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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.
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174 Comments:
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".
" 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
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.
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
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
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
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
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
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
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
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
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.
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.
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.
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
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.
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.
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
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?
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
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
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.
Maurice
The Hippocratic Oath. " I will respect the privacy of my patients"
Respectfully, there is simply no validity to your comments or arguments.
PT
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
(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
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.
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?
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.
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
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
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.
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.
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.
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.
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.
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
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
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.
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.
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
"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.
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
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
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
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.
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
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.
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
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
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
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
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
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.
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.
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
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
Maurice,
Earlier you posed a question about transgender persons.
Basically, a trans person is either male or female, just that their body does not match their gender.
Simply, treat them as the gender that they identify with, AND ask them their choice (preference) of their care givers.
The gender issue will be fixed by the ACA and the courts. See the latest volley in the battle:
Mother sues U.S. hospital for discriminating against dead transgender son.
The next step is a lawsuit alleging gender discrimination because a cisgender male patient was not afforded male caregivers...
--Banterings
Banterings, that suit is not based on modesty considerations or the provision of same sex staff but rather the transgender teen being referred to as a she rather than a he. It would be quite a stretch to extend it as having implications for same gender care for men.
That said, my guess is that the suit will result in real change for transgenders given transgender rights have enormous support on many fronts. There is little to no support for male patients wanting same sex medical staff for intimate procedures.
Biker,
It is no stretch. That suit is based on dignity. Do not forget that a transperson is just like a cisperson, except in the wrong body. This suit is basically that a "male" was referred to as "she," "her," etc. A good lawyer will most definitely pull in the fact that this "male" was being treated by female nurses (the ones that abused her).
The other issues are being treated with dignity; hence women offered same gender care, but not men?
The biggest victory is going to be showing that healthcare is NOT gender neutral, and that gender DOES AFFECT care.
Thank you A. Banterings as you hit it right on the nail. Healthcare is not gender neutral!
PT
PT,
Let me tell you how this affects male care: A male going for a procedure and given a female chaperone may interpret that as them being labelled a woman. There are numerous PubMed studies that show most women prefer another woman as a chaperone and most men prefer no chaperone.
To impose a female chaperone upon a man is paramount to addressing him as a woman. That is exactly what the Prescott v. Rady Children's Hospital-San Diego lawsuit is all about.
Beyond healthcare NOT being gender neutral, the best part of this suit from my point of view is that it will validate preventable psychological harms as side effects from medical procedures.
Once this is established, providers will be responsible discussing psychological side effects from procedures as part of informed consent, AND be liable for psychological harms when they ignore things such as gender and patient dignity. This will be no different than the discussions that they have about the side effects of imaging (radiation) or vaccines.
This will also hit providers and facilities who ignore dignity and gender in the place where change in healthcare comes from: the wallet.
I do not doubt that the patients' dignity in the Prescott case and the Rumble case case were disregarded. Yet we hear from providers how compassionate providers are AND how these are just a few "bad apples." Being a systemic problem, you are going to see more lawsuits.
Even if it was just a few "bad apples," is NOT One lie is enough to question all truths?
One must marvel at how our laws are crafted. Just look at the Constitution... That being said, the ACA does have an elegance to it as well. Part of what it was designed to do is bring healthcare to all (more) people. What better way of doing it that guaranteeing dignified care to people who may have opted out of the healthcare system (like me) so that they will (may) return.
--Banterings
What a pertinent and interesting discussion! Actually, I agree that patient gender discrimination in our medical system is real and does need to be corrected. At least the education of physicians are no longer infected with gender discrimination (med schools, like mine, have virtually 50-50 percent, female to male students. Now is the time to get male to female representation in medical nursing and tech schooling. ..Maurice.
