Bioethics Discussion Blog: Patient Modesty: Volume 77

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Tuesday, September 13, 2016

Patient Modesty: Volume 77











Interestingly, the conversation is back to this blog thread #24 begun September 2009. and here is the link to zoom back in time and visitors to compare.  I do think that this direct communication with the medical provider is the best way for the individual patient to make his or her standards known.  It may be that there is no way to change the medical profession through political or legislative action. Isn't that what the consensus of my visitors are here?  ..Maurice.

56 Comments:

At Wednesday, September 14, 2016 4:52:00 AM, Blogger Biker in Vermont said...

Bantering, as awkward and unpleasant as the age determination processes have been in Europe, they do recognize the problem and will likely shift gears if they can find a better way. I noted with interest that the articles didn't speak to whether the "children" were afforded same-sex examiners or not. My guess is yes given the religious aspect to that population. If only we would do the same for our high school athletes getting physicals. I wonder how age determination is done in the US for unaccompanied "children".

 
At Wednesday, September 14, 2016 11:39:00 PM, Anonymous Anonymous said...

" A study performed in June 2003 revealed that male students made up less than 10 percent in class offering medical assistant
training. Despite of the interest in the profession men have historically been discouraged and frequently denied access to
medical assistant education and entering in the workforce."

From the Advanced medical assisting of America newsletter Vol 5 May 2004

Ok, first realize that the article said less than 10 percent and it was usually one or two males in a class of 15-20 students.

secondly, one male said he finally found a Job After 3 years of looking while all the females in his class had jobs the second week.

Who looks for a job for 3 straight years? You would think that some re-inventing yourself might be a better option. Another male
student was rejoicing after 2 years of graduating he finally got his first interview at a hospital. Just an interview! Ever notice that
urology clinics never advertise who their staff are, only the physicians and maybe the office manager who by the wY is always
female. The forums on male posting that men are virtually never hired as medical assisting literally goes on for over a decade on
some of these sites. The only solution I see is some kind of a class action lawsuit, otherwise I don't see change anytime soon and
by that I mean decades. Considering the fact that because i bought a new Toyota over the last few years I received a small
settlement from a class action suit, I reviewed one from Sprint as well. Maybe I'll get another as a result of some savy attorney
in the future because his urology clinic never hired male medical assistants due to his religious beliefs. Maybe we on this site
can solicit some hungry attorneys fresh out of law school and change the way things are as I don't see any other solution to the
obvious discriminatory process.

PT










 
At Thursday, September 15, 2016 7:40:00 AM, Blogger Biker in Vermont said...

PT,legal action is perhaps the only way to get widespread change quickly but what would the basis be? Society as a whole does not recognize that males have any right to or expectation of privacy. Society recognizes that females do. Courts have ruled in this manner concerning prisoners.

Whenever new rights have been recognized by the courts or via legislation it has been when the aggrieved group has demanded change in a very public way. Men are not yet demanding change, or at least not enough are. Those men that do demand change are doing it quietly one on one with specific providers.

When there are public debates on social issues there are always entrenched interests posing the case for why change is not necessary or not in societal interests. The medical world would push back hard on the issue. To prioritize the hiring of men as nurses & techs will run counter to the interests of the several million female nurses & techs already out there. Women's groups would likely also fight it because changing the nursing & tech mix will be perceived as not being in the interest of women used to ready access to all-female staff. They won't say that however but will instead say that men are being discriminatory against the professionalism and qualifications of female nurses & techs. Political correctness will not favor men in this debate.

 
At Thursday, September 15, 2016 8:37:00 AM, Anonymous Anonymous said...

Biker in Vermont

As I have said before society is not to blame. Society has no clue and they can't be blamed . Those culpable reside within hospitals
and medical clinics and as an example hospital X employs only female techs in their mammo suites, female nurses only in their
L&D suites yet male patients are not accommodated if requested. Most class action lawsuits are initiated by one person only.

PT

 
At Thursday, September 15, 2016 10:23:00 AM, Anonymous Anonymous said...

Ref: At Thursday, September 15, 2016 7:40:00 AM, Blogger Biker in Vermont

You nailed it perfectly, but let's redouble our campaign
efforts anyway. Male modesty in a medical setting is important.
BJTNT

 
At Thursday, September 15, 2016 6:34:00 PM, Anonymous Anonymous said...

After typing into any search engine " lawyers who specialize in class action lawsuits" brought up some interesting websites. Although
I just can't help wondering about these medical assisting schools who promise employment yet the male students who cannot
hopelessly get a job it seems. Were they warned or was it even mentioned? I think on many fronts there is some legal recourse
as continually submitting to this thread will not solve these problems. Writing to hospitals and medical clinics will not solve these
problems. Complaining by individuals will not solve these problems.

PT

 
At Friday, September 16, 2016 2:55:00 AM, Anonymous Anonymous said...

To Biker in VT who asked at the end of the last volume what changes resulted from my letter (submitted in the last volume in 3 parts). The institution replaced the urology clinic administrator who was female with a male administrator. The new administrator called and discussed issues raised in my letter. So they committed to and hired two male MAs. And they have a male nurse. So male patients can get a same gender team for intimate urology care now. They still have female MAs so the female patients also can get same gender care if they desire. So they are moving in the right direction. Letters can make a difference.

Here is a related issue. This medical center, like thousands in the US, is Joint Commission accredited. I would say the Joint Commission appears to have intentionally ignored the lack of staffing diversity in their accredited medical centers the past 30 years. If they and other regulatory bodies would enforce their own standards this would have the effect of having medical centers drive the training schools to produce more trained (male) ultrasonographers, rad techs, MAs, and nurses. Training schools make their money by enrolling students. They do work with their local hospitals and they do respond to those hospital’s and community needs. If hospitals were cited for not having adequate staff diversity to provide equitable privacy, patient rights and patient dignity they in turn would push the training schools to recruit more males. The percentages of males graduating certainly would grow faster if the training schools were being pushed because of the urgent need for male techs, nurses, MAs, etc. Demand and Supply. So consider informing the Joint Commission of your adverse experiences at a accredited medical center that provides women’s health service lines, clinics and imaging centers and seems to have disparities in staffing. - AB

 
At Friday, September 16, 2016 3:49:00 PM, Anonymous Anonymous said...

Dr. Bernstein - I took your advice at the top of the blog and read the volume from back in 2009. Interesting reading and it prompted these thoughts and questions.

First let me state a hypothesis of mine: when an healthcare institution and healthcare providers respect patient’s cultural and personal values, and beliefs/preferences the healthcare encounter becomes more comfortable for the patient, which can build trust and enhance communication with the provider(s). This is critical for better treatment, outcomes, and satisfaction. If these happen than health care may be improved, health costs may be decreased.

In addition, I think contributors to your many volumes would likely support that statement that, in general, patients want to be treated with respect and dignity.

A conflict arises because healthcare institutions are under tremendous pressure to see high volumes of patients with limited resources and heavy cost containment. That is, an healthcare institution (from a small doctor’s office to a large hospital) may think it is financially advantageous to have each patient act the same or treat them as if they were the same and not have the patient ask too many questions, and to be compliant with whatever staff say/do, and basically go along with the healthcare institution’s protocols, treatments, operating methods, etc. without seeking deviations (like personal preferences). That is, many healthcare institutions may believe they enhance their profitability by trying to treat all patients in a similar vanilla flavored manner and not design their operating model to really address patient cultural and personal values, beliefs and preferences. And this gets pushed down to the very busy staff (who were hired to also fit the institution’s operating model) and pretty soon patient’s are confronted with unexpected unpleasant experiences in their healthcare encounter.

However, whether the healthcare institution is a for-profit or not-for-profit big or small there is one constant in each and that is the physicians in the organization have tremendous influence on the design and operation of the healthcare system. Their opinion carries the most weight and they drive many of the treatment actions and protocols. After all, they are responsible for each patient.

