Bioethics Discussion Blog: Patient Modesty: Volume 76

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Sunday, May 29, 2016

Patient Modesty: Volume 76







The narrative currently going on in the previous Volume 75 reminded me of what was being discussed back in November 2011 in Volume 45.  For my newer visitors, you might be interested to go back to that Volume or the ones previously to see that this issue of medical staff intentionally violating patient modesty was and still has been a "thorn" or more in the list of complaints about medical practice. ..Maurice.

Graphic: From Google Images


NOTICE: THIS "PATIENT MODESTY: VOLUME 76 IS NOW CLOSED FOR FURTHER
COMMENTS.  GO TO "PATIENT MODESTY: VOLUME 77" FOR FURTHER COMMENTS


178 Comments:

At Sunday, May 29, 2016 3:08:00 PM, Anonymous María said...

Don, hope she recovers swiftly and the best for your wife.
I disagree that we need (or should!) get used to public nu-
dity with either sex or any kind of cross-gender care (espe-
cially the intimate variety).
Especially is as Biker in Vermont suggest, is because of the
inadequacies of the health care system. Fit the shoe to the
foot, not the other way round. Otherwise, it's you that's ca-
tering to their needs, instead of them making the long over-
due adjustments to accommodate patient modesty.

 
At Sunday, May 29, 2016 7:59:00 PM, Blogger Don G said...

Hi Maria, I totally agree and thanks to this blog I feel that I can ask any question anytime and not allow this garbage to happen again. As I stated before to them it's routine to us it's huge and they need to realize that. I also want to add that the surgeon and his staff were amazing and I can't imagine they were anything but exceptional.
Problem was and is how the nurses see hip replacement and it's the same old same old instead of reading the charts and determine the proper protocol. I feel that too many times it's just business as usual and the best nurses don't treat it that way, unfortunately there is always one that had to ruin it for the others.
Thank you!

 
At Monday, May 30, 2016 9:30:00 AM, Blogger NTT said...

Good Afternoon Everyone:

Everyone here agrees there is a problem within the medical community that somehow must be resolved.

So how do we get the Medical community to work with patients and come up with a solution?

It's hard to work out a solution when they refuse to acknowledge their is a problem and talk about it.

I've written so many letters and made so many phone calls and all I keep running into is a brick wall.

Nobody from the medical community is willing to talk about this & come up with a viable solution to the problem more than likely because it's going to cost them some revenues.

Any solution must be built on the cornerstone of Choice, Respect, Dignity, and Privacy for the patient.

Choice. When a patient goes to a medical facility they will from the start of their visit without hesitation or reservation be offered the choice of same gender care to have throughout their stay at the institution.

Respect. Patients will be treated at all times with the same level of respect that you yourself would want to be treated like if you were a patient.

Dignity. Patients will never be exposed for any reason any more than absolutely necessary. While exposed, only personnel directly needed for the task at hand and pre-approved to be there by the patient, will be allowed in the area while the patient is exposed. In the case of any intimate care testing or procedures the patient will be asked again ahead of time if they wish same gender care givers. In the case of surgery, at the patients request, the facility will assign a same gender surgical team who will meet with the patient before surgery so they know who they are trusting their life to.

Privacy. All records of your visit, anything seen by or conversations had between a patient and any healthcare personnel, will be kept in the strictest of confidence.

Any healthcare employee found violating any of these cornerstone principles, will be immediately fired upon proof of violation and a record made in their file. If the violation is of a criminal offense nature, the facility will notify the authorities immediately.

These I think are the type of changes most people would like to see happen throughout the healthcare industry right now not just a place here and there. Make the entire system more patient friendly for BOTH men and women.

Yes these changes are not gonna be liked by a lost of medical people. For starters, patients will have to start being treated like people instead of a piece of cattle.

Yes it will cost money as they will have to start hiring an equal amount of qualified men and women to fill positions currently held mostly by women.

Those that do make the changes & hire the needed personnel, will see their revenue streams increase as people will not go where they won't have a choice, be respected, allowed to keep their dignity, and have their privacy protected.

These type of basic cornerstone principals MUST be drilled into all current & future medical students.

So the question becomes, how do we bring the healthcare system to the table or must we find a way & go over their heads to some sort of governing body that can force the changes on the industry? If we have to go over their heads, where do we go?

Lots to think about. Sometimes even gives ya a headache. :)

Best regards to all,
NTT

 
At Monday, May 30, 2016 6:45:00 PM, Blogger Biker in Vermont said...

NTT, what you suggest would be great but it would take Federal mandates to make it happen.

Pressuring the medical world in this regard is good and it can result in incremental improvements, but in the aggregate what you suggest is not likely to be embraced by the medical community. Women generally can find all-female medical staff for much of their care, and with half of the newly minted doctors being women, the one area where historically women had no choice is rapidly changing in their favor. It is all but impossible for a man to find all-male medical staff in most instances, and though the # of male nurses is very slowly increasing, the option of finding a male doctor is slowly decreasing as more women become doctors.

Even were there to be Federal mandate, the reality is that there are so few male nurses/techs out there. A couple million would be needed to balance the gender mix. A Federal mandate would start to change that gender mix real fast, but what are the odds? We're talking male patients, and anything that can be perceived as favoring men is about as politically incorrect as you can get. The nursing/tech industry would quickly go on the offense saying that what is being proposed is slandering the professionalism of female nurses/techs and is anti-woman. No politician is going to advocate for men being favored in the hiring practices of the medical world. In the current social/political environment men's rights are a non-starter.

The other alternative for change might be some form of class action lawsuit based on treating male patients less favorably than female patients. Hit them in the pocketbook. If there is an attorney reading this it would be good to hear him/her comment on this.


One aside here, the Feds have already come down on the side of effectively eliminating privacy in the sense that you describe it. Forcing medical records to be kept electronically has seemingly given everyone in the medical community access to them. When I had my recent colonoscopy with a doctor that I met for the 1st time the day of the procedure, he starts rattling off my family's cancer history. Not only hadn't I ever met him before I had never been a patient in that hospital even, yet he had all my records. Last year at age 62 I applied for life insurance to replace what I had at work. My insurance agent came back to me asking for more information on a surgery I had when I was 11. Yes, the insurance company knew about a surgery I had 51 years prior. There is no medical records privacy.

 
At Tuesday, May 31, 2016 5:42:00 AM, Blogger Biker in Vermont said...

In looking at my last post I can see how pessimistic I am about the chances of meaningful change on the topic of male modesty & choice in medical settings. After sleeping on it, I am thinking maybe we should be talking about how did the current vast (for us older guys) improvements come about? There are always going to be rogue individual medical staff who are inappropriate but for the most part men are treated respectfully. That wasn't always so. Men rarely have a gender choice when it comes to nurses/techs but women medical staff aren't as a matter of course doing what they did years ago.

I have previously described the respectful manner in which the several dozen intimate exposures have been done over the past 11 years by multiple female nurses. Yes I am self conscious being exposed in that manner but never have they needlessly embarrassed me. In my younger years I can't recall a single time that a female nurse ever treated me in a respectful manner.

At age 30 I had a vasectomy. Before the doctor came in the prep nurse commented on my genitalia and then proceeded to leave me completely undraped for the procedure. I had a shirt on and nothing else covering me. The male doctor didn't say anything so I assume it was normal in his eyes for patients to not be draped. I was too mortified to say anything.

At age 11 when I was in the hospital a nurse came in and without saying a word just pulled my gown off and started to bath me. No draping, no curtain pulled, no door shut. I was in plain view of anyone walking past the room and anyone coming into the room for my roommate. I was tall for my age, had already started puberty and more had the body of a 13 year old than 11. I was frozen in fear and couldn't utter a word.

School physicals were by female nurses with their female assistants and they didn't think anything was wrong with having pubescent and pre-pubescent Middle School boys lined up in the school's main hallway waiting their turn in just their tighty whities. They didn't see a problem leaving the door to the adjacent main office open, and having us stand naked right in that doorway where the women and anyone else coming in to the office could see us.

That's the way the medical world used to be for males. It doesn't happen that way anymore. Why? What caused the rather profound changes that brought us to where we are today? I'm thinking it was lawsuits, the threat of lawsuits, and the threat of criminal prosecution when it involved needlessly exposing children. So, maybe lawsuits are the way to go to effect another round of change?

 
At Tuesday, May 31, 2016 6:21:00 AM, Blogger NTT said...

Hi Biker:

Hope you're doing well.

"The nursing/tech industry would quickly go on the offense saying that what is being proposed is slandering the professionalism of female nurses/techs and is anti-woman."

A woman can have her privacy and a man cannot?

This shouldn't even get out of the hanger as all men are doing is asking to be treated with the same level of respect & dignity that women already get.

There's nothing "anti-woman" about it.

There are qualified men out there available for the jobs but they can't get past that "only females need apply" crap.

If it takes federal mandates to make change happen then maybe that's what needs to be done.

For years women screamed for equal rights & they got them.

Men are just asking for the same thing & if under the worse case scenario they have to let a few female nurses go here and there in order to hire some male nurses & techs so be it.

Change is never fun nor easy but nonetheless, change must come to the healthcare system for the benefit of all.

I've written some senators. One wrote back I presented some good points that might be worth looking into. Told them all to take the time & look at this site. See for themselves what's really going on.

On another point, that no medical record privacy comment is really scary. :(

Have a good day.

Regards to all,
NTT

 
At Tuesday, May 31, 2016 10:27:00 AM, Anonymous Anonymous said...

Hi everyone.
I.d like to comment to Biker In Vermont. We are miles apart on our opinion on respectful medical treatment.I wouldn't call it respectful having females doing intimate care to males without first asking if they are ok with that. The very fact that they don't offer a alternative or ask is disrespectful in itself.
You should be asking yourself how did we get to where it is normal to have female personal doing intimate care to males. They just assume males are ok with it. How many females will present you with a alternative ? Most just run their mouth and try to make you feel like there's something wrong with you. If your first reaction is there's something wrong here , your usually right.
So, how did we get here. I believe most men just don't speak up. They go along to get along.Most just go to the nearest clinic for whatever care they need. To drive across town or to a different town is just to much trouble. They need to know that they are not the only game in town. If they won't give you the choice of gender , they need to know that you will walk out and go elsewhere and complain to the appropriate people . The loss of revenue is the best way to get their attention. Don't look toward the government. They think it's ok for men to use the women's bathroom/ locker room. Lawsuits. Good luck with that. I agree 100% with NTT. If they refuse, go somewhere else but let the higher up's know why. The all male/female clinic's are popping up for a reason. Make it a point to use them or they won't be around for long.
Good day......AL

 
At Tuesday, May 31, 2016 1:37:00 PM, Blogger NTT said...

Good Afternoon:

Al you are correct in that most men WON'T speak up when they go to the doctor and TELL them their preference not to have female caregivers.

For the most part this happens because men in general do NOT want to appear weak.

This is a BIG reason why the medical community as a whole won't take guys that do speak up seriously. They get shamed into submitting to a female nurse.

My best friend was in the ER recently with what turned out to be a bad bladder infection. He had his wife with him.

A female nurse was going to cath him he said no not by a female. Nurse (older woman), came back "you afraid of a woman".

Wife lost it at that point. He told them coming there was a mistake & they left. His doctor gave him meds for the infection the next morning.

I went to see him that afternoon & his wife asked me was that the way they treat all guys that go to the ER.

I told her yes, men unlike women don't get a real choice because not enough men are speaking up when they go in. She replied that's wrong.

So Al, until more men speak up & federal mandates are put into place to force change, this is the crap we have to put up with or stay away from medical care.

Regards to all,
NTT

 
At Tuesday, May 31, 2016 1:42:00 PM, Anonymous Anonymous said...

NTT

Having worked in healthcare for decades I can assure you
it would not result in lost revenues, just a change in culture.

PT

 
At Tuesday, May 31, 2016 7:03:00 PM, Blogger Biker in Vermont said...

Al wrote:
You should be asking yourself how did we get to where it is normal to have female personal doing intimate care to males.

I don't know when it became normal but I'm 63 and there was never a time in my life that pretty much all the nurses weren't female. Our family doctor when I was growing up was male and as an adult I have always chosen male doctors but I have yet to have had a male nurse or tech at any time in my life. What has changed is that we went from the world of my youth and young adult years where every single one of my intimate exposures were done by female nurses without any physical privacy or respect to now where they do everything they can to minimize my exposure and be respectful.

I know that minimizing exposure and having the nurse otherwise be respectful is not enough for many men, and I understand that completely. I really do wish men had the same choice women have. At the same time I would hope that we can at least acknowledge that we have come a long way from the way it used to be, and contemplate how did those changes come about.

Al, you also noted being asked before intimate care is given. That is exactly how it was done for me last week when I had my periodic cystocopy. I had described it in another post, but before she lifted my gown she asked if it was OK and waited for my response and then she said it a second time before she actually did it, followed by her promptly covering everything but the penis being nothing else needed to be visible for the procedure to occur. Then when we were waiting for the doctor she maintained eye contact with me (vs looking "there") and I could tell that doing so was purposeful. Based on my dozens of experiences these past 11 years this is standard protocol these days. Contrast that to my example of the nurse bathing me when I was a pubescent 11 year old. Something caused the system to change along the way, even if men still don't generally have a real choice when it comes to gender.

If govt action isn't likely (my opinion at least) and lawsuits wouldn't work (I'm not convinced of this), then all that is left is men speaking up, and the women in their lives speaking up too.

 
At Tuesday, May 31, 2016 7:49:00 PM, Blogger Biker in Vermont said...

NTT, on the anti-woman thing I agree with you. I'm just saying what the nursing industry response would be. Sadly, given anything pro-male is politically incorrect these days, the nursing industry will have the media on their side. It would not be posed as men getting the same rights as women but rather as men disrespecting the professionalism of female nurses. It's not right but it is the way things are.

 
At Tuesday, May 31, 2016 8:26:00 PM, Anonymous Anonymous said...

Healthcare costs in the United States is close to 4 trillion dollars
spent annually. Almost 40 million hospital stays a year and there
are literally hundreds of different healthcare occupations one can
choose from yet, one occupation in healthcare stands out
exclusively as occupied by women, mammographer. No other
healthcare career in the United States can boast this. In contrast,
there are simply no healthcare jobs that men are employed
exclusively. Yet, I have never seen a physicians office, urology
clinic, general practitioner, orthopedist that employs one male.
What is wrong with this picture?

PT

 
At Tuesday, May 31, 2016 9:40:00 PM, Anonymous Anonymous said...

PT
Several years ago we called numerous different clinics ( Urology and GI ) asking if they had any male techs and if i could be assigned a male tech. Most said no , we don't have any , but 2 each said yes. One urology clinic said they have 4 male techs. Search and you may be surprised. AL







 
At Wednesday, June 01, 2016 5:12:00 AM, Blogger NTT said...

Hi Biker:

The nursing community would have people on their side until the guys actually need medical care. Then we'll see who's on who's side. :)

I think if guys really knew ahead of time that choice is practically non-existent, they'd push for change.

Because choice is practically non-existent, I see more males avoiding healthcare.

Hi PT.

I went to a physician at one time that had one male nurse in it. It was great. He automatically was assigned to any men that came in for appointments. Then they hired a young female NP. The NP didn't like the guy so eventually she got the ear of the physician who ran the office & she managed to get the male nurse ousted saying she could take care of all the patients save him money.

She saved him money alright. Needless to say most of the guys that went to him bolted including myself. He asked me one day in passing why i left & I told him "you dumped your male nurse". Some men don't want female caregivers.


Al, in my area if a doctor orders a scrotal ultrasound for one of their male patients and the patient wants a male tech to do the test, they have to drive 85 miles one way. Otherwise you'll have the female tech and her female chaperone for the test. That to me is insane with all the hospitals, and radiology clinics in the area.

Maybe Biker is right. Federal mandates or lawsuits more likely are the only way to get the changes we seek.

Have a great day all.

Regards,
NTT

 
At Wednesday, June 01, 2016 5:20:00 AM, Blogger Biker in Vermont said...

In reading the paper this morning a thought occurred to me. Many newspapers have guest editorials on all manner of topics in which lay people are advocating for something or simply expressing an opinion. This differs from Letters to the Editor in that guest editorials can be longer and more comprehensive in presenting the argument. This can be done on the male medical modesty issue, though one has to be careful to not trip the virtually automatic landmines of political correctness. By that I mean if you are just railing against unprofessional nurses, either the newspaper won't accept the article or your potential audience isn't going to take you seriously. Instead the approach that though most female techs and nurses work hard to minimize exposure and treat male patients with respect, men deserve the same option women have of having same-sex staff for intimate procedures. Including the argument that many men avoid healthcare because they don't want to be exposed to female nurses and techs, but that these men generally won't admit to that being the case, might be seen by some male physicians as a potential business opportunity to set up an all-male clinic. Nothing ventured, nothing gained.

 
At Wednesday, June 01, 2016 6:10:00 PM, Blogger Don G said...

First, I would like to thank everyone that contributes here! In my initial question I was curious as to procedures in the OR. Is a patient already sedated while laying there completely naked when being draped and prepped for surgery? Do the or nurses put up a cover while doing these pre op procedures and does the medical field allow students, sales people and non required staff to come in and out while this is happening? I know that there is a moment when a patient needs to be exposed for sterile reasons but how long? How many bystanders are just standing there? I would think that while in the or the nurses keep a patient covered unless absolutely necessary not to and that while the prepping is by eing done there aren't a lot of people just waiting to get started. It really is out of curiosity and I would like someone to give me a straight answer.

 
At Wednesday, June 01, 2016 6:23:00 PM, Anonymous Anonymous said...

Biker in Vermont said

" Instead that though most female techs and nurses work
hard to minimize exposure and treat male patients with
respect,"

This is where you are wrong, they do not. If they worked
hard at it then they would find a male nurse or tech. Never
does this occur and should you ask for a male nurse or
tech the typical response " I'm a professional or you do
not have anything I haven't seen before. Both responses
in my opinion are unprofessional. Look at state nursing
boards and see how many female nurses are reprimanded
for boundary violations. That is just a Nice phrase for seeking
sex from your patients. Show me one male trauma patient
that was not immediately covered up once the trauma was
over. That never happens, yet they make sure the female
patients are covered up immediately. State nursing boards
state that unnecessary exposure or inappropriate draping
is considered sexual misconduct. Would it be fair to say that
all those female nurses assigned to trauma are unprofessional.
Absolutely, I don't make the rules the state nursing board
does and this unnecessary exposure runs over to surgery,
the emergency rooms, all intensive care units and floor
patients. I don't need to read about it on this site, I've
seen it for 4 decades. Digital medical records is the best
thing that has happened in medicine for years, improving
efficiency, rapid retrieval of records, etc. Healthcare workers
require user ID's and passwords and those passwords require
changing every 2 months. The advantage to digital is it is
recorded who makes an entry into records. Take a guess
which gender exclusively violates patients hipaa rights.

PT



 
At Wednesday, June 01, 2016 6:52:00 PM, Anonymous Anonymous said...

Biker in Vermont

My opinion is this: Let's restrict our focus to only the female
nurses who do patient care, in other words female nurses
who take care of male and female patients. Female nurses
will always ensure female patients are always covered up,
provide adequate draping than their male patients. This
deviates from the " all patients should be treated the same
regardless of gender." For the nurse is now operating from
a cultural perspective or perhaps from a " men don't care
about their modesty" perspective. Thus I don't care or
whatever the motivating reason, nonetheless it is a
deviation from the standards of care. State nursing boards
say it is considered sexual misconduct to leave patients
exposed unecessarily, providing inadequate draping etc.
Remember the nursing board set these rules. And if over
50 percent of female nurses behave this way and I'm
willing to say they all do then the phrase all female
nurses are unprofessional must apply.

PT

 
At Wednesday, June 01, 2016 7:20:00 PM, Anonymous Medical Patient Modesty said...

AL: I have done some research and found some urology clinics do employ male nurses or assistants. Unfortunately, they seem rare. You have to keep on calling different urology clinics in different towns. You will notice our all-male clinic directory is very small.

NTT: it is horrible that a female Nurse Practitioner was able to manipulate the male doctor to get rid of the male nurse. I wonder if the female NP was offended that many male patients preferred the male nurse over her. She may have been a control freak. There are some female nurses who understand male patient modesty and are not offended that male patients want male nurses. My cousin who is a female RN agrees that male patients deserve to have male nurses if they want. I am glad you told your male doctor the reason you left his practice.

Biker in Vermont: I like your idea of writing an article in the newspaper raising awareness about male patient modesty. I agree with you that it would be best to not focus on misbehavior of female nurses for this kind of audience. The truth is many male patients do not want females to be involved in intimate procedures on them at all and professionalism & compassion of female nurses make no difference. I think it is important to raise awareness that it is much easier for women to get their wishes for an all-female team honored and how there are not many urology practices that have male nurses available. Of course, there are some areas of this country where it is hard for a woman to be guaranteed a female gyn would deliver her baby. I do not know if you saw this article in Chicago Tribune about medical modesty.

Misty

 
At Wednesday, June 01, 2016 8:16:00 PM, Blogger Biker in Vermont said...

PT, have you actually had intimate medical care in the past decade or is where you are coming based on very long ago experiences? I have been catheterized probably 3 dozen times over the past 11 years by a number of female nurses (mostly NP's)for cystoscopies, bladder cancer treatments, and two surgeries. At the beginning of the process I also had an abdominable & testicular ultrasound by a female tech. I have been self conscious each and every time but my exposure is always kept to the minimum necessary, and they have always followed the most professional protocols (asking for an OK before exposing me etc). As noted in other posts about my experiences growing up and as a young adult I full well know the difference between how things were done then and how they are done now.

Last month my wife had surgery in a very large teaching hospital. The recovery area she was sent to had a couple dozen patients and all of the men were fully covered (vs the stories of how men are left naked while the women are covered). Last month I had a colonoscopy. Only my butt was exposed, nothing else at any time was ever exposed (I was not sedated and so I know for sure). I undressed/dressed in private. During those times, the nurse would call to me asking if I was ready for her to come in. It was all 100% professional.

Of course in none of my experiences has there been a choice for male nursing/tech staff. I am fully cognizant of that, but I cannot accept being told I am wrong on how things are generally done now. I'm kind of a frequent flyer in the intimate care world at this stage of my life and I know how its done.

 
At Wednesday, June 01, 2016 8:51:00 PM, Anonymous Anonymous said...

