone would expect anything else, yet they do.
This arugment is an old one but is getting worse as years go on because of their ridiculous gender/neutral position that they are trained professionals and they've seen it all.
It's not about them. It's about us. When we all start to take command, dictate the rules, they will have no recourse but to change the system. We are paying customers; not animals.
belinda
*** At Monday, October 27, 2014 3:00:00 PM, Blogger Maurice Bernstein, M.D. said...
And think of the doctors, too. Read this Atlantic article on why you may be treated the way you have been. Does this article help to explain anything? ..Maurice.***
We get that doctors are people, and some people get stressed, lose interest in their jobs, get frustrated, and some are just plain a-holes from the start.
That's not really our problem as patients.
If you were to order a pepperoni and cheese pizza, and what shows up is a moldy crust covered in anchovies, do you really care what's going on in the pizza makes life?
If the delivery driver shows up and just tosses the pizza at your front door, do you care what kind of a day he's been having?
I honestly don't really care how much time, money or effort someone puts into becoming something... if it becomes something they no longer wish to do, then it's time to quit doing it, and move on.
Jason K
Perhaps this is the remnants of that paternalistic thinking: we are unhappy so let's anger the people that we need behind us to make things better, the patients (AKA the general public).
Referring to Maurice's post about "Patients Killing Doctors," perhaps a better solution is that any US doctors, nurses, etc. not happy with their profession QUIT!
We will bring in foreign providers who will be happy to live in the United States and be willing to treat patients the way we expect.
--Banterings
Here's a thought. No rationalization justifies humiliating patients, lying to patients, abusing patients.
They know there's a problem with institutional care. Prisons, mental hospitals, hospitals, the military, the police.
There's also a culture of protecting themselves within. Maurice, we are not outliers. Abuse issues are way under reported.
What I am suggesting that there is might be a subliminal flaw in the training of these insitutional professions, or simply a flaw in the human psyche that comes out when people are confined to too many rules and regulations and have decided that the patients are the weaker of the two forces in medical care. But, is that really true? If every patient would read the fine print, reject what is unacceptable, the medical system would be forced to change. if patients don't stand up, the perception is that they are the weaker of the two dynamics. Every patient who doesn't stand up for their rights influences this power dynamic to the favor of the institution and those in it.
Abuse is accepted and unrecognized by some who grew in a culture because they don't know the difference.
Until society steps up and considers infractions that hurt people for the rest of their lives punishable by prison time, nothing will change.
We're just seeing it now with rape, another under reported crime.
Anyone who has been victimized before is mentally ill if they put themselves in a position to be abused again. The best weapon is to make public that you know the law, you know how to enforce the law and that you will. We have every right as consumers to demand we be treated with dignity, Instead we are treated as somehow less competent, that we don't know what's best for ourselves and by seeking healthcare we must allow the system to behave in unacceptable mores because it's less expensive?, the doctors and nurses are overworked? they are tred?
It's time for the medical industry to recognize that they have a problem because it can't be fixed if they don't. Laws have been put into place.
So, Maurice, would you rather put yourself in an environment that mistreats you in horrible ways, or do you tread carefully and perhaps choose another route?
The medical community can stand on their "high horse" and claim that it's the patients who won't do whatever they have to to save their lives and that something is wrong with them. Or, does the problem rest on the system and those who protect the abuse by pretending it's rare and we are all 'outliers'?
Wee know the anwer to this one. They think what they think and we think what we think. Somewhere in the middle are the answers.
Human society will always look for someone to be weaker to victimize. That's the animals that we are. We are the only species that harbors ill for each other. The lower animals just want to survive.
We share that instinct with the lower animals but if i were from outer space looking at our socities, wars, and history, would not look favorably , nor trust human nature. It can be cruel and ugly or it can be beautiful. But, the real issue is can we be trusted?
belinda
Hello Everyone. I'm troubled by something that just happened. We recently buried a coworker. He was just diagnosed with prostate cancer. Rather than go through the medical system he chose a bullet. What makes people so afraid of the medical system that they would choose a bullet over the necessary health care. The system failed him. Several people have said on here that they will never go to the hospital but how many would chose to end their life with a bullet ? Maybe the cancer would be fatal , but now we will never know. Would he have felt differently if he felt safe and people listened to him . We'll never know now. How many more people like him are out there. Something needs to be done. On that note where are all the idea's for change that were asked for several volumes back. I have read very little even through Dr. B has brought it up. Idea's ??? AL
Al,
I am very sorry for the loss of your friend. I suspect that he had a previous (very) bad experience with the healthcare system.
I will bet you will hear a story from his wife/mother/brother/etc. something to the effect "he hated doctors... because when he was 10..."
Most people find death taboo, but let us look at a people who held something other than life as a higher virtue. The samurai (bushi) held their honor in a much higher regard than their life.
The samurai followed a set of rules that came to be known as bushido ("way of the warrior"). Zen Buddhism spread among the samurai in the 13th century and helped to shape their standards of conduct, particularly overcoming fear of death and killing.
Bushido is defined by the Japanese dictionary Shogakukan Kokugo Daijiten as "a unique philosophy (ronri) that spread through the warrior class from the Muromachi (chusei) period. From the earliest times, the Samurai felt that the path of the warrior was one of honor, emphasizing duty to one's master, and loyalty unto death".
Feudal lords such as Shiba Yoshimasa (1350–1410 AD) stated that a warrior looked forward to a glorious death in the service of a military leader or the emperor: "It is a matter of regret to let the moment when one should die pass by....First, a man whose profession is the use of arms should think and then act upon not only his own fame, but also that of his descendants. He should not scandalize his name forever by holding his one and only life too dear....One's main purpose in throwing away his life is to do so either for the sake of the Emperor or in some great undertaking of a military general. It is that exactly that will be the great fame of one's descendants."
Most samurai were bound by a code of honor and were expected to set an example for those below them. A notable part of their code is seppuku or hara kiri, which allowed a disgraced samurai to regain his honor by passing into death, where samurai were still beholden to social rules.
Healthcare is a profession based on life and death, the ultimate power. It is assumed that patients would be beholden to that. Healthcare can not comprehend a higher enlightenment.
Your friend chose to live his life with dignity. Nobody can define our own dignity, only we can. No one can say that he was not or would not have been treated with dignity because they are referencing their own dignity.