So one strong avenue to address many of the concerns raised in your numerous volumes is for physicians to recognize and promote each patient as an individual that should receive patient centered care that may include reasonable preferences. How than, if at all, is this concept included in your medical students training? Do the students actively participate in evaluating personal beliefs, say about modesty or gender of care givers in intimate exams. Are they instructed on the appropriate use of chaperones? Do they have instruction on actively advocating for their patients comfort in a variety of settings (like the clinic, inpatient units, etc.)? Do they get taught the meaning of the institution's patient rights where they rotate? Clearly the medical students have to learn a tremendous amount of technical knowledge, but in what course(s) or rotations do they learn, if at all, to advocate for patient beliefs and preferences? If they are not expected to assimilate this concept in med school, when are they? It is more than just asking the patient if they can be examined. Do you ever see med students documenting the patients personal preference information say if the patient is about to have an intimate outpatient procedure?

I’ve worked almost exclusively with MDs, but I do know DOs receive some holistic medicine training (that MD schools don’t teach). So I also wonder if a “holistic” approach better appreciates the individual and their preferences. Have no idea. Thoughts? - AB

 
At Friday, September 16, 2016 5:30:00 PM, Anonymous Anonymous said...

The joint commission has no control over gender diversity in the workplace. If you are a medical facility or a hospital you pay the
Joint commission to come out every other year and survey your hospital. Then you can hang on a placard that you are joint
commission accredited. It is a big joke. The joint commission loves donuts too. They have no power to do anything. A perfect
analogy would be that if you own an automotive repair shop and you advertise that your mechanics are ASE certified, that's it.
I have been through so many JC inspections that it is a joke. I have never known any urology clinic that is joint commission
accredited. Essentially, only hospitals and not all hospitals are accredited, why because it's expensive. Does it ultimately improve
standards of care. NO

PT

 
At Friday, September 16, 2016 5:42:00 PM, Anonymous Anonymous said...

Hospitals, medical clinics do not and I repeat do not correspond with nursing programs, allied health programs regarding its gender
needs. I know, I sat on many of those committees. The truth is, having students come to your facility is a Hugh liability, it's time
consuming, takes a substantial effort on staff to manage, mentor and train students for their clinical rotations. There is a fine line
in having students doing the work vs being there to learn. It can cause problems you can't begin to imagine.No hospital, medical
facility is going to approach, suggest, recommend that the school train, recruit a specific gender of student.

PT

 
At Friday, September 16, 2016 5:58:00 PM, Anonymous Anonymous said...

Physicians make terrible businessmen, it's just a fact. They are very busy seeing patients, keeping up with new drugs, treatments
etc. Typically, a large practice of surgeons, urologists, etc will hire an administrator usually someone with an MBA to oversee
and manage the business end of the practice. I do not believe that such a practice would replace their administrator based on a few
letters and as a result hire some male medical assistants, cna's in the process. Not going to happen, would not happen.

PT

 
At Friday, September 16, 2016 6:19:00 PM, Blogger Biker in Vermont said...

Thanks for the followup AB. My guess is that the female administrator that was replaced was hostile towards your letter when it was being reviewed/discussed internally. That or when they decided that a few males would be hired that she objected to taking that action.

I wish that 11 years ago I had done a letter like you did. The urology practice that I have had several dozen intimate procedures at (cystoscopies, bladder cancer treatments) has male doctors but 100% female staff. Due to an insurance change I will be changing to a new hospital going forward. I asked already and they have a male RN there. It is a very large practice however so while one male RN is one more than most places have, one male RN is not much in a practice with 9 physicians. I plan to ask for that male RN when I make an appt. and then depending how things go I will have a basis upon which to send a letter. In fairness to myself, 11 years ago I did not know that guys could speak up. I've just come to realize that this past year.

 
At Saturday, September 17, 2016 12:15:00 PM, Anonymous RobH said...

Dear Biker in Vermont: I don't know whether this will work all the time or not, but if I am ever in a situation where I need an intimate procedure or care and no male medical assistant is available, I will insist that a male doctor be available and will simply refuse anything else. I really don't know what sorts of procedures we are talking about, so I don't know whether that will work or not. I suspect in some cases it will.

I also wanted to comment about the idea that it is "complicated" or "expensive" to provide men with same sex intimate care. I think that depends on the meaning of those words. Maintaining a Da Vinci robot: expensive. Maintaining an MRI machine: expensive. Maintaining a pharmacy with a zillion medications: expensive. Maintaining a cafeteria that can provide dozens of different kinds of meals, plus halal and kosher: expensive. Making sure there are a few males on staff who can provide intimate same-sex care: relatively speaking, not so expensive or complicated. It depends on your perspective.

 
At Saturday, September 17, 2016 3:13:00 PM, Blogger Biker in Vermont said...

RobH, there have been guys on this forum who have gotten their physician to agree to do certain procedures by themselves rather than with assistants. I suppose the feasibility of that depends upon the physician and the procedure. I recall someone here getting a vasectomy without a nurse being present. Some guys have been successful getting dermatologists to do full body exams without an assistant present.

I suspect in most cases, it is simply a matter of efficiency for the physician to have a much lower paid person do the prep work while he is seeing another patient,and to then stay with the patient for any wrap up matters (cleaning up/getting dressed etc) after the doctor leaves. The physician can see double the number of patients this way, maybe more. Of course some procedures need a second set of hands as well.

With cystoscopies, there is definite prep work that is about as intimate as a guy ever experiences in a medical setting. When the doctor is present her only role is helping him get into his gown & putting his gloves on, and handing him the cystoscope. Her being present then doesn't really matter being she already did the prep work. After the doctor is done, he leaves and she then tends me until I leave.

There are many intimate procedures that are deemed a lesser skill level than what doctors do, and so there you face nurses or techs. This includes catheterization for any reason, testicular ultrasounds, urodynamic testing, and many prostate cancer treatments. In all those instances you would be hard pressed to find a doctor to do them, though I do recall reading of someone's account of getting their doctor to do the urodynamics test. If I recall the patient wouldn't yield after a bait and switch occurred with a guy who had scheduled the test with male staff only to arrive and be told there weren't any male staff that day.

Note that it isn't just medical assts, nurses, and techs that the physician might want present. It can also be scribes and medical or nursing students. Shortly before going into surgery for bladder cancer, I was ambushed by 5 medical students on clinical rotation (4 female, 1 male) who told me they'd be observing my surgery. In a teaching hospital it is common for the doctor to have a resident present who may in fact be the person performing the procedure.

As noted before, back then I never even considered speaking up nor did I file a complaint about the OR nurse who said something of a sexual nature to me moments before I was put under. Never again. Now I have my voice.

 
At Saturday, September 17, 2016 4:04:00 PM, Anonymous Anonymous said...

PT - obviously you don’t think much of what the Joint Commission (JC) does and that is fine. They now answer to CMS so if one doesn’t get a response from the Joint Commission than submit it to CMS and complain to them also about the JC.

Regardless, I think you might get better satisfaction submitting a complaint to the Office for Civil Rights (OCR) now. The final rule (loosely titled) Nondiscrimination in Health Programs and Activities implementing Section 1557 of the Affordable Care Act became effective July 18, 2016. Here is the link: https://www.federalregister.gov/documents/2016/05/18/2016-11458/nondiscrimination-in-health-programs-and-activities

The format of the Rule publication is there first is a lengthy discussion of the public comments and the gov’t response and decision. By reading the discussion one learns how the rule is to be interpreted and enforced. Than the final Rule is published at the end. Here is one interesting paragraph on page 31455 discussing the new rule:

“Under the sex discrimination prohibition, however, providers of health services may no longer deny or limit services based on an individual's sex, without a legitimate nondiscriminatory reason. Although a large number of providers may already be subject to state laws or institutional policies that prohibit discrimination on the basis of sex in the provision of health services, the clarification of the prohibition of sex discrimination in this regulation, particularly as it relates to discrimination on the basis of sex stereotyping and gender identity, may be new. We anticipate that a large number of providers may need to develop or revise policies or procedures to incorporate this prohibition. For example, if a hospital or other provider has specific protocols in place for domestic violence victims, but engages that protocol only for women, the provider would have to revise its procedures to require that protocol for all domestic violence victims regardless of sex. A provider specializing in gynecological services that previously declined to provide a medically necessary hysterectomy for a transgender man would have to revise its policy to provide the procedure for transgender individuals in the same manner it provides the procedure for other individuals.”