Don G

I will answer your question for you. First, it depends on
the procedure and the mindset of nursing staff as there are
no set rules. Typically, the patient is brought into the OR
suite. Propofol an anesthesia is administered via iv that
puts you to sleep. Once the patient is anesthetized the
anesthesiologist will intubate the patient. The scrub tech
and/or the circulating nurse will prepare the patient for
surgery by exposing the area, prepping the area.
Thus, depending on the prep the patient may be exposed
for some time. OR staff not assigned to the case may
come into the room, students and or an associate of
the surgeon you may or may not know about. Note, often
when you sign the surgical consent it may read, " I give
Dr so and so or his associate permission to do so and
so. Yes, there may be reps in the room. The rep could
be an ortho rep, surgical instrument rep, depending on
the new instrumentation. Surgery suites are not as
private as people think. Hope this helps.

PT

 
At Wednesday, June 01, 2016 8:56:00 PM, Anonymous Medical Patient Modesty said...

PT,

I think it is also important to raise awareness about misbehavior of nurses and doctors in the newspaper. I think it should be done separately from the issue of how medical facilities need to work to accommodate patients’ wishes for modesty.

I am too disgusted by some misbehavior of some female nurses. I am sure you have noticed that newspapers tend to focus more on sexual misconduct by male medical professionals than female medical professionals.

Misty

 
At Wednesday, June 01, 2016 10:38:00 PM, Blogger Maurice Bernstein, M.D. said...

If political pressures can be simulated to attend to political solution by the unequal salaries of women in the United States compared to men, how about using the political system to make changes to stimulate an increase in the numbers of males in the nursing profession.

Maybe I missed the explanation here, but what exactly is keeping the male population in nursing low? Is it salary? Is it related to demands by patients? Is it simply "unmanly" to study and become a nurse?

..Maurice.

 
At Thursday, June 02, 2016 12:32:00 AM, Blogger Don G said...

Thank you PT I will make sure I read every single form that myself or a loved one is asked to sign. Knowing that we can ask these questions does help and I feel that patients when possible (non emergency situations) just need to speak up about these issues. I still think that the medical field needs to realize that for us it's nut just business as usual and give every patient complete respect when it comes to exposure. There is no reason that anyone other than the prepping team have to see a patient completely naked especially sales reps and others that are just dropping in. I hope that more people read these blogs and understand just how patients feel and the anxiety that they have as a result. Just because they're asleep doesn't mean it's ok. Once properly prepped and covered of course our experienced doctors should be showing the students how to do certain things as they will be the future of medicine. Again, thank you to all that contribute here! It's a start and maybe with knowledge more patients will express their concerns.

 
At Thursday, June 02, 2016 3:52:00 AM, Blogger Biker in Vermont said...

Good question Dr. Bernstein. I see more and more families where the wife working as a nurse or school teacher makes more money than the husband who oftentimes is self employed in some fashion in a job without benefits. Logic would dictate that more men would see nursing and the medical tech fields as career opportunities. I think the answer could be as simple as men seeing women-dominated fields as being for women and not them.

A few years back a self-employed neighbor of mine went back to school and became a nurse in his late 50's. When the economy tanked the last time his little business went with it, and he knew he needed to re-invent himself. He's healthy and fit and will likely work long past normal retirement age.

 
At Thursday, June 02, 2016 3:59:00 AM, Blogger Biker in Vermont said...

Dr. Bernstein, on your other point about political pressure, I think the issue is that many men who haven't been in the intimate medical care world aren't even aware of the issue because they haven't lived it, many (most) others assume the "man up" pose and silently accept this is the way it is, some are just not modest, and the rest avoid getting medical care. It doesn't seem that there is a critical mass yet who are willing to speak up. That may change as the younger generation of hyper-modest guys start aging into the medical system. The current batch of older guys grew up in a very different world and are grateful things have changed in a way that at least they can now expect to be treated respectfully (vs their younger years when they were not). It hasn't even occurred to many (most) of the older guys that they can even request male caregivers for intimate procedures. I myself have only fairly recently come to realize that I can do that myself.

 
At Thursday, June 02, 2016 4:38:00 AM, Blogger Biker in Vermont said...

I would like to add to Don G's question about operating room protocols. I have read many accounts where medical staff assume that a patient doesn't (or shouldn't) care who sees what when they are not conscious in an O.R. That is illogical to me because it is still my body which at a minimum is being seen by people who don't have a need to see it. Even worse, it is potentially subject to approving or disapproving judgements and possible commentary, things I would stop in an instant if I were conscious. I too would love to better understand O.R. protocols and know better what is reasonable to ask for prior to being put under.

This is an issue for me because shortly being put under and brought into the O.R. for bladder surgery (and after having been ambushed by 5 interns/medical students (not real sure what they were, just that 4 were female & 1 male) for an intimate exposure surgery, the O.R. Nurse tells me "we're going to get to know each other real well". At the time I was naive enough to think maybe she'd be involved with my care after the surgery and so I was wasn't alarmed. It was only afterwards that I realized she perhaps found me attractive and was looking forward to doing my penis prep. Alternatively maybe it was just her way of trying to lighten the mood giving the nature of the surgery, her thinking maybe I'd find that comment funny. She had greeted me in the waiting area by singing Happy Birthday (it was actually my birthday). All these years later I still wonder what happened once I was put under.

 
At Thursday, June 02, 2016 5:38:00 AM, Blogger NTT said...

Good morning everyone:

Hi Misty.

I am in total agreement with you. ANY medical professional be he male or be she female is caught abusing their patient, should have their name plastered all over the newspapers & on TV news casts.

Prosecutors should lose their ability to take any type of plea deal with these pervs then after a very public trial, sentence these people to prison no questions asked along with permanent loss of their license.

Dr. Bernstein,I feel what's keeping men from making real inroads in the nursing profession is the attitude of many of the women in the profession.

They don't want them there so they make working conditions miserable enough that they leave. Especially if a female was let go in favor of the man.

I do believe that of the men & women already in the profession, some women are paid less then the men for equal work with equal education. Female nurses have been screaming about this issue since men started getting into the profession.

Maybe the answer is to address the equal pay for equal work & the hiring of more men for male patients together.

What I can't understand is they assign female techs to say do the mammograms even if a male is available to do it. They do this without any thinking whatsoever.

However, even if a male sonographer is on staff they don't automatically assign him to handle male patient scrotal ultrasounds. They assign a female again without any consideration to the guy. They should assign him without hesitation unless the patients themselves asks for opposite gender care?

It make no sense.

Maybe tie fixing the women's wanting equal pay issue to fixing unresolved male dignity/modesty issues & you might be able to solve two problems at the same time.

So how do we move this forward & start some meaningful talks that will solve the issues at hand?

Hi PT.

To keep unnecessary viewing in the OR to an absolute minimum could one write something on the informed consent form?

Something along the lines of;

While, my body is in the OR, I consent to only my immediate surgical team in the room. I do NOT consent to students, sales reps, or any other hospital or non-hospital personnel in the room while my body is in theater.

Thanks.

Respects to all,
NTT

 
At Thursday, June 02, 2016 7:43:00 AM, Blogger Maurice Bernstein, M.D. said...

As I have repeatedly, in many Volumes, written to this thread, I want my visitors to consider the real possibility that virtually all the comments regarding the negative experiences with regard to personal or family modesty in the process of medical care and attention may represent the views of statistical outliers. I have again many times noted that in my 50 plus years of internal medical practice, I have never received a complaint from my patients regarding an issue of personal physical modesty related to themselves or family members either based on their experience with me or with other physicians or others as part of their medical care. Zero!

Now, also, I may have noted this on a Volume previously, but my wife who happens to have been an RN on a hospital ward for many years (retired a few years ago) has never had complaints from patients about their modesty concerns. She has catheterized many male patients over the years and she said when one has a distended symptomatic bladder, her patients never expressed concern about whether their genitalia was being exposed or handled by her.

Think of this: when a patient is ill and symptomatic and concerned as to what is going on and how the illness is going to be treated and whether they will be cured, the necessity for care trumps concerns of physical modesty. It is therefore my conclusion that there is a real possibility that the comments written here by my visitors which representing a real and distressing issue regarding personal modesty and dignity, that the comments do represent a group of statistical outliers.

However, notwithstanding that personal conclusion (which obviously needs more study than my own personal conclusion), there is no doubt in my mind that the medical system should be attentive to all their patients outliers or the general population and that is why I have repeatedly been calling here for attempts to awaken the system that it needs to pay attention and accommodate the outliers since they have the same illnesses that required attention and care as the majority.

Sorry, if what I have written is annoyingly familiar to some long term readers here but I had to repeat this in view of what appears to beyond Misty and PT, as examples, a more recent group of participants discussing patient modesty on this blog. ..Maurice.

 
At Thursday, June 02, 2016 9:11:00 AM, Blogger Don G said...

I feel that everyone here has legitimate concerns. The most important thing is knowing that as patients we can and should speak up as it relates to modesty. I still think the medical world needs to be more respectful of patients and keep them covered except when necessary not to be. As far as the male/female issue, if it concerns you then speak up, no one is going to realize your concern if you don't. Also as I've said previously, th them it's routine and to us it's huge. Speak up!

 
At Thursday, June 02, 2016 5:10:00 PM, Anonymous Anonymous said...

Some interesting parallels I read about in various forums
regarding healthcare workers and their experiences. First,
I have to say that very few complaints that patients make
actually get back to those responsible for causing the
distress in the first place. Having worked in hospital
management I can attest to this first hand. Secondly,
you might read say as an example on Allnurses a nurse
might say, " well I don't know about other nurses but
I always drape my patients and provide privacy."
Really, you work side by side with your co-workers and
yet you don't know about them! Just because patients
don't complain doesn't mean they are ok with it. Prior
to the mid 90's patients really never had an outlet or
any kind of real mechanism to voice their concerns.
Now you can submit an on-line complaint to the state
board of nursing, state medical boards, the Joint
Commission, Hipaa , the hospital association as
well as a slew of others. Why? Because people
need to be held ACCOUNTABLE for their behavior!!!

PT

 
At Thursday, June 02, 2016 6:10:00 PM, Anonymous Anonymous said...

Biker in Vermont said

" Last month my wife had surgery in a very large teaching
hospital. The recovery area she was sent to had a couple
dozen patients and all of the men were fully covered( vs
the stories of how the men are left naked while the women
are fully covered.) "

Recovery also called PACU should have all their patients
covered due to something called pre and post operative
hypothermia. It is a now mandated standard of care. I
would certainly hope they were covered and so should
risk management and the joint commission although
certainly didn't happen 30 years or so ago. Ask me
how I know.

PT

 
At Thursday, June 02, 2016 6:43:00 PM, Blogger A. Banterings said...

Maurice,

OUTLIERS????

Have you forgotten all the research and news articles presented (ad nausium) by Ray, Dr. Sherman, Doug Capra, Misty, Kevin, myself and others that show these are valid views?

Have you forgotten Volume 68?

You and your wife never had complaints: Absence of proof is NOT proof of absence.

Let's start again with a 2015 study: Emotional harm from disrespect: the neglected preventable harm .

How about my favorite Canadian publication: Handbook on Sensitive Practice for Health Care Practitioners:
Lessons from Adult Survivors of Childhood Sexual Abuse
?

What about "cultural competency" as a part of the medical education? I am sure that this has even changed your curriculum in the last few years.


-- Banterings

 
At Thursday, June 02, 2016 8:11:00 PM, Blogger Maurice Bernstein, M.D. said...

Banterings, as I have repeatedly stated here since the beginning this thread 10 years ago, I was totally unaware of the disgraceful behaviors by healthcare providers with regard to patient modesty issues as described here. This was an education because none of my patients informed be about this issue. Since I have not found any statistics about the frequency of this misbehavior or the frequency of patients rejecting appropriate care because of issues of modesty, though not denying that it wasn't occurring, nevertheless I have considered that it was possible that my visitors with their experiences were possibly statistical outliers. What is needed is a valid statistical study. However, I say again, nevertheless, any patient treated by healthcare providers without concern about potential modesty issues or ignoring communicating with the patient about such issues is wrong and unprofessional and I teach this concept to my first and second year medical students. Attention to MODESTY is on the top of our physical exam checkpoint lists that the students must follow. But again and nevertheless, show me the statistics. Banterings, I didn't find the statistics on physical modesty in that 2015 study you linked.
Again, statistics of majority vs outlier is less important than all healthcare providers should attend to patient modesty to ALL patients regardless of the statistics or patient input and that is what I have followed throughout my medical career. ..Maurice.

 
At Friday, June 03, 2016 2:20:00 AM, Anonymous Medical Patient Modesty said...

Dr. Bernstein,

I wanted to respond to the below comments you made about not receiving complaints about patient modesty.

I have again many times noted that in my 50 plus years of internal medical practice, I have never received a complaint from my patients regarding an issue of personal physical modesty related to themselves or family members either based on their experience with me or with other physicians or others as part of their medical care. Zero!

Most male patients who are modest who had you do genital exams on them without a female assistant present would likely not complain because they got their wishes for a male doctor. There are many women who are uncomfortable with a male doctor doing intimate exams. Those women would never go to a male doctor for intimate exams so this is why you have not heard complaints from them because they simply did not come to you. Many women flock to a gynecologist and not an internal medicine doctor for female health issues. There are so many female gynecologists in Los Angeles area and women just choose to go to them. I am sure that all of the female patients who let you do intimate exams on them most likely do not care about their modesty and this is why you did not hear complaints from them.


Now, also, I may have noted this on a Volume previously, but my wife who happens to have been an RN on a hospital ward for many years (retired a few years ago) has never had complaints from patients about their modesty concerns. She has catheterized many male patients over the years and she said when one has a distended symptomatic bladder, her patients never expressed concern about whether their genitalia was being exposed or handled by her.


It is much harder for men to speak up when they are uncomfortable with female nurses because they feel intimidated by the medical industry and are often afraid that they will be labeled as weak. I have interacted with a number of men who were uncomfortable with female nurses doing intimate procedures on them, but they did not speak up. Some of them talk about their regret in letting female nurses do intimate procedures on them afterwards. I also have seen some men who were traumatized and embarrassed by female nurses doing intimate procedures on them suppress their wounds. Many men falsely assume they have no choice and want to be “tough”. Remember that many patients are taken off guard when they are sick because they are so worried about their illness that it makes harder for them to stand up. The truth is your wife probably had some male patients who complained to their family members or friends later on. I am sure that if some of your wife’s male patients were offered the option of a male nurse, they would have chosen him over your wife to catheterize them. I wish that all hospitals would offer all patients the choice of same gender care for intimate procedures. We would see more patients willing to get the medical care they need. Even some men have decided to stop their treatments for cancer due to lack of male nurses.

Misty

 
At Friday, June 03, 2016 7:19:00 AM, Blogger NTT said...

Good Morning All:

PT, if very few complaints that patients make actually don't get back to those responsible for causing the distress in the first place is true, then the system will never get better and after one bad visit, more people will walk away from getting healthcare.

Sad situation.

Regards to all,
NTT

 
At Friday, June 03, 2016 9:10:00 AM, Blogger A. Banterings said...

I must do this in 2 parts:

Maurice,

To answer your question about severity of the problem, I have to say it is rampant in the healthcare system. The system is designed NOT to accommodate. Look at any chaperone policy, they do NOT require choice of gender of the chaperone, they only recommend it if available. There are no requirements for staffing levels based on gender either, this is seen in the large percentage of females in nursing. The truth is that healthcare does NOT want to know and really doesn't care (unless practicable).

As you and I have discussed previously, the issue is NOT modesty, but that of dignity. (Reference: Patient Leaders Urge Hospitals To Eliminate Emotional Harm By Focusing On Respect And Dignity For Patients) Modesty implies a patient asking for more than they deserve (as in being too modest).

Dignity is what is owed every human being. In terms of dignity, healthcare comes up very short. George Annas in his book "Judging Medicine," labels the modern hospital a "human rights wasteland."

This AMA JOE article (Dissecting Health Disparities in Cardiology Patients) addresses "what is due [owed]" as a matter of justice. It also supports the concept of gender equality in healthcare (gender choice being an [unmentioned] part of that.

Moving forward from the standpoint of dignity, the BMJ of Quality and Safety in 2015 looked at the "Emotional harm from disrespect: the neglected preventable harm" that the BIDMC program addresses. What you call "modesty" is part of the greater issue of dignity addressed here.

Perhaps one source of the statistics you seek about gender can be seen in patients of nonconforming gender ( LGBT). A resource from the National Women's Law Center (Health Care Refusals Harm Patients: The Threat to LGBT People and Individuals Living with HIV/AIDS ) gives statistics to healthcare providers refusing to care for LGBT patients. This is absolutely relevant to gender!

—Banterings

end of Part 1

 
At Friday, June 03, 2016 9:10:00 AM, Blogger A. Banterings said...

Part 2:


HERE ARE SOLID STATISTICS:

One study found that androgynous lesbians are more likely than those with more traditionally feminine presentation to avoid medical care out of fear of disdain by healthcare practitioners (Clark MA, Bonacore L, Wright SJ, Armstrong G, Rakowski W. The cancer screening project for women: experiences of women who partner with women and women who partner with men. Women Health. 2003;38(2):19-33.) —for good reason.


Ruth McNair writes that such discrimination can reduce the patient’s trust of her care and caregivers causing patients to avoid healthcare. (McNair RP. Lesbian health inequalities: a cultural minority issue for health professionals. Med J Aust. 2003;178(12):643-645.).

Note on this AMA JOE poll (Sex and Gender in Medical Care), when you View Results, in question #3, 40% of respondents favor men's and women's centers. Granted only 148 respondents, but it is an AMA site.

A 2005 study published in Pediatric Emergency Care("Doctor" or "doctora": do patients care?) to determine whether pediatric patients or their parents have a preference for physicians of a particular gender.

A total of 200 children aged between 8 and 13 years presenting to our pediatric emergency department for laceration repair were enrolled. With the knowledge and consent of their parents, the enrolled children were given a short questionnaire. They were asked, if they had a choice, would they prefer to have a male or a female doctor or would they prefer the doctor with the most experience. Their parents were also then given the questionnaire.

Results:
Most children (79%) preferred a female physician for their sutures, whereas parents overall (60%) appeared to prefer a male physician. The children did not appear to care if the physician was the "best." Surprisingly, many parents also chose physician gender rather than physician experience. —a definite preference. Please note that sutures are very different from intimate care. We can only assume that the rates would be higher.

Perhaps another patient preference may shed some light on gender choice: Patients’ Racial Preferences and the Medical Culture of Accommodation. Although unethical and illegal in most cases, it is very common and often accommodated. One can safely assume that bigotry (with its attached social stigma) occurs much less than gender preference (which is celebrated for women in healthcare).

After all I have just cited now (and over the years), by the fact that you have continuously faced this criticism for 10 years, you can NOT deny that this is a significant problem facing healthcare.


—Banterings

 
At Friday, June 03, 2016 6:16:00 PM, Anonymous Anonymous said...

A. Banterings

Part 1. Outstanding, no one could have said it better.

I'll add that for hospitals whose core values mention dignity,
tell me exactly how do they expect to provide, ensure that?

PT

 
At Friday, June 03, 2016 7:42:00 PM, Blogger Biker in Vermont said...

Don G., you are 100% right. People need to speak up. Regretfully I don't think most men at least know that is an option in a medical setting when you are dealing with intimate care. I've only recently come to realize that I can speak up.

Misty, excellent summary of the situation.

Banterings, seeing your references to BIDMC studies caught my attention because that is where all of my bladder cancer repeated treatment has been. I didn't read everything but I'm not seeing where their studies deal with opposite sex intimate care. You maybe seeing what you want to see in their studies.

Dr. Bernstein, I have seen several times in various places the example of men who are sick and in pain that need to be catheterized not caring who does it or what they see. That is similar to the argument women nurses make concerning male modesty.... they jump right to life and death situations in the emergency room. I have been catheterized several dozen times these past 11 years and not once was I sick or in pain when it was done. Similarly most intimate care treatments or exposures involve people who are not in dire straights. Many men don't care who sees what, most others are perpetually in the "man up" mode afraid to show weakness, and some just avoid healthcare if at all possible. Only a few will ever make an actual request or voice a complaint.

 
At Saturday, June 04, 2016 5:32:00 AM, Blogger NTT said...

Since the medical community knows most men & some women won't say anything about being modest why don't they just eliminate the need to embarrass someone and just put a line item on the intake paperwork you have to fill out that asks do you require same gender care.

A simple check mark on a line item.

The paperwork would serve two purposes.

For the client they get a way to express their wishes without any bedside confrontation with a nurse and/or tech.

At the same time the medical facility gets a gauge as to just how much they might want or need to adjust their staffing to meet the needs of their patients.

A simple starting point to maybe resolving a major problem.

Have a great weekend all.

Regards,
NTT

 
At Saturday, June 04, 2016 10:04:00 AM, Anonymous Anonymous said...

NTT said

" For the client they get a way to express their wishes without
any bedside confrontation with a nurse and /or tech."

There should be no confrontation with any healthcare
worker, provider etc.

This is direct from the state nursing board in the state which
I reside.
Behavior which is considered unprofessional conduct
: Neglecting or abusing a patient or resident physically,
verbally, financially or emotionally.
: Violating the rights or dignity of a patient or resident.

Would you want someone who is going to stand there
and argue with you about the care you recieve. Sounds
like verbal abuse to me.

PT

 
At Saturday, June 04, 2016 10:47:00 AM, Blogger NTT said...

Hi PT:

I agree it is abuse but we all know it happens.

Sometimes when a patient doesn't "go with the flow" and allow whomever is on duty to take care of you they will go to great lengths to shame the patient into submission. I've watched it happen. Some in the medical community are real artists at it.

The real problem is the patient won't report it because they are afraid of what might happen to them if they have to come back to the same facility in the future.

Take care PT.

Regards,
NTT

 
At Saturday, June 04, 2016 10:57:00 AM, Anonymous Anonymous said...

NTT: The paperwork you suggest may be a good start. Perhaps it doesn't already exist because the medical profession dorsn't intend to change but rather intends patients to change. They may anticipate that patients will eventually make no distiction between caregivers regarding sex and orientation as is likely already the case for caregiver race, ethicitu, national origin, and religion. REL

 
At Saturday, June 04, 2016 5:34:00 PM, Anonymous Anonymous said...

This doctor who performs vasectomies must believe some men care about gender. On his web page it states he performs them without the embarrasment of a female assistant present.

https://no-scalpelvasectomy.com/patient-information/no-scalpel-vasectomy/

 
At Saturday, June 04, 2016 6:18:00 PM, Blogger Don G said...