He took back whatever had been taken from him. It is a tragedy, but it was not his fault. It was the fault of the healthcare system and what experiences he had that drove him away.
I feel the same way. If I decided that I was going to check out, I will do it on my terms, with dignity, and make it look good.
What happened to him should never have happened. It happens more often than we really know. Just as our pets, many ill people go off somewhere to die alone, for fear of being taken against their will to a hospital.
We only hear later that they were found dead from what ever condition. Some, like your friend are more proactive.
Again, I am sorry for your loss.
--Banterings
Sorry for your loss Al.
I'm willing to bet it happens a lot more than people realize. Maybe not a bullet per say, but "accidentally falling asleep" at the wheel and wrapping your car around a tree wouldn't surprise me for a lot of people.
On an unrelated note... or maybe it's semi-related since it would be good practice for med students to do...
I was talking with a friend of mine, and she recently joined an art group / class... As part of the "initiation" and to make sure you're serious about the group / class, on your first day there, you pose nude for the other artists. To save themselves the models fee, they rotate and every week one of the artists pose nude.
You read that right... people who are there to learn are themselves being used as the subject ...
and shocker of shockers... the people they see often have seen them naked, and they've seen their co-students naked.
And you know what happened?
Nothing.
The world didn't end, the sky didn't fall, nobody imploded...
If Med students (nurses and doctors) also followed this practice, they might just learn a bit more compassion and empathy, and who knows... someone might come up with a better idea how to do a procedure that DOESN'T involve nudity. (read Eds post about his endoscope)
At the very least it'd eliminate the "need" to sexually assault sedated patients.
Jason K
There is no need for the medical students to see each other naked as there is no need for the medical students or later as physicians to see their patients naked. Sequential undraping is all that is needed including for full dermatologic inspection. There is no need and I have never seen an operating room patient incidentally or purposefully lying naked on the table.
Along with Al, I, too, am awaiting signs on this thread of movement forward toward informing the system about the physical modesty and provider gender selection issues. It is almost like my visitors are implying "Maurice, you are part of the System, it is your job to educate and initiate change of the medical system!" The medical system whose duty is to attend to its patients would be looking more for its patients and not its co-workers for patient input. So, where are the signs that there is constructive interest to accomplish the changes? ..Maurice.
"There is no need for the medical students to see each other naked as there is no need for the medical students or later as physicians to see their patients naked. Sequential undraping is all that is needed including for full dermatologic inspection. There is no need and I have never seen an operating room patient incidentally or purposefully lying naked on the table. "
Semantics.
Or like I've said before... if you really think there's a difference between sequential exposure and being naked, go do it in a grocery store, and see if a judge agrees with you.
Jason
Al,
I am so sorry to hear about the loss of your co-worker. Did he explain to you about why he decided to not get medical treatments? Do you know if he checked on several medical facilities? About a year ago, a woman shared on a radio talk show that her dad chose to not go back to the hospital to seek further medical treatments because his modesty was violated badly. He died.
The whole medical system will never change. However, there are some great medical professionals who will listen to our concerns. I helped a young woman who was very upset that her local hospital could not guarantee her that a female gynecologist would deliver her baby in emergency. That hospital had several midwives, two female OB/GYNs, and male OB/GYNs. The patient advocate at that hospital was not helpful at all. In fact, he even went as far as encouraging her to have a scheduled unnecessary C-Section on a day that a female gynecologist was there. He would not take this lady’s concerns seriously at all. Fortunately, this lady found MPM’s web site and emailed me. I encouraged her to go to another hospital that was 45 minutes away. It turned out that this hospital was much more sensitive to patient modesty. They were able to guaranteed her that no males would be involved in her childbirth.
One of the most important things patients have to do is to shop around for medical facilities & doctors that are willing to accommodate your wishes even if it means driving farther. We need to let medical facilities that are not willing to honor our wishes for modesty and same gender intimate care that we will not give in and find another medical facility that will work with us. Think about how business at medical facilities will suffer if more patients went somewhere else.
Misty
This will be in 2 parts because of length.
Maurice,
This is part of the problem. There is a disconnect between providers and the rest of society. I would attribute it to the way providers are trained.
What providers may find acceptable, the rest of society does not. Healthcare has granted itself privileges to our bodies that nobody else has. Not even law enforcement.
Warning: the following example is to illustrate the control over our own bodies. It compares sexual actions to medical actions. Although the actions are the same, the intent and purpose are different.
Again I will present this scientifically and respectfully. It will also illustrate the disconnect.
There are married couples (partners, significant others, etc,) who are adventurous sexually and those who are vanilla. One area that is taboo for many is anal sex. There are many ways to stimulate the anus, but I will use digital stimulation for my example.
There are people who will not allow this, even for the most important person in their life; their partner.
Our partners are more important than healthcare. The species can continue without healthcare. It did for millions of years.
Yet, depending on our age, healthcare imposes an annual DRE on both partners. Imagine the psychological effect this has on people; healthcare imposing something a person would not even grant their spouse.
If a partner were to allow the other to try this stimulation out of love and trust, they have the right to say NO, otherwise it is considered assault (even within a marriage).
Yet in certain situations (the ED), a healthcare provider can ignore our wishes and it may not legally be assault, but I am sure the patient feel assaulted.
I am sure we have heard the adage of the American College of Surgeons in their Advanced Trauma Life Support (ATLS) is a training program: Reasons to omit digital rectal exam in trauma patients: no fingers, no rectum.
There are some spouses who do not like their partners to see them undressed. In certain Jewish sects, intercourse involves a sheet with a hole in it. Again, healthcare expects us to annually undress for a physical exam.
End Part 1
Part 2
Now to the issue of naked: Healthcare seems to define naked as no clothes at all. Society defines naked as having the bathing suit areas uncovered. That is why we wear pants and not chaps.
As Jason pointed out, exposing those parts in public get you arrested. Many people are uncomfortable in bathing suits, let alone having those parts exposed.
It does not matter how you sequentially drape, the issue is exposing and touching those parts feels like an invasion of our person and an assault.
The reason that so many of us say things like "you undress first" or "providers should practice on each other (sequentially draping of course), is because if the practice is so acceptable, prove it by going first OR hopefully you will realize how the patient feels.
I am going to be brutally honest, Maurice please do not be offended.
I think that many people do not know your position on this issue. As I said before, having been trained in philosophy, I am familiar with the Socratic Method. I feel that you use this to stimulate discussion.