Also provided was a sample of the required notice, which starts out: “[Name of covered entity] complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. [Name of covered entity] does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.”

This rule applies to most hospitals, clinics and physician offices. Do you think medical centers that expend significant amounts of capital and human resources to ensure their female patients get privacy rights is treating patients differently because of sex? - AB

 
At Saturday, September 17, 2016 5:27:00 PM, Anonymous RobH said...

Dear Vermont Biker: I have had to decide what price I will pay for physical privacy. I have a hydrocele and have decided that the odds of it being a serious problem--especially now after 12 years--is so small (about 1 in 2,000, I figure) that privacy trumps the hassle of trying to obtain a male ultrasound technician (especially since I would attempt to impose additional restrictions; he can put the wand against the testicle, but if he needs it rotated, I'll do that). I have a male dermatologist and I keep my underpants on. He picked it up to check my buttocks without my permission. So I went on the web and determined that I have a 1 in 800 chance of developing melanoma any year. That probably translates into 1 chance in 8000 for the area covered by my underpants. So the underpants are staying on and no, he can't check my buttocks any more. Next time I see him--and I have decided to go once every other year rather than annually because the odds are small and frankly I don't like having someone examining me closely, even a male--I will explain to him that he can't lift the underpants even to examine my buttocks. Privacy trumps. My tentative decision--subject to modification in the future--is that privacy trumps if the risk to my health is less than 1 in 100. And that means a male examining me as well. With a female, it needs to be an absolute emergency. That's my choice and I have made it freely.

 
At Saturday, September 17, 2016 6:31:00 PM, Blogger Maurice Bernstein, M.D. said...

What is the intellectual argument to explain the relationship of physical modesty during illness or suspected illness? Is it something that is really a matter of statistics-- a probability that one is not going to be harmed if one chooses the comfort of physical modesty when diagnosis and treatment of illness is at stake?

If the comfort of modesty always can trump illness in this regard is that always a rational excuse with the exception, perhaps, if one's life is immediately in danger of death Or is even that exception not acceptable? A real philosophical question and is there full consensus here on the answer?

Another question..I know I probable asked previously: why don't I get visitors to my Patient Modesty blog thread who can argue their philosophy that protection of any modesty can never trump their protection of their own health? Where are they?? ..Maurice.

 
At Saturday, September 17, 2016 6:41:00 PM, Anonymous Anonymous said...

AB

Not all hospitals and medical centers participate in Medicare/Medicaid. Participation with the Joint Commission is
voluntary. The only aspect CMS has with the Joint Commission is regarding language interpretation. Does the hospital
have interpreters,ie blue phones. There are 10 rules regarding language interpretation and essentially was the patient
communicated with effectively. The surveyors from the Joint Commission especially like glazed and jelly donuts. Ask
me how I know.

PT

 
At Saturday, September 17, 2016 7:51:00 PM, Anonymous RobH said...

You ask a very interesting question, Dr. Bernstein, though I am not sure I understand it. It seems to me that there are always tradeoffs between health and covering being made. My first primary care physician wanted me to take off everything but the underpants and wear a gown for my physical, and he expected to see under the underpants as well. My second primary care physician--I had to change because of insurance and went with my wife's physician--listens to your heart and lungs through your shirt, checks reflexes through the pants, and doesn't ask one to take off anything at all. The first wanted to a DRE every year, even when I was 38; the second didn't even ask (though maybe that's because he knew my views). The first strongly pressured me to get a colonoscopy when I was 50 and started me on hemoccult tests when I was 38; the second explained that the American College of Family Physicians recommended either an annual hemoccult test or a decadal colonoscopy once one was 50. Clearly, they were balancing risk to patient's health against other factors in different ways. The hemoccult versus colonoscopy issue involves perhaps 1% or 2% risk and that has been a model for me in thinking about the risk I will accept if I need to. Obviously, the ideal is to avoid risk AND remain reasonably covered. Does that answer your question?

 
At Saturday, September 17, 2016 8:17:00 PM, Blogger Al said...

Maurice.
Why would the medical profession even put you in that position ? They are there to provide a service to their customers and the customer in turn pay's for that service . Why is it so wrong for that customer to expect it be performed to their satisfaction ? How many times here has it been said it's their way or the highway . These past 76 volumes are filled with patient venom toward the medical profession . All you usually read about is excuses about how it's not possible. Impossible is putting a man on the moon safely with 1960"s technology yet they say they can't find men to fill the jobs. B.S. Plain and simple they don't want to. AL

 
At Saturday, September 17, 2016 9:03:00 PM, Blogger A. Banterings said...

Maurice,

I have made this argument in past volumes (especially with the PubMed citation of Tomophobia, the phobic fear caused by an invasive medical procedure - an emerging anxiety disorder: a case report.

The profession accepts the false notion put forth by Beauchamp and Childress in their textbook Principles of Biomedical Ethics, of the patient choosing health above all else. This easily justifies paternalism and the emergency exception to informed consent.

If this were an absolute, then we would not have POLSTs (DNRs), informed consent, or the right to die (with dignity). Physicians would refuse care to skydivers, firemen, suicide attempt victims, and others that face the threat of death or injury based on them not choosing health.

That is the whole point of death with dignity laws, (California the most recent enacted).

Please note that the correct issue here is death with dignity and NOT just the right to die. Society has enacted laws that allow people to choose dignity (modesty being a part of dignity) over "protection of their own health."

Banterings





 
At Sunday, September 18, 2016 6:38:00 AM, Blogger Biker in Vermont said...

Dr. Bernstein, I'll attempt to answer your questions too. On the first, yes it is a matter of statistics. If you think the health matter will resolve itself without treatment, then many won't seek treatment for reasons of convenience, cost, and/or modesty. The same can be said if the health issue at hand is not felt to be life threatening and/or it won't seriously impact quality of life.

At this point my urologic oncologist says I have a 3% chance of my bladder cancer coming back in any given year. Being it was a high grade aggressive variety and having seen a brother (age 47) and my Dad (age 67) die horrible cancer deaths I have willingly submitted to several dozen extremely intimate procedures with female RN's & NP's since I was 52. Though I would prefer male staff do the prep, I will continue to be monitored regardless.

In contrast to that, earlier this year the urologist was a little concerned about my PSA reading having risen. Should it rise to the point that he wants to do a biopsy or anything else intimately invasive, I will only agree if he is assisted by male staff. Why? I view the prospect of prostate cancer as less threatening than the kind of bladder cancer I had. Statistics.

On your last question, there are plenty of guys for whom modesty is not an issue at all. Those guys don't come to this forum and so you will never hear from them.

Much of my stance on these matters come from resenting the double standard so often discussed here more than it does being overly modest. I don't like the medical world seeing me as less worthy of dignity than female patients. That, and having had a couple experiences that make me leery of female staff until such point as they demonstrate they will conduct themselves professionally (which is almost always the case).

I am not an extremely modest person so long as I don't think I'm being judged. The problem is I can't know ahead of time if female medical staff will be judgmental. At age 11 a bicycle accident resulted in emergency surgery to remove a testicle. The unspoken message I interpreted from the medical world and my parents was that it was something to be ashamed of. The doctor and other staff at the hospital never spoke a word to me explaining what happened. For a long time I thought it might grow back. My father never said a single word to me about it. My mother only spoke of it once and that was to give me a lie to tell people at school why I had been absent for 3 weeks. The wall of silence told me it was something shameful, very shameful. Regretfully my very first intimate medical encounter as an adult in my 30's (vasectomy) affirmed it. The nurse prepping me made an inappropriate comment about it. I was totally humiliated and ever since then I have been leery in medical settings with female staff.