No one should ever be afraid to speak up! In societal situations people have no problem voicing their opinion to a waiter, the bank teller or whomever is giving them service. The medical field should be no different, we are paying for a service and our wishes should and can be upheld. No matter what the circumstance medical people need to understand that we don't want to be exposed unless absolutely necessary. Just because we're "patients" and they've seen it all doesn't make us feel any better. I see no reason for a patient to be completely exposed at any time, even when prepping and draping the patient should an can be covered. This is causing people to shy away from care that they need and as long we allow it to continue the medical world will just keep doing it. As I have said before and I do want future doctors to gain experience from their predecessors but there is no reason a patient lay there completely exposed for the entire room when not necessary. As others have posted, how would these medical professionals feel if it were them, their wives, daughters, sons or other family members. I think that more patients need to step up and voice their concerns and let the medical world know that just like anything else, we are paying customers and our wishes need to be upheld. Thanks again to everyone that contributes to these posts an d especially
Dr Bernstein!

 
At Saturday, June 04, 2016 7:26:00 PM, Anonymous Anonymous said...

Modesty issues are present for both men and women today. There are more men in the radiology and nursing fields. I have had a few upsetting issues at our local clinic. One with CT where a male tech called my name, didn't speak, took me to room and told me if I had a bra on take it off. I asked him to leave room or take me to a change room. He saId I will stand behInd the wall. The wall was glass. I turned and discretely removed my bra. When done he told me to put my bra back on and he would show me the way out. I was in tears and told him I would go to the restroom to put my bra on and found my way out. My pulmonary Dr wanted to know what was wrong and I told him. He was furious. I choose my doctors. I have a relationship with my doctors. I don't the people doing ct scans.

The other happened when I had to have a stress test. I called to verify that I would not have to take my bra off because my paperwork said to wear loose clothing to do test. I was assured I would not have to remove bra. Wrong. Again a man first asked my bra size and then told me to change to just a flimsy gown. I feel awful like this and sitting in a room with men while waiting for next part of test.

My husband had to have TURP. We neither one knew what position he would be in or that a CNA would prep him and put a catheter in him. Can't the doctor do that? To me the medical profession is turning all the care of scrubbing, and catheterization to people who have less education than they should have to touch our private areas. In our state an ma or cna can get a degree in 9 months or less. Also get from a technical school. Male nurses or doctors should do mens catheterization.

My husband now has to have his knee replaced. We went to a doctor our friend referred us too. We really liked him but when we called his nurse to get thi gs set up she told us exactly the opposite of what he had. We asked if he could have all male team. She said positively no, we are all professional". Problem is I remember how professional that place is as I worked there years ago and recall how they talked about things they shouldn'tt and laugh about it.

Another issue we have is my husband doesn't like do do the talking or make appointments. She told me she couldn't talk to me. I relayed message to him. He took phone and told her she was to talk to me. She didn't like it but did. She called a week later to see why we hadn' t sent paperwork in or set up surgery and I told her we were going to someone who said they will be treating both of us and we didn't like her attitude.

 
At Saturday, June 04, 2016 7:37:00 PM, Blogger Maurice Bernstein, M.D. said...

As I have been periodically-repeatedly stating on this blog thread it was time--it IS time for my visitors here to something more than chew over the dignity-modesty issues of patients and DO SOMETHING about it. As is mostly agreed upon here (and to which I agree) it is important that all patients be told that if they are unhappy with how they are treated regarding dignity-modesty or if they are concerned about how they MIGHT be treated, they should SPEAK UP to the healthcare providers and the system. There is NO medical professional rules that I am aware of that gives the medical profession any power to seal the lips of their patients. In fact, we teach the medical students to LISTEN to their patients. But the students and later as physicians, nothing will be accomplished in this regard unless the patient will SPEAK UP and not only provide a history to work with to establish a diagnosis but also
SPEAK UP about the process itself of making and treating a diagnosis. That means, SPEAKING UP if the physical examination is uncomfortable and SPEAKING UP if the approach to diagnosis or to treatment is uncomfortable. Physicians and nurses are not mind-readers.

So, I say again, my visitors should not be satisfied with communicating amongst themselves on this rather limited blog---but to do something more: to discuss ways to SPREAD THE WORD to MILLIONS of potential patients: SPEAK UP, SPEAK UP, SPEAK UP!
You are on the right track--so get to work! ..Maurice. p.s.-hopefully our current group of thread participants will find a way to start the education process.

 
At Saturday, June 04, 2016 7:50:00 PM, Blogger Maurice Bernstein, M.D. said...

To the two Anonymous writers to this thread today, if you want personalized responses here, please use a pseudonym at the end of your future postings. ..Maurice.

 
At Saturday, June 04, 2016 8:07:00 PM, Blogger Maurice Bernstein, M.D. said...

Regarding what the anonymous female writer noted today in her posting, it is unprofessional for a doctor or office staff to reject communication with a patient. If the set up for a procedure is unacceptable for the patient and because of office issues, the patient cannot be accommodated, this information should be discussed without anger by either party but with the goal of education by both parties regarding request of the patient and the limits set by the professionals. ..Maurice.

 
At Saturday, June 04, 2016 8:10:00 PM, Blogger Biker in Vermont said...

Dr. Bernstein, you are correct of course on the "speak up" message and I am embarrassed to say that until fairly recently there was just something different about medical settings that caused me to not realize that yes I can. And yes I will going forward. In fact I did when I had my recent colonoscopy. Before signing the form and undressing I asked if they were looking to have any students or other observers in attendance that day. No. I then asked if other staff were allowed to enter the room once I am on the table. No. I was otherwise prepared to speak up if anything concerning my privacy wasn't up to the standards I have come to expect. There were no issues at all, though for me this was the very 1st time I ever advocated for myself in this manner in such a setting. I told them why I was asking the questions, including "I'll be the only naked person in the room". The nurse told me she completely understood where I was coming from and said that they take patient privacy very seriously. I really think that is the norm these days, even if same gender choice is still not an option. On the student issue I explained there is a difference to me as to whether the student is a high school girl studying to become an LNA (Vermont's version of a CNA)or it is a medical student from Dartmouth.

When I had my cystoscopy last week I was ready to speak up, but as usual for that practice, there were no issues at all. All that was different was that I was ready to speak up.

Late this summer I will have a follow-up colonoscopy at a large teaching hospital (not where I had the prior one) and so again it will be a new setting and I will ask my questions beforehand.

I just got word this week from the urologic oncologist that the last PSA indicated there will be more prostate exams in my future and so I'll be ready for them too.

Of course I am sitting here wondering why the only medical issues I have all involve intimate exposure. Oh well.

 
At Sunday, June 05, 2016 3:25:00 AM, Anonymous Medical Patient Modesty said...

To Anonymous Female at 7:26 PM on Saturday, June 4, 2016: As the founder of Medical Patient Modesty, a non-profit organization that works to educate patients about their rights to modesty in medical settings, I am so sorry to hear about your bad experience and your husband’s experiences. I suggest you both consider going to other medical facilities that would be more sensitive to your needs.

I agree with you that a male doctor or a male nurse should do men’s catheterizations. Male doctors actually used to routinely do catheterizations on men.

As for knee surgery, it is possible for a patient’s private parts to never be exposed. There is no reason why a patient should not be allowed to wear 100% cotton underwear for this procedure since the knee is being operated on. There are some alternative non-surgery options your husband might want to consider. If you all decide to move further with knee surgery for your husband, there are some steps you both need to take that his private parts are never exposed to females. Surgery patients are very vulnerable.

Please contact me via email privately through MPM’s contact page and I would like to help you with some of your concerns. Click on the link that says Email For General Information or fill out the contact form.

Misty

 
At Sunday, June 05, 2016 3:39:00 PM, Blogger NTT said...

Hello All:

Dr. Bernstein wants us to spread the word.

For most people, they don’t believe something is really happening, until it happens directly to them.

Case in point, many of my male friends were of the belief that if the day came they need a male related test or procedure, the medical facility will just automatically assign a male to do the test. They laughed at me when I told them that not normally the case. A couple even said I was nuts.

Then the day came for one of them and he found out just how the system currently really works. He was shell shocked. LOL. Now he KNOWS and he is telling his family and friends.

So one way we have to spread the word is by word-of-mouth to family and friends.

Next I called a few hospitals in my area including a huge teaching hospital.

I asked various people there if I were to need a test or procedure done at their facility is there a line item on their patient intake paperwork that I could check that tells the staff I require same gender caregivers while I’m at their facility?

As expected, they ALL said no. But that’s okay. By talking to them I may have planted an idea in someone’s head.

Getting answers from hospital administrations is next to impossible. They never return my calls, letters, or emails. I called the Joint Commission and my call was just shuffled around until they dropped the call.

I’ve emailed my state senators about this issue asking for federal mandates to address the issue. One liked the idea while the other one (won’t be voting for him again), completely ignored me.

Who and/or where else at the federal level can I/we write/email to in order to ask for help and/or plant another idea in someone’s head there is a problem in the system that needs looking into.

It’s very hard to spread the word far and wide when like I said most people don’t think about this before they go in for a test or procedure. Then it’s too late unless they speak up.

Was thinking about the allnurses website but as we all know, the minute you open up a topic like patient modesty over there, the powers that be kill it. :)

On a side note. PT you have many years in the industry. If a patient has surgery, is there a document the patient can get their hands on after they’ve been discharged that shows them exactly who (hospital personnel and otherwise), was in the operating room during their surgery? Thanks.

Have a wonderful evening wherever you are.

Respects to all,
NTT

 
At Sunday, June 05, 2016 4:45:00 PM, Blogger Biker in Vermont said...

NTT, yesterday I had the occasion to meet a college student who is looking to become a PA. The context of the meeting had nothing to do with medical issues let alone privacy but I used the occasion to say I am glad to see young men going into the field on account of how hard it is for modest men to have male medical staff other than the doctor. I told him that there are many men who avoid healthcare to their detriment due to modesty concerns that the medical world isn't addressing. I could tell he was intrigued by this in that he was totally unaware of the issue. For me, it was the planting of a seed that may one day bear fruit.

 
At Sunday, June 05, 2016 7:01:00 PM, Anonymous Anonymous said...

NTT

There is a document in the medical records and that document will only say who the surgeon or his/her associate/ associates
are. It will say who the anesthiologist is as well as the scrub tech and the circulating nurse is. It will say if there was an xray
tech and what their name is. It may or may not say if there was a rep in the room. It will NOT say who popped in and out of the
room. This document is really for legal reasons only and is not meant to document the head count. It will NOT record the names
of observers or students. One of the hipaa laws is the availability of your medical records. Any medical facility must release your
medical records to you within 30 days or face a Hugh fine! What else would you like to know?

PT

 
At Wednesday, June 08, 2016 12:01:00 PM, Blogger Biker in Vermont said...

In the theme of taking action rather than just complaining, something that some can do is speak to Human Resource Depts. about pre-employment & worker's comp physicals and employer-required drug testing. Job applicants are not going to make waves over intimate exam issues but those of us who have access to HR decision makers can speak up.

What prompts this thought is a conversation I had with a neighbor this morning. She is an executive with a large corporation and then like me a part time Town official (it is a very small town). She is otherwise a wife, Mom, Grandmom, and farm girl, a very down to earth person. Anyway she asks me how a recent medical test went and given the several issues I have dealt with early in the game of late, I noted that lots of guys won't go to the doctor on account they don't want intimate care by female nurses & techs, and they risk not having things early-detected such as I have. She tells me she's had to push her husband to go to the doctor for a physical, and then tells me a short story. A friend of her 20 something daughter does pre-employment physicals. The daughter says "you must get to see lots of naked men". The friend then says when you do physicals every day that you don't really notice or pay attention to their genitalia, that giving physicals is just doing a job rather than being anything personal. What was of interest to me was the way my neighbor said it. It was in the manner of its OK being the woman doing the physicals isn't viewing them as "naked men". It wasn't from the perspective of the men.

Coming back to the HR issue, they are the ones who hire the firms that do the pre-employment & worker's comp physicals and periodic drug testing if such is required. HR Depts are female-dominated and more often than not, female-managed. The male modesty/privacy issue likely doesn't even occur to them when going out to bid and making a decision as to which firm to go with. Applicants aren't going to raise the issue but sometimes others of us can.

I never worked in HR but there was a time that they reported to me, and after that period I was still in a position to influence what they did. Regretfully back then the issue never occurred to me either. I am retired now but still do some Per Diem work for them. I may be in the office for a couple days next month and if so I will visit the VP of HR and pose a question as to whether the firm we use offers male applicants and employees a choice of genders for intimate exams. The long-term former VP & HR just retired and so the current woman is brand new in the role. I already know her and also know she is making various changes trying to put her imprint on the role. That might make her more receptive to the issue if in fact the provider is another all-female practice.

If we think about it, we probably all have opportunities to at least plant seeds that increase awareness of the issue.

A side issue here is my understanding is that the current standard for drug tests require the medical staff person to actually observe the guy urinating. This is to preclude guy's cheating by supplying someone else's urine. I had a druggie nephew who passed an employer-required drug test by strapping a baggie of someone else's urine to his leg and then when they gave him privacy to urinate, he put that other person's drug-free urine in the cup provided. The problem with the direct observation methodology of course is that it's pretty embarrassing for most guys to have a woman actually watching him pee. You'd think such firms would have a male employee for at least that function.

 
At Wednesday, June 08, 2016 5:43:00 PM, Anonymous Anonymous said...

Urine is usually tested for temperature which should be 98.6. I seriously doubt anyone is going to watch someone void as that can
put that company in legal liability. Additionally, employment physicals only consist of a blood, urine and chest x-ray and more often
than not the chest x-ray has gone by the wayside.

Furthermore, to have an opposite gender watch someone void, really. What if the applicant claimed the other person grouped
them. Certainly wouldn't look good for that company's reputation and would only take one instant and complaint to put them out
of business. I would expect in this day and age for places that operate in that manner to get set up. With potential applicants not
really looking for employment but just a payday. Truthfully and in my opinion, they deserve to get put out of business.

PT

 
At Wednesday, June 08, 2016 6:47:00 PM, Blogger Biker in Vermont said...

PT, I'm referring to medical practices that specialize in pre-employment, worker's comp, and employer (or govt) required drug testing, not employers that do it themselves.

My nephew did get away sneaking in someone else's urine for his employer-mandated drug test, but perhaps it was the right temp being it was strapped to his leg. He eventually was fired for drugs anyway and has since been clean for about a year and a half. On the direct observation technique I have read of men going in for random testing as is required for certain licenses and been expected to do it in front of whoever was assigned that duty that day. I hope that isn't true but it seems plausible.

Sorry for the tangent. The real issue is that those of us with access to the decision makers in HR departments should raise the question as to whether those practices offer a same-gender option for those folks that want it.

 
At Thursday, June 09, 2016 4:27:00 AM, Blogger Biker in Vermont said...

One further comment on medical practices that specialize in pre-employment & worker's comp physicals and employer & govt. mandated drug testing. I forgot to note that a couple weeks ago I saw in the local paper an article about such a practice just having been started. It had a photo of all the staff and their roles were noted in the article itself. 100% women, from the doctor on down to the receptionist. With women in charge of most HR depts there likely will not even be an awareness that some/many male applicants and employees will find having to go to that practice uncomfortable if not embarrassing. This is why those of us who can do so need to start making HR Directors aware of the issue.

 
At Thursday, June 09, 2016 4:20:00 PM, Anonymous Anonymous said...

Hello Everyone.
I came across this article while browsing the net. I think you will find that it plays right in with our on going discussion .
https://www.nlm.nih.gov/medlineplus/news/fullstory_158551.html . Later......AL

 
At Thursday, June 09, 2016 5:44:00 PM, Blogger A. Banterings said...

Biker,

I am going to address your first question to me in a later post, but your comments about HR reminded me of a white paper a friend who has a HR company gave me to look at in 2009. He got it at a HR trade show in Florida and at first I thought it a joke because the name of the company that the person who wrote it owned sounded more like a seafood supply company (fish, lobster, clam, or something) than a HR company. His name began with an "E," because that was also in the company's name.

The paper dealt with the pre-employment physicals and cautioned employers that this could lead to accusations of discrimination based on sex (gender). He said that requiring men to have the hernia test presented a barrier based on sex that women do not have (genital exam) even though they can also get inguinal hernias.

He further cautioned that requiring women be checked for them to would be good for the reputation of the company due to the intrusive nature of checking women), especially in light of most warehouse jobs paying $8.00 an hour at the time. Furthermore, this would also allow women to claim sexual harassment (trying to keep women out of traditionally male jobs) and sex discrimination (as men do not need an "internal" examination but can be examined "internally").

He really did not have a solution other than having the applicant lift something weighing 25 lbs. in their presence. He further recommended working with the medical center on a nondiscriminatory of ensuring the person can do the job.

I am going to contact my friend to see if he still has a copy of that paper. I am using this in the opening of the book I am writing on the subject of patient dignity (modesty).

That is what will change the whole issue. First off imagine all the male workers of some national chain suing for sex discrimination based on men must have a genital exam as a condition of employment. The whole discrimination claim is furthered by the fact that half of the men (based on 50% of GPs being female) were further humiliated by being examined by a woman.

Let's not forget some bringing another woman in the room (chaperone) to cause further humiliation. I have been restrained in my verbiage, just imagine a seasoned discrimination lawyer presenting this.

Of course the companies that are sued will in turn sue the physicians for practicing medicine that is discriminatory.

A good lawyer can even go farther; what about for sports participation in schools and colleges? This is systematic discrimination against males.

Then you get a few prosecutors who want to make a name for themselves...

That is how you change the system!

-- Banterings


 
At Thursday, June 09, 2016 7:05:00 PM, Blogger Biker in Vermont said...

Banterings, you may recall I very recently suggested that lawsuits may be what it takes to effect change. A successful suit against a single major corporation would likely cause change across corporate America. Such a suit would likely drag on for years, but the changes would start before it is ever settled. This is because other companies would not want to get dragged into similar suits.

 
At Friday, June 10, 2016 5:48:00 AM, Blogger NTT said...

Good Morning All:

Banterings you are correct in that a lawsuit like he one you spoke about would indeed start the dominos falling.

However, finding a guy willing to push the 1st domino & file a suit won't be easy.

Al, I read the Medline Plus article you referenced. The women that wrote the article called them "Macho men". I believe all it's men who aren't respected by the system and just want to protect their dignity not the "Macho men" she writes about.

Have a great day all.

Respects to everyone,
NTT

 
At Friday, June 10, 2016 3:34:00 PM, Blogger Biker in Vermont said...

Al, I read the article too. I see it as she already had her preconceived answer and then did research to fit her conclusions. It doesn't sound like she dug deep to get real answers from the guys. Sometimes people can't see the elephant sitting in the middle of the room.

 
At Friday, June 10, 2016 7:29:00 PM, Anonymous Anonymous said...

Hello Everyone.
Here is another site about two urologist traveling across country for men's health. They claim to have heard all the excuses. They run a clinic in Florida that deals in ED. I would assume that the majority of their patients are male yet their entire support staff is female , yet they don't see that as a problem. Anyway , here is the site.
https://www.sciencedaily.com/releases/2016/06/160609064534.htm Take care.....AL

 
At Saturday, June 11, 2016 2:54:00 PM, Blogger NTT said...

Good Afternoon:

Al, I read the article then I sent them a nice email asking if they've heard it all before, why haven't they addressed the male respect/modesty issue yet.

I noticed they deal with male issues but have females in their staff. I asked what they do for male privacy.

It will be interesting if they reply at all.

I'm not holding my breath.

Have a great weekend all.

Respects,
NTT

 
At Sunday, June 12, 2016 9:44:00 PM, Anonymous Anonymous said...

Al

I have asked the author how she would react to a mammogram performed by a male. Would she herself be perceived
as a " Macho" woman? That she would first ensure that no male was there first and then schedule the appointment. We
will never know since male mammographers don't exist. She never considered that, her research is flawed thus she has
failed in whatever she was hoping to convey.

PT

 
At Tuesday, June 14, 2016 8:29:00 PM, Anonymous Anonymous said...

Hello everyone. To NTT and PT. Thanks for picking up the ball where I dropped it. I just figured why bother. I have sent numerous letters and emails in the past and never had any of them answered. I just figured if you ask a question that they don't like they just don't answer it. That way they can claim they never knew and plead ignorance .
Thanks............AL

 
At Sunday, June 19, 2016 6:03:00 PM, Anonymous Anonymous said...

Maurice is the outlier. Doesn't have a clue, never did, never will.

Usually, these violations happen in the operating room so unless one is a surgeon, they wouldn't have complaints if treated fairly.

It is insulting to be told that we are outliers when there clearly is a problem and hospitals are how hiring ph.D's in Psychology to prevent harm to patients and look to making medical care "patient centered".

Guaranteed, this comment will never be published - the negative comments are normally not posted. as

 
At Monday, June 20, 2016 8:42:00 AM, Blogger Maurice Bernstein, M.D. said...

I agree that I am a physician outlier. I am probably the only one physician who has a thread on the internet extending 11 years for both the pro and con discussion of patient modesty issues.

There is nothing wrong with being an outlier. Making the outlier's concepts able to be accepted within the general population is the need to find ways to "spread the word". This is what I have repreatedly emphasized in my postings to this blog thread. ..Maurice.

 
At Monday, June 20, 2016 10:05:00 AM, Blogger NTT said...

Al.

So far, the clinic has yet to respond. Their silence speaks volumes.

Regards to all,
NTT

 
At Monday, June 20, 2016 6:29:00 PM, Blogger Maurice Bernstein, M.D. said...

I apologize to Dr. Joel Sherman who along with Doug Capra who have maintained a discussion blog on patient modesty concerns Medical Privacy A Patient Oriented Discussion also over a number of years--so I am not a solitary outlier on presenting this issue to the public as a physician. However, I still believe that Joel and myself are still indeed outliers in this matter of physican internet discussion on patient modesty. ..Maurice.

 
At Wednesday, June 22, 2016 5:04:00 PM, Blogger Biker in Vermont said...

Al, I read that article you posted and then sent an email to their urology practice. I applauded their efforts to raise awareness of men's health issues and then noted their omission of the very major matter of many men not being willing to have intimate care by female staff as a reason for not seeking health care. I said I don't understand why urology practices don't make it a point to have at least one male nurse and tech on staff to accommodate modest men. I saw on their website that the doctors who wrote the article have an all-female staff. I did not get a response back from them.

I think the effort on the part of those doctors was just to self-promote rather than to increase awareness of men's health issues.

 
At Wednesday, June 22, 2016 8:45:00 PM, Anonymous Anonymous said...