People may assume that by pointing out opposing points of view, you are defending such practices.
You also make technically correct statements while ignoring the context. Technically naked is no clothing, fully exposed. But the average person covered head to toe, except with genitals exposed would define that as naked.
Furthermore we have shared many intimate parts of our lives and you remain very sterile (like most physicians) which is your right.
Here is a simple example: despite our choices of gender in our healthcare being minimized, I am sure that most providers have gender preference in their own healthcare and know how to achieve it by the nature of working in the system.
I would bet "dollars to doughnuts" that you Maurice, have gender preferences too. An interesting study would be how providers choose their healthcare.
Going back to my example of "digital rectal penetration," from the point of view of the patient, whether it is a sexual tryst with a partner, or an exam (with appropriate draping and conducted in a professional manner) to make a diagnosis, it still feels like a finger in my a**.
I do not mean to be vulgar, but do you see my point? The magic white coat does not make it feel any different or the patient any less violated.
--Banterings
Monday, November 03, 2014 11:06:00 AM
Blogger Maurice Bernstein, M.D. said...
"There is no need and I have never seen an operating room patient incidentally or purposefully lying naked on the table."
No disrespect Dr. B., but the MDs arrive after the prep work has been completed. It's expected that you would first see the patient after draping.
BJTNT
Banterings, physicians are carrying out the socially required and socially permitted responsibilities. It is all about disease and injury to the human body. Society has specifically given physicians permission, with the patient's informed consent, to view, to touch and to invade with fingers and instruments and to operate on the human body. Of course, it all must be done, ethically and legally within professional and lawful (set by society) limits. As long as physicians fulfill the societal directed requirements and laws and from a professional point of view do their job primarily for the patient and not simply for the physician's self-interest, that is what medicine is all about.
An airline pilot, a plumber or a lawyer have no societal permissions and responsibilities to look and touch and manipulate parts of the human body as part of their job. Those writing to this thread must finally realize that physician DO have those rights as part of the profession. However, all of this has to be carried out within the limits of informed consent and professional ethics. (For example, a physician cannot undress a patient and "make love" even with the full informed consent and willingness of the patient. This is not what society nor the profession itself has allowed.)
So, it is up to patients (society) to reset the limits of what physicians can or cannot do as part of their profession. And this "reset" is what I have been steadily encouraging to be considered and begun by those writing here.
If behaviors of staff in emergency rooms, operating rooms or offices and clinics are unacceptable to you (society) then begin to make the system aware of your concerns and begin changes in the system. Present with documentation the need for attention and changes to the state medical boards, hospital licencing organizations, state politicians, medical associations and medical school educators.
But to waste time arguing what is meant by "naked" or pointing to the rare physician criminal behavior on this blog is not the wisest way to change the system.
Society has given me my duties and permissions and I expect society to make any changes and I will be required to follow, that is felt to be in all patients' best interest. ..Maurice.
Al, so sorry for your loss. I'm wondering if you ever had a discussion about "our" issues with your friend or perhaps there was another reason he made his decision.
Humiliation is the mental equivalent of a physically extreme traumatic event. Wars are fought over it, bullied children become killers over it, and the humiliated doctor who collected his patient's exposed bodies on his computer, committed suicide over it.
Maurice, the laws are already in place. What is it that you would like to see our lawmakers do when the laws on the books are ignored already? Let's go to congress and make more laws that are ignored.
Solving a problem is a team effort yet your stance is that the medical community has done nothing wrong and the burden of fixing the system lays with the public. The "few" abusers out there aren't a few. There are many and it goes unreported by both patients and collegues who have witnessed abuse. You talk about people are never left naked? I can personally vow that I was not only subjected to it for no reason, but have seen others in the medical setting left in bed naked, or on the toilet with the door open, or in the hall with their behinds hanging out.
There is no reason for all of the above yet it's not the exception , it's the rule.
A problem cannot be fixed until it is recognized and it is not, eventhough there is documentation of problems in every hospital assigned risk department.
The medical industry has to stop protecting abusers, screen all levels of personnel, mandatory reporting of infractions and punishments for the same.
We can carry on until the cows come home and until the medical lobby recognizes it has lots of work to do, the system will not change because it doesn't have to.
Every interchange I have with a doctor, hospital, I bring up this issue. I get their feedback on these issues. Most not only recognize the problem, but off the record, say that it goes on all the time. May I suggest one day, you take off you doctor hat and go into a different hospital and just walk around. You will not leave without seeing things that shouldn't be.
belinda
Maurice,
The problem is that healthcare is granted the right without limitation.
“We were told that breast and pelvic examinations are part of the physical examination of the body,” he testified.
During the hearing, he read from a variety of medical textbooks he said he used while attending medical school in Wisconsin in the late 1960s and early 1970s. The textbooks were all published or copyrighted around the time he was a student.
“Neglect of the pelvic examination often leads to serious errors in diagnosis,” he read from one of the books, Bedside Diagnostic Examination by DeGowin and DeGowin. Source:
In opening statements presented Monday, the hearing was told that Patient A underwent nine pelvic and nine breast examinations in a 10-month period when she was 17.
Another woman, Patient B, had 71 pelvic examinations over a 24-year period, 41 of which were deemed medically unnecessary by an expert witness who will take the stand Tuesday afternoon. Patient B also had 62 breast exams, 46 of which were deemed unnecessary, over the same time.
A third patient, Patient C, had 229 pelvic and 159 breast exams over a 24-year period. Of those examinations, 86 pelvic and 131 breast examinations were deemed medically unnecessary. Source:
During the cross-examination, Alice Cranker, counsel for the College, told Chung that Patient A had 18 pelvic and breast examinations in just over two years. The lawyer asked him if he now believes every examination was necessary.
“They were necessary at the time of presentation,” he said, adding that in hindsight, there may have been some that were unneeded, but there was no way of knowing that until the examination was performed. Source:
Can you honestly say 18 pelvic exams in 2 years has no psychological effect on a person??? What about 4 pelvic exams a year over 24 years???
Don't think that we are not trying to change the system. The problem is that the only thing the system hears is lawsuits. I have contacted a number of providers, they ignore all requests.
Maurice, here is a prime example. Please opine on this situation:
Oral contraceptives state on the package "pelvic exam not required for dispensing." Yet 40% of physicians ADMIT to requiring a pelvic exam before they will prescribe or renew prescriptions. From stories I have heard, I suspect that the percentage rate is much higher.