This is not specific to modesty but it is interesting nonetheless in how this doctor lied under oath to protect his colleague in a malpractice suit. It reminds me of how again and again there have been accounts here of how medical staff see modesty violations but say nothing and often times do nothing about it. All too often the medical profession protects their own rather than doing the right thing for the patients.
http://www.healthleadersmedia.com/quality/doctor-confesses-i-lied-protect-colleague-malpractice-suit?page=0%2C3
I've read a considerable amount of the previous posts (Vol 76 & 77) on patient dignity & modesty because I WAS recently scheduled for outpatient arthroscopic surgery but found that I had NO rights regarding my care while in the OR. As such, I'll have to deal with the pain,etc.; i.e, until I find a surgeon, who understands this issue and CARES. With this in mind, I write to the below - problem and reasonable potential solutions - and hope that someone, who has influence on the FEDERAL level, reads this and takes action ASAP.
For the medical professionals, it seems that many, if not all of you [from what I’ve read online and been told directly], have forgotten that providing care is about the WHOLE PERSON. There is lengthy dialogue online on the topic of ‘patient dignity.’ Understandably, medical professionals have a JOB to do but they CHOSE a field that SERVICEs PEOPLE and that entails everything; i.e., mental well-being as well as physical no matter what the medical specialty. As such, medical professionals can no longer hide their heads in the sand and deny that patient’s want and deserve more rights/say about WHO - besides THEIR CHOSEN medical professional(s) - sees them naked, especially, while they are vulnerable (e.g. under anesthesia). Globally, both men and women are noticing that two nurses in the UK have created Digni patient surgical tops/bottom, which allow all patients to maintain their dignity - and have less anxiety about this issue as they anticipate surgery. [See below from RCNI journal June 26::vol 27 no 43::2013 7; http://journals.rcni.com/doi/pdfplus/10.7748/ns2013.06.27.43.7.s8 )
“Two nurses have designed a paper bra to protect female patients’ modesty during theatre procedures. Recovery nurses Fiona Cartwright (left) and Natalie Reid (right), who work at Vale Healthcare Hospital in Cardiff, came up with the design after a survey found that female patients dread being exposed during surgery. The royal blue, disposable ‘Digni Bra’ and matching paper knickers (on model) form a ‘dignity underwear’ set. These were distributed across the hospital this month after a successful trial in April and May involving more than 100 patients, and are being introduced throughout other Nuffield Health hospitals. Ms Cartwright said: ‘The feedback has been tremendous. It is not a fashion item but is there to give patients added dignity, which is really important.’”
The Atlanta Journal-Constitution
Doctors & Sex Abuse
http://doctors.ajc.com/doctors_sex_abuse
See Part II From: Unconscious BUT Conscious Patient
Part II From: Unconscious BUT Conscious Patient
The Atlanta Journal-Constitution
Doctors & Sex Abuse
http://doctors.ajc.com/doctors_sex_abuse/
If the abuses documented by AJC and others are happening to conscious patients, just imagine what has and continues to happen to UNconscious patients?! Measures to eliminate or reduce these issues are not costly or rocket science! It’s simply a matter of putting the patient’s best interest and safety FIRST; mandating policies and procedures that protect patients and give patients rights when they are particularly vulnerable (psychiatric care; under anesthesia; male doctor – female patient OR vice-versa, etc); Federal Laws mandating prison for convicted medical professionals and loss of licensure – accountability is not a factor even today. Measures to adopt include: 1) all surgical patients should be given the option to have same gender staff in Operating Room;; 2) all surgical patients must be provided with Digni sterile surgical underwear top & bottom; i.e., for said anatomy (breasts and/or genitalia) not involved in planned surgery and no planned treatment requires access to said anatomy (breasts and/or genitalia);; 3) surgical patients should be advised well in advance [for planned surgeries] of available anesthesiologists so that they may research and approve/reject those either acceptable or not acceptable for their planned surgery;; 4) for all medical procedures involving different doctor/patient gender, attendant of same gender as patient must be present at all times;; 5) medical staff/professionals and non-medical colleagues, etc. with access to patients in a state of undress, vulnerability (e.g. under anesthesia) may NOT carry personal photographic equipment on her/his person and all medical facility photographic equipment should be secured by password permission control to log exact medical professional and type of action taken;; and, finally, those medical professionals found to be in violation and, in turn, convicted should lose their license to practice and be sentenced to a suitable prison term of not less than 5 years [without probation] for the most minor violation (e.g. taking a photograph of a patient for personal purposes; i.e., not medically necessary/warranted) – those non-medical professionals working in a medical environment/facility should, also, be governed by the same laws/policies/etc.