Hello Everyone.
I thank everyone who sent emails to the sites i posted. Your probably thinking why i didn't sent them a email. I have sent numerous letters and emails to clinics asking why they don't have male personal over the years . Some even say on their sites that for the comfort of their female patients they have a all female staff. I have never received a answer from anyone. That doesn't surprise me. It is easier to ignore the question when your don't like the answer. Plead ignorance and then beg forgiveness. With all that is written do you really believe that they don't know that some men are uncomfortable being naked around the female staff. I missed the boat. I should have fired off a email even if i knew they wouldn't respond . I still find that a face to face is the best way. That way they can't dodge the question by saying they never knew . I won't slip up again.
Later........AL

 
At Thursday, June 23, 2016 11:19:00 AM, Blogger NTT said...

Good Afternoon Everyone:

Biker, I agree with you in that those gentlemen were out more to talk up their practice and their hospital rather than men’s health issues.

The medical community doesn’t really care if more men back away for needed healthcare. They really don’t.

WE like our female counterparts DO have a choice and it’s up to each one of us to STOP suffering in silence.

To start with, if you haven’t already done so, at your next doctor visit, TELL your doctor (whatever sex they may be), you choose to keep your dignity intact therefore going forward, any male related issues (including yearly physicals), must be dealt with only in the presence of them and other males. No females allowed. If he/she doesn’t agree, then maybe they not the doctor for you.

Make sure the doctor knows if they want male related tests or procedures that only male healthcare personnel can be present if that’s what you really want. DO NOT settle for something you don’t want.

The medical community wants most guys thinking they will be less of a man if they open their mouth and make a choice.

Reason they want them thinking that way is if more men stood up for choice, facilities would have to change and as we know, the healthcare system hates change. Especially if it cost them money.

They would have to make a choice, let go of some of their female nurses and techs or increase their payrolls in order to hire the male personnel needed to take care of their patients.

It’s time for guys everywhere to stand up and declare where male related issues are involved we want only MALE caregivers involved. Most men have nothing against female medical personnel but what most men really prefer but won’t say is they do not want to discuss male related issues with or in front of female personnel.

Guys, tell your wives about your choice of same gender caregivers. Explain to her why. Tell her about all the men that are stepping back from needed healthcare all because of the lack of choice to keep their dignity. Ask her how she’d feel if you stepped back.

Reference her right to choice that she’s had all along to try to get her to understand your position so as not to just shrug it off as some male ego trip.

The more people we get to talk openly about this the better are chances become of putting pressure on the healthcare industry to hire more men into positions traditionally held by women.

If enough guys get up the courage to make a choice rather than go with the flow when they go to the doctor, clinic, or hospital, they won’t be able to ignore this.

For the industry it’s about dollars and cents. If hospital A has the male personnel men are looking for and hospital B doesn’t, hospital A will get the business. Plain and simple.

Keep your dignity intact by telling everybody the facts.

Regards to all,
NTT

 
At Thursday, June 23, 2016 3:50:00 PM, Blogger Biker in Vermont said...

Al, I do give the urology clinics credit for at least being honest that their female patients are who they prioritize. Better that than the usual non-answers. It is just another reminder of how deep-seated "women need privacy, men don't" is ingrained into our culture.

NTT is right in that it will not change so long as men stay silent on the matter. My guess is that it will come, but not anytime soon. Given most medical conditions come later in life, men who came of age in the 60's or earlier are the ones who primarily populate medical settings currently. For the most part these guys feel like they are being treated in a respectful and dignified manner compared to what they experienced growing up and in their young adult years. My guess is that most would prefer male caregivers if given a choice, but they were raised to believe it would be a sign of weakness if they spoke up. Real men are tough and all that. Equally important is they judge current professional protocols against the ones that were in place when they were young. Modern day female doctors/nurses/techs are comparatively extremely professional when it comes to matters of intimate exposure. In the old days, there was no consideration given at all when it came to male privacy, and the older guys remember those days. The older guys are not going to lead the charge. It is going to eventually be the current younger guys who demand more consideration. They have been raised to be as modest as women are, and for the most part don't yet realize what awaits them.

Just speaking for myself as one who has had already had more intimate medical care than most ever will, though it came as a bit of a shock following my bladder cancer surgery when I realized it would be female RN's and NP's doing all of that care, in short order I was thrilled at how my exposure was always minimized and the professional manner in which they interacted with me. In my mind I compared that to the bad old days and I wasn't about to complain.

I have now begun speaking up in advance such as with my recent colonoscopy so as to avoid any unpleasant surprises given I had no history with them. I will do the same in a couple months when I have to have it done again, but at a large teaching hospital that time, someplace else that I have no experience with. Regretfully the blood test done in conjunction with my recent cystoscopy indicated an elevated PSA and so maybe I'll be heading on a prostate journey too. That'll offer its own opportunities to speak up. As an aside, whereas urologists have both men and women patients, prostate cancer specialists and prostate cancer treatment facilities only have men patients, yet the nursing & tech staff is almost exclusively women there too. It'll be interesting to hear what their excuse is.

 
At Friday, June 24, 2016 2:44:00 PM, Blogger NTT said...

Good Evening:

Hi Biker.

If the older gentlemen out there really do prefer male caregivers its time to get past being seen as weak stigma and SAY SOMETHING.

Why should change wait for the younger men?

It can start here today with the older gentlemen.

Like you said though for the most part the younger guys really don't yet realize or have a clue as to what awaits them.

My younger brother & his wife just recently found out how things really work for guys after having the "female tech with female chaperone" experience with the scrotal ultrasound. Now, they have both become advocates for men's right to choose same gender care.

She's a school teacher and she's getting the word out via her teachers union.

According to my brother she hasn't cooled down yet from the incident. She always was a fiery individual :-).

So yes, change will take time but, there's absolutely NO time like the PRESENT to start it happening!

Regards to all,
NTT

 
At Friday, June 24, 2016 5:42:00 PM, Blogger Biker in Vermont said...

NTT, I'm not saying older guys shouldn't. I'm saying they won't. For them present conditions are far better than they used to get, and so they're not as upset as your brother is. He didn't experience the bad old days and so he brings a newer higher standard and expectation than the old guys have. This is why I say it is the younger guys that will drive the change. I assume your brother is letting that facility know how unhappy he was with the experience? As an aside when I had my scrotal ultrasound done there wasn't a chaperone. I was extremely self conscious but the female tech was completely professional and kept me covered as much as was possible. There was nothing more she could have done to make it less distressing.

 
At Saturday, June 25, 2016 7:11:00 AM, Blogger NTT said...

Hi Biker:

Like you said.

This was the first real dealings my brother & his wife had with the medical establishment.

They didn't know that he could ask for same gender care or outright refuse the test (his doctor told him afterwards he could refuse the test).

He hasn't had a chance yet to let these people know the way this was handled was wrong because his spitfire wife has not stopped spitting fireballs at the facility that performed the exam & their family physician.

Their family physician personally apologized to my brother for not explaining how the test was performed. He did tell him he wasn't however aware the facility didn't have any male sonographers to handle male cases.

He said going forward he wasn't going to refer anymore patients to use the facility anymore unless they hired a couple of men since he has a lot of male patients.

What his wife is all hot about is there was nothing said about a female doing the test nor was anything said to either of them or written in the paperwork about a chaperone.

She's contending that number one, this was an intimate type test and they had no business letting a female do it. She told them they should have had the decency to cancel the test rather than embarrass her husband.

Number two, had they "needed" a chaperone they should have talked to them & she would have gone back with her husband as the chaperone.

I'm going back to see them again & try explaining how things work & how there aren't enough male techs to go around which is why he got stuck with a female. Plus my brother has questions he doesn't want to ask around his wife.

From talking more with my sister-in-law, she's upset by the way the healthcare industry treats men and I feel from listening closely to her this whole episode morphed into the monster its become over the chaperone issue.

The part where the facility did not offer to let her the patients wife rather than another woman go back in the exam room with him as the chaperone. That part really has her spitting those fireballs.

I told my brother I understand she's upset but needs to cool down then they should set up a meeting together with the facility management and just tell them how they think the way facility handled the situation was inappropriate in their opinion.

I told them in the end, there may be a few reprimands, apologies, and facility policy changes for the way things were handled but that's about all.

My sister-in-law says she's not going to let this go.

She's going to make it her job now to make sure word gets out as much as humanly possible on how the healthcare industry in inadequately equipped to take care of their male patients especially where dignity and privacy are concerned.

All the power to her.

This should be interesting to say the least.

Regards to all,

NTT

 
At Saturday, June 25, 2016 4:33:00 PM, Blogger Maurice Bernstein, M.D. said...

I most appreciate the ongoing description and discussion of personal attempts to change the system regarding patient modesty and dignity issues which are occurring in the medical profession and organizations. To simply "moan and groan" as has been done so much in the past on this thread, particularly in the earlier Volumes accomplish nothing in the long run except inform those who haven't experienced such issues that these issues exist, at least for those who write about them. But what I have always championed was to suggest and demonstrate approaches to change the system to the betterment of every patient.

Again, good work and keep it up. ..Maurice.

 
At Sunday, June 26, 2016 4:58:00 PM, Anonymous Anonymous said...

NTT, when the timing is right, please give us the final outcome on your brother's situation. I will admit that back when I was sent for an ultrasound I was naive enough to not really understand how it would be done, nor did it even occur to me that it wouldn't be a male doing it. At least I didn't have a chaperone. In fact I have never been in a situation where I had a chaperone, though I have always had male doctors.

 
At Monday, June 27, 2016 1:18:00 PM, Anonymous Anonymous said...

Definition of outlier: A statistical observation that is markedly different in value from the others of the sample. If you envision a
bell shaped curve an outlier would constitute anything from the mean, therefore, the opposite of outlier is the mean. What group
constitutes the mean? Would all women who receive a mammogram fall into this value? No. A large majority of female patients
who receive such types of care would be exempt from the sample. I'm suggesting there are no outliers, but if statistical data were
available it might be those that don't care are the outliers. When hospitals commit to core values and the word dignity and respect
are incorporated statistics should not apply. When nursing ethics state that there are only patients and not broken down by gender
then statistics should not apply, outlier becomes synonymous with discrimination.

PT

 
At Monday, June 27, 2016 7:24:00 PM, Blogger Hexanchus said...

PT,

Good description.

There are a couple of ways to detect outliers, a scatter plot with best fit linear regression and standard deviaton limit values or a box plot with statistically determined inner and outer fence values that are calculated using the median and the lower and upper quartiles - which you choose depends on the type of data you're dealing with.

A histogram plot with overlayed box plot is probably the easiest to understand.

I agree with your implication that the available data is flawed - as the saying goes, "garbage in - garbage out".

I also agree that we're not talking about "data points", but real humans with their own core values and rights, and as you said, statistics should not apply.

Hex

 
At Wednesday, June 29, 2016 7:53:00 AM, Blogger Maurice Bernstein, M.D. said...

The USPSTF (United States Preventative Services Task Force) stated today that they are considering the final conclusion (only a Draft at present) that "the current evidence is insufficient to assess the balance of benefits and harms of performing screening pelvic examinations in asymptomatic women for the early detection and treatment of a range of gynecologic conditions. Evidence is lacking and of poor quality, and the balance of benefits and harms cannot be determined." The Task Force is now requesting the public's input on this subject before they submit the final recommendation to the government and the people of the United States.

I am sure you all have some view on this topic (certainly weighing the modesty and dignity concerns in a routine procedure which may not be statistically of value. Read the full draft document and then click on the "Send Us Your Comments" link at the bottom of the USPSTF page and send your comment.

This presents one way of communicating directly with the U.S. government about your view and concerns. ..Maurice.

 
At Wednesday, June 29, 2016 4:32:00 PM, Blogger A. Banterings said...

In 2014, the American College of Physicians, which represents internists, reached a similar conclusion, finding that routine pelvic exams have not been shown to benefit asymptomatic women. The procedure rarely detects hidden disease and does not reduce mortality, the group concluded from decades of studies.

Obstetricians and gynecologists disputed the internists’ position; ACOG currently endorses annual pelvic exams for women 21 and older. But it is reviewing the task force’s draft recommendation, said ACOG president Dr. Thomas Gellhaus. His group’s current recommendation “is based on expert opinion” rather than rigorous scientific evidence, he said, and the “limitations” of pelvic exams “should be recognized.”
Source

Here is how I read the last sentence: Science be damned! I am a doctor!. I don't care what the evidence says, it is my expert opinion that only matters...

What more is there to say?


-- Banterings

 
At Sunday, July 03, 2016 2:06:00 AM, Anonymous Anonymous said...

From NTT "The part where the facility did not offer to let her the patients wife rather than another woman go back in the exam room with him as the chaperone. That part really has her spitting those fireballs."

IMO, that's so if anything goes horribly wrong, the "witness" is one of their own and will in all likelyhood lie to help cover the wrong doer and the facility. (to protect their job if nothing else)

Don't forget... we're talking about an industry that doesn't see the problem with drugging and abusing women for "teaching opportunities". You really think they're going to allow the "tie breaking witness" to not be under their control?

Jason.

 
At Friday, July 08, 2016 7:06:00 AM, Blogger A. Banterings said...

I am going to be the first to share this: a yearlong investigation by The Atlanta Journal-Constitution into sexual abuse by doctors.

This series looks at the issue of many victims NOT reporting the abuse. This is highly relevant because if patients will not report blatent sexual abuse, then why would they be expected to speak up about modesty concerns (that has been mentioned here repeatedly).

One of the issues overlooked is that the culture in medicine that discount patients' modesty (dignity) is exactly what allows this to happen. Just like the Twana Sparks case I mentioned in previous volumes where hospital administration remarked; "she is doing genital exams again..." (being an ENT).

That seems to be the sentiment throughout medicine.

I refrained from commenting on this story when it broke because I do NOT believe that all physicians are sexual predators. I do believe that the education has severely hampered their empathy and knowing what is socially acceptable.

The good thing about this investigation is that it will bring much needed attention to the subject matter, more regulation about patient dignity, a more common sense approach to the use of these exams (being thorough will no longer be an excuse), and (best of all) regulation will no longer be solely at the hands of physicians. The public (patients) will now shape the profession.

-- Banterings

 
At Tuesday, July 12, 2016 10:31:00 PM, Blogger A. Banterings said...

In light of the he USPSTF (United States Preventative Services Task Force) moving forward with their recommendation matching the American College of Physicians recommendation AND the Atlanta Journal-Constitution investigation of sexual abuse by physicians, this blog has been unusually quiet for an unusually long time.

I have emailed off list with a few regular contributors and readers. The consensus has been, "This is part of what we have always said contributes to the problems of modesty and dignity..." It is NOT only the necessity of such exams, science vs. ritual, BUT also the fine line between abuse and healthcare AND how they are accepted as necessity.

Slowly we (the OUTLIERS) are being validated. What comes next are solutions. If you think that being a physician is a horrible profession now, wait until you see what the people who brought you the ACA, EHRs, MOC, etc. come up with next.

There is another alternative to this, but the profession only wants paternalism (again) as the solution. [NOT going to happen!] The best and most humane solution is to turn over control to the patients. Let the patients design the system and call the shots.

The leash is only going to get tighter and shorter. The question is who does the profession want holding the leash? The government who sees healthcare as an expense AND corp med who sees healthcare as a commodity, OR the patients who love their physicians and nurses AND want to see them be the best that they can be?


Either way the end result will ultimately be the patient being protected, so technically either is a win/win for the patient. As a patient, I want to see our physicians treated humanely, that is why I prefer the solution to be the patients. If they refuse to accept this solution, then society has no choice but to institute more harsh measures to comply with the expectations of society.

-- Banterings


 
At Wednesday, July 13, 2016 8:02:00 AM, Blogger Biker in Vermont said...

Bantering, I had read the article you posted but am not seeing any particular solution or set of changes being presented.

Like with anything else, when bureaucrats get involved and try to fit all scenarios into a single solution set, the possibility exists that trying to address the small minority of abusive doctors could make things worse for patients. For example, if it is mandated that there always be a chaperone present, costs will rise and most likely it would mean men always have a young female receptionist type (but called a Medical Asst) observing their intimate procedures. Any new regs will not require same sex chaperones given the industry does not yet recognize that men are entitled to any privacy.

 
At Wednesday, July 13, 2016 8:13:00 AM, Blogger Biker in Vermont said...

As a follow-up to a discussion a month or so ago, earlier this week I was at my former employer's place doing a little Per Diem work (I'm retired). I stopped by the HR Dept and asked the woman in charge about company required physicals for new hires. Physicals are required but not drug testing. Going to your own doctor is not an option. She said that if someone requests a male or female that they should be able to be accommodated given the firm used has both male and female doctors. However when she said that I could tell from her body language that this was not an issue that had ever occurred to her. That is understandable given women don't normally have to think about having same sex caregivers available to them. The problem for men however is that most HR depts. are managed by women and I suspect that the male-female issue is not discussed when they contract with firms for employment physicals. I believe I may have mentioned that where I live a new practice recently opened up specializing in employment related physicals and related medical services. It is 100% staffed by women.

 
At Wednesday, July 13, 2016 11:13:00 AM, Blogger A. Banterings said...

Biker,

That is not an issue at all. Here is why: For a work place physical, a genital exam is NOT required (unless you are working at a Nevada brothel, or as a porn star. Now for men, they use to do a hernia test, but since they do not test women for hernias, that is gender discrimination in employment. Any male employee can sue the pants off that company.

If they start requiring a hernia test for women, that is an "internal exam." Now women are presented with a gender discriminatory hurdle to employment that men are not presented with (men can have an internal exam too).

Just one gender discrimination lawsuit will end that practice.

-- Banterings

 
At Wednesday, July 13, 2016 2:44:00 PM, Blogger NTT said...

Good afternoon everyone:

Went to see my brother as he requested.

Before I got there they had spoken with the facility mgmt. over what happened. They got a letter four days later apologizing for the way he was treated.

What he was so upset about was;

1. The facility didn’t say upfront that a young woman would be doing the testing whereby giving him a chance to back out. He like most men didn’t know to ask first. He like most guys thought the healthcare industry would protect his dignity by having a male do the testing. He feels really stupid & that he let his wife down.

2. There was nothing said, no signs posted, nor anything in print that they signed about a facility policy using chaperones. When he asked if his wife could come back with him they just told him no. When the tech showed up in the room with her female chaperone, he asked again could his wife come back. They said no again the chaperone was there for both their protections.

3. During the test he was not shielded from the view of the chaperone so he was made even more uncomfortable.

4. After the test he covered himself up quickly. The chaperone left. The tech handed him a box of tissues & a couple of towels and told him he could clean himself up & get dressed. Then rather than leave the room & give him his privacy, she just turned around & waited for him.

As expected, he has a real sour taste in his mouth from this whole experience. His wife is still livid over the whole thing. She wants to talk to a lawyer.

After the dust settled, they went about getting a new doctor as they felt the old doctor was not in tune with what’s really going on. They asked their friends & found someone who they feel will take better care of them & the family.

They want him to see a urologist. I told him make sure it’s a male and call the office beforehand and ask if they have a chaperone policy and can you decline one. If not, go somewhere else. I also told both of them they have the right to call ahead if they need any kind of gender specific testing or procedure & request same gender caregivers from the facility. If they can’t provide it. They can choose to call another facility.

His wife’s teacher’s union is rolling out their new healthcare plan for the coming year later this month. She is going to be a guest speaker about protecting your privacy in medical situations.

She’s also asked her union leaders that she’s friends with, to make inquiries about whether or not the company doing the hiring physicals is using both male & female personnel to do them. If not, she told them she’d start a petition in the rank & file to have them replaced with a company that uses a coed team of doctors and nurses.

They are slowly moving on from it but with the firm belief that they not going to just outright trust the medical community again like they did and now they will look into what’s involved with any tests or procedures their doctor orders before they get scheduled so they don’t have to deal with this type of situation again.

They are also warning friends & family about the facility so they don't get blindsided like they were.

All in all it was a tense visit to start with but when I left level headedness seemed to have prevailed.

Regards to all,
NTT

 
At Wednesday, July 13, 2016 3:28:00 PM, Blogger Biker in Vermont said...

Thanks for the follow-up NTT. Hopefully that facility will make some changes in their protocols going forward. The whole episode is just another reminder that the medical world does not consider male privacy anything to be concerned about. It is not that they tried to embarrass him or make him uncomfortable, they literally just didn't see why it wasn't OK for any female on their staff to see any male patient naked.

 
At Thursday, July 14, 2016 7:51:00 AM, Blogger NTT said...

Morning All:

Biker, I have a solution for the any female on their staff to see any male patient naked.

Get all the wives & girlfriends together then put them in the same room with all the female medical personnel & lets see who comes out of the room. :-)

Regards to all,
NTT

 
At Sunday, July 17, 2016 11:09:00 AM, Anonymous Medical Patient Modesty said...

I wanted to encourage everyone here to check out the discussion between Reginald, NTT, and myself starting at this link on MPM's blog. Reginald took steps to speak up about his wishes for modesty during colonoscopy. You will notice that his doctor seemed to be puzzled at some of his requests. Patients who speak up change things.

Misty

 
At Wednesday, July 20, 2016 5:35:00 AM, Blogger Biker in Vermont said...

In the spirit of Dr. Bernstein encouraging us to do something rather than just complain about it amongst ourselves I have over the past couple months sent several email queries to "men's" clinics looking to confirm that any intimate care would be provided only by males were I to be a patient. I am always polite in posing my question. I never get a reply. Hopefully it at least plants a seed with them that it is an issue for some men.



 
At Wednesday, July 20, 2016 5:41:00 AM, Blogger Biker in Vermont said...

Misty, I think I spoke to this a couple months ago but for my most recent colonoscopy this past April I was not sedated and it was not a big deal in the least. Anyone worried about exposure during a colonoscopy might feel better in control knowing that in fact there is no exposure other than their butt. Yes we are disrobed under the gown but the front of the gown covers your front and they will place a sheet on top of you as well ensuring no risk of exposure whatsoever (other than the butt which must be exposed).

Most doctors prefer patients be sedated but if you insist they will usually go along with it. Again, it is not a painful procedure at all, and I for one will never agree to sedation again. I will be having another in a couple months at a different hospital and have already affirmed that they will do it without sedation per my request.

 
At Friday, July 22, 2016 1:15:00 PM, Anonymous Anonymous said...

Incase anyone missed it

http://www.cnn.com/2016/07/22/us/florida-selfie-war/index.html

Two Florida paramedics have been arrested for engaging in a "selfie war" competition by taking pictures with patients under their care.