Medicare reimbursement for a pap smear is about $75 (private insurances are much higher). Very lucrative for a 3 minute procedure. The pap smear reimbursement covers 30%-50% of the office visit to the physician.
The American College of Physicians said Monday that it strongly recommends against annual pelvic exams for healthy, low-risk women.
So how do you explain this???
Being thorough is not an acceptable answer.
I mean no disrespect, but legally it can be considered a coerced assault or extortion of insurance reimbursement.
How do we distinguish? Simply accept the physician's word?
--Banterings
Banterings, if any of the pelvic exams or breast exams are presented as a threat to the patient and not presented as a part of informed consent, then this could represent legal assault. If the exams were actually carried out without the informed consent of the patient then that could be legal battery. In either case, this represents a criminal behavior and the case may demand a court trial. Presenting unintentional and not self-serving misinformation regarding professional guidelines (which change often) is poor professionalism and if repeated needs review by state medical boards but is not criminal. If the patient finds any of the recommendations by a physician not in keeping with their lay knowledge and the physician cannot document source of such advice, then the patient should speak up and refuse the procedure and consider changing physicians. I can't defend physicians who ignore professional guidelines but you should know many guidelines are in a state of flux with frank disagreement between various academies and medical organizations. Again the issue of physician self-interest is important in deciding whether the recommendations for the patient to accept is unprofessional or not or even indeed criminal. ..Maurice.
real quick question for Dr B.
What do YOU feel should be done to doctors who do perform exams without consent / informed consent?
(for a contextual scenario, assume either the patient is sedated and the "exam" is in no way beneficial to the patient, OR the patient is ambushed by a doc / nurse pulling on a glove and telling them to turn around and drop their pants without any further conversation about it, when the patient was not there for any kind of "below the waist" issue)
Jason
Jason, first, if the patient has the capacity (that is, able to communicate) to refuse a suggested action or an attempted action, the patient should speak up and refuse and try to avoid the unwanted contact. Any physician or healthcare provider who proceeds despite the patient's words or actions are indeed committing a crime of assault or battery itself. If the patient, at the time, has no capacity to make the objection known but can recall afterward it should be brought to the attention of the provider's superiors, state medical boards or the police (the latter, particularly if the action was carried out without consent). The experience should also be documented in writing. I am not a lawyer so it would be worthwhile Jason to verify what I wrote with a lawyer but I can tell you from a medical professional point of view and as a patient myself, that is what I would do.
Look.. this is what I teach my students..in fact, this morning I was observing a first year medical student who was about to perform "vital signs" on a patient (taking temperature, pulse, respiration, blood pressure and the 5th vital sign "pain" estimation). And, yes, the student, even for these "non-invasive" procedures directly told the patient what was to be done and asked the patient's permission. The student had followed exactly what the students are instructed to do: obtain informed consent.
..Maurice.
Al, my sincerest condolences for the loss of your friend!
Based upon the information you provided, it's difficult to conclude the primary reason he chose suicide vice treatment was due to the admittedly traumatic (physically and emotionally) healthcare he faced IMO. Had the cancer spread so far that treatment was simply a delaying tactic? If so, might he have simply chose to end his life on his terms with dignity. I understand dying from untreatable prostate cancer is one of the most painful deaths one can endure. If faced with the same choice, many of us might consider the same option. Personally, I can't imagine dealing with the issues men are faced with even if the cancer is treatable!
Read the following tearjerker for additional perspective on what dying from prostate cancer means:
http://gruntdoc.com/2006/11/my-grandfathers-guns.html
Ed
"Those writing to this thread must finally realize that physician DO have those rights as part of the profession."
Sorry - No one has ANY rights regarding my body.
-JR
JR, my entire expression was "An airline pilot, a plumber or a lawyer have no societal permissions and responsibilities to look and touch and manipulate parts of the human body as part of their job. Those writing to this thread must finally realize that physician DO have those rights as part of the profession.
Yes, these are the rights permitted to physicians (with the patient's informed consent) which is not part of what society gives to these other jobs.
But also, no one has the rights to your body.. well, unless deemed appropriate by society for the health of the public with examination and quarantine or unless your body is imprisoned for punishment for a crime. Otherwise, you are correct. ..Maurice.
"If the patient, at the time, has no capacity to make the objection known but can recall afterward "
What about the scenario I suggested where "for a contextual scenario, assume either the patient is sedated and the "exam" is in no way beneficial to the patient, "
if they're sedated, there would be no recall... is that your round about way of saying that you feel once a patient is out, doctors have free reign to do whatever they like to a patients body, and there should be no consequences to the doc?
Forget what a lawyer would say... what do YOU feel should happen to a doc who goes around doing things like DRE's on sedated patients "just because", or walks in and stands there watching while other docs are performing procedures for no reason?
Jason
Maurice,
I ask you, how does a patient protect one's self from:
--a gynecologist who insists on pelvic exams and pap smears before prescribing/refilling Rx for oral contraceptives because they get reimbursed the most money for little work, yet the physician claims that he is following recommended guidelines?
--a physician who gets sexual gratification from looking at patient's genitals, yet the physician claims that he is following recommended guidelines?
--a physician that feeds his sadistic tendencies by having patients undressed and gowned, performing humiliating procedures (such as DREs, genital exams), using chaperones and medical students only to add to humiliation,yet the physician claims that he is following recommended guidelines?
All guidelines say the physician should earn the trust of the patient, yet all physicians say there is barely enough time in a visit to do cursory vitals.
The only solution is that the patient can decline the exam WITHOUT penalty. This keeps within the physician's fiduciary responsibility to put the welfare of the patient ahead of their own.
Simply just saying "I am a physician therefore you can trust me," is NOT earning the patient's trust and therefore NOT following guidelines.
That is just my point of view.
--Banterings
Jason and Banterings, all interactions with a doctor depends on trusting the physician prior to the examination or procedure. The patient must trust the doctor before the exam or procedure to perform it wisely (the basis for the action was appropriate and for no self-interest but for the benefit of the patient) and safely. Without first establishing that trust, the patient should reject the examination or procedure and move on to another physician. Trust is essential since whether the patient is awake or asleep, trust at the outset is critical to minimize emotional or physical harm. Trust is developed by previous experience with that physician and by communication before the exam or procedure understanding the basis for the exam or procedure and the risks and feeling confident that the physician understands the patient's concerns and will follow the patient's requests. In an emergency, where the patient's life is at stake, there may be no opportunity to establish trust in a specific physician and so prior trust in the institution may be the only trust available to that patient.