The medical world just hasn't a clue what baggage patients may be carrying, and in the case of men, they don't care.

 
At Sunday, September 18, 2016 7:13:00 AM, Anonymous Anonymous said...

Maurice

The Hippocratic Oath. " I will respect the privacy of my patients"
Respectfully, there is simply no validity to your comments or arguments.

PT

 
At Sunday, September 18, 2016 12:29:00 PM, Blogger lefteddie said...

Maurice,

(Part one)
The intellectual argument isn't so much about statistics per say.
It's more about discrimination; I think most men would just be happy to be treated as our female friends are treated. It hasn't seemed to be a problem to set up same gender intimate care for them. When it comes down to men having to ASK ahead of time and make ARRANGEMENTS to HOPEFULLY get the same treatment women already get, that is outright discrimination. The statistics these men refer to is in their head something to try and justify why they forego medical care because of something women don't even think about. PT has discussed this issue and how it evolved, females protecting females. Females in authority in say director position as in the case of the Urology center head being female. The key to all of this is desperate men wanting their healthcare to be on par with what women now are offered. When women talk about how men don't take better care of their health the thought never occurs to them that we aren't treated the same as they are. A trip to the hospital for a man means a guaranteed course in his modesty & dignity being breeched. He is 100% guaranteed he will have a sea of women forced on him for any intimate care. He is not asked his preference when it comes to a female assisting a prostate ultrasound, a catheter insertion, a sonogram of his scrotum and worst of all an already sick man with prostate cancer having to submit to a sea of women being naked from the waist down for radiation therapy (this would never happen to a woman without her permission). And men are not for warned about the fact he will be on display for however many radiation treatments are involved. Not only does the opposite gender intimate care happen once, it happens maybe 15 times and no one thinks a thing about his modesty and dignity, women aren’t treated this way. In fact he can pretty much count on all of these procedures being done by opposite care personal. This problem has already been solved and solved many years ago for Females. When a woman goes in for a mammogram the thought never occurs to her that it would be done by a male or for that matter there will be any males what so ever even in that facility. The statistics the men are talking about in this blog is a way for men that won't normally go to the humiliation factory (Hospital) as a final attempt (possibly before dying of a horrible disease) as a way of using math to make it a last ditch effort before heading off to the Humiliation Factory.
(Hospital)

Please see part two:
Lefteddie

 
At Sunday, September 18, 2016 12:31:00 PM, Blogger lefteddie said...

(Part Two)
If same gender intimate care can and has been provided for women's most private areas and exams and men's care isn't even thought of let alone addressed for these procedures THATS OUTRIGHT DISCRIMINATION. So rather than look at these various issues of WHY, Statistics or any other reason, when you sift it all down and come to the one issue to describe the WHY it’s men are blatantly discriminated against. Solve Discrimination in the healthcare system against men as far as intimate care goes and the problem is solved. Like we had to do for women back in the 70’s to make things equal for them in the work place it involved hiring more women to balance out various jobs and affirmative action to help promote this. Of course this was to MAKE THINGS EQUAL for women. Now we have a situation where men are being discriminated against as fare as intimate care goes and what’s being done, nothing. With 95% of hospital staff from RN’s, CAN’s, Mamo techs, L&D nurses, etc. being female where does that leave a modest male? I’m an engineer, the solution seems simple to me, HIRE MORE MALE RN’S, SONOGRAM TECHS, CNA’S, MA’S ETC.
Ask during triage, do you require same gender intimate care YES OR NO. Whittle that 95% figure for female staff down thru attrition, retirement etc. and do what you did for females, automatically assume a man wants same gender intimate care even if he doesn’t that’s what the model is for women, then I think those 30-40 percent of men that don’t go for the care they need might show up and that figure of men dying seven years sooner than women might change. Do that and the humiliation Factory will change for the better for everyone and hospitals will really care about their patients ALL THEIR PATIENTS.

Lefteddie

 
At Sunday, September 18, 2016 1:32:00 PM, Anonymous RobH said...

I am very leery of ethical absolutes, and that would include "I must have physical privacy at any cost" and "death is preferable to having my body invaded." We live in a web of relationships, and they convey responsibilities. I have responsibilities to my wife, my daughter, my son (in spite of his angry 13 year old adolescent outbursts), my brother, my parents in law, other relatives, my friends, my religious community, my work . . . etc. I posted a picture of my lucky tee shirt on Facebook and already have a dozen or more wishes to write on it. So I have obligations to all those people, too. I even have an obligation to my physician and his staff, who would feel terrible if I were to die on their watch. So all that tempers my desire for moral purity and simplicity.

Philosophically, also, I do not believe in a moral hierarchy, where rule ten is important but can be trumped by rule 9, which can be trumped by rule 8, etc., until you get to rule 1, and nothing can trump rule 1. The closest thing to rule 1 I can think of is "do not take life and preserve life." But we can all think of moral situations where giving one's own life to save ten others would be the noble thing to do, even if it is very difficult.

As a result, my concern for physical privacy--I prefer that term to modesty, because the opposite of modesty to me is boastfulness and I am too boastful to call myself modest--is in uneasy tension with my duties and obligations. Consequently, my greatest source of anxiety is when my moral imperatives cannot be reconciled, as might happen, for example, when some nurse insists she has to check my catheter and I insist no that she can't, and I don't even want a male to check it if I can check and make an adequate report. If I can do it, why should I have any "intimate care" at all? If they want a second opinion and my wife is around, she can provide that! But if they were to insist that they check or they will kick me out of the hospital--not something they'd every do, but to set up a true moral clash--what would I do? I don't think I can or should say, because I am not sure I can really imagine such a scenario in enough detail to issue a pronouncement. Certainly, I don't want to spend all my time trying to imagine every dilemma I could be thrust into; that would be an unhealthy fixation on the problem.

 
At Sunday, September 18, 2016 2:06:00 PM, Anonymous Anonymous said...

The point that men may not go into the doctor as often as women do, due to modesty concerns, has been made many times in these volumes. From there, it's often asserted that men's lives are cut short because of their modesty concerns. It's not clear to me that those who trail in frequently for medical appointments are living longer than those who don't. Males in many species have a shorter life expectancy than females ( http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2688912/ ). Male patients deserve to be treated with respect -- period -- but where is the proof that those men who forgo dealing with the sea of women in medical offices due to modesty issues are, on balance, risking their lives?

 
At Sunday, September 18, 2016 3:09:00 PM, Blogger Maurice Bernstein, M.D. said...

First, I want to say that I am honored to have such thoughtful and descriptive discussions going on now on my blog thread. Not only just currently but on so many of my previous Volumes. It isn't just about "moaning and groaning" but about responding in a hopefully constructive and effective fashion to a particularly emotionally upsetting issue.

Again, I want to state that every year, I and my teaching colleague instructors teach our first and second year students that their assigned patient is "in charge" of the learning activities of history taking and physical examination. No element of either, can be performed by the student without first informed consent by the patient. That's it! However, later in their learning years and in their careers although the matter of informed consent continues, detail and consent matters may "soften" due to pressures of one sort or another, part of the life-long potential "hidden curriculum" which seems to trump our first and second year teaching.

Now, for a question which might stir up some anger here but maybe not though is may represent an analogy to the gender inequality in the medical system which is being discussed.

The question: Do you find the gender inequality in medical care with regard to patient's modesty and dignity the same or different in the area of the transsexual's request for modesty and dignity with respect to their changed gender? This changed gender is profound both psychologically and even through medical/surgical procedures anatomically or functionally. Do they also deserve their dignity to be preserved such as a born male now a transgender female and the public restroom for females. ..Maurice.

 
At Sunday, September 18, 2016 3:30:00 PM, Anonymous Anonymous said...