"Many patients were intubated, sedated, or otherwise unconscious at the time," said Okaloosa County Sheriff Larry Ashley's office Facebook page. "The defendants exchanged texts challenging each other to produce more selfies and to 'step up' their game."
Deputies arrested Kayla Renee Dubois, 24, of Navarre, Thursday and Christopher Wimmer, 33, of Crestview, turned himself in later that day.
Dubois faces two charges of interception and disclosure of oral communications, a felony, and Wimmer faces seven counts of the same charge plus a charge of misdemeanor battery because he allegedly posed while holding open a patient's eyelid.
He also posed with elderly woman with her breast exposed, the sheriff's office said.
Ashley's office started investigating the case in May after getting complaints from other emergency system employees, who had also received the texts with pictures and videos. Investigators identified a total of 41 patients who were props in the game, three of whom apparently gave their permission, the sheriff's office said.
Nineteen of the other patients are female, 17 are male, ranging in age from 24-86, and two have died, the office said.
Dubois was fired and Wimmer resigned on May 20.
The sheriff's office did not immediately return a phone call asking for a more detailed explanation of the Florida charges.

- Jason K

 
At Friday, July 22, 2016 4:03:00 PM, Anonymous Anonymous said...

I didn't do very well in our campaign for male modesty in the medical industry. I didn't ask for an all male surgery team for a TURP procedure earlier this week. Since I requested a spinal tap rather than a "general" and Versed, I was aware of the surroundings. Of course, a curtain is placed so you can't see that much. Except for the female anesthesiologist, I only saw three male faces [male surgeon] although there probably were 2-4 females in the background [How many are used for the TURP?]
On the way to the recovery room, but waiting on the gurney, a CNA [?] lifted the blanket at the groin level for her peek. I then lowered the gown, so that 5-10 minutes later, while still waiting for transport to recovery, another CNA [?] lifted the blanket at the groin level, but w/o success. Control, control, control with impunity.
In my hospital room, the male nurse [he was the first of two 12-hour shift nurses in the 22 hours I was in my room] did not look at my groin [Should he have checked since this was 2-3 hours after surgery?]. The female nurse on the next 12-hour shift took her peek.
A grandmotherly-type employee asked me about "service", so at least I had an opportunity to make a few points, but I tried to make too many points, so she bowed out after about 15 minutes.
BJTNT

 
At Friday, July 22, 2016 4:38:00 PM, Blogger Biker in Vermont said...

A question here for anyone that might have some experience in this matter. I have come to understand that surgery patients are put under before prep begins. I had that experience myself for my bladder cancer surgeries. I am thinking this is purely for the comfort of the OR staff so as not to have to be concerned with the manner and extent (others in the room) in which they expose the patient during prep. Can a patient insist that they not be put under until after the prep is complete?

To me I'd rather deal with the reality of how my prep was done than to be knocked out and wonder. I am also guessing that if the patient were awake that the OR staff would be more careful concerning exposure. As noted in the past I'll accept opposite gender care so long as it is respectful and my exposure is minimized to that which is necessary.

The prep process is a nagging question for me because of a sexually suggestive comment made by the nurse I had in pre-op just before I was put under for my initial bladder surgery and wheeled into the OR. I have wondered what she may have done during the prep process or after the surgery while I was still out. I know my doctor would never have tolerated anything inappropriate while he was in the room so it is the prep period that concerns me.

 
At Saturday, July 23, 2016 4:58:00 AM, Blogger Biker in Vermont said...

BJTNT, what you describe (lifting the gown to take a peek) is an example of the kind of disrespectful treatment that I will no longer tolerate. I'll allow that they probably had a valid reason for needing to check the catheter but they need to say something first such as "I need to check your catheter and will be lifting your gown for a moment, is that OK". As noted in the past I have had a couple dozen cystoscopies. I know the process by heart and after more than 11 years any of the NP's that prep me surely know that I know the process by heart, but they still follow the protocol of telling me what they are going to do before they do it each step of the way. That is how true professionals do it.

 
At Saturday, July 23, 2016 2:35:00 PM, Anonymous Anonymous said...

Biker in Vermont [July 23]. Thanks for responding. I expected the nurses to check, but not non-nurses. I don't think that nurses would be standing by the gurney waiting for an opening in the recovery room. What would non-nurses be checking for?
BJTNT

 
At Sunday, July 24, 2016 4:49:00 AM, Blogger Biker in Vermont said...

BJTNT, I am going to go out on a limb here and talk about an elephant in the room that people don't like to talk about. Though it is possible they genuinely needed to check the catheter, it could instead be that the non-nurses just wanted to get a look because either you are a good looking/fit guy and they wanted to see the rest of the package or they already heard from other staff that you were a genital outlier, either on the large size or the small. One of those "check out the guy in Room 202" kind of things.

This is what my recent mention of the OR nurse who made a sexually suggestive comment just before I was put under was about. She was attracted to me and was looking forward to getting a look. It embarrasses me but in all facets of my life there have been women who have come on to me since I was 15. I know when it is happening and in non-medical settings I can gently deflect them. Medical settings add another layer of complexity given the exposure issue. This is why I still wonder what that nurse did once I was put under. Despite her credentials she was definitely not a professional.

An example of a true professional in this regard was the NP that prepped me for my most recent cystocopy. That prep is as intimate as medical care can be. I knew it was happening again and could see how hard she was working to be the total professional as she prepped me. That mother nature was a little on the kind side to me down there too likely only made matters worse for her. Once she completed her tasks and we had to wait for the doctor to arrive she maintained eye contact with me and never once looked "down there", and even stood right at my side so that she'd of had to turn around to see anything. She was the ultimate professional in how she controlled her attraction. I am always self conscious during these procedures but it doesn't cross over to embarrassment when they behave in a professional manner such as she did.

 
At Sunday, July 24, 2016 12:35:00 PM, Anonymous Anonymous said...

As the thread implies privacy is not just violated on the physical level but information level as well. Nurses, cna's floor
secretaries, and just about anyone working in a hospital often may have a knack for wanting to know your business on
a level that is not necessary. Here we have the intruder, inter meddler , sneak, snake, gossiper, interloper, busybody,
Sidewalk superintendent, noses Parker, snooping, intrusive, prying. All they need to do is look in your chart, looking
at the face sheet they know your occupation, where you work, where you live, your home number, your cell number
if you are single or married. Your social security number and more than your credit card company knows about you.
Maybe if these kinds of people would just focus on doing their job your medical outcome would be better. It doesn't
end when they get off work. They spend their evenings watching reality shows all the while eating Bon-bons. Why does
the entire hospital staff need to know where you live and what you do and where you work and what your social
security number is? Next time you are in the hospital don't think for a moment the nurse who was just in your
room, the cna, the respiratory tech and everyone else who at some point took a peek under your blanket, also took
a peek in your chart at the face sheet.

PT


 
At Sunday, July 24, 2016 2:41:00 PM, Anonymous Anonymous said...

Biker in Vermont [July 24], I think you hit the nail on the head. I am definitely an outlier [without providing TMI].
I probably should feel lucky that there wasn't a parade of employees visiting me. This is a compliment
to them, since there's nothing to prevent them.
I'm reminded that the second female, while I was on the gurney, didn't lift the gown. After your earlier comments I thought there might have been a reason, and since she didn't look, just faked an entry, but I guess now I should feel "sorry" for the poor female that she didn't get to see something unusual [a compliment to her].
This also explains why 34 years ago when a candy striper was doing my catheter [and almost finished]
said that she couldn't do it and needed to get an expert [her word]. She returned with another candy striper and they jointly did the catheter. Why not? If I were a young person with that opportunity and knew there was zero chance of any repercussions, I probably would have done the same.
BJTNT

 
At Sunday, July 24, 2016 3:32:00 PM, Blogger Biker in Vermont said...

PT, I'm not in a position to know what personal data the hospital staff can see but I doubt there is a whole lot of interest on their part. Outside of the medical world, a tremendous amount of your personal data is readily accessible by many many people, more than you perhaps realize. Generally speaking those who have such access don't look unless they have a need to do so. For them it is just data points. Yes there are some nosy people in every organization but I don't really care if hospital staff wants to know some of my background. Except for my social security #, the rest of that stuff is easily accessed even if it wasn't on my patient chart. Part of my reaction here is that living in a very small town such as I do is that I am used to not being anonymous.

What I do care about is the lifting up of the gown as BJTNT describes. That violates a whole different kind of privacy.

 
At Sunday, July 24, 2016 3:37:00 PM, Blogger NTT said...

PT:

Will electronic health records help keep prying staff eyes out of a patients record?

Regards to all,
NTT

 
At Sunday, July 24, 2016 6:53:00 PM, Blogger Biker in Vermont said...

BJTNT, that I correctly guessed what the sneek a peak was all about speaks volumes. Most female medical staff may have been trained to behave in a professional manner in front of the patients but as we both know they still view the genital outliers, younger men, and the better looking/more fit men in a sexual way. That's understandable, but I'd much prefer it if the medical community at least acknowledged this. Nurses/techs are human, not machines. The medical community won't acknowledge this however because that would put pressure on them to better provide same sex provider options for men.

I always pick male doctors and would opt for male nurses/techs if that was an option, but failing that I will no longer sit quietly for what I consider disrespectful treatment. Years ago I stayed silent in the classic male tough it out manner because I honestly didn't know there was any other option. No more.

As an aside, at that last cystoscopy where the NP was working so hard to suppress her attraction reaction, her discomfort did make me feel somewhat more in control. It made it easier for me to lay there exposed than it was for her to be there doing the prep and having to look at me. That's not very nice on my part given she truly was doing her best to be the total professional, but being I was the one lying there naked, I can't deny that I enjoyed that bit of power shift from her to me.

 
At Sunday, July 24, 2016 6:55:00 PM, Anonymous Anonymous said...

Biker in Vermont said

" I'm not in a position to know what personal data the hospital staff can see but I doubt there is a whole lot of interest on their part."


It is for much of this very reason that Hipaa laws were passed in 1995, Unfortunately, for celebrities they get no break in this
regard with their personal health information being sold to Enquirer magazine by hospital staff. Hospitals and medical facilities
give the best opportunities for identity theft.

" Will electronic health records help keep prying staff eyes out of a patient's records. "

No, virtually all hospital staff have access to your medical records online. There are still paper charts on every patient floor. In
my opinion electronic medical records have made it easier for snooping to occur as staff can eavesdrop on patient information
whereby there are sister hospitals patient information is accessible. Typically, in the old days when a patient was discharged
by the hospital all paper and the chart were sent to medical records where they were kept. Now, all patient data is online for
anyone to access.

PT







 
At Sunday, July 24, 2016 7:04:00 PM, Anonymous Anonymous said...

NTT [July 24],In theory, electronic health records {EHR} will be password protected, so this allows marketing to say your records are protected. In practice in the current medical culture, which won't change with EHR, an employee will be able to obtain the password from a fellow employee without fear of repercussions. It's the culture.
BJTNT

 
At Sunday, July 24, 2016 7:06:00 PM, Blogger Biker in Vermont said...

NTT, I hear that hospitals monitor staff access to patient electronic records but I don't work in a hospital and can't speak authoritatively.

Based on my limited experience however, I think electronic records will eliminate any shred of medical history privacy patients ever had. Two examples. When I went for my colonoscopy last April, the day of the procedure was the 1st time I met the doctor and was the 1st time I had been a patient at that hospital. The doctor walks into the room and starts rattling off my family's cancer history. He had it all there even though I hadn't given it to him. Last year I bought life insurance to replace what I had at work. This was through an agent I have used for at least 30 years handling my insurance and whose partner manages my investments. I get a message from him asking for more info on a surgery I had when I was 11 years old. It was of a personal nature and I'd of never shared such a thing with him but the insurance company knew of it and wanted to know more.

The advent of electronic records (which clearly has included digitizing old manual records) means a whole lot of people now have access to your full history whether that history is pertinent to the matter at hand or not.

All that said, electroinic records are a different matter than what this blog is all about. I don't like this new electronic record system, but my bodily privacy remains a far greater concern for me.

 
At Sunday, July 24, 2016 7:26:00 PM, Blogger Biker in Vermont said...

A couple questions here. BJTNT mentions Candy Stripers having done catheterizations long ago. I have seen other references to Candy Stripers having done that and also modern day CNA's doing them. First, are Candy Stripers entirely a thing of the past? I think so but if not, then I'd just as soon be mentally prepared to encounter one some day.

The larger question is how common is it for CNA's to do catheterizations? I have been catheterized several dozen times these past 11 years for bladder cancer treatments and subsequent cystoscopies. It was always an NP who did the treatments via catheter and always an NP who did the cystoscopy prep. I know that RN's would do them too in other settings, but do we really allow CNA's with their minimal 2 or 3 months trade school training catheterize patients? Do we really allow teenagers to do what I consider majorly invasive medical procedures? Please tell me this is not so. I can't see myself allowing anyone less than an RN doing such a procedure on me.

A related question here concerns identifying the exact level of licensing medical staff holds. I like the operations where all staff wears a name tag that includes exactly what they are (CNA, RN, NP etc) but this does not seem to be a universal practice. Anyone know why this isn't the case? I am thinking that going forward I will ask anyone providing treatment for me who is not identified in this manner exactly what they are. Of course I would be polite in asking. That is my nature. Has anyone here encountered objections when asking this type question? Or received a less than clear answer? I am thinking asking this question is particularly important at a medical practice when the doctor brings and "assistant" in.

 
At Monday, July 25, 2016 12:22:00 PM, Anonymous Anonymous said...

As I said recently, I didn't do well in our modesty campaign, but I tried. In my pre-surgery interview
with the surgeon, I made several of our points, but couldn't get him to engage. Only once did he contribute.
When I told him of a past surgery negative experience and reading bioethics discussion blogs for nine years,
maybe it be would be less stressful if I adopted "ignorance is bliss". His response was that the patients
with the best outcomes were the ones with the least knowledge. This response is open to several interpretations,
but they seem to include psychology. Are we considering psychology in our campaign?
BJTNT

 
At Monday, July 25, 2016 4:14:00 PM, Blogger Maurice Bernstein, M.D. said...

BJTNT, I would strongly disagree with your surgeon. I would never teach my first and second year medical students that medical outcome would be best if the patients have the "least knowledge". Patients are not objects in a medical professional relationship. They are humans with brains, bodies and emotions just as critically important to them as to the physician. The patient deserves to be educated and informed. The results of diagnosis and therapy is dependent on communication of the facts of the illness as presented by the physician as well as the feelings, uncertainties and concerns of the patient as expressed to the physician. To consider otherwise is a dumb concept. Period! ..Maurice.

 
At Monday, July 25, 2016 5:50:00 PM, Blogger Biker in Vermont said...

Here is something that doesn't make sense to me. The sheer growth of the healthcare system over the past generation means that the majority of nursing and tech staff are younger people. Most are in their 20's to 40's. Their husbands, boyfriends, and brothers grew up in the current world where males were not subject to the kinds of forced nudity that older guys were. Their sons are growing up in that same world where guys aren't subject even to showering with other guys in school. Knowing this, why are they OK with the males in their lives being expected to drop their draws on demand for any woman wearing scrubs?

Older nurses that are now approaching retirement I understand. They grew up at a time when there was no consideration for or expectation of privacy for guys. They would have come into nursing with that culture deeply ingrained.

It is the younger generation of nurses that perplex me in that they don't see in their patients the faces of the males in their lives. What am I missing here?

In a similar vein, why are the modern day Moms (and Dads) OK with their sons still being subject to sports physical genital checks by female practitioners with female nurses or assistants observing? Do they not realize how humiliating that is for their sons? In the old days no parent would have given it a 2nd thought but why does it still go on today?

Maybe the culture hasn't really changed? Is that what I'm missing? There is no doubt but that male patients are treated in a vastly more respectful manner than in the old days in medical settings. There is no longer forced nude swimming in school nor forced gang showers, and boys aren't having school physicals in settings that leave them exposed for all to see. To me all this should mean that the underlying culture changed, but yet the prevailing wisdom is still that modesty doesn't matter for guys. I don't get it.

 
At Wednesday, July 27, 2016 7:17:00 PM, Anonymous Medical Patient Modesty said...

Biker in Vermont,

In response to your question below:
A question here for anyone that might have some experience in this matter. I have come to understand that surgery patients are put under before prep begins. I had that experience myself for my bladder cancer surgeries. I am thinking this is purely for the comfort of the OR staff so as not to have to be concerned with the manner and extent (others in the room) in which they expose the patient during prep. Can a patient insist that they not be put under until after the prep is complete?


Yes, a patient has the right to insist that they not be put under anesthesia until the prep is complete. Also, you should insist that you not be given any drugs especially Versed that would cause amnesia. Yes, I believe that if a patient is alert, medical professionals would be more careful about how they expose a patient.

I wanted to respond to your latest posting about the current culture. Let me share some things I have observed over years. I have come across many older men in their 60s and beyond who care about their modesty. It is true that forced nude swimming does not exist today. But many of those men who were forced to do nude swimming are still modest. I have come across a number of men who were desensitized by the medical industry to accept that they cannot speak up against female nurses and that they must let go of their modesty. Many of those older men were very reluctant to let female nurses take care of them, but they did not speak up. Some men do not even have any intimate exams until they are in their 50s or so.

Actually, the medical system was better at providing men with male health providers for intimate care years ago. Are you aware that male orderlies and male doctors used to do intimate procedures on male patients years ago? Now, CNAs and nurses do most of those procedures now.

Our society has a false misconception that because that many men will use open urinals in a men’s restroom that they do not care about their modesty. This is not true. Actually, many of those men who use public urinals are upset about the thought of a woman who is not their wife to see their private parts. Also, our society seems to view modesty as a weakness.

It is sad that many people especially parents do not think much about how genital exams by female medical practitioners can affect their sons. The reality is hernia checks are not necessary for sports physicals and should be abandoned. Hernia exams do not help to ensure safety of playing sports at all. Most small hernias do not even cause a problem. I believe that intimate exams should not be done on teenagers who have no symptoms. Hernia exam is just a rite of passage. I think that teenage boys should be given some information about doing self examinations for hernias and if they have a problem, they can go to a male doctor of their choice. Most teenage boys are more comfortable with a male doctor for intimate exams.

Misty

 
At Wednesday, July 27, 2016 7:22:00 PM, Anonymous Medical Patient Modesty said...

Hi everyone,

I wanted to share the wonderful testimonial Reginald submitted about his colonoscopy to Medical Patient Modesty’s web site. It is so encouraging that he feels MPM’s colonoscopy article helped. He shares some great insights about how patients have to speak up. I am glad he mentioned this doctor’s name and maybe some men in the area he lives in will go to this doctor. I think that doctors who honor patients’ wishes deserve to be recognized. You have to look for a doctor and/or medical facility that will work with you.

Misty

 
At Thursday, July 28, 2016 9:54:00 AM, Anonymous Anonymous said...

Misty said "Also, you should insist that you not be given any drugs especially Versed that would cause amnesia."
I used this advice [previously recommended] for my surgery last week. The female anesthesiologist honored my request with a spinal tap. This allowed me to hear the surgeon raise his voice to tell the nurses that they had connected the tubes on the triple lumen catheter incorrectly. In my youth this would have bothered me, but now I know that the administrators are never going to spend adequately on training. When the review of medical mistakes is by fellow members of the medical community, the administrators have no need to be concerned. The patient's choice is either
accept the mistakes or do without medical care.
BJTNT

 
At Thursday, July 28, 2016 10:39:00 AM, Blogger Biker in Vermont said...

A few things.

The testimonial from Reginald speaks to an excellent process in addressing his modesty needs. Good for him and for you Misty in helping him via your site.

And before going further I also thank Dr. B. for keeping this site going for so long. Though I am a relative newcomer to the discussion it has helped me realize that I can speak up.

Much discussion here includes talking (in a calm professional manner) with your doctor about your modesty needs being they can't read your minds. I just want to note that much of the time you will be in a gown on a table before you can see the doctor given receptionists/schedulers won't let you talk to anyone but them. Not ideal but so long as you are willing to walk out if there is an unacceptable (to you) exposure involved in that day's procedure, you are still in charge. It is also still an opportunity to have a meeting of the minds on what your needs are for future visits.

Misty, on the colonoscopy without sedation matter that Reginald spoke to, know that when the receptionist/scheduler tells you it can't be done that way, it doesn't really mean it can't. I was told no and politely said that's OK, I'll get it done at (their primary competitor). Then she said she'd ask the doctor and of course the answer was I could have it done without sedation.

On inquiring of receptionists/schedulers about basic procedural policies that impact patient modesty/respect/dignity, my experience has been a combination of puzzlement and defensiveness. Asking questions at that level is a waste of time. Save it for the doctor or other medical staff when you come for your appt. Not ideal, but speaking of such things with non-medical office staff isn't likely to be fruitful, at least in my experience.

There seem to be many accounts from people who were surprised as to the doctor's gender when he/she walks into the room. I can see how that can happen in a large practice with multiple physicians. These days you can often see who the physicians are via the practice's website. Rather than just make a general appt and then getting whoever they assign to you, just pick out someone from their list and ask for an appt. with that specific person.


 
At Thursday, July 28, 2016 11:18:00 AM, Blogger Biker in Vermont said...

Misty, I wasn't suggesting that many of us older guys (I'm 63) that grew up in a very different world as concerns male intimate exposure in medical, school, and other settings don't have modesty concerns. My question is that despite the many outward changes that have occurred, it seems that the underlying "it doesn't matter for guys" culture hasn't changed. That's what puzzles me.

You are correct about male orderlies. I was an early bloomer at age 11 and when I was hospitalized for emergency surgery, it was a male orderly who came to shave my few wisps of hair. Nobody told me what surgery I was about to have let alone what the prep was and so it was a bit of a shock when he told me what he was there for. I was self conscious but not overly embarrassed given it was a guy. I'd of died a thousand deaths if a woman came to do it. I did die a thousand deaths a couple days later when a woman (nurse/cna?) came in and without even talking to me, pulling a curtain or closing the door yanked my gown off and proceeded to bath me in full sight of anyone walking past the room or coming into the room for my roommate. The hospital at least got it half right with the shaving episode. Fast forward 50+ years and now the bathing would be handled much more discreetly (but likely still by a woman), but would it be a woman coming in to shave a kid like myself? I sure hope we don't humiliate pubescent boys that way. There were a number of male nurses in pediatrics when my wife has surgery in April and a room shortage forced them to send some adult patients up there. Perhaps those male nurses would handle tasks of that nature?

 
At Thursday, July 28, 2016 3:08:00 PM, Anonymous Medical Patient Modesty said...

Biker In Vermont,

I am glad to hear that you have gained insights about speaking up. You have some good points about the receptionist or front desk staff. It is a problem when a patient can only talk to the receptionist about her/his wishes for modesty. You really do need to talk to the doctor and other medical professionals such as nurses about your wishes for modesty. This can be a problem if you cannot talk to your doctor ahead of time. It is pretty apparent that Reginald met with his doctor at least one time before the colonoscopy was performed.