Trust is what we need to establish with the pilot or airline before we fly a commercial airline. And the same applies to the plumber and lawyer. No trust: then no consent and then switch. ..Maurice.
You guys and gals need to back off Dr Bernstein. He has repeatedly stated his views, quite forthrightly in my opinion, and rehashing the same ole same ole via veiled attacks, despite an honest difference of opinion, is counterproductive. He is the only medical professional that will routinely engage with us and we would do well to remember that!
Ed
Re: Eds "He has repeatedly stated his views, quite forthrightly in my opinion, "
- Actually Ed, Maurice has ignored or side stepped pretty much all my attempts to get clarification. I know he's the only doc that routinely engages us, which is why I'm still trying to understand his mindset.
I'm trying to ask him what he thinks should happen to docs who take advantage of sedated patients, because he openly admitted to taking a field trip with med students to observe a surgery without checking if there was consent first. Yet his replies are "well, build trust with the doc or go see a different doc", which has nothing to do with a doc walking in on a sedated patient.
He was the one who said that the doc who was secretly photographing his patients bodies could be justified in doing so depending on "why" he was doing it.
Also, he keeps insisting that there's some kind of difference between naked and sequentially exposed. (technically I'm sure there is... but when you're genitals are exposed to strangers in a room, does anyone really tell themselves "Gee willickers... I'm not naked because I have a gown covering my chest!" ... really?)
If the "champion of patients rights" is ok with doing all this then A) where does he draw lines, and where does he feel we should draw lines, and B) What does this tell us about other docs and nurses mindsets if they DON'T "know patients have modesty"
This is why I'm pushing, because I'm honestly trying to get a peek at the thought process.
Jason.
Ed,
(I can't speak for Jason), but if you have seen my previous posts, I see this forum and Dr. Bernstein as a Socratic debate. I think Maurice is more aware of the problem than most physicians, if no other reason than his 10 year devotion to the topic.
I have also conversed with Maurice privately (off blog) and shared some details of my life with him, more than most here (probably) share. I hope that Maurice and everyone sees that I respect him for his commitment to this issue. I also know that his blog and this topic must come up in his teaching. If nothing else, his students are aware of the problem.
I have learned much from him and changed my opinion on a couple issues.
I have ADHD, and I see the world very differently than most people. I describe it as a cross between Sherlock Holmes and Dr. John Nash.
My most recent point was that with physicians so pressed for time that they can hardly get through a cursory examination, how are they suppose to build trust with the patient (as per all guidelines that I have read).
Has anyone else seen this conflict? Has Maurice even considered this "irony."
I have also posed a Kobayashi Maru scenario. It is a no win situation. Physicians doing exams for nefarious reasons, but claiming practice guidelines. So how do we protect patients in these situations?
I believe the answer is the physician's fiduciary duty to put the wellbeing of the patient ahead of his own of being "thorough." Many physicians already do this. That is the debate that I am raising.
Now Maurice responded. I will counter:
With so many practices NOT taking new patients, this particular physician may be the best that this patient may find. It will take time for the physician to earn this trust. It can not be expected instantaneously, although in many doctor-patient relationships that occurs.
"Do no harm" and the physician's fiduciary duty dictate that the physician skip these parts that the patient is uncomfortable with.
Look at Al's coworker. I prefer not to check out like that, but I hold my dignity at the same level of importance as my life. I am willing to check out on my own terms. (My way involves a mountain and search parties not being able to get up until the spring thaw.)
I believe that my life and dignity, and that of all people is worth fighting for. I also believe that this system is out of equilibrium, hence the state it is in. I am trying to wrap my head around this and look for the solution.
If I have offended anyone, I am truly sorry.
I have also learned as a veteran of philosophic debate that it can be a blood sport.
You cannot offend me, but you are welcome to try.
--Banterings
I think Dr. Bernstein has part of the answer. Trust, unfortunately true trust takes time something many MD's don't have or don't invest. Not always their fault, work loads, referrals for specialties etc. And then there are the support staff, we don't even know them so how in the world would we be expected to trust them? I think the issue is resolved for some with trust, partially resolved for others, doesn't solve much of anything for others....but then again, as I said, true trust takes a bit of time. don
It's an imperfect world and it would be quite boring if we all agreed. Dr Bernstein is a physician and he's perfectly comfortable with patient nudity; I get that. The vast majority of patients are not, to varying degrees, whether sequential or complete. Unless we get a Patient Bill of Rights (with teeth) which addresses these issues enacted by Congress, nothing we say here will change the system in the slightest. And we all know there's a snowball chance in hell of that happening in our lifetime. The system is too big with Mariana Trench deep pockets. Where does that leave us? Essentially, you're on your own; advocate for yourself respectfully but insistently and walk if you have to as I recently did. The true value in this blog is the ideas we share on how to deal with these issues, not Dr Bernstein's beliefs, values, or opinions. And if he did agree with us, I can guarantee you there are literally millions of "providers" out there who disagree. Which leaves us exactly where?
Ed
I want to make it clear here that I do not support doctors or the other medical staff here who are criminals, who examine and perform procedures primarily for their own self-interest (sexual or otherwise) and not for the medical interest of the patient, who fail to follow well-established and publicized professional guidelines and I do not support doctors who under excuses of "too busy" to listen to what their own patients have to say. All this misbehavior and missed professional functioning is not acceptable and I do not defend any of this here or elsewhere. In fact, me and my medical school and I am sure from my readings on medical education listservs other schools teach their students behaviors which are contrary to the "bad" that I have previously described.
But, you know as I have repeatedly written here, that patients themselves (as part of society) have some responsibilities to keep the medical system as true to the needs, to the interests, to the protection of all patients including the individuals themselves. And that is by "speaking to" their physicians, the office staff, the medical administration, their state medical boards and their governmental agencies about their observations of impropriety, unprofessionalism, crime or, in fact, also suggestions for changes in the system to make medical care more effective and more tolerable and even more safe for those patients entering the system.
You are clearly"speaking to" me and the others who visit this thread about all sorts of personal and newsworthy calamities but that is not enough.