I firmly believe that if a class action lawsuit can be successful against say one major hospital
chain then change would be evident and force compliance with other facilities. Those facilities
that would be targeted are hospitals with mammography and L&D suites, in addition to having
high female to male nurse ratios this would be a strong indicator that discrimination occurs
towards male patients. That privacy, respect and dignified care although expressed in core
measures in these facilities was non existent. I believe this is the solution and the direction this
blog should take.

PT

 
At Sunday, September 18, 2016 3:39:00 PM, Anonymous Anonymous said...

Ref:The question: Do you find the gender inequality in medical care with regard to patient's modesty and dignity the same or different in the area of the transsexual's request for modesty and dignity with respect to their changed gender?
I find these different issues. A separate blog thread
would be appropriate if you decide to discuss this issue.
BJTNT

 
At Sunday, September 18, 2016 4:40:00 PM, Blogger Maurice Bernstein, M.D. said...

BJTNT, I really wonder whether the question I brought up is truly a "different issue" related to personal gender dignity. I am not transgender and I never had a disclosed transgender patient as my patient. However, with regard to the gender issues in relation to the medical profession as discussed here it appears that what is important to the patient is that the patient's gender be recognized by the medical system and attended to it fairly because the patient has deep emotions linked to their own gender and the responses of others to their dignity needs.
Can't the same concerns be recognized about the transgender individual. By their deep personality, psychological and even anatomic and perhaps endocrine alterations they look upon themselves as the gender they desired and not the unwelcome gender from birth. If the woman now has become a male, he may find it impossible to accept entering a female washroom and much more appropriate and comfortable to enter the washroom where other men are entering.

Isn't that similar to a male patient, as been described here, to want to be treated as a male and not subjected to the medical environment in which women patients come and go. Folks writing here I think are arguing "As a man, I want my dignity not to be degraded by being compelled to enter a "woman's restroom" in order to obtain needed diagnosis and treatment. What's the difference? ..Maurice.

 
At Sunday, September 18, 2016 6:19:00 PM, Blogger Biker in Vermont said...

Dr.Bernstein, I'm not following the transgender thing. If a transgender is holding themselves back from going into the bathroom of their choice, that is something they are doing to themselves. I don't see how that relates or compares to men being forced to face a sea of women for intimate care. Nobody is forcing the transgender person to do anything. They get to choose which bathroom they use. Men don't get to choose which gender provides intimate care for them.

 
At Sunday, September 18, 2016 7:07:00 PM, Blogger Maurice Bernstein, M.D. said...

Biker, it is not an issue of the "transgender holding themselves back from going into the bathroom of their choice".It is that they are denied. It is currently the State of Virginia having passed a law preventing a female by birth and who is now a male student to go into the school's men's bathroom. The restriction was defeated by a lower court decision but currently the Supreme Court has voted to overturn the lower court decision and to reconsider when a 9 member Supreme Court exists. So this transgender now male student is denied admission to a school men's bathroom. So, for the time being, this transgender man is being compelled to accompany the female sex in their bathroom. Isn't this analogous to the discussion here about male patients being subjected to female medical attention despite the male's objection to that female attention. ..Maurice.

 
At Sunday, September 18, 2016 7:10:00 PM, Anonymous RobS said...

I like your point about transgender and bathrooms, Dr. Bernstein.

Vermont Biker, it's easy to take a pair of boxer shorts and cut a hole in the back about 4 inches long and 3 inches wide, call them "home made colonoscopy shorts," and ask to wear them in a prostate biopsy. All they need is access to the rectum. One can make the opening pretty small and there's nothing else for anyone to see, male or female. Frankly, the way they ask you to curl up, I doubt the genitals are very exposed anyway, even with just a gown. I had no problem wearing my home made colonoscopy shorts, though. There was a woman in the room bustling around not assisting the doctor--he really didn't need any help. And by the way, other than the indignity, THE BIOPSY WAS ABSOLUTELY PAINLESS. I was quite surprised. Dental work is really far more intrusive and painful.

On a different matter: do we know where patient nakedness comes from historically? I suspect it has something to do with the rise of modern medicine and the modern hospital in the late 19th century. Once people understood the germ theory, there was need for cleanliness and everyone--doctors, nurses, patients--began to wear uniforms. At that time houses did not have running water or hot water so bathing was rare, so patients were often dirty. I could see the need to admit them, take off their dirty clothes, bathe them, and put them in clean hospital gowns. But even then, why didn't hospitals issue underclothes? Maybe they were afraid patients would steal them, since underpants were still rare and expensive?

I can also see a certain argument of convenience even today. If you take off all your clothes and put on a hospital gown, you are consenting to a certain relationship with the staff. The clothes express a power relationship. The nakedness under them is implied consent to the staff to see anything any time, without having to ask permission (which can be embarrassing). One of the reasons I am planning to wear underpants and a "lucky tee shirt" after the prostatectomy is to subvert the implied power relationship and symbolically declare my independence and autonomy. I doubt I have to say anything, either, for that implication to be clear to the staff. Clothing is very powerful symbolism. I am very surprised by the powerfully positive response my lucky tee shirt has gotten on Facebook. People love the idea. And I haven't said anything about nakedness or modesty.

 
At Sunday, September 18, 2016 7:25:00 PM, Blogger Maurice Bernstein, M.D. said...

Here is the link to the current status of the transgender bathroom issue.

http://www.usatoday.com/story/news/politics/2016/08/03/supreme-court-transgender-bathrooms-virginia/88037966/

.. Maurice.

p.s.- I am not taking a stand here about the analogy between the two issues. I am just asking if this current court issue is
in my readers mind an dignity conflict analagous to the one currently being discussed on this thread.

 
At Sunday, September 18, 2016 8:12:00 PM, Anonymous Anonymous said...

If you are a male patient you will be treated like a Farm Animal regardless if you are heterosexual, homosexual, or hermaphroditism
undetermined. If you are a homosexual with a vibrating instrument lodged in your rectum expect to have cell phones clicking
unbeknownst to you of body parts. At any time the Farm Animals may and will be escorted to the bathroom and watched provided
you are lucky enough not to be cathed. in the event number 2 is required you will be watched regardless.

Most of the time Farm Animals never get a private room, those are reserved for female patients only. Be aware that Farm Animals
are managed by female staff not assigned to you specifically and will be observing you frequently during testing. Disregard any
literature wether written or posted regarding dignity, not applicable to Farm Animals. Complaints about the treatment of said Farm
Animals will be met with anger and indignation from female staff. If you are a male and identify as being a female your stall will
not change from anyone else in which case see first paragraph above.

At any time Farm Animals may have their gowns suddenly removed for no apparent reason in intensive care units by female
nursing staff. Certain body parts of Farm Animals may be posted in female nurse bathrooms at their discretion. If you have
an unusual body part a cell phone pic may be taken at the female nurses discretion.

PT


 
At Sunday, September 18, 2016 9:59:00 PM, Anonymous Anonymous said...