Comment by: Unconscious BUT Conscious Patient Dignity/Safety
To Unconscious but conscious patient
Do a Yahoo search for outpatient surgery ENT physician performing unnecessary genital exams on unconscious patients. Only
lawsuits are going to curtail some of this behavior in healthcare, otherwise these kinds of blogs can go on essentially to
infinity.
PT
Unconscious, I am sorry you have come to learn of the reality of the healthcare system. What brought most of us here is our having experienced it up close and personal. Though women have it much better than men in this regard, there have been plenty of stories posted here from women too about their opposite gender care, most often dealing with surgeries where they too cannot get same gender staff. That and childbirth scenarios.
As your links point out, there are sexual predators in the medical ranks and their peers largely choose to look the other way. No different than teachers protect their bad apples, police protect their bad apples, the Catholic Church protected their bad apples etc. I would not allow such articles to deter me from receiving care however given the odds of encountering a sexual predator are exceedingly low.
The real issue is needless exposure and opposite gender exposure. Those digni bras and underwear that you described sound like an excellent idea. I'll bet they wouldn't add but a dollar or two to a surgery so it is a matter of priority, not cost. For the medical industry to adopt using them in surgeries would be an admission that modesty is an issue which has larger ramifications than simply spending a dollar or two for them.
I have had literally several dozen extremely intimate procedures by female NP's and RN's, almost all handled in a very professional manner that did not add to my embarrassment. Almost all, not all. On the modesty continuum I am not as modest as some here and I will not forego care that has the potential to save my life. For example I will go for cystoscopies even if I know a female nurse will prep me because to not do so could mean a recurrence of my cancer not being detected early.
What I can do is make it known that I'd prefer a male nurse and insist that all of the proper protocols are followed so as to minimize my exposure to that which is absolutely necessary. Doing these things does send a message and it is how we got to the point that men can expect to be treated in a respectful and professional manner. Older guys that grew up in the 50's & 60's can recall when the medical world made no attempt to provide any privacy or respect for men and boys because the prevailing wisdom used to be males had no modesty and no provision for such needed to be made. That is no longer the case.
On the assumption that it would be extremely difficult to get a single gender surgical team, one thing that you can do is not consent to opposite gender medical & nursing students being present nor any other observers. Another is to request that you not be put under until the prep work is done. I doubt there is a medical reason why someone needs to be out for prep work. I suspect it just makes it easier for the staff to not have to worry about patient exposure. Lastly, just making it clear to anybody and everybody that you are concerned about your exposure may get them to take a few extra precautions to respect your wishes.
Good luck.
Maurice,
Please do NOT take this comment the wrong way (you know that I am respectful but NOT afraid of taboo subjects):
There is either some pathology or something lacking in the training of physicians. Failure to obtain consent for intimate physical examination on patients under anesthesia is still common throughout the world.
USA 2003
Canada 2010
Canada 2012
USA 2012
USA 2012
France 2015
Israel 2016
Why can supposedly caring and compassionate people do this?
If this is happening in 2016, there is a real problem.
--Banterings
A. Banterings
Consent, what's that? Most of the time there is not even a valid reason for a genital exam.
PT
In a follow up, read here the victims of CIA torture still suffer long after release. These torture programs had the input of physicians to maximize the psychological assault. The conditions of the torture have many of the same elements as healthcare: nudity, bodily invasion, coercion, gender issues, power differentials, seclusion, restraint, assaults upon the body, objectification of people, etc. These are all are means of the individual losing control of their person.