For example, if you want to change the teaching programs of medical schools regarding students watching surgery, you and a few hundred other patients write a petition to your local medical schools and explain your reasons for change. Don't just moan about it here. I can't, as one teacher, make such changes and, in fact, I think watching surgery done in a professional manner is exactly what students should be watching. But if you think that something more than "implied patient consent" is needed then write that petition.
Is it really fair to "beat me up" since I am the moderator or the only physician to steadily contribute to this thread? I don't think so. This behavior is no substitute for taking the approaches I mentioned above and repeatedly on this thread to begin change. ..Maurice.
I have one more important comment to make. I think that if those who write here want to "get together" to form an activist group to change the system, which has been my suggestion in the past, then what is currently interfering with this idea is the fact that virtually every writer to this blog thread is ANONYMOUS, pseudonym or not, ANONYMOUS.
Anonymity is understandable since very personal feelings are being expressed but on the other hand it prevents group functioning and, to be frank, can leave some visitors reading this thread with the question as to the reality or motivations of those writing here. Even as Moderator, I can't fully exclude such a possibility when the writer is fully anonymous. (To be fair, a few contributors here have written me personal e-mail so I do have some confidence in their motivations. But the majority are still anonymous.)
If those writing here want to get together and plan together to attempt to accomplish change, there should be some central trusted site where anonymity is removed. Perhaps Misty would want to participate with such a site. I would rather that I not be involved in such a site. But some naming real names and naming real contact information would be necessary for such a group to function. And it is my opinion, that simply writing anonymously to this thread is insufficient for change to be promoted and possibly accomplished. ..Maurice.
I "walked" to a private surgical practice literally across the street from the hospital that refused to meet my consent requirements and received the endoscopy procedure from a different physician today with absolute zero flak. The hospital has a self imposed two week deadline on responding to my complaint; will update when I hear more. If I'm not completely satisfied, I intend to file formal complaints with the state medical board, the Joint Commission, and the U.S. Department of Health & Human Services Office for Civil Rights.
Ed
Ed, great! You are doing something which will be more productive then simply "moaning" here on this thread. ..Maurice.
Maurice,
2 simple questions:
As a physician, are you open to the possibility that what you (think) you know and were taught might be wrong OR do you have to believe that is absolutely a true an unchangeable fact so that you do not second guess yourself (think the trauma physician model)?
How would your life as a physician change if you found out tomorrow that what everybody on this blog has been saying was the rule and not the exception?
--Banterings
To answer Banterings "2 simple questions":
1. What we are taught (as I was taught in the 1950's-1960's period) are always open to modification and change both from the clinical science aspect but also from the doctor-patient relationship. For example since my period of formal medical education, the paternalism of that period and before was subsequently changed to patient autonomy. The direction went from "the doctor knows best" to "patient informed consent is an absolute in decision-making".
2. No change in my life as a physician nor of a medical school teacher. I would, as I have been attending to currently, emphasized the importance of communication with the patient regarding their personal desires and their emotional comfort.
Whether every other doctor would do the same..I don't know. Why not, as a patient, go ahead and ask them. ,,Maurice.
Again I must post this in 2 parts....
Maurice,
I have asked other providers this and the majority of the responses I get is "there is no problem with modesty, gender choice, assumption of access to our bodies, etc. Occasionally I get "new drugs and treatments are coming out," again Ignoring the issues. A couple have mentioned that they the system being broken (almost acknowledging the problem, not necessarily the extent).
They go on to say that the second part is irrelevant because they are doing things the correct way and there is no problem. The ones that are open to the possibility and (interestingly enough) the ones that mention new drugs and therapies, say they will wait for new guidelines.
There has been mention by a couple that if I am referring to incidents of abuse, these are isolated and not following guidelines.
I disagree with that last statement. Dr. Stanley Bo-Shui Chung (excessive pelvic exams), endocrinologist Dr. George Reardon (used a medical study as a pretense to take obscene photographs of children), Dr. Leo D’Souza (sexually touching or improperly examining the genitals of eight boys), and Dr. William Ayres (performed unnecessary genital exams on children) all claimed that they were following established guidelines.
Maurice is ahead of most providers in regards to these issues, again evidence of his 10 year commitment to this blog. Many providers are in denial that it CAN happen let alone it does happen. By not accepting the possibility that it CAN happen, they do not recognize it when it DOES happen.
Denial is NOT a river in Egypt!
I do have one point of contention with Maurice's answer to the second question; how would it change his life. He said it wouldn't.
If it was found to be true that despite what was thought to be acceptable is not, OR what was taught to providers is routinely ignored, not only Maurice, but ALL providers should be working to change the system. I think that would go beyond what he is doing now. Would he not reexamine what and how he is teaching (despite his methods being more advanced in their sensitivity to patients)?
I know professionally that I always question myself, "Can I do better," even when I believe that I am doing the best and doing it correctly.
I believe that is part of the problem with the system. It is the same problem that causes providers not to report other providers who are incompetent, abuse patients, etc.
A 2009 report by Public Citizen found that nearly half of all U.S. hospitals had never filed a single report on a dangerous doctor to the National Practitioner Data Bank in the past two decades—a fact that critics say points to hospitals' reluctance to aggressively police medical staff members who are key to generating revenue for the organization.
How can a system improve when it refuses to acknowledge that it MAY have problems AND could do better let alone reporting and confronting real problems (by current standards)???
The system fails to ask patients for their input because it knows that our desires and recommendations would be inconvenient. It also assumes if the healthcare system does not know about the problem, none exists AND asking if there is any problem is paramount to acknowledging that there IS a problem."
Part 2....
One last point:
Providers fall back on "current guidelines" and "current standards of care." These are NOT the final standard. These standards MUST conform to higher standards, namely the US Constitution, the Bill of Rights, English Common Law (which our legal system is based on), and the Human Rights that we are all endowed with, just to name a few.
For example, a truly paternalistic model may statistically have better outcomes in treatments and mortality rates, but it violates the Bill of Rights (life, liberty, pursuit of happiness), English Common Law (our bodies as the Castle Doctrine), and our Human Rights (autonomy/self determination).
Lack of gender choice increases efficiency but violates the US Constitution and the Bill of Rights.