Dr. Bernstein - sorry I'm a bit behind. In the last volume (in June, ’16) you made the following statements: “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. “

Okay, here are some reasons. First, patients select their physicians and make appointments with them. So one factor in the modesty equation has been handled up front by the patient, they selected a physician of the gender they prefer. Now about your wife. Her anecdotal nursing note is at best an extremely weak argument against the existence of gender preference in intimate care. The reasons for this I would think would be self evident. Some are:
1) Hospitalized patients are often EMOTIONALLY VULNERABLE - they are by definition sick, maybe with a life threatening condition or the possibility of permanent damage.
2) Hospitalized patients are the VULNERABLE PARTY in the Hospital-Patient relationship. Physicians, nurses, CNAs, etc. have the power, knowledge, and means to provide care and treatment or to withhold it or delay it or even to abuse the patient. I hope you don’t think the vulnerable party doesn’t think about the consequences of speaking up to demand or request accommodation? This kind of discussion (about intimate care) needs to occur much earlier, before the patient is unclothed, in a hospital bed, vulnerable. It is frankly unethical to expect a patient to assert their rights at all times in their sometimes terrifying patient journey. The hospital and care givers have responsibility to establish the patient preference if they want to build trust.
3) Most men have spent a lifetime having females involved in their intimate care and having their requests denied for a male nurse/MA/CNA/LPN/Ultrasonographer or their basic privacy denied. That is, many would assume a request was futile, or been there and done that to no avail, and revert to their coping mechanisms if they are bothered by the female nurse.
4) Hospitalized patients may be under the influence of drugs. They may not have full mental capacity, because of the medications, to assert what theoretical rights they should have.
5) When faced with multiple nurses, students, residents, etc. in their room there is the intimidation factor.
6) Previously patients have had verbal or other abuse when asking for their preference in intimate care and they are fearful of the response
7) There may be a communication barrier (i.e., you wife doesn’t speak Vietnamese, Mandarin, etc.) and she doesn’t bother getting an interpreter to check or change a catheter.
8) The patient already asked at admitting or in radiology or in preOp, etc. and were denied their request(s) (that your wife is unaware of being farther downstream).

And there are many more. I’m sure your wife was/is a fine nurse and has sensitivity to modesty issues. But unless the matter is clearly discussed well before the patient is placed in a compromising or vulnerable situation it is not a valid conclusion. A teaching point for your students - it is shockingly cruel of the medical profession to expect all patients to speak up and defend themselves and their preferences at the point they are already in a vulnerable and compromised state and situation. - AB

 
At Monday, September 19, 2016 6:06:00 AM, Blogger Biker in Vermont said...

Dr. Bernstein, using your Virginia example I get your point, though transgenders are free to use whatever bathroom and locker room they please in most of the country. A better example is a story I recently about about in CA. A school district there was forcing 14 year old girls to change for swim class in front of an anatomically male transgender. Complaints by the girls and their parents were rebuffed. The outrage grew, a few students were lost to other schools, and the school district chose to put in private changing stalls for the girls. A question for you then. What if it were reversed, 14 year old boys being forced to change for swim class in front of an anatomically female transgender? Would the school system give the boys private changing stalls? Not likely. The CA example is more akin to what happens in the medical world.

Transgenders are also an example of rapid change. They and their supporters were very loud in their demands, and change happened almost overnight.

 
At Monday, September 19, 2016 7:26:00 AM, Blogger Maurice Bernstein, M.D. said...

Biker, you realistically write "Transgenders are also an example of rapid change. They and their supporters were very loud in their demands, and change happened almost overnight" So, my question is "why can't the very likely much larger community whose representatives write here also activate an "overnight" change? ..Maurice.

 
At Monday, September 19, 2016 9:57:00 AM, Anonymous Anonymous said...

Dr. B., I accept your premise "What's the Difference" in our discussion between transgender and male modesty issues [respecting our dignity and humanity].
The transgender folks soon realized they were getting nowhere with the medical community and resorted to litigation, now with the Supreme Court deciding.
Some males with well-written letters, sufficient time to wait, willing to walk with a bait-and-switch, etc. can probably achieve their goal, but most of us are not that resilient.
PT is right. We need a leader who can not only present our cause verbally, but also take action, i.e. litigation. Biker, Banterings, and PT could fill that leadership role. I pledge $1,000 to litigation.
BJTNT

 
At Monday, September 19, 2016 9:59:00 AM, Blogger Biker in Vermont said...

"So, my question is "why can't the very likely much larger community whose representatives write here also activate an "overnight" change?"

I'd say the answer is somewhere between most guys haven't experienced the intimate medical procedures world yet and guys are afraid to advocate for themselves in this regard on account it isn't manly. I am definitely guilty of the latter. When I had my initial bladder surgery and was ambushed by 5 medical students (4 female) followed by the OR nurse making a sexual comment to me just before I was put under, I said nothing to them or to the hospital afterwards. To my male buddies I put on the typical male bravado of laughing about it despite it having bothered me very much. I told them they'd of rounded up random women off the street to watch except the OR was already full of female staff and students that wanted to be there. That was sure to get a laugh whereas saying it bothered me ran the risk of them calling me a wuss even if they themselves would not have liked what I experienced. This is how guys are. When I seemingly have a different nurse prep me every time I go for a cystoscopy I joke to the guys that they have a lottery for who's going to have the opportunity to do it. Again, making a joke rather than sharing my discomfort.

 
At Monday, September 19, 2016 2:00:00 PM, Blogger NTT said...

Good Afternoon:

I agree Biker that most men haven't had the "nightmare" of intimate care testing, or procedures in a medical setting done by and around women.

Those that have & didn't say anything where more than likely not told in advance a woman would be doing it whereby catching them completely off guard and rather than not look like a "macho man" they kept quiet & prayed it was over with quick.

The facilities do not spell everything out to the guys.

Instead of saying;

Mr. John Q Public, we need to run test ABC.

Once back in our testing area, you'll need change into a hospital gown.

The test we want to run requires that your private area be exposed for the entire test. As we don't have male technicians on staff here to run the test, your test will be run by a highly qualified & professional female technician. She may also have a female chaperone there for her and the facility's protection.

So, are you okay with proceeding sir? Then wait for a go or no go at that point.

What they say to the guys is short & sweet because they are under the old & stale misguided hospital culture notion that ALL men are NOT modest;

Mr. John Q Public, we need to run a test. After we get the results, we can go forward from there. Guys not knowing better go along with it.

By doing it this way they're setting him up for an ambush because they already know if they tell him ahead of time that he may have to be exposed in front of at least one strange woman maybe more, He's going if he wants to keep his dignity have the chance to think about it & maybe even ask for a male tech and they don't have any males on staff to replace the females.

Then when they tell him no males are available, he may in turn tell them to cancel the test & go somewhere else.

More often than not, once they get him back to the testing area & in that gown without him knowing ahead of time what's coming, "they got him".

Because 9 times out of 10 the guy is totally embarrassed, overwhelmed, and shocked when he finds out while laying there about to be prepped for the test that the woman who brought him back and said nothing to him but "change into this please", will be doing the prepping & testing.

He is too afraid and overwhelmed at this point to say "NO" & stop everything in its tracks.

He just wants to get it over with & get out of there & they know it full well.

A lot of hospitals hold health & wellness classes during the month on all different subjects.

Why don't they hold classes related to male medical issues whereby a male doctor explains to guys ahead of time what testing and/or surgery entails & most important who is involved in the process from check-in to discharge?

I'll tell ya why, because they don't want you going somewhere else & on your way out, telling prospective other male patients that their institution does NOT have the male staff available to handle male related intimate needs.

Bad for business especially all the while they advertise on how well equipped they are to handle everyone's care.

Without that first hand knowledge ahead of time that the United States healthcare industry as a whole has VERY LITTLE capability to handle male related intimate care needs, guys everywhere will continue to get ambushed and suckered into doing something they really don't want to do.

Guys who need any kind of medical assistance, will have to let go of the "macho image" & speak up (even if its embarrassing), if they don't like what's happening & want change.

Change won't come overnight. If however men everywhere find out ahead of time what they are looking forward to if they need male related medical care and start talking about it enough, it will force the issue to go mainstream.

Then and only then will change come because once the issue has gone mainstream, the healthcare industry won't be able to ignore us ANYMORE.

Regards to all,
NTT

 
At Monday, September 19, 2016 3:38:00 PM, Blogger Biker in Vermont said...

NTT, you said it perfectly.

When I went for a vasectomy I had mo idea who was going to be in the room let alone that I would be in that chair thing spread eagle wearing just a polo shirt and with not so much as a sheet or towel to at least let me pretend I had some coverage. That the nurse might say something to humiliate me was not on my radar at all.

My next encounter was bladder cancer surgery where I had no idea there might be student observers until they appeared at my bedside in pre-op. That the OR nurse would signal her eagerness to see the goods just before I was put under again took me by surprise.