How U.S. Torture Left a Legacy of Damaged Minds
Here is a historical perspective on physicians participating in psychological torture: The Worst Psychiatrist in History
Continuing on my previous post, what happened to "First, do NO harm?"
--Banterings
The articles primarily focus on pelvic exams which is particularly egregious but I'm guessing the issue also includes prostate and/or other rectal exams, catheterization practice (by nursing students as well as medical students), and breast exams.
Something particularly upsetting in one of the articles that Banterings posted (and that I have seen written previously) is the notion that if you are a patient in a teaching hospital that students should have an automatic right to practice on you without your knowledge or permission.
This is just wrong. A teaching hospital is not a charity hospital where people get free care in exchange for being teaching subjects. If anything we are paying a premium for care at teaching hospitals. I am perfectly willing to participate in the education of nursing and medical students but I expect to be asked permission beforehand. Some things I will say yes to and others no. For example I would not allow a nursing student to practice catheterizing me because if she gets it wrong I could be seriously injured. To anyone who says they need to learn that too, I say offer yourself up as a test patient in my place. If its OK for me its OK for you too, so you can go ahead and help them. My general nature is to be helpful and I will try to say yes to most things, but I must be asked.
Good Morning.
There are doctors that are of the mindset that consent for say an examination is implied in the hospital setting and that asking permission from the patient to go forward is unnecessary.
This is one of the reasons why there are so many problems.
These are the people teaching the nurses & doctors of tomorrow.
System is broke. When a few maverick lawyers finally come along willing to take on the healthcare industry, the lawsuits will start flying & then we might start seeing change.
It's more than apparent that our lawmakers don't have the backbone to stand up to the industry or are in the industry's pocket.
Best regards,
NTT
PT said:"Do a Yahoo search for outpatient surgery ENT physician performing unnecessary genital exams on unconscious patients. Only
lawsuits are going to curtail some of this behavior in healthcare, otherwise these kinds of blogs can go on essentially to
infinity."
I actually received several letters (as I am sure many here did as well) from one of the Doctors that we posted about a few years ago. Most of them were re-litigating the "accusations", but in the end she requested that I remove anything that I had ever written or posted about her. Though she did say that she could not bring any actionable lawsuits against me, she said she remained damaged just the same. Family..friends...all in her life were affected , as well as the fact that she was finding it difficult now to get any patients to her practice.
We can argue here if these results were good or bad, but lawsuits are not the ONLY answer.
Suzy
I had my prostate surgery Tuesday and all went well. The surgeon had agreed I could wear my underwear into the surgery; that once I was unconscious he'd ask everyone but the anesthesiologist to leave and he would remove my underpants, catheterize me, and install a sterile blue cloth; at the end of the procedure he'd do the same to replace the catheter and would put the underpants back in place. So I went to sleep with underpants and woke up with underpants! When I arrived the nurse told me to take off everything and put on a gown and I said I had permission to keep on my underpants. She was surprised, but had no problem with the arrangement and we had a pleasant banter. When a urology resident showed up, he told me the surgeon had briefed everyone about my modesty arrangement without me asking. So overall, that went well.
When I woke up, I mentioned to the nurses in post-op I still had my underpants on and they laughed because they thought I was joking, but when they realized I was serious, again they had no problem. As soon as I was in my room, my daughter helped me out on my "lucky tee shirt" which was covered by get-well wishes by 40 or 50 friends. At 6 pm--5 hours after I had awakened--I decided I wanted to walk around. A nurse helped me get my pajama bottoms on over the catheter tube and I walked the floor several times that evening. The next morning I got up, walked around, then sat in a chair the rest of the morning until I was discharged. It was easier to do email sitting than laying down!
I was there for three nursing shifts. At least two of them had a male nurse. They wanted to do an anal swab to make sure I didn't have c-diff; the male nurse asked and I agreed, and he just pulled the back of my underpants down a little bit. The nurses wanted to check the incisions a few times, so I lifted my tee shirt for them; that was fine. No one even asked to look under my underpants.