You CANNOT say that current guidelines and standards of care adhere to the US Constitution, Bill of Rights, English Common Law, etc. Look at the above examples. Of the 4 examples, I believe (after doing my own research on the cases that Dr. William Ayres and (most likely) Dr. Stanley Bo-Shui Chung had NO criminal intent. Yet they did not recognize what was socially acceptable and other issues under English Common Law and Human Rights. If anything they were professionally negligent and MAY have been criminally negligent in not recognizing the psychological side effects of intimate exams OR not earning the trust of their patients prior to the exams.
Again, I fall back on the example of Dr. Bo-Shui Chung:
...Patient A underwent nine pelvic and nine breast examinations in a 10-month period when she was 17....
As I stated, I believe Dr. Bo-Shui Chung was being (overly) thorough, and from a diagnostic point of view, each exam justifiable. But when stepping back and looking at this, having a 17 year old girl go through monthly pelvic exams for almost a year is paramount to sexual abuse. You have to be a complete idiot to believe that there would be no psychological side effects. (Sorry if that was inflammatory, but i think it better to be an idiot than a sexual predator.)
If he had earned the patient's trust, then this would never have been an issue, and complaints would never have been filed. If you think our system presses a physician for time, the Canadian system (being fully socialized) where this occurred is worse. Even though this occurred in Canada, it is relevant because Dr. Bo-Shui Chung was US trained and Canada and the US have similar social values.
The worse part of Dr. Bo-Shui Chung was his failure to apologize to his patients.That combined with the lack of criminal charges (or lesser charges in many other cases) only adds insult to injury. A sincere, face-to-face apology, acknowledgement of (at the very least) lack of sensitivity, and a change in the physician's future protocols would have avoided the inquirers and investigations. (This is another flaw of the healthcare system, one that is self inflicted.) How could one expect an apology and acknowledgement to a lack of sensitivity when the physician doesn't take the time to earn the patient's trust?
This is NOT an attack on Maurice. As I have repeatedly said, he is more aware of the problem and doing more than most. I also do not know other endeavors that he may have in making this issue known to the healthcare community. In the nature of philosophic discord, I question his second answer in hope of finding some enlightenment for me, for him, and/or all who debate this issue.
Perhaps my question should be: "Why does the healthcare community continually ask if it can do better in all aspects of patient care?"
--Banterings
As we have reached 176 comments here and time to go on to Volume 70, my response to Banterings and all here is where is the "speak to" the system beyond ME which is going on with those participants here? My teaching of medical students is now descriptive and more supportive of much of what has been written here. I have written two articles in recent years to the "system" via AMA News on this subject. I have attempted an internet petition which, if successful, would have been significant for system distribution. So, I ask again, who are YOU speaking to the system besides ME? ..Maurice.
Dr. Bernstein,
While I agree that efforts need to be exerted to change the institutional mindset regarding patient's rights and respect for their dignity and modesty, in and of itself it won't accomplish much.
I still don't believe that there will be any fundamental change to the medical system unless/until patients stand up for themselves on a one to one basis. For example, they need to be able to say "no" and stand by it and not be coerced. They need to be willing to say what they will and will not accept, and be willing to stand by their commitments to the point of taking their business elsewhere if necessary.
The more folks that stand up for their rights, the easier it will become.
Hex
Hex, but will that patient to medical system "ultimatum" ever really occur on a large scale, large enough to cause the attention of the medical system to make the changes which will accommodate even those patients who did not "stand up"? Or will it be "piece by piece" to those patients who write here or non-visitors who just decide they have to "speak their minds"? ..Maurice.
This is gonna sound far more incensed than I intend to, but societal permission to do such tasks (of which
in itself I'm not so sure, because at different times and places those might e different), don't per se extend to a articular individual. Who are you asking to remove their clothes, the wall? No, sir, you´re asking that of an individual, who may be opposite gender.
That's why I have such an issue with "societal permission", because it's used as an excuse to curtail free choice.
And like I said before, different societies vary in the leeway doctors have regarding such examinations. For example, many Muslims find them utterly unacceptable. As they were
centuries ago. Proof that progress doesn't always bring morality... I also wonder about the noxious process from which they went from taboo to enforced.
María
Part I
Maria, nurses were always female, but hospitals employed male personnel to take care of intimate male needs like catheter insertion, prepping for surgery and the like (that was done in a private setting because patient's came in the night before surgery and were admitted).
1964 was the year that the Civil Rights Act was passed into law. and withing that law is something called Title VII.
The law says that an employee cannot be denied employment due to race, religion, or gender (and here's the crux of this issue) unless there was a bona fide job qualification that made it necessary that in order to perform the job or if the job removes privacy from the client that it might be consider a bona fide job qualification to hire one gender over the other. Example...if you worked at a lingerie store and were hired to measure and fit intimate women's apparel, it would be mandatory that the gender of that employee be female.
Somehow, the medical industry decided to ignore the privacy provision that the laws provides and became gender neutral. I don't think you'll find an orderly in a hospital anymore.
The rules were bent in such an egregrious way when same day surgeries, and cutting costs came into play. It is not unusual to be prepped for surgery in a room of several medical employees of both genders by being shaved publicly.
There has never been any consideration to the patient as a whole human being. Because these little details have been left out of informed consent forms, many have been traumatized even though there was nothing out of the norm (for them) and the medical industry took the ridiculous position of gender neutral and that as long as they can do the job, forget about the law, forget about what humiliates someone.
When all of these situations fit into the "standard of care", then there is no issue...or is there?
Today, it's not uncommon to find only female nurses in labor and delivery, mammography suites, etc. Lawsuits have been filed, some won and some lost.
Men have not had their intimate procedures regulated in the same way and that deserves immediate attention.
Even though some of these issues have been addressed, you are just as naked if you are having surgery during the prepping stage when they remove your gown, swipe antiseptic solution over the surgical site and this is done in full view of anyone who happens to be in the room, whether they are supposed to be there or not.
After the fact complaints do not help the traumatized patient. Very often their complaints are marginalized and the medical industry blames the mindset of the patient.
This together, with deviant behaviors that exist in all institutions has eroded the trust of some individuals that they avoid all healthcare.
belinda
Part II Belinda
This is not rocket science. Any medical professional who doesn't understand the ramifications of humiliation needs to take psychology classes and sociologists need to take a look at standard of care practices, divide them into categories and help the medical profession change things that need to be changed.
So many of us on the blog are the end result of being treated without respect, having our dignity stripped away and living with such pain that nobody unless they have experienced something similar, does not and cannot understand.