The doctor sets me up for what turned out to be a year's worth of post-op BCG & Interferon treatments but he doesn't tell me how they are done or by whom. It was a female NP doing it via catheter of course. It was only when I show up for my first follow-up cystoscopy that I learn how they are done and who does the prep (only female RN's & NP's for 11 years running). All I knew the first time was that I was going for a checkup.

Same story when I go to the ER for a swollen testicle. Having been forced to tell the admitting triage nurse (female) what I was there for in a not very private lobby area, I'm then called into a room with a female nurse who proceeds to examine me. Whether there was any male staff in the ER that day I'll never know. She then sends me for an ultrasound. I'm told nothing about how such a thing is done or by whom, and of course I find myself again wearing just a shirt and its a female tech.

I was late to the party here finding my voice but now I am researching things myself in advance. Before my colonoscopy this past spring (my 3rd) I did some research and realized I could do it without sedation (allowing me to know what was happening the entire time). They tried telling me no but yielded when I said I'd go to their competition who had already told me yes. When I arrived I quizzed the nurse on a couple privacy issues and let her know my expectations before I got into a gown.

Being I am switching to a different hospital for my future cystoscopies I have already had one conversation with someone in their office about these issues. Researching their urology practice further I see that while they have several male physicians with a bladder cancer focus, they have a number of residents, half of whom are female and that residents actually do many of the procedures including cystoscopies. Had I not researched their practice I could have had an unpleasant surprise the day I arrive. Instead I will discuss this with them ahead of time and will also inquire about medical students. My wife was there for something that led to surgery of an intimate nature and she had 5 people there for her initial exam and consult. She isn't sure what they all were.

Knowing that maybe there are some prostate issues in the future I have already educated myself on the biopsy process and a few other things so that I can have informed discussions with the doctor rather than just be told where and when to show up for something.

And absolutely I will complain to all concerned should I encounter another unprofessional nurse or tech. My days of silently suffering are over. I kick myself for not having found my voice years ago.

My son has not entered the system yet and so it is all academic to him but I have told him he will face a sea of women when he does and that he can speak up before, during, and after as he feels appropriate.

Short of a major lawsuit, change will only come if men insist upon it,even if it is only by one man at a time

 
At Monday, September 19, 2016 9:29:00 PM, Anonymous Anonymous said...

To Biker in VT - you have had a series of very bad experiences. I want to remind you that a nurse that makes any kind of sexual remark or any inappropriate remark to you, the patient, is guilty of unprofessional conduct. Vermont, like all states I worked in during my career in medicine has statutes defining unprofessional conduct for nurses and for physicians. Here are three (of many categories of actions) defined in VT as unprofessional conduct for a nurse:
“(11) sexual misconduct that exploits the provider-patient relationship, including sexual contact with a patient, surrogates, or key third parties;
(12) abusing or neglecting a patient or misappropriating patient property;
(13) failing to report to the Board any violation of this chapter or of the Board's rules;”

“abusing” a patient would include physical, sexual, verbal or emotional abuse. Remarks of a sexual nature especially when you are in a vulnerable position are at the very least abuse, and likely sexual misconduct. If this ever happens again in any hospital setting you need to report this individual immediately to the Chief Nursing Officer of the Hospital AND file a complaint to the State of Vermont (Board of Nursing). (If it happens in a physician office you would report to the Board and the physician. However, be sure to distinguish whether the offender is a nurse or a medical assistant. If it is a medical assistant the physician would have responsibility.)

Notice #13 above requires the institution, at the very least, to report nurses they believe may be guilty of unprofessional conduct. So these complaints always get investigated by the Hospital. Even if it comes down to your word against the nurses (and no one else in the OR steps up to corroborate) it gives the Hospital pause that they may have a problem nurse.

Great you have found your voice. - AB

 
At Tuesday, September 20, 2016 9:30:00 AM, Blogger Biker in Vermont said...

Thanks AB, back when those things happened I really thought the only option was to "man up" and make like nothing bothered me. Having grown up in an era where there was little to no consideration for boys modesty in school settings such as physicals done in a way that women not even participating in the physical could watch all I knew was that guys were supposed to go with the flow no matter how uncomfortable. The other thing is that prior to starting treatments post-bladder cancer surgery at age 52 I had only ever been treated in a respectful manner once (a bladder ultrasound by a female tech that kept my genitals covered throughout the process). With that one exception, the few experiences I had were not good and to me that was the norm to be expected. Since then I have come to know I will pretty much always be treated respectfully, though I remain leery of women medical staff until they prove themselves to be professional.

Rest assured I will not tolerate disrespectful or inappropriate behavior ever again.




 
At Tuesday, September 20, 2016 4:54:00 PM, Anonymous Anonymous said...

I received a post card in the mail yesterday that was an advertisement by a 3-male physician group in my area. It was advertising their outpatient clinic (which performs intimate procedures for both male and females) and right there on the front of the post card was a picture of their “care team”. 30 people shown, including the three owner physicians. So 27 staff members, all dressed in scrubs. 26 of the 27 staff were female (and this was verified at their website also). Since nursing schools in my area have graduated >15% male nurses for over the past DECADE, and MA schools are graduating over 10% every year it is quite blatant to see this in an advertisement, despite having encountered this personally as a patient many times. Going to forward this post card to either the state EEOC agency or the Office for Civil Rights. Shoot, women account for more than 15% of the active duty personnel in the US military. But we can’t get diverse staff in medicine, really? - AB

 
At Tuesday, September 20, 2016 8:08:00 PM, Blogger Biker in Vermont said...

I went down to MA today for a meeting on the campus of one of the country's top tier boarding schools. It made me curious about health services and so I went online to see what I could see. The 600 or so students are roughly evenly split male/female with most being 14 - 18 years old and almost all living on campus. It costs about $60,000 per year to attend.

There is a 10 bed accredited hospital on campus staffed by a physician (male), NP (female), 13 RN's (female), plus several medical chaperones and office staff (female). The campus hospital only provides limited services of course but they are caring for kids that are inpatients for days at a time. I believe kids need to submit health forms from their personal physicians each year that amongst other things serve as the sports physical. The student body includes kids from numerous countries and backgrounds.

I was incredulous that all 14 nurses were female as are all the medical chaperones. Many of these kids come from powerful and influential families who are used to getting what they want and yet they apparently haven't demanded there be a few male RN's for their sons. To me it says a lot that even at the top of the economic and political hierarchy this issue is not on their radar. I know that occasionally the Secret Service has run security when certain family members came for a visit and that limos sporting diplomatic plates and those little flags have been there. This is the level of people that could make change happen in the medical world if they saw it as a problem, yet they apparently don't see it being a problem.

 
At Saturday, September 24, 2016 1:29:00 PM, Anonymous Anonymous said...

In order to move this issue into a legal arena we need an additional venue where we can discuss progress, hospital chain conglomerates
and names of attorneys. It can be easily demonstrated that hospitals clearly discriminate against male patients and male employees
by hiring female mammo techs and L&D nurses exclusively for those areas. While we respect Maurice and all the work in bringing this
issue to light it would not be appropriate to utilize this blog for our purpose.

PT

 
At Sunday, September 25, 2016 2:47:00 PM, Anonymous Medical Patient Modesty said...

It is very important that Labor & Delivery units at hospitals continue to only hire female nurses and for only females to be hired as mammogram technicians for a variety of reasons. Many women are uncomfortable with male nurses for intimate procedures. I was very pleased to learn that a hospital I called recently still only employs female nurses for Labor & Delivery unit. That hospital has male nurses in other departments which is very important. They should have enough male nurses at all times for male patients. Utah is one of the worst states for female patient modesty. Some hospitals in that state employ male nurses and male midwives.

I think that urologists and other departments at hospitals need to look at how Labor & Delivery units at many hospitals are sensitive to women’s needs for modesty and follow that example to hire more male nurses and technicians for male patients in other departments. It is definitely not discrimination for an urologist to hire male nurses or assistants over female nurses or assistants for male patients. Gender of nurse does not matter for certain specialties such as ear, nose, and throat where no intimate procedures are done. Both female patient modesty and male patient modesty are equally important.