For surgeries, you have to talk to a number of medical professionals about your wishes including surgeon, anesthesiologist, nursing supervisor, etc. You could have a great surgeon who is willing to accommodate your wishes, but an anesthesiologist who is not willing to work with you. It is worse if the surgery is planned at the last minute.

Thank you for clarifying what you mean about the culture! My personal opinion is that many women have contributed to this attitude, “male modesty does not matter”. I heard of some women who are not in the medical profession claiming that most men do not care about their modesty. One woman said women were more modest than men. This puzzles me as a woman because I believe that men deserve the same amount of privacy as women. I think it is strange that a number of medical facilities do not look down on women who same gender intimate care, but they treat men differently.

I was personally encouraged about 6 years ago to see that a teenage or young adult male had a male nurse tending to him in ICU when I was there visiting another family member. The nurse closed the curtain & door to his room and I think he may have given this male patient a bath.

Misty

 
At Friday, July 29, 2016 6:14:00 AM, Blogger Biker in Vermont said...

Between the current conversations and having looked back at some of the older threads I am seeing the issue of medical modesty as falling into a 4 quadrant matrix. On one side is the timeframe, the old days vs now. On the other is the medical system itself vs individual medical staff.

None of us can change the past. While for many of us it was past experiences (usually the negative ones) that shaped our mindset, it is the modern day system we live in with modern day medical staff. Rehashing what may have happened long ago can be therapeutic, but that world is gone. Staffing and the policies/protocols have changed. This is both positive and negative. An example of a positive change is that women now have the option of female OB-GYNs. A negative example is the situation got worse for men with the introduction of chaperones and scribes which are usually going to be women. A positive for all is that draping and other procedural changes seek to reduce exposure vs how it was done in the old days.

The other side of this is a bit more complex. There is a huge difference, especially for men, between the medical system itself and the individual medical staff. On oft discussed example are testicular sonograms. The medical system has to a very large extent staffed such positions with women. Most men at least, and many women too, would agree that this is profoundly disrespectful of men. When it comes to the individual tech who is doing the procedure, all we can judge her on is whether she conducted herself in a professional manner and followed best practices for draping etc. She is just doing the job she was hired to do for patients that agree (even if grudgingly) to let her do it. The system itself is failing men there but not her. I have seen numerous posts dragging the tech through the mud simply because she did the procedure rather than what level of professionalism she exercised. The system is at fault, not her. In my experience every single medical interaction I have had of an intimate nature (and there have been many)over the past decade has been totally professional on the part of the staff while at the same time the system itself was very disrespectful in terms of not affording me the option of male nursing staff. All of my negative experiences in the old days involved both disrespectful staff and a disrespectful system.

Others may have different thoughts concerning what constitutes the old days vs now but I'm thinking the old days is anything greater than roughly 10 years ago. There have been lots of systemic changes over the past decade which can differentiate it from prior periods. That doesn't mean that some of the exact same kinds of offenses can't occur. They can, but much of what used to happen just absolutely doesn't happen anymore.

For me as I think through potential scenarios, it is helpful to separate old days vs now and to separate the system itself vs the current staff working within in. It is hard to totally let go of the past however. That causes me to only choose male doctors and though I know it is highly unlikely a female nurse or tech will be anything but professional in every sense, I still have my guard up until she proves to me that she is. The piece about choosing only male doctors though does have a "protect me from the system" aspect to it. A male doctor is never going to try to force a female chaperone on me. A female doctor might, and so I will avoid that issue until such point as the system changes and medical practices have male staff serving as chaperones.

 
At Friday, July 29, 2016 12:35:00 PM, Blogger Maurice Bernstein, M.D. said...


Interesting historical note from NEJM. Could the explanation apply to issues being discussed here? ..Maurice.


An 1833 article in the Boston Medical and Surgical Journal (forerunner of the New England Journal of Medicine) explained why prescriptions should be written in Latin to protect patients from knowledge of the names of and indications for the prescribed drugs:
“The question is often asked, why physicians do not write . . . prescriptions in English. The answer is obvious — that if they did, the patient would often be less benefited than he now is. There are very few minds which have sufficient firmness, during the continuance of disease, to reason calmly on the probable effects of remedies, and to compare their wonted action . . . with the indication to be fulfilled in the particular case. . . . The only state in which the mind can rest . . . during severe illness, is that of implicit reliance in the skill of the physician, and an entire acquiescence in the course adopted, without the slightest question or argument.”

 
At Friday, July 29, 2016 6:09:00 PM, Blogger Biker in Vermont said...

Dr. B., that 1833 article almost exactly matches the conversation you and BJTNT had just a few days ago in which BJTNT related his surgeon saying the best outcomes came with patients with the least knowledge. Amazing that condescending arrogance hasn't changed in nearly 200 years.

 
At Sunday, July 31, 2016 8:55:00 AM, Blogger Biker in Vermont said...

I was curious as to the male/female nursing mix in VT and came across the attached which some might find interesting. It shows the rate of growth in the % of males over a period of years(8 for RN's,12 for LPN's). I couldn't find any gender mix data for LNAs (Licensed Nursing Assistants, our version of CNAs)
https://www.uvm.edu/medicine/ahec/documents/2014NursingDataDashboard.pdf

Though the % of men is still very low, there is at least steady progress. As an aside where it mentions a survey of 15 hospitals, that represents 100% of the hospitals in VT. We only have 15 including the VA Hospital. Only one is large at 562 beds. The 2nd largest is only 144. 8 of the 15 are less than 50 beds, the smallest being 19 so VT is a pretty small universe.

I also came across the attached Vermont Nurse Connection newsletter which I found interesting on a couple points. Page 2 has an advertisement for a nursing school in NH with 2 of the 3 students being males. Clearly that is not an accident. They are trying to recruit men. Page 3 then has a very positive article about male nurses written by a woman. It doesn't mention the modesty issue though as a reason for it being a good thing for more male nurses. Page 6 then has an ad for Flight Nurses, both of whom are males in the photo. Lastly page 11 features 4 of the members of the VT Board of Nursing, one of which is a male. My takeaway from this is that male nurses are being welcomed and encouraged here in VT. If only there were more of them.

http://nursingald.com/uploads/publication/pdf/157/VT10_12.pdf

 
At Monday, August 01, 2016 4:20:00 PM, Anonymous María said...

"Most of the time you'll be on a table wearing a gown before
the doctor arrives given receptionist won't let you talk to
anyone but them" Since when is that respectful medical care?
I have to disagree. That's a situation that already is indi-
cative of disrespect. If the very first time a doctor (that
be opposite gender)lies eyes on me I'm already in the nude or
wearing just a gown, that's outrageous. Nor is it so easy to
walk out as you seem to imply. However, if a nurse barks ns-
tructios for a patent to disrobe before they've even met the
doc, that might be a red flag, and a warning.
As for the "it's not her fault as long as she''s professional
I again disagree. By joining an institution as part of their
workforce, you become a part of that system.

 
At Monday, August 01, 2016 8:50:00 PM, Blogger Biker in Vermont said...

Maria, I wasn't saying it was the preferred way nor that it was respectful. I was just stating the reality of the situation. I have read again and again that we're supposed to talk to the doctor about our concerns but much of the time we are in a gown and on a table before we ever even meet the doctor. Walking out is often the only option you have short of not making an appt. at all when you can't get past the receptionist/scheduler.

I stand by my quadrant view of healthcare (old days vs now and the system itself vs the individuals working in the system). How can you blame the individual female nurse or tech who is doing an intimate procedure on a male patient when she was hired to do that job and the patient (except in emergency situations) agreed to let her do that procedure? Yes we can hold her accountable to using all of the professional protocols for the procedure but what is the alternative for that nurse/tech as to doing the procedure itself? Do you really expect literally millions of female nurses & techs to quit their jobs rather than treat the male patients? The healthcare system would collapse overnight and countless thousands of patients would die for lack of care. The fault lies with society as a whole that thinks the medical double standard is acceptable. Your elected officials could fix the problem but they don't. Are you then at fault because you voted for them?

Lawsuits might bring about certain changes but thus far the courts have not been especially sympathetic to male privacy issues. Women guards being able to strip search male prisoners and women reporters being allowed into men's locker rooms being just a couple examples. I am becoming increasingly convinced that improvements are going to come from men finding their voice in the same manner that women demanded changes.

I will add that sometimes you can get answers and provide input without actually reaching the doctor. I recently lost my long standing health insurance and under my new policy my urologic oncologist and the hospital he works at is now out of network. This afternoon I called the urology dept where I plan to transfer my care. I quickly stated my situation/background and said I wanted to talk to someone about how cystoscopies are done there. She said she could help. I posed a technical question and got the answer I was hoping for. With a little bit of levity I told her that was the right answer and now for a question that's a little tougher. I say this is a very intimate procedure and being its a teaching hospital would I be subject to a room full of people looking at me? She says no, just the doctor, the nurse and maybe a Resident. I tell her she's doing great, that's what I wanted to hear. I then say the next question is the toughest, is she ready for it? Do you have any male nurses in urology? Yes they have one. I say that's one more than most places have and that I'm glad to hear it given the nature of the procedure. We then cover a couple quick administrative things concerning transferring care and selecting a doctor and I thank her for being so helpful. I think the manner in which I approached her and interacted with her made for a fruitful conversation that never once got adversarial.

A side benefit is that she can share with others there the pleasant conversation she had with a guy concerned about male patient modesty. Had I been angry or accusatory what she might share with her co-workers some guy with mental health issues called.


 
At Wednesday, August 03, 2016 6:09:00 PM, Anonymous Anonymous said...

Society never took a vote as to what gender should work where in the hospital. Female patients were never asked what gender
they prefer in the L&D suite and they certainly were never asked if they preferred female mammographers prior to the performance
of their exam. Society should accept no blame and shoulders no responsibility in this regard and you certainly would not
expect the average non-medical person in society to understand the dynamics and logistics in the function of a hospital.

The people responsible for the discrimination, double standards, lack of advocacy are the female nurses directly. That is the
directors of the various nursing floors. The nursing directors are responsible for hiring staff, not human resources. Human resource
departments recruit and ensure the potential applicants have the proper credentials and license. The nursing directors are solely
responsible for hiring and in that regard they set the tone, culture by whom they hire.

The Radiology directors decide the gender and hire only female mammographers for their departments. The nursing director of
L&D hires female only nurses to work in labor and delivery suites not because female patients preferred female nurses, rather
the female director decided this is the gender who should be employed in that area. The average female floor nurse could
advocate for the male patient by finding a male nurse but won't. They don't understand that aspect of advocacy because when
they require a mammogram or deliver their child those decisions have already been made.

If you the male patient ask for a male nurse for an intimate procedure you are met with you don't have anything I haven't seen
approach or they may document that you refused the care as the female nurse on the ultimate nurse forum states that she
does. They may say that they do not have any male nurses in which case they could find one. The conversation never reaches
this level of unprofessionalism when they are the patient.

PT










 
At Wednesday, August 03, 2016 7:49:00 PM, Blogger Biker in Vermont said...

You are right PT in that most of the individual hiring decisions are made by the people (usually women) in charge at hospitals and private practices. They could effect change but they choose not to. Some may not recognize that there is a problem. Others may know, but choose to err on the side of protecting female interests. Just to be clear though, we are talking the people doing the hiring, not the individual nurse or tech that is just doing the job she was hired to do. That latter group are not the ones to be blamed.

Govt could force their hand though in the same manner that govt. forced businesses and govt entities to let in women and minorities into areas that had been denied them. Govt. chooses not to take any action on behalf of men though because society as a whole does not see a problem.

You only have to go back 50 or 60 years and the only consideration for male modesty was that it was necessary anywhere that it might offend women. Women in general are less offended by male nudity now and so in some regards the underlying culture has gotten worse. It has only improved for men in that more professional standards of conduct came into play. Offsetting that is chaperones & scribes making it worse for men, and the heavy presence of women physicians now making it not so assured that a guy is going to at least have a male doctor in an emergency situation or in some settings where a guy has no choice (employer physicals etc).

In the end though, maybe the real blame lies with men for not speaking up. I know that I didn't ever speak up when I should have until only very recently when I came to realize that I could (and that I should). I was the classic tough it out kind of guy. Others have instead avoided healthcare. Men have allowed the double standard to continue.

 
At Thursday, August 04, 2016 7:45:00 AM, Blogger Biker in Vermont said...

For those who choose to portray LNA's as medical professionals, I took a look at the requirements in NH given that is where I will moving my medical care from Boston. An LNA has to be at least 16 years old, no high school diploma or GED is required. The classroom training is 50 hours and and the clinical training is 60, and they can enroll in a training course to get it all done in 3 weeks. This is even worse than here in VT where they have to be 18 years old.

So guys, if that LNA looking to bath you looks like she is only 16 years old, that may in fact be the case. Don't worry though, after a full 3 weeks of schooling/training she is a professional.

To make it even worse, when taking tests they can use an audio CD so that she doesn't have to read the questions. That couldn't be because of literacy issues could it? Who needs medical "professionals" to be able to read at a high school level anyway?

 
At Monday, August 08, 2016 6:31:00 PM, Anonymous Medical Patient Modesty said...

Hi everyone,

I wanted to share a letter that a man I’ve been working with received with from an urologist who he wrote a letter to. This man asked me to share letters with hope of helping others who feel the same way as him. I have cropped out the man’s name and the urologist’s name to protect their privacy (the man asked me to exclude his name). This man has written letters to numerous urologists and hospitals in Detroit area and has not been able to find a hospital or urologist willing to accommodate his wishes for an all-male team if he has prostate surgery.

You can find the letter on MPM’s web site by going to this link.

I have encouraged this man to not give up and to keep on trying until he can find a medical facility willing to accommodate his wishes for an all-male team. I wish more men were as bold as this man. It is disappointing that this urologist tries to assure the mane that the care from female providers is excellent. Many men do not want any females for intimate care no matter how compassionate or experienced they are.

Misty

 
At Monday, August 08, 2016 7:38:00 PM, Anonymous Anonymous said...

Misty

Thank you for taking the time to bring this to our attention. I find it daunting that a urologist would dictate the staff gender
at any hospital. Urologists do not own any of the Hospitals you mentioned. They are on staff and just like a hospitalist they are
employed by the hospital. They are Employees! I will look into this as I am certain the hospital you mentioned has
mammography suites whereby only females are employed as are their Labor and Delivery suites.

PT

 
At Monday, August 08, 2016 9:53:00 PM, Anonymous Anonymous said...

Misty


Apparently that health care system provides mammography and Labor and Delivery services under Women's services and
very much touted as patient centered care for women. I do not have an opposition to this model, patient centered care for
women but what a health system does for one gender should be provided to another gender.

PT

 
At Tuesday, August 09, 2016 3:41:00 AM, Blogger Biker in Vermont said...

Misty, the interesting, though not surprising aspect of the letter he got is that they ignore the modesty issue altogether. They only focus on technical competency.

PT, given the sheer imbalance of male/female nursing & tech staff and with roughly half the doctors now being female, it is easy for hospitals and other medical facilities to provide all-female care for certain female specialties such as you point out. When you come to general surgery though, it isn't all that easy for women to get an all-female team either, though it is more feasible than gathering up an all-male team for a guy.

 
At Tuesday, August 09, 2016 2:37:00 PM, Blogger Biker in Vermont said...

I spent much of the day in the Emergency Room of our local hospital. It is the only hospital for an hour in any direction and so it is the only option we have for any immediate care needs. Today's experience was not intimate or personal in nature but it was informative as to how professional their protocols are. We don't need to experience an intimate procedure to get a feel for the culture of an institution, and so for me my takeaway is that should I find myself there for anything that involves intimate exposure I need to be prepared to speak up early and clearly. We should all be keen observers in any medical interaction because it can better prepare us for when the time comes that need to have our wits about us.

What they did well included asking me if I wanted the curtain closed whenever anyone left the room and the 1st nurse to come in knocked before entering and waited for me to say it was OK. After that I always had the curtain left open so there was no need for anyone to knock. Also, the Tech who did my EKG asked me to lower my gown from the shoulder (vs him doing it himself). I should add that at least half the nursing and tech staff were males.

Where I found the protocols lacking included the admitting nurse walking me to a room, throwing a gown on the bed, telling me to put it on, and leaving. Being I was sent there by my primary care doctor for a CT scan of my head it made no sense to me why I needed to put on a gown. The doctor comes in with a scribe in tow, does not introduce her nor does he ask if it is OK that she is there. Granted there was no intimate exposure or discussion, but I considered it bad protocol anyway. A Tech comes in, tells me he was there to do the EKG and after asking me to lower my gown from the shoulders just whips out an electric razor and proceeds to cut patches on my legs and on my chest. He never told me that he was going to do that before he did it. The transport woman who came to bring me down for the CT scan asks if I want a blanket to stay warm. I say no. She then throws a sheet on me and says "I don't want everybody we pass in the hallway looking at those beautiful legs". She then gives me the look and I know its happening again. She flirts with me all the way down and all the way back. Had she the opportunity to sneak a peak she surely would have done so, but I had kept my boxers on under the gown.

The culture might be different in other areas of the hospital but if strict adherence to proper protocols is the mantra from on above, it would filter through to every dept. None of the items I observed today were upsetting given the non-intimate circumstances but they did speak to a casualness on their part. I now feel better prepared should I find myself there for a more intimate procedure. We can all learn in the same fashion.

 
At Tuesday, August 09, 2016 3:04:00 PM, Anonymous Anonymous said...

Occasional reader here. I want to thank Maurice for raising awareness of modesty and dignity.

I am male, and I prefer a male physician. But more importantly, I prefer a physician who understands that being a patient is a time of vulnerability. There are too many callous physicians of all genders. Same-gender preference is a start, but it is no guarantee of humane treatment.

For me, it went like this:
- At age 21, having a very humiliating physical exam by a callous male physician.
- After years with few medical visits, having my wife schedule an urgent appointment with a female physician. I was nervous about it, but she was unexpectedly compassionate.
- Later resolving to find a male physician who is just as compassionate, and finally finding him.

A big epiphany happened when I saw a chiropractor for a back problem. I assumed that I would need to undress and asked him what I should keep on. He produced a pair of athletic shorts and said that most of his patients bring their own. Such a simple solution!

To me, the standard practice at primary care practices is dehumanizing, whether I'm expected to strip to my underwear, or to change into a gown. Either way, the effect is for the provider to take control of the patient's body, rather than to collaborate with the patient. I've heard the argument that patients' clothes are somehow a vector for infection, which I find suspicious.

- "Class of '98"

 
At Tuesday, August 09, 2016 3:57:00 PM, Anonymous Medical Patient Modesty said...

PT: Thank you for your comments! This man has researched a variety of hospitals in the Detroit area and none of them seem to be willing to accommodate his wishes for an all-male team for his surgery. This should not be hard if the surgery is scheduled in advance. They can always bring male nurses from other departments to help with the surgery. I would like to know if the urologist contacted the hospital to inquire about male nurses and assistants. You are right urologists do not own hospitals and they just have privileges at the hospitals they perform surgeries. This same man shared that his urologist (a different one) at first thought it was okay for him to have an all-male team for his surgery, but then said that female medical professionals at the hospital would claim discrimination. I am so tired of hearing this discrimination argument. I agree that medical facilities should give both male and female patients equal opportunities for having an all-same gender medical team if they wish.

I am sure you probably recall the below paragraphs about discrimination from Doug Capra who wrote this article, Patient Modesty, Values, and Rights on Dr. Sherman's blog at: http://patientprivacyreview.blogspot.com/2010/11/patient-modesty-values-rights.html:

Don’t let someone tell you that your choice of one gender over the other for intimate care is discrimination, in the legal sense of the word. Don’t let them compare it to racial discrimination. A racist is someone who negatively stereotypes a whole race and/or thinks that race is inferior to his own. If, as a man, you believe that all women are inferior to men and can’t do the kinds of procedures you need, then, indeed, you are practicing discrimination.

But that’s not what most people believe who request same gender care. Most patients welcome basic care from either gender. It’s only for the most sensitive, intimate care that they prefer a same gender provider. Their assumption isn’t that both genders can’t do the job equally as well. For modesty and privacy reasons, these patients just prefer a specific gender. So -- don’t accept this “discrimination” argument if it’s used.



I agree with Biker in Vermont about how hard it can be for women to get an all-female team too. It is pretty easy for a woman to find an all-female ob/gyn practice in most big cities and some small towns. But there are some challenges when a woman undergoes surgery in the hospital because they could let a male anesthesiologist or a scrub technician be part of her surgery. In fact, look at this horrible experience Maggie from Utah had at this link when she underwent a hysterectomy. She chose a female ob/gyn from an all-female practice to do her surgery. But she was deceived that she would have an all-female team. She ended up having a male anesthesiologist and a male nurse. At that hospital, they employ male nurses and midwives in Labor & Delivery and Women’s services. While male nurses and midwives are rare in Labor & Delivery at most hospitals in America, there are some hospitals in states such as Illinois and Utah that employ them.

Misty

 
At Tuesday, August 09, 2016 3:58:00 PM, Anonymous Medical Patient Modesty said...

PT: Thank you for your comments! This man has researched a variety of hospitals in the Detroit area and none of them seem to be willing to accommodate his wishes for an all-male team for his surgery. This should not be hard if the surgery is scheduled in advance. They can always bring male nurses from other departments to help with the surgery. I would like to know if the urologist contacted the hospital to inquire about male nurses and assistants. You are right urologists do not own hospitals and they just have privileges at the hospitals they perform surgeries. This same man shared that his urologist (a different one) at first thought it was okay for him to have an all-male team for his surgery, but then said that female medical professionals at the hospital would claim discrimination. I am so tired of hearing this discrimination argument. I agree that medical facilities should give both male and female patients equal opportunities for having an all-same gender medical team if they wish.

I am sure you probably recall the below paragraphs about discrimination from Doug Capra who wrote this article, Patient Modesty, Values, and Rights on Dr. Sherman's blog at: http://patientprivacyreview.blogspot.com/2010/11/patient-modesty-values-rights.html:

Don’t let someone tell you that your choice of one gender over the other for intimate care is discrimination, in the legal sense of the word. Don’t let them compare it to racial discrimination. A racist is someone who negatively stereotypes a whole race and/or thinks that race is inferior to his own. If, as a man, you believe that all women are inferior to men and can’t do the kinds of procedures you need, then, indeed, you are practicing discrimination.