So everything went VERY well. I was very comfortable, so I was laughing and joking with the nurses all the time. I am now home and healing. I've done two 15 minute walks today and will go out on a third one soon. I've taken Tylenol and Ibuprofen but tomorrow I won't even need that.
Good Morning:
RobH glad your surgery & nursing experience went well for you.
Suzy, the ENT physician got exactly what she deserved for what she did. She and any other healthcare worker that does the same as her, should have their license revoked permanently and go to jail for awhile.
They should get no second chances. Kudos to the CRNA and any other healthcare worker who has the guts to turn these people in. There is NO room for people like these in healthcare.
As far as lawsuits go, no they are not the only answer however, it seems to be the only way right now that the healthcare industry will listen to the people and that's too bad that it has to be dealt with in that manner.
It takes both sides to resolve the issues & it seems as if the healthcare industry wants things there way or the highway right now so the lawsuit seems to be the only way they will listen right now.
Regards to all,
NTT
Suzy,
Nice to see that you are still around and active on the subject of patient dignity.
NNT, et al,
Unfortunately Twana Sparks' punishment was revoked and she, and her license reinstated WITHOUT any restrictions. See here: (Note the November 12, 2011 order.
See Her New Mexico Medical Society contact page
If you read the story that Suzy alluded to, you will see that her being reported was the result Perhaps her wedding may have insights as to why only men were targeted.
But this really scares me:
Twana Sparks listed as a resource for a PEDIATRICS PRACTICE
This is ironic: As a delegates going to the Democratic National Convention, Twana Sparks is quoted about integrity.
--Banterings
First, congrats RobH on a successful surgery process for you.
Concerning Twana Sparks however, I am speechless that they removed all restrictions on her. I am also speechless that anybody would go to her for care. Is it possible that somehow locals don't know what she was doing? Or is what she did somehow quasi-culturally acceptable in New Mexico? I always thought Hispanics were a generally modest and respectful group and that the underlying culture in NM would not tolerate that kind of behavior. Then again, her co-workers apparently thought it was OK for a long time, and her employer apparently thought it was OK too.
Rob H,
Glad to hear that all went well. Perhaps it will give your surgeon something to think about, like why can't this be the way it is done all the time?
Biker,
The answer is because she is the only ENT in a 200 mile radius.
Even more disturbing is that she works with children's charities. I have cited the link previously, but can not find it at this time. It has been suggested that because of her sexual orientation, men are the target of her attacks. If you read the NM medical board complaints, there are no allegations that she assaulted women in such a manner.
One other possibility is that it is acceptable to assail unconscious men in healthcare, but not women.
I have too many friends here in Philadelphia that fall in to the LGBTQ spectrum, and I would be devastated to find out that the attacks were related to her sexual orientation.
Perhaps Suzy has some insights...
-- Banterings
Banterings, my guess is that the largest factor is the culture at that hospital. It is the same facility that illegally performed procedures on David Eckert which was eventually settled for $1.6MM. That what happened to Mr. Eckert was years after Twana Sparks reprehensible behavior tells me that the Twana Sparks episode did not trigger any soul searching in how patients are treated at that facility. There is another lawsuit against them for having done to Timothy Young what they did to Mr. Eckert so his case was not an isolated lapse in judgment. I wonder if they have learned anything from the David Eckert and Timothy Young cases?
http://www.usnews.com/news/articles/2014/01/14/new-mexico-man-given-forced-colonoscopy-by-cops-wins-16-million-settlement
I doubt Twana Sparks being a lesbian had anything to do with her behavior. LGBT medical staff are just as professional as everyone else, and are going to have their bad apples same as everyone else. That she only abused men could be because the other staff wouldn't have tolerated her abusing women. Hopefully she at least learned her lesson from the temporary restrictions she did have and is now respectful to her male patients.