One male patient I have been working with feels that he is being discriminated against because they cannot provide him with an all-male team for prostate surgery and I agree with him. He has found out that it is easier for a woman in his city to have an all-female team for surgery. He said that some of the urologists argued that the female nurses would claim discrimination if they got him an all-male team. It is not discrimination to refuse opposite sex intimate care. You are not discriminating as long as you do not claim that one gender does not have capability to do procedures. Those female nurses are not losing their jobs. They are just simply not asked to work with male patients who value their modesty.

Misty

 
At Sunday, September 25, 2016 4:34:00 PM, Anonymous Anonymous said...

Misty --

Did you mean to say this: "You are not discriminating as long as you do not claim that one gender does not have capability to do procedures." Then my experience with having a catheter placed suggests I am certainly discriminating and will continue to. Do I need to claim a modesty violation to stay legal?

Let me explain. A number of AUR episodes have landed me in the ER in the US and a foreign country as well. Every episode has been a traumatic, bloody mess with female staff; a male nurse in Utah placed the catheter trauma free. I asked him how? "Trained on himself." Given that dealing with getting through the prostate is the tricky part, how do females learn the feel and technique as well as a male can? A male can feel it from both sides and can relate their fingertips to what's going on inside. I ended up training for CISC at a well known clinic (there are 3 in the US) and it's very clear to me that none of the females in the ERs really knew what they were doing. Of course, my experience might have been different in Downtown LA than in the hinterlands where most people are treated; but I firmly believe that same gender care for placing a catheter in a male can be based on male staff being able to train in the most effective manner while females cannot due to anatomy.

REL

 
At Sunday, September 25, 2016 5:59:00 PM, Anonymous Medical Patient Modesty said...

REL,

I definitely do not feel you are discriminating at all. I can certainly understand why male nurses would be more skilled in inserting urinary catheters in male patients. I personally believe male nurses are actually better for inserting catheters in male patients. I agree with you that male nurses are more understanding of male anatomy than female nurses. I wish that they would make it standard for male nurses to actually insert catheters in male patients when it is necessary like it is standard for female nurses to insert catheters in female patients in many departments of a hospital. I am glad you had a wonderful male nurse who inserted a catheter well and there were no complications. Are you aware I did an article about informed consent missing from urinary catheters article on Dr. Sherman’s blog?

Look at the wonderful example Doug Capra used about discrimination 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.


Many women prefer a female gynecologist to deliver their baby over a male gynecologist who has 30 years of experience delivering babies. It has nothing to do with his skills. It is simply because he is a man. One man a few years ago shared on this blog that he would prefer to have an inexperienced male than a female nurse who had 30 years of experience for male procedures. I am sure this male patient probably would not mind having a female nurse for a procedure on his foot.

Misty

 
At Sunday, September 25, 2016 7:00:00 PM, Blogger A. Banterings said...

This is very interesting: Australia has a formal chaperone system, but it is failing to protect patients and allow physicians CONVICTED of sexual assault to still practice:


Calls for national system of chaperones for doctors to be reviewed


So what is this formal chaperoning system?

Read the following links; receptionist, no experience necessary...

Chaperone Careers


Chaperone Policy


Reception Training


--Banterings





 
At Sunday, September 25, 2016 9:33:00 PM, Blogger Maurice Bernstein, M.D. said...

My group of first year medical students last Monday had a session in a course which they take in professionalism and the overall profession of medicine and the issues that need to be discussed and learned. That session was centered on Healthcare Disparities. Many examples were reminded to them and what they discussed in groups. Areas of discussion were lower quality of medical care in racial/minority groups, care of the elderly, LGBT population and patients with disabilities among others. Other areas of disparities of the healthcare system were also discussed, however on talking with my group on Tuesday the topic I asked them about: disparities in the gender of nurses and technicians (far fewer men than women) practicing in the medical system and available on request to male patients who desire for modesty and dignity issues that attendance by a man be present--was NOT mentioned or discussed in their class.

So, aware of this patent disparity and after years of reading postings on my blog thread, I talked to them to put this issue into their collection of medical system disparities which needs analysis and correction. This is my contribution to the matter.. only 6 students but a start and who knows..they might start a discussion with their other medical student colleagues. ..Maurice.

 
At Monday, September 26, 2016 4:27:00 AM, Blogger Biker in Vermont said...

Thanks Dr. Bernstein for what you do. Your example is just another reminder that the medical system as a whole chooses to ignore the male modesty issue. I wonder how many male doctors are OK with any woman that wears scrubs to have intimate access to their bodies when they are patients. My guess is that many of them quietly arrange things so as to get male nurses & techs and that there aren't female chaperones present when they are being examined.

 
At Monday, September 26, 2016 3:46:00 PM, Anonymous Anonymous said...

Misty - thanks for all you and your organization do to promote individualized care, respect and optimized comfort and dignity for each patient. Hopefully your client will get his healthcare nonetheless, but he should at least insist that his needs and beliefs be met at each step of the admission. If they refuse and/or can’t accommodate then after he has received treatment he should file complaints. As you know about 45 states have State discrimination laws. As an example, I’ve looked at NY, AZ and OR and they read similarly to Oregon Revised Statues § 659A.403 which states “(3) It is an unlawful practice for any person to deny full and equal accommodations, advantages, facilities and privileges of any place of public accommodation in violation of this section.” A hospital and clinic or doctors office is a place of public accommodation. Since all hospitals have at least one or more examples of defending that patients (i.e., females) should have privacy in intimate exams, that includes providing same gender staff for those exams, the other patients (i.e., males) need to be provided similar privileges, advantages, and accommodations.

Now the importance of the final rules for Section 1557 of the ACA is 1) that the Office For Civil Rights will enforce and 2) practices and programs available to one sex must be available to the other except in highly specific exceptions. I can tell you from lots of experience that the OCR does a very thorough and comprehensive job of investigating and forcing compliance on a Hospital, where necessary. I would highly encourage your clients to complain to the OCR after being discriminated. There are night and day differences in enforcement between the OCR and the Joint Commission and/or the local licensing agency.

Hospitals and their Risk Managers generally will not allow a personal rep of the patient into the OR during a surgery. Lots of good reasons for this during the surgery. However, those same hospitals do have Observers in their OR rooms from time to time. In fact, chances are the Informed Consent your client would sign has in it a sentence about allowing Observers to be present. So I would suggest that your client, if he has a significant other, might consider asking the Hospital if his significant can accompany him into the OR and remain in the OR while he is prepped, if the Hospital cannot accommodate his request for the same gender OR team. As long as the significant other is given scrubs, hair cover, and disinfects his/her hands and they just observe and DO NOT approach the sterile field, there is NO compelling reason this can’t be allowed to make sure the patient’s dignity is preserved during prep. After the patient is prepped and draped the significant other can leave the OR. This might provide some reassurance to your client in a stressful situation. And also your client may want to refuse the presence of other Observers.

Next, if they cannot provide an entire same gender OR team, they should be able to provide a nurse of the desired gender to prep and drape him. This is the least they can do.

Finally, I presume you are aware of the Hospital Conditions of Participation and the Joint Commission Standards that promote patient privacy, etc. I’m happy to share all of those with you for helping your clients file complaints. The former would also be of interest to the OCR. - AB

 
At Monday, September 26, 2016 10:29:00 PM, Anonymous Anonymous said...

AB

With all due respect, however, the following agencies couldn't care less about violations of physical privacy. They are, OCR,
Office for civil rights, JC, the joint commission, American civil liberties union. ANA, American nurses Association, AMA,
American Medical association. American hospital association. All unions, federations, associations, whatever. Show me one
example whereby a hospital or medical clinic was fined, sanctioned etc. for a violation of a patient's physical privacy. Doesn't
happen.

PT

 

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