But that’s not what most people believe who request same gender care. Most patients welcome basic care from either gender. It’s only for the most sensitive, intimate care that they prefer a same gender provider. Their assumption isn’t that both genders can’t do the job equally as well. For modesty and privacy reasons, these patients just prefer a specific gender. So -- don’t accept this “discrimination” argument if it’s used.



I agree with Biker in Vermont about how hard it can be for women to get an all-female team too. It is pretty easy for a woman to find an all-female ob/gyn practice in most big cities and some small towns. But there are some challenges when a woman undergoes surgery in the hospital because they could let a male anesthesiologist or a scrub technician be part of her surgery. In fact, look at this horrible experience Maggie from Utah had at this link when she underwent a hysterectomy. She chose a female ob/gyn from an all-female practice to do her surgery. But she was deceived that she would have an all-female team. She ended up having a male anesthesiologist and a male nurse. At that hospital, they employ male nurses and midwives in Labor & Delivery and Women’s services. While male nurses and midwives are rare in Labor & Delivery at most hospitals in America, there are some hospitals in states such as Illinois and Utah that employ them.

Misty

 
At Wednesday, August 10, 2016 2:57:00 PM, Anonymous Medical Patient Modesty said...

I wanted to share an article, Can I guarantee an all female surgical team? Sorry. No can do. that a female plastic surgeon who does breast surgery wrote about how a prospective female patient asked her if she could guarantee her an all-female team if she had surgery. It Is not illegal for a female patient to request an all-female team. The same is true of a male patient who wants an all-male team for a surgery that exposes his private parts. I am glad that this female patient was bold in speaking up and decided to look for another surgeon if she could not be guaranteed an all-female team. I think it is odd that this surgeon used the discrimination argument. This female patient never asked her to fire the male professionals. In fact, medical professionals of both genders are needed at the hospital.

Misty

 
At Wednesday, August 10, 2016 4:47:00 PM, Blogger Biker in Vermont said...

Interesting article Misty. I wished it had a comments section as I'm guessing she'd of gotten skewered. The ending had a bit or irony to it:

"So, no I cannot guarantee an all female surgical team. But I can guarantee a team of professionals who come to work every day wanting to make your surgical experience as comfortable and pleasant as possible. And if anyone feels a little embarrassed, don’t take it personally. We won’t."

She wants the experience to be as pleasant as possible but doesn't care how embarrassing it might be. How comforting to know she won't take offense at your embarrassment.

 
At Thursday, August 11, 2016 12:50:00 PM, Blogger NTT said...

Good Afternoon Everyone:

In regards to the plastic surgeon, she states she "cannot not discriminate based on gender or even on gender identity. I have to give equal consideration to a male nurse, a female nurse with a unibrow and soul patch, and a cross dressing nurse of either gender."

Hospitals & radiology centers discriminate ALL the time.

Man & woman go for radiology position. Male is more qualified. If the position involves doing something like a mammogram, 99% of the time, the woman who is less qualified will get the job. No equal consideration here. Same thing with L&D in the hospital. 95% of the time due to the nature of the beast, the woman will get the nod over the guy.

Discrimination lawsuits by guys and/or congressional intervention are the only ways this is going to change & help guys out.

Until then guys will have to get used to be embarrassed or walk away from healthcare. Sad state of affairs.

Women are screaming all the time they want equal pay for equal work.

Men need to shout as loud, men want and deserve equal consideration in a medical setting.

Regards to all,
NTT

 
At Thursday, August 11, 2016 6:51:00 PM, Anonymous Anonymous said...

NTT

Excellent response.



PT

 
At Thursday, August 11, 2016 7:27:00 PM, Anonymous Anonymous said...

The plastic surgeon states that she needs to give equal consideration to all genders ( ie employees). What she does
not say is wether this is in a hospital or outpatient surgery center. I'll venture to say the majority of plastic surgery cases
are performed at outpatient surgery centers. Again, if this were at a hospital she would not have a say.

Her last comment about patients being embarrassed strikes me odd considering she has spent her entire life and career
concerning others people's vanity. Perhaps she pretends to imply she has never heard nor considers the concept of
patient centered care. She should, this is where healthcare is going and I assure you should she ever walk in a facility to
have a mammography and a male mammo tech greets her she would have a cow.

That fake demeanor she presents on her thread sounds more as if she is mad that she lost some business and considering
plastic surgery is a 99.9 % CASH BUSINESS she is a little butt hurt. Considering what breast enhancement surgery costs,
8 Grand on up and cash, credit is only excepted patients should get the choice of their gender in the OR and that goes for
all patients.

I have seen a number of female plastic surgeons advertise on their website, in magazines that their office, their business
employs female only employees and that is their business if that is their choice and it makes the patient comfortable. In
conclusion, I want to mention the male urologist from a hospital that was mentioned on Misty's website. The specific hospital
where he is employed was the exact hospital an incident occurred that prompted the thread on Allnurses, Whoa,
Innappropriate. I wonder if he is aware of that.

PT










 
At Friday, August 12, 2016 1:45:00 PM, Anonymous StayingFit said...

I find the discrimination argument to be an interesting one, given a commercial that I saw while visiting family in the Western New York area. This was for a law firm, and it showed a steady stream of pictures of female attorneys. As it did so, the narrator stated that their clients can choose a female lawyer, for those issues that another woman would understand. Naturally, no similar offer was made to men. If I am able to find it, I will post a link to the law firm associated with this commercial.

It seems to me that directing clients to female lawyers at a firm, because of their gender, is similar to a patient requesting a male urologist and that only men assist with his surgery. If such a thing constituted illegal discrimination, surely the male lawyers would be the first to sue?

I believe that gender, in both cases, is a bona fide occupational qualification. If the company in question offers same-gender services, the gender of the providers of those services is germane. This is unlike race or religion, which are specifically prohibited, under law, from being used as criteria for employment.

This is also true outside of matters of employment. While it is legal to offer services based on gender, such as a women-only gym, it is expressly illegal to deny services based on race, religion or similar attributes.

The urologist in question either knows all of this, or should know it. I think his real motives for refusing this request were his desire to avoid criticism from his staff, as well as his disregard for the importance of this issue to the patient.

 
At Friday, August 12, 2016 5:00:00 PM, Blogger Biker in Vermont said...

A nurse from the Emergency Dept at my local hospital called me as a followup to my visit there three days ago. When we were done with the reason for her call I politely asked her if it was OK if I made a suggestion. She says "of course" and I tell her that from the patient's perspective it would be appreciated if the doctor would introduce any scribe they bring into the room and ask if it is OK for them to be there. I said my particular visit did not involve any intimate exposure or personal discussion and that I was OK with her being there this time but that if my visit had included intimate exposure or personal discussion I wouldn't have wanted her in the room. I said I would speak up but many patients might be too intimidated by the setting to say anything, and that the scribe being there could add to the patient's stress.

She agreed wholeheartedly and thanked me for bringing up the topic. She said she wasn't aware of what their standard practice was concerning scribes but agreed my suggestions made sense. She said she would follow up with the ED staff on this.

 
At Monday, August 15, 2016 7:30:00 PM, Anonymous Anonymous said...

My primary care office has both scribes and medical students at times. I have the same feelings as "Biker in Vermont." I am prepared to ask my doctor to dismiss those people for an intimate procedure or discussion.

At my last physical, two students as well as the doctor took my history, listened to my heart, and palpated my liver. This was fine with me since I was only undressed from the waist up, and the history did not include anything traumatic or embarrassing. I would not have allowed these students to perform genital or rectal exams. I acknowledge that they do need to learn how to do those exams, but perhaps a standardized patient is a more appropriate person to teach them.

To me, this is just common courtesy. If I'm meeting with a lawyer or tax professional to discuss something routine, it's OK if an intern is part of the discussion. But if we're discussing something very sensitive or embarrassing, it's not OK. Outside the medical profession, this seems to be common sense.

"Class of '98"

 
At Saturday, August 20, 2016 7:48:00 AM, Anonymous Gordon said...

The double standard seems to upset me a lot. I had a scrotal ultrasound done the last week to rule out mass. The tech, a female in her 50's asks me undress waist down and wear a poorly fitting gown, and then enter the room. She then completely lift the gown upto my navel and asks me to pull my $@$ up. Only after that she gives me a towel to cover myself. She found something abnormal on her screen and needed to call the radiologist, I started to get worried. When the radiologist came in she completely removed the towel and started the scan again. That left me completely exposed waist down. Like a man I finished the scan and left, didn't want to be frowned or laughed upon. We need more male techs in healthcare. Otherwise these embarassing situations will continue. Has anyone else here had a ultrasound done ? Could what I experienced be called normal procedure ?

--Gordon

 
At Saturday, August 20, 2016 10:42:00 AM, Blogger NTT said...

Hello Gordon:

Welcome. Your experience is "normal" in that a woman did the test as there are more female techs than males & the males that are out there looking aren't being hired due to discrimination practices on the part of hospitals & clinics.

If you are a male & your doctor orders a male related test of any kind, it's up to the male patient to call the location doing the test/scan/x-ray ahead of time & ask is there a male tech available to run the test as you don't want it done by a female tech.

Many of us (including myself), have learned this lesson the hard way.

I won't allow my doctor's office to schedule any male related tests or procedures before I find a male tech to do it. They tell my what they want.

Then I call around until I find a location that has a male tech available to run the test. After i find a place, I call the doctor's office & tell them where & with who to schedule the test.

I have found that it is the only way to keep your respect because the healthcare industry doesn't give a r**s a** about male modesty.

I'm curious, did the tech OR the radiologist ask permission for or tell you ahead of time they were going to raise your gown or remove the towel?

Regards to all,
NTT

 
At Saturday, August 20, 2016 1:41:00 PM, Anonymous Gordon said...

No, at the start of the ultraspund the tech didn't say anything. She just went on to lift the gown. Asked me to pull my $&@ up. This raised the testicles. She went on to do the ultrasound after which she found something abnormal, for which she had to call the Radiologist. When the radiologist came in , the tech completely removed the towel leaving me exposed waist down for nearly 10 minutes.

 
At Saturday, August 20, 2016 3:41:00 PM, Blogger Biker in Vermont said...

I have had two similar ultrasounds one. The first was an abdominal ultrasound done as part of my bladder cancer diagnosis. At the time I had no idea what the procedure entailed and though I was extremely self conscious at having had to strip completely (in private) and don a gown knowing the tech was a female, the middle aged tech did not do anything to add to my embarrassment. My genitals were covered with a towel before my gown was lifted and though she came as close as one can without exposing me she did not actually expose me.

The 2nd time was part of an emergency room visit for a swollen testicle. It was embarrassing to have to tell the admitting desk what I was there for (all female) and then after being brought to an examination room a female nurse came in to have a look and so I had to drop my drawers. She then sends me for a testicular ultrasound. That tech was a young female. I had to strip (in private) except for my shirt and socks and don a gown. She did put a towel across my penis to cover it up after she lifted my gown but clearly it was visible in the process of putting the towel over it. Embarrassing as the procedure was, I can't think of anything she could have done differently.

Both ultrasounds were before I realized that I could speak up and ask for a male tech. Both were in a small local hospital though and there even being a male tech there is anything but assured. At the time I consoled myself saying the nurses & techs were as professional as they could be. Having experienced unprofessional behavior at other times I knew the difference.

Now I know to seek a male tech in a non-emergency situation, and even then I know I can at least ask.

 
At Sunday, August 21, 2016 10:03:00 AM, Anonymous Anonymous said...

WWW.ARDMS.ORG located in Rockville Maryland is the agency that certifies Ultrasound technologists. There is no criteria by which
they determine how an ultrasound tech performs any Ultrasound . Its up to the tech. I can tell you that for a pelvic ultrasound
that includes a transvag ultrasound if the tech is a male he will have a chaperone and the female patient will be completely covered
by a sheet. The female patient will insert the probe and the probe will be manipulated from outside the sheet. It is a double standard
and a scrotal ultrasound could be performed in the same manner but they don't.

PT

 
At Wednesday, August 24, 2016 5:45:00 AM, Blogger Biker in Vermont said...

Having thought about your post PT, it is understandable that a certifying or licensing agency is going to primarily focus on the technical aspects of the role rather than the soft side of patient interaction. This is why even if you have had a procedure before, when you go to a new facility or a new practitioner that you should always ask questions beforehand even if you think you know what the answer will be.

I have had numerous RN's & NP's prep me for my many cystoscopies over the past 11 years. My takeaway is that the fact that each and every one of them has done it in exactly the same manner speaks to that facilities training & protocols rather than a national standard. Given I will likely be going to a new facility going forward due to an insurance change, I will need to guard against complacency on my part in assuming they will do things exactly the same as I have grown used to. Maybe they will but maybe their training and protocols are different as concerns male modesty and dignity. Thanks for the reminder.

 
At Wednesday, August 24, 2016 9:25:00 AM, Blogger NTT said...

Good Afternoon All:

I've been reading the thread.

Don't know if its possible but, it seems to me there should be one set of protocols out there that all healthcare facilities should have to follow when it comes to all patient testing.

The protocols should be setup by a panel of lay people with input from the medical community and patients. If the medical community has oversight, we'll never clean up this mess.

It just doesn't make sense to me that one location does their testing one way any another location does it another way.

Standardize the protocols across the industry using input from people that have had to endure these procedures (some being very intrusive & embarrassing for the patient).

Hospitals rarely "listen" to the patients when it comes to protocols. It's their way or the highway.

I fear the only way they will listen is if the protocols come from a governing authority that can & would punish the facility and/or people for non-compliance.

People I've talked to so far don't want to "rock the boat" out of fear of retaliation from industry.

Sad state of affairs.

The system is broke and it needs fixing.

Regards to all,
NTT

 
At Friday, August 26, 2016 9:29:00 AM, Blogger Biker in Vermont said...

NTT, common protocols could probably be put together at a generalized level so as to guide patients as to what they might expect and so as to provide a framework for training medical staff. I doubt you could carry it to too high a level of detail though.

For example you can say sonography patients will have all genital areas (and also breasts for women) draped except for that which is then currently being examined. Saying exactly how to drape would be going too far I think. Such a protocol can be applied to pretty much any procedure other than certain emergency room situations where draping just might be unreasonable under the circumstances. Even then there can be guidelines to help define unreasonable.

What I would love to see at a policy level is for any procedure which involved intimate exposure that patients be advised ahead of time who will be present, their gender, and the patient asked for their consent. Patients that do not consent might need to find a different provider but that is their choice. Such a policy would not require providers provide same gender care but it would certainly open up the conversation and providers would get a whole lot more patient input than they currently receive. Again, emergency room situations would need to be treated differently.

 
At Wednesday, August 31, 2016 11:48:00 AM, Anonymous Anonymous said...

Hello,

I've read some of the postings from the past weeks and I'd like to relate an anecdotal experience from 25 yrs ago. A ton of steel fell on my back causing a massive pelvic fracture. I was rushed to an ER where a team of medical personnel were waiting. (I suspect that the paramedics had radioed a gruesome story before my arrival.) Upon arrive the usual divesting process was initiated. Fortunately, I was conscious and refused this in the presence of the female personnel. One young lady said, "We do this every day!" To this I responded, "But I don't!" The male docs asked the females to leave and my issues were addressed. This was in a large metro area where the absence of the female personnel did not seem to affect the course of treatment. Additionally, there was no blood (externally) so that surgery was not directly necessary.

I relate this story (from 25 yrs ago) to indicate that patient concerns can be addressed, even in the ER. Letting medical personnel KNOW of your desires is the important sine qua non. Beware, however, that the medical profession has a HORRENDOUS information transfer problem, even with EMR's. What you tell one individual may need to be related to each individual you meet during your progress through the medical maze. If you're conscious, and strong enough, you may be able to inform each staff member of your desires. If you're unconscious, an ADVOCATE would be extremely useful. (Obviously, this only works, if you have advance notice of your medical visit. Stay conscious as long as possible in an emergency.) Written advance directives may or may not be read, especially in an emergency.

I'd be remiss if I neglected to mention the fine, dedicated men and women that populate our medical system. The nurses (usually female) do the tiring grunt work and are exhausted by the end of their shifts. They've rendered compassionate care for 12-16 hrs (or more) and they receive little thanks for their heroic efforts. Let them know what you require and they'll do their best to humanely accommodate you. (I really think that every doctor should be required to do one nursing shift per month. Wow! The system would change in a flash.) I return with cookies and gift cards for the individuals who helped me. Saying, Thanks!" is an important gesture.

Finally, I'd like to address the issue of doctors' manners. I try to visit doctors as infrequently as possible. (From the other posts, I think I'm not alone.) I visit G Scott Smith MD, Orange, CA (Unfortunately, he's not accepting new patients. Sadly, he's getting close to retirement.) As he begins an exam/ procedure, he says, "I'd like to ...., if you'd allow me." I've never asked him why he says this; but, I presume it's because he wants to treat his patients with the utmost respect. He's an extremely competent, jovial and humble medical professional. I feel HONORED to be his patient. For those of you who don't have this encounter during your doctor visits, you may wish to subtly mention to your doc, "I've heard of a great doctor who says, 'I'd like to ...., if you'd allow/permit me.' " Maybe your doc will take the hint. I do sincerely think that one small ripple can affect the entire pond. We need to make that ripple.

Reginald

 
At Thursday, September 01, 2016 3:54:00 AM, Blogger Biker in Vermont said...

Reginald, good for you. 25 years ago I was still in the mode of thinking men had no choice but to silently submit and make believe it didn't bother them. It is only in the past year that I found my voice, and I'm 63.

My guess is that the doctors involved in that emergency room knew that young nurse in particular enjoyed that aspect of her role a bit too much and that they chose to protect you being you did speak up. Without you speaking up they'd of had no basis to remove her without getting in trouble themselves. The code of silence would have ruled the day.

My guess is that the doctors further saw you as fitting into one of the groupings that rouse the curiosity of some nursing staff, in this case a fit younger man. The other groupings would be a particularly good looking man or a genital outlier, either on the large or small side.

That's good advice on showing appreciation to the nursing staff. They really are the backbone of the medical world and are often unappreciated. I would add thanking doctors for being thorough or going beyond the minimum is a good thing too. After my bladder cancer surgery I sent my primary care doctor a nice thank you note for having been so thorough in my annual physical. My urologic oncologist said had my primary care doctor not done a urine test I'd likely have been terminal by time it was discovered. He said primary care doctors often don't include that test anymore when there are no risk factors evident. In my case I was younger than the typical patient in addition to having no risk factors.

 
At Monday, September 05, 2016 6:09:00 PM, Anonymous RobertH said...

Many of you may remember my posting 15 months ago—mid June 2015—about how I have managed to get urologists to accommodate my physical modesty and how I had no problem wearing home-made colonoscopy shorts when I had to have a colonoscopy (which found no cancer, I should add). I now have more story to tell. It’s both good news and bad news.

After 4 years of my PSA bouncing around in the 3.8 to 5 range (with free PSA of around 30%; over 25% means a lower risk of cancer), I finally decided to have a biopsy. I had started to take finasteride to improve urination and it cuts your PSA roughly in half, so I worried that my PSA would no longer be a reliable marker. Also, the colonoscopy shorts worked out well. So I asked my urologist whether I could wear colonoscopy shorts for a biopsy. He emailed the doctor who does the biopsy and we had a quick three-way email exchange. No problem at all! God bless email! One of the advantages of going to a hospital connected to a Medical School is that the doctors will email you!

There was no problem with the biopsy. The home-made colonoscopy shorts were not in the way. There was ZERO pain, which surprised me; the doctor said “you may feel a needle now as it injects lidocaine into your prostate” and I paid very, very careful attention and felt a very tiny bit of pain. Much, much less than a needle for dental work. Going to the dentist or the dental hygienist is much worse. The twelve needle stabs to extract cores of tissue consisted of snapping sounds only; I felt nothing.

So if you need a prostate biopsy, ask whether you can use home-made colonoscopy shorts. If they say no, ask why!

That was the good news. The bad news is that they found cancer. Of the 120 millimeters of cores they took (12 cores, 10 mm each), two cores had 2 mm and 3 mm of cancer, for a total of 5 mm. It was Gleason score 7 (3 +4, the less dangerous kind). So that has led to some interesting and overall positive negotiations with my urologist, who will also be my surgeon. That’s for the next installment.

--RobH

 
At Monday, September 05, 2016 7:30:00 PM, Anonymous RobertH said...

I received the biopsy results about a week before my appointment with my doctor, so I had time to do some additional web research. Checking various websites, I ascertained that active surveillance was not an option with Gleason Score 7 (it is with Gleason Score 6). My urologist, who is the university’s expert on active surveillance, later confirmed my conclusion. I also wrote him an email reminding him of my modesty concerns and stating my opening “negotiating position” in the kindest, most professional manner I could devise.

When we actually met, we first focused on the advantages of radical prostatectomy versus brachytherapy (implanting radioactive seeds in the prostate to burn it up, basically). The latter has a slightly lower success rate and the damage it does complicates any subsequent surgery. Since I am about to turn 63 (same age as Vermont biker!) the surgery seems to be a better option. It also has the advantage that I have known the doctor for 3 years and he has known me that long, I like his communications style, and he has done 600 DaVinci procedures. He appreciates how informed I am and is very respectful of me. I trust him. There is no easy way to develop that rapport in a short time with someone else.

He also offered me what is probably the absolutely best arrangement I could obtain from anyone. More on that in the next installment.

RobH

 
At Monday, September 05, 2016 7:34:00 PM, Anonymous RobertH said...

This is the arrangement my doctor and I negotiated:

1. I will be able to wear my underpants in pre-op and actually into the surgery suite.

2. Shaving of chest hair will not go as far down as usual, which I think means the pubic hair will be spared.

3. Once I am asleep, the doctor will ask everyone to leave the operating suite except the anesthesiologist. He will remove the underpants, catheterize me, and place a sterile blue cloth over my loins.

4. At the end of the procedure, the doctor will ask everyone to leave again except the anesthesiologist, will replace the catheter, and (I think) put my underpants back in place. This means I will not be naked through the surgical procedure. I am not worrying about a same-sex surgical team.

5. After I wake up, I can put on a tee shirt. I have confirmed this with the doctor by email and have purchased a plain white tee shirt and taken it to a tailor, who has install Velcro all along the left side. This way, I can put it on without disturbing the intravenous lines. I am asking friends and loved ones to write comments on the tee shirt, which I am referring to as my “lucky tee shirt.” This was my perfect brainstorm because I can refer to it as a lucky tee shirt to medical personnel and friends without bringing up modesty issues directly, and everyone will accept it. Anyone who has a modesty concern can learn from the idea without me having to push it. Nurses will have to tolerate it. Several people who have written on it have praised me for the cleverness of the idea.