What we, on this blog are so upset about is the lack of recognition that change needs to be made. The onus of the change is really on the medical system because they know the harm they are causing, yet are resistent to change because they don't have to.
What does this say about these trusted individuals that we go to for healthcare? Some of us respect our individual doctors, do not respect the medical industry as a whole. This only hurts them as a provider and doesn't help anyone. The right of entitlement days are over. We do not have to accept what we do not want.
I will share that I am going through a catestrophic medical experience. I can also tell you that there's not a doctor I've seen, male or female that I have not had a discussion regarding this matter and have refused procedures that I felt weren't medically sound for me, but always put the equation out there, that because of my past experiences makes me a higher risk for complication.
So, when making these decisions and discussing the medical aspects only as reasons why I don't want to proceed, then add what I call "the icing on the cake", they really have to think about whether this is safe for this person. You know what, they have changed their minds about the way to proceed with me. That's because the medical statistics are against me, a higher incidence of complications due to abnormal raises in blood pressure (due to previous abuse in a medical setting) make me a poor candidate together with the medical issues involved. You would think this is enough to evoke system change. Sadly, it is not.
As explained before, the laws are there. The privacy dictate in the Civil Rights Act, preservation of dignity in the Patient Bill of Rights. Yet, nobody is paying attention. That's why I do not feel that any petition, going to the government. It has to come from a brave hospital system who takes this on as a way to gain trust in patients that would having patients running to their hospitals and the decency of the human spirit to recognize that we are not just a sum of our parts.
belinda
Belinda,
Thank you for the excellent points in your postings! You are right that many patients may be happy with their doctors who are willing to accommodate their wishes for modesty, but not happy with the medical industry. You could have a wonderful surgeon for an operation, but a very insensitive anesthesiologist.
In response to the below comments you made:
The law says that an employee cannot be denied employment due to race, religion, or gender (and here's the crux of this issue) unless there was a bona fide job qualification that made it necessary that in order to perform the job or if the job removes privacy from the client that it might be consider a bona fide job qualification to hire one gender over the other. Example...if you worked at a lingerie store and were hired to measure and fit intimate women's apparel, it would be mandatory that the gender of that employee be female.
Somehow, the medical industry decided to ignore the privacy provision that the laws provides and became gender neutral.
I too find it strange that the medical industry does not seem to think that many patients may not want opposite sex intimate care and “force” them to accept it. You are right that other industries are much more sensitive to patient privacy. While it is true that many hospitals do not employ male nurses in Labor & Delivery units, there are some hospitals especially in Utah that have male nurses in L & D and gynecological services. One hospital in Salt Lake City told a woman who underwent hysterectomy that she should accept male nurses since they were professionals after she was deceived that she would have an all-female team as she requested.
Misty
Misty, the medical industry, doesn't think, they simply don't care. Everyone has a right to feel same in a vulnerable setting, the right to determine who see and who doesn't see your naked body, the right to refuse anyone not directly involved in your care (even if a teaching hospital) and, they cannot refuse to treat you based on those needs. Everyone has requirements of one sort or another. It's important to stay firm in your convictions. When having a baby, there is something called a privacy tent. The only person under the tent is the doctor. Nobody sees anything.
That's an option too. The used to use leg drapes and only expose what was needed, now they expect women to let everything hang out in front of everyone. The idiocy of it, boggles my mind.
belinda
Just to show my visitors here that folks in the medical system are thinking about patient modesty and the need to keep their patients happy and willing to return for care, listen to this brief episode on ReachMD where a physician and a gown designer talk about the designer's gown product and other hospital coverings. Perhaps, with responses from discharge surveys of patients, if not out of concern specifically for patient emotional modesty comfort but for self-serving financial benefit, these institutions are seeking and making changes.
Click on the "speaker" graphic to start the recording. ..Maurice.
p.s.-if the link doesn't work, let me know.
This blog is primarily about ethics. The modesty/dignity issue has been the most discussed topic here. Recent posts have reminded me about some quotes Joseph Stalin (Soviet Union dictator from 1924 until his death in 1953).
I will show how these concepts used to seize and maintain power (despite the atrocities and violations of human rights) are used against patient choice, modesty, and dignity. In keeping with Maurice's theme of "Speaking To," we need to know what issues to address with providers.
Said by Stalin: "Everyone imposes his own system as far as his army can reach."
Commentary: Quite simply providers control healthcare, so they can decide what considerations to modesty, gender choice, etc. that patients receive. That is why the status quo (of healthcare) is so hard to change; it will take a (patient's) army and a major, messy conflict.
Said by Stalin: "It is enough that the people know there was an election. The people who cast the votes decide nothing. The people who count the votes decide everything."
Said by Banterings: "It is enough that the people know there is a Patient Bill of Rights. The people who are subject to the protocols and procedures decide nothing. The people who write the protocols and procedures decide everything."
Commentary: When patients complain, file grievances or charges, everything comes back to the standard of care. Providers by their own admission of being trained to be gender neutral and see intimate body parts as any other body part are incapable of realizing what is socially acceptable and what patients expect.
Said by Stalin: "The death of one man is a tragedy, the death of millions is a statistic." (said to U.S. ambassador Averill Harriman)
Commentary: This is an example of the hundredth monkey (effect). This is a phenomenon in which a new behavior or idea is spread rapidly by unexplained means and once a critical number of members exhibit the new behavior the new idea, it becomes a universally accepted principle. In relation to patient modesty/dignity issues, it becomes "the way we have always done it."
Fighting fire with fire: Stalin also had some quotes that have given me insight on how we need to speak to.
Said by Stalin: "Ideas are more powerful than guns. We would not let our enemies have guns, why should we let them have ideas."
Said by Stalin: "Education is a weapon whose effects depend on who holds it in his hands and at whom it is aimed."
Said by Stalin: "Print is the sharpest and the strongest weapon of our party."
Said by Stalin: "I believe one thing only, the power of human will."
Commentary: Ideas make a revolution. That is how we change things. We educate the public and providers using print, the internet, etc. This change has to be fought with human will. It is going to be a hard fight, but it can be won.
--Banterings
NOTICE: AS OF TODAY NOVEMBER 14, 2014 "PATIENT MODESTY: VOLUME 69 WILL BE CLOSED FOR FURTHER COMMENTS. YOU CAN CONTINUE POSTING COMMENTS ON "VOLUME 70.
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