The good news however are the examples such as RobH gave us. Some doctors and medical facilities do get it.
I am in process of switching my care from one of the major teaching hospitals in Boston to Dartmouth Hitchcock in NH. Their code of professional conduct includes: Respect the privacy and modesty of patients.
Many places just say privacy which could be interpreted to just mean HIPAA medical record privacy. DH's inclusion of the word modesty speaks to their intention. My wife has been a patient there several times and they do not ask about preferences, but I have spoken to the Urology Dept a couple times and they were very respectful of my concerns. They said if I ask that no female medical students or residents be in attendance for my cystoscopies that none will be present. The woman I spoke to said I could request the male urology nurse for my prep, though noted they only have one. When I said one is more than most places have but it would be nice if there were more, she agreed. It is a very large practice and so there is no guarantee I can get that sole male nurse, but they at least are trying to accommodate patients who express a concern.
I know this is old news but sparks should be in prison. Each patient she groped is (1) sexual assault charge and this
went on for years. The entire staff in that OR should be charged for not reporting it. The Crna is not an angel and
should be charged as well. She too knew this was consistent behavior with sparks. It's hard to realize that this sick
culture goes on and on in healthcare in this country with healthcare costs as they are. No checks and balances and
not one moral person on high ground to say something. There is no lesson here for her to learn, only a prison sentence
would be appropriate.
PT
PT,
This also shows how effective chaperones are in protecting the patient too. I don't care what industry you are in, but when you self regulate, you are going to make the rules that benefit yourself. The medical center also turned a blind eye because she was a money maker for them. I have seen the figures at what she brought in as the only ENT there.
There was a really great article online titled "Is Dr. Mark Donnell lying to protect a sexual predator?" that has since been removed. It talks about how it was common knowledge to personnel at the medic center that this was going on. One high ranking member commented, "is she doing genital exams again...?"
Let me really make everyone's skin crawl; Bill Cosby got the Quaaludes he used to drug women from a gynecologist.
--Banterings
Hello Biker,
I'd like to suggest that you make your urology appointment when the male nurse is available (he may only work selected days) and that you state to the scheduler that you'd like to have him for your procedure. If he's occupied during your appointment, indicate to the staff that you'll wait for him. Continue with this for every appointment and eventually, hopefully, the office personnel will be aware of your preferences and they'll assign the male nurse to you as a matter of course. Keep us posted. Take care. Reginald
Dr. Bernstein, two questions for you. I know that you can't speak for all medical professionals but you have great insight into the mind of the collective medical world.
Any patient that questions opposite gender intimate exposure in medical settings is told that the staff person is a professional, whether that person is a physician or a teenage CNA who may or may not have graduated high school or a "Medical Assistant" who might have even less training than a CNA. That's the public position of the medical world. Amongst yourselves, do the denizens of the medical world really consider everyone that wears scrubs to be a professional? Bear in mind we're not told that someone has been trained to act professionally with patients but rather that they are a professional. There is a big difference in connotation. Words have meaning.
The other thing that we're told is that to medical professionals patient intimate exposure is not sexual, sometimes to the degree that a penis is not viewed any different than an elbow. If it isn't sexual, then why does the medical world go to so much effort to shield female intimate exposure from male medical professional eyes? Why wouldn't women also be told "he's a professional", "you don't have anything he hasn't seen". Either it is sexual or it is not, yet the medical world seems to want to be in two places at the same time. It is sexual if it is male staff with female patient but not sexual if it is female staff with male patient. How does the medical world justify this discrepancy to themselves?
Thanks for any insight you can provide.
Here is an update to something I posted about a month ago about one of the country's most elite boarding schools. I had noted they have their own small accredited hospital on campus with a male doctor and otherwise all female staff. Yesterday I was at that school again and I talked with my friend who is the number two person there. In response to my questions I learned that they have a female NP who handles any intimate female issues rather than make a girl see the male doctor. As for the boys being subject to intimate exposure with the female staff, my friend acknowledged his awareness of that being difficult for teenage boys, but that the boys "need to just deal with it". And so ladies and gentlemen the rules of the medical world are not any different for the children of the country's and the world's elite.