6. I am still uncertain about the 24-30 hours I have to stay in the hospital before discharge (the operation only requires one night’s stay). I suppose nurses will want to see the bandages. I can pull the tee shirt up easily to allow that (I can even unvelcro the bottom to make that easier). I am not sure anyone will want to check the catheter. My policy will be that only a male can do that, and only if I can be convinced that my reported observations are insufficient. As far as I am concerned, I will have allowed them to invade my body, so they can’t invade my privacy; that adds insult to injury! So I will be kind, friendly, professional, but firm and, if necessary, militant. Currently, I have no intention to let anyone lift my underpants even half an inch, including the doctor, but I can be persuaded that it is necessary if the medical person is patient and knows how to make a case. My impression from my doctor is that I will not have to show anyone anything during my one-day stay.

7. The doctor has said that 7 days later when I come in to remove the catheter, I can do the removing, I have already confirmed that with his nurse (female) with whom I will meet. The doctor said he has had other patients who have done that.

RobertH

 
At Monday, September 05, 2016 7:35:00 PM, Anonymous RobertH said...

I am mostly pleased with this arrangement. I would have preferred to self-catheterize before the operation and be allowed to keep the underpants on during surgery. The doctor’s concern was purely medical: there are sterility issues that must be considered. Normally, catheterization is a clean procedure, not a sterile one, but when they are removing the prostate, they have to remove a section of the urethra as well, so the catheter must be sterile. The catheter can be damaged in surgery, so it has to be replaced at the end of the procedure.
We will see how all this goes on Monday, October 17. When I am tired, especially at night, or while I am sleeping, I get anxious. I don’t like this situation at all, but I am convinced it is the best we can make of a difficult medical diagnosis. Removing my prostate reduces the danger of prostate cancer by 90%; leaving it in means it will metastasize and kill me at some point, probably 5 to 15 years from now. My main concern is there will be an unanticipated demand for UMN (“unnecessary medical nakedness”) that I will refuse, causing a breakdown in relations. I could always turn to brachytherapy then, but I’d rather not deal with the stress of a whole new set of negotiations. I will let everyone know how it goes. In the next few days, also, I may ask for advice, but I need to think about that a while.

RobH

 
At Tuesday, September 06, 2016 8:03:00 PM, Anonymous Anonymous said...

Hi Dr. B. It has been sometime since I've taken the time to visit this forum, as I myself had experienced a medical life event 2 years ago..., but I had just came across the subject link which I think touches on some of the complexities involving opposite gender care, including my own experiences. If I could kindly encourage folks to read through the full article link below, including the author's caveat question at the end, including those who support the husband's actions, that perhaps the medical community at large perhaps need to be aware of the sensitivity of opposite gender intimate care. Thanks! H.

http://www.inquisitr.com/3138066/saudi-husband-shoots-male-doctor-because-he-saw-his-wife-naked-during-childbirth/

 
At Wednesday, September 07, 2016 4:47:00 AM, Blogger Biker in Vermont said...

RobH, first, good luck to you in your upcoming procedures. Good for you in doing your research so that you could have informed discussions with your doctor as to the course of treatment. In reading your posts as concerns how you handled your modesty concerns,all I can say is wow you really did manage it well and you clearly have a doctor who takes your concerns seriously. My guess is that those working with him have also learned something about patient modesty from the experience.

H, I had seen that story when it first came out. It might be easy to dismiss it being it happened in Saudi Arabia but the high rate of Arab and African Muslim immigration into the US and Europe will bring new pressures on the medical community to accommodate patient modesty demands. Clearly the medical community already does what they can to accommodate the women but the expectations may rise to a new level. I doubt the medical community is prepared at all for the Muslim men who are going to object to the sea of women they will encounter when it comes to intimate care.

 
At Thursday, September 08, 2016 6:48:00 PM, Anonymous Anonymous said...

That's a concept. All men now claim they are Muslim and the medical community must adhere to our wishes based on our religion.

PT

 
At Friday, September 09, 2016 8:11:00 AM, Blogger A. Banterings said...

RobH,

Good for you for standing up for your dignity. Let me make one final suggestion; type out a letter reiterating what you have negotiated with your surgeon. In the letter be sure to thank him for his understanding and commitment to patient dignity. You can put it in the tone that you want to be sure that you correctly understood what was negotiated.

Also include a sentence that says these negotiations will supersede any "boiler plate" consent forms that you may subsequently sign for admission. I would mail it with "tracking" (does not have to be certified) so there is proof your surgeon's office received it.

The day of your surgery, after you sign all the forms, I would hand a copy to the room nurse, ask that it be part of your medical record.

Anyone can tell you those terms are fine and that is the treatment that you will get. The day of, the story can change and they can point to consent forms that you signed to nullify the negotiations.

By you doing this, and mentioning the boilerplate consent forms (see contract of adhesion ), you are protecting yourself.

-- Banterings

 
At Saturday, September 10, 2016 7:37:00 AM, Anonymous RobertH said...

Dear Banterings:

I have the surgeon's commitment in writing because we exchanged emails about it. I plan to print that out and hand it to the nurses and others when I am admitted for surgery.

I have wondered how to handle the permission form. I could staple a copy of the email and add a note that I consent based on the agreement on the attached email. That's what I was considering.

I will need a third copy for the after surgery team as well. I'll probably print out and keep at least 4 copies with me. If anyone dislikes the arrangement--for example, when I have to be shaved before surgery--I'll firmly insist they consult the surgeon and that he consult me if there has to be a change, even if that creates a delay. Above all, I plan to stay professional, calm, polite, and kind, but firm. That combination appears to be the most effective. Where shaving is concerned, I can always insist on doing it myself, but the surgeon says they do not have to shave as far down as they usually do and I should arrive a bit early so that can be accommodated. I plan to confirm that detail by email as well.

--RobH

 
At Sunday, September 11, 2016 12:24:00 PM, Anonymous Anonymous said...

Haven’t been able to join the discussion since February because of my prostate surgery, complications, and recovery (along with many Urology visits). But yesterday while perusing the comments of Feb - June ’16 I saw Dr. Bernstein’s suggestion that action rather than complaining is needed. I do recall past visitors commenting they had no success contacting clinics, hospitals, etc. Last year after relocating to another part of the US I started visiting a new Urologist (at a urology clinic that is part of a large hospital based metropolitan medical center). This clinic was so completely staffed with females it was sadly laughable. I’m going to attach the most relevant parts of my letter in January to the Medical Center in two successive posts. But let me say up front this correspondence and subsequent phone conversation has resulted in POSITIVE CHANGES in the staffing and operations at this Urology clinic so that all patients can be treated with respect and dignity. Below you can see some of the issues I hinted at while trying to not be too accusative, but the real problem for a large institution like this is they establish their policy that their outpatient’s have a right to same gender staff for intimate exams by; 1) operating many women’s health clinics and service lines staffed only with female staff, and 2) their patient rights state individuals have the right to privacy, and respectful, dignified, patient-centered, individualized care and yet they hired exclusively females for a clinic that sees a heavily male population. Further, since they are so large I know from experience working at a similarly sized institution, they have staff turnover of 10-20% per year and hundreds of male and female applicants for position openings. To only hire only females where being male would be the BFOQ raises red flags about federal and state employment discrimination laws and violation of a state law in the provision of equitable services in a place of public accommodation, and in violation of CMS standards and Joint Commission standards.

Letter to medical center, Part 1 of 3:
“Thank you for reading this submission. I am a prostate cancer patient in your Urology department. I’ve had five visits to the ABC Medical Center Urology clinic so far and after my surgery I will have many more visits.

You undoubtedly know that the patient population in the outpatient Urology department is overwhelmingly male. It is the specialty men go to for genitourinary issues. For men it is the Women’s Mammography Imaging, Women’s vaginal Ultrasound Imaging and the Women’s Health Center (OB/GYN) rolled into one. Many trips to Urology involve intimate examination, intimate care/treatment, and intimate issues for men.

You have women’s outpatient departments (some stated above) that are staffed so that women only encounter female staff (MAs, RNs, NPs, Techs) during their intimate care (regardless of the sex of their physician). You can do this because the Supreme Court and many State courts have ruled that patients (both female and male) have a right to bodily privacy and a right to same gender intimate care. You have learned women are sensitive to exposing one breast from their gowns for mammo imaging or a biopsy and they are more comfortable having female staff present to perform or assist in their mammo exams and biopsies and conversely on the whole women would prefer male radiology techs and male assistants not be present at these intimate exams. Similarly for the other outpatients departments involving intimate women’s care you have learned the default position of providing all female staff for these situations provides a female patient experience that is overall more comfortable and dignified for the female patients. I applaud this.” End Part 1 - AB

 
At Sunday, September 11, 2016 12:25:00 PM, Anonymous Anonymous said...

Letter of medical center, Part 2 of 3:
“During my multiple visits to ABC Medical Center Urology I’ve spent a couple hours in the Urology waiting room and I’ve never seen a male MA or any male for that matter come out to collect and room a patient. 100% of the patients (who were nearly all male) were roomed by female MAs. My own admittedly limited personal experience of five visits to date is that I’ve only encountered female staff (I’ve been roomed by multiple female MAs, I’ve met multiple female RNs, I had an office visit with a female NP and there was a female MA present for my prostate biopsy and afterwards when I got dressed).

As a patient I have no idea of your overall staffing in Urology. But after five visits it is curious that for a predominantly male outpatient service line usually involving intimate care there are no male staff involved. I know ABC Medical Center provides “patient and family centered care” and that you “attend to [my] physical, emotional and spiritual needs” and provide “individualized care that takes into account [my] comfort and dignity.” Since ABC Medical Center has determined gender of staff involved in intimate outpatient care is important (e.g., in the many outpatient women’s health situations) I would have expected at some point in my urology department visits to be queried on preferences on this matter unless of course the operating model of urology was analogous to the women’s care clinics and only same gender staff assist physicians in intimate care procedures/tests. What the staffing model in Urology is not clear to me but I truly hope male patients don’t have to ask for same gender intimate care if that is important to them. That would be a barrier for males that female outpatients do not encounter at ABC Medical Center. That barrier could compromise the level or standard of care for males. Such a barrier could be misconstrued.

I know ABC Medical Center practices evidence based medicine. I would ask that you discuss with your HR department and your chief nursing executive to learn if any peer reviewed publications indicate that a high majority of males prefer only female staff (MAs, RNs, NPs, Techs) assisting with their intimate care in outpatient Urology departments. I would imagine there are none but I’m open minded. Studies I’ve seen and even court opinions suggest that just like women’s preferences, a significant fraction of male patients would prefer (and are entitled too) same gender intimate care, a fraction of male patients would accept either male or females involved in intimate care, and the remaining fraction of males would prefer opposite gender for intimate care. Even the US military recognizes and addresses this issue. This is not surprising nor new information - its decades old.” End Part 2 of 3. - AB

 
At Sunday, September 11, 2016 12:37:00 PM, Anonymous Anonymous said...

RobertH.
You're wise to have multiple copies of your requirements available.
Five days before my surgery, two months ago, I completed pages of pre-registration at the hospital. I crossed out, initialed, and dated the sections on observers and photographs. I crossed out, initialed, dated, and wrote in big letters "Do Not Agree" to pay if medicare and my insurance didn't cover the costs.
The day before my surgery I received three phone calls at my home requesting vital stats and meds
[all this info was in my pre-reg]. One call was from an 800 number and a self identified pre-surgery nurse. When she was finished getting all the info again, I asked her the duties of a pre-surgery nurse. She replied that her job was to collect the info that we had just completed.
I was surprised that no one contacted me regarding my "Do Not Agree" to pay. I expected a receptionist/clerk
to inform me that I had to agree to pay because it was "policy" - the only answer that I have ever received in these situations and that's why the administrators send someone w/o answers. I wasn't surprised that no one contacted me regarding no observers and no photographs,filming, and recording because a.] as RobertH knows
this info is not communicated to employees and b.] even if it were passed on, what difference does it make.
Good luck RobertH.
BJTNT

 
At Sunday, September 11, 2016 12:42:00 PM, Anonymous Anonymous said...

Less you think that all I do is complain, I sent two compliments to the medical center after my recent surgery.
One compliment was to the anesthesiologist who honored my request for no versed and general although she
gave me the pro forma arguments. The second compliment was to the food service worker who went the
extra mile and did so with an excellent attitude. Perhaps this was a left-handed compliment since I'll sure the
medical community won't accept her as a member.
I never send complaints to the medical community because I find it highly insulting to get that form letter reply.
Notice that it's a medical center and not a hospital. Undoubtedly the administrators are patting themselves on the back about addressing the negative connotations of hospital by changing the name to medical center. Marketing is much easier than managing.
BJTNT

 
At Sunday, September 11, 2016 2:33:00 PM, Blogger Maurice Bernstein, M.D. said...

I really appreciate the current responses to the issue of medical system behavior with regard to the modesty issues well covered on this thread. I thoroughly agree and have repeatedly restated my advice to "speak up" directly to the component of the system (the physician, the clinic, the hospital) which the individual is a patient since it seems that it may be fruitless to try at this time to change behavior of the entire medical system at once. Of course, every patient must make their own personal decision with regard to their own personal medical consequences of this "speaking up but rejected" for their medical illness in terms of any delay or obtaining less than proper care. But.. keep it up and best wishes.

I am still trying to support the concerns expressed on this thread as I now have taken on another year of medical school education of my group of 6 first year medical students. From the first day I urge them to "listen to the patient!" And, of course, "listen" means more than sound bouncing off or vibrating the tympanic membrane of the student's (and later as physician's) ears but to think, understand and consider what the patient is saying in terms of making the upcoming medical experience therapeutic and not emotionally destructive.

Best wishes to all to continue this "speaking up". ..Maurice.

 
At Sunday, September 11, 2016 4:45:00 PM, Anonymous Anonymous said...

AB

That is a very informative post and we should somehow get your post to every urology office that sees male patients.

PT

 
At Sunday, September 11, 2016 7:50:00 PM, Anonymous RobH said...

Dear BJTNT: Thank you, I am assuming I will have to make my policy of being properly covered clear to every medical person I interact with.

These posts about intimate care have got me thinking. My plan is to wear underpants right after my prostate surgery and it appears that I have permission to do exactly that. I also have permission to wear my "lucky tee shirt" covered with the comments and wishes of my friends. So I should be well covered. I will lift up the tee shirt if anyone needs to see the bandages. I have no plan to let anyone--even a male--see under my underpants. My policy about intimate care at the moment isn't same sex only: it is no one at all. I think I can get away with that for 24 hours, but if there is an emergency, I will allow a male to look. I already have detailed written instructions from the hospital about how to take care of a catheter. I plan to print out a diagram of the male genitourinary system, so that if anyone wants to "show me" I'll pull out the diagram.

I have not thought about intimate care in the case of longer hospital stays because I have never been in a hospital overnight in my life, except after birth. But having had to help my father in law twice with hospital stays, when I helped him go the bathroom with his "ass flapping in the breeze," and having accidentally seen his genitals twice because nurses were careless, my firm policy is to wear underpants. It will be very difficult to convince me otherwise, too. I was appalled by my father in law's situation and profoundly shocked and insulted on his behalf (though I should add that he didn't care). I suspect the hospital staff will have to give in if I refuse to let anyone--male or female--lift up the top sheet unless I have underpants. I will certainly refuse to walk to the bathroom with a gown open in the back; that's dehumanizing. If they don't agree to adequate minimal covering, I might sneak to the bathroom without any help--they'd be furious about that, I know--or failing that, I'll stick my backside over the side of the bed and drop a load on the floor! Of course, all this assumes I have a modicum of personal strength, which I might not. Then I will just be continuously disgusted and furious, I'm afraid.

I apologize if I am getting worked up about this, but I find hospital policies totally unacceptable.

 
At Sunday, September 11, 2016 8:48:00 PM, Anonymous Anonymous said...

An interesting point should be made and that is who dictates the hiring practices at a urology office, the physicians or the office
manager? I've been to one urology office whereby there were 5 male physicians and over 20 medical assistants all female. The
first thing I noticed was that the clinic was divided into two sections, one sections involved prostate patient issues only, the other
side associated with female and male patients. Never did I see any male ma's at any time. The second thing I noticed was that
the ma's did not know how to properly take a blood pressure. Why were there no male medical assistants at the prostate clinic?

You never see male mammographers and there are none. Mammographers must possess a radiographers license before thay
learn mammography as on the job training. No one is going to let a male learn mammography. The managers of these mammo
suites ensure males are never trained or hired, why? Are all males considered perverts or just too unprofessional of ever
performing such a job. The same line of reasoning exists at L&D suites, no male nurses either. Are male nurses considered
potential perverts or just too unprofessional at ever performing that job.

It is exclusively female nurse managers and female radiology managers that ensure men are not accepted employment into
these areas. We see the complete opposite regarding men's clinic. Prostate clinics within a urology office are strictly men's
health issues.

PT





 
At Monday, September 12, 2016 12:58:00 PM, Blogger A. Banterings said...

AB,

You stated: ...But let me say up front this correspondence and subsequent phone conversation has resulted in POSITIVE CHANGES in the staffing and operations at this Urology clinic so that all patients can be treated with respect and dignity...

Let me shed some light on why your letter caused change. For a large corporation to offer same gender care only to women constitutes gender discrimination. I am sure that any of us who are on this blog have visited other sites about medical topics like KMD.

I am sure that we have read comments and topics other than patient dignity and have seen the view many physicians take of lawyers and of (malpractice) lawsuits they consider frivolous. Imagine if these lawyers were able to find "sex discrimination" in perfectly competent care...

The sad reality is that the healthcare system only changes from legal actions.


-- Banterings

 
At Monday, September 12, 2016 2:29:00 PM, Anonymous Anonymous said...

I noticed part 3 of 3 of my letter did not get posted. So above you will find parts 1 and 2. Here is the end. Sorry they are not consecutive posts, you will have to scroll to read full letter than.

Letter to Medical Center, Part 3 of 3:
“ABC Medical Center is a large medical center. You undoubtedly hire hundreds of employees a month, dozens of nurses a month, many medical assistants a month. Certainly there is plenty of opportunity to hire male staff for an outpatient department like Urology. So it is statistically unlikely that you would have all or nearly all staff in Urology that are female to complement and assist the male and female Urologists (physicians). Statistically speaking an equal opportunity employer that is sensitive to providing comfortable and dignified intimate care for both the female and the male patient would have both female and male staff on hand to assist the physicians and to provide the ongoing intimate care assistance per patient needs and preferences.

Some would try to say it is hard to find male nurses or male medical assistants or male radiology techs or male techs (for other duties) in Urology. That of course is a specious argument and in the interest of brevity I won’t address it but would be happy to discuss such a statement further on the telephone if of interest.

I would like to express that denial to accommodate patient preferences for intimate care can have serious consequences. In my own recent patient experience what if I had told Dr. "Jones", when he and his female (MA) assistant rushed into the procedure room where I patiently waited, that I didn’t feel comfortable with the female assistant? Could my biopsy still have proceeded that day in Dr. "Jones"’s tight schedule? Dr. "Jones" definitely needed another pair of hands to do this ultrasound guided biopsy procedure, he needed an assistant. Would a male MA have been available in the department for the female MA to switch with? I not soliciting the answer to this but offering it as an internal assessment exercise. I do wonder whether if a patient made such a request would their biopsy have to be rescheduled, thereby delaying their cancer diagnosis, thereby delaying their cancer treatment, and thereby potentially decreasing their survival chances? A simple situation like this could have Risk, Licensing, CMS and Joint Commission implications especially since female patients do not encounter the analogous situation at their outpatient clinics at the medical center.

With a plethora of Urology visits I have in the future (e.g., a voiding cystogram, 3-month checkups, 6-month checkups, possible interventions for ongoing surgery induced incontinence, erection rehabilitation) I can’t help but wonder what the staffing at the intimate procedures will be like. For now, despite appearances and experience to the contrary, I’m assuming your urology department is attuned to this basic right for all patients.

Finally, let me point out that as a male ABC Medical Center Urology outpatient at the first clinic visit and periodically thereafter I have to complete a detailed and extremely personal questionnaire on the quality of my erections, the success of penetration in sex, the frequency of sex, etc. etc. Despite asking for two pages of extremely personal genitourinary information no where on the form is the patient asked “do you have any preference for gender of urology staff that may be present during your intimate examinations and procedures”? To me it seems that this form would be ideal to capture that patient centered preference information and at the same time establish actual data on the preferences of your urology patient base? To me this would be the natural starting point to demonstrate “Individualized care that takes into account your comfort and dignity.” End of letter. - AB

 
At Tuesday, September 13, 2016 5:23:00 AM, Blogger Biker in Vermont said...

AB, that has to be about the best written letter I have ever read. Thank you for such a powerful contribution to the cause. Can you tell us what changes have been made there as a result?

 
At Tuesday, September 13, 2016 10:50:00 AM, Blogger A. Banterings said...

Early on in my contributions here, I brought up the point that some people may perceive genital exams as a sexual assault despite how professionally it is done. That does not even touch on exams that are coercive or lack sensitivity. Here is a a study published in the British Medical Bulletin in 2012 (Medical, statistical, ethical and human rights considerations in the assessment of age in children and young people subject to immigration control) that shows some minors considered intimate genital examination as sexual abuse.

It states:

...Just as importantly, intimate genital examination for administrative purposes may be, and most likely is, experienced as abusive. Sexual development is an issue of intense privacy and sensitivity for most adolescents, particularly in those from certain cultural and religious backgrounds...

...This raises important ethical issues over the propriety of such examinations especially when they are conducted for administrative purposes alone. The lack of medical benefit is not, in itself, necessarily a reason for ethical concern. However, it becomes a concern when its absence is reinforced by knowledge that such intimate examinations, which cause difficulty in many adults, may lead to psychological harm for some children...


This study comes on the heels of the fact that child refugees are subjected to genital tests to prove their age.

The UN’s Committee on the Rights of the Child also released a damning report in 2014, where Germany’s age assessment process was criticized for involving “degrading and humiliating practices”(genital exams), which didn’t necessarily produce accurate results.

Many people are abused and traumatized in their childhood and young adulthood by providers who force these exams upon them ("I NEED to so you can get birth control pills", "I NEED to in order to clear you to play sports", etc.).

Note that the WHO's Guidelines for medico-legal care for victims of sexual violence (chapter 7) states that in regards to the physical exam, coercion may represent yet another assault to the child...

--Banterings

 
At Tuesday, September 13, 2016 8:49:00 PM, Blogger Maurice Bernstein, M.D. said...

NOTICE:It is time now to move on to Patient Modesty: Volume 77
There will be no further posting here on Volume 76.

 

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