This prompted me to look into an all-boy boarding school for kids grades 7 to 9 that I am familiar with. It too is very exclusive for the sons of the US and world elite. They have a part time male doctor and otherwise full time female staff for a 100 percent young teen boy student population.
The conversation I had with my friend had me thinking that maybe I'm the one who doesn't get it.
Biker, the only curriculum I personally know about the education of professionalism is the is that for medical students. In the first years at our school professionalism is a once weekly course where the definition of what constitutes and maintains professionalism is dissected out to the students and they are involved in discussions. This course is augmented by the education and supervision by instructors within Introduction to Clinical Medicine, the course where I teach my group of 6 students. Yes, gender selection and modesty issues are discussed regarding general patient interaction but particularly when the students learn about the genital exams. Hopefully, they will carry on our teaching and continue the practice of professionalism through their careers.
However, we know in later years and beyond there is the "hidden curriculum" set primarily by the pressures of medical practice, pressures which are set by patients and the medical system itself. These pressures may lead to behavior of physicians which appears "rushed" and with rushing, in order to complete the physician's work with a patient and to "move on", assumptions may be made by the physician regarding the goals of the patient: only to facilitate diagnosis and treatment. Therefore, the issues of gender-selection when a task is to achieve those goal may be impractical in practice and is not necessarily professionally considered.
All this means that it is time for the patient "speak up" and set their goals beyond diagnosis and treatment but to remind the doctor that personal modesty issues must also be kept in mind and attempted to be followed. ..Maurice.
Thanks Dr. Bernstein, though I wasn't speaking to curriculum so much but rather perception within the larger medical community. I can't conceive that MD's and RN's actually consider CNA's to be medical professionals even if outwardly they are represented to patients as such. Why this matters is that a male patient who objects to a teenage female CNA coming in to bath him is likely to be told it's OK because "she's a professional". No they are not professionals so I need a different reason for why I am supposed to be comfortable with her bathing me. That's a rhetorical question Dr. B. I don't expect you to tell me why I'm supposed to be comfortable.
I suppose in part I am voicing my own prejudices here. Right or wrong, fair or not, in my mind the higher up one is in the medical food chain the less sexual opposite gender intimate exposure is going to be. By that measure for example I'd be more comfortable with a female MD than a female RN and more comfortable with a female RN than with a female CNA. In the same vein the older the medical person is the less sexual opposite gender intimate exposure is going to be. For example I am much more comfortable being exposed with an RN in her 50's than one in her 20's. Basically with age comes maturity and understanding, in my mind at least.
Biker,
If you go back to previous volumes, you will see that this was discussed. What these professionals are really doing is objectifying the patient. This is the same way that the Nazis dehumanized the people in the concentration camps to allow human beings to commit genocide then do home and have dinner with their families. I also wrote 5 very long posts on my blog (titled "How to Create a Sociopath""
As far as the response that they treat the genitals just like any other body part such as the elbow, that is a complete and absolute lie." (I have called many people out on this.
In order to prove my point, I simply ask them to show me their elbow."
I have never had ANYONE do it. Most get indignant and accuse me of perversion.
Others have argued that only in a therapeutic setting, etc. They totally miss the fact that they lied AND they do NOT treat the genitals just like any other body part (...maybe YOUR genitals).
The problem is with the profession. They want to do what they think is right, NOT what society thinks is right. Read the AMA's Principles of Medical Ethics:
The second to LAST is:
A physician shall, while caring for a patient, regard responsibility to the patient as paramount.
If the patient is truly paramount, then that would be the first and only principle needed. Being honest, providing competent medical care, with compassion and respect for human dignity and rights, etc., would all be dictated by the first.
The American Medical Association was created to run the profession in a manner very similar to that of the medieval guilds (free of external (state) regulation. (Source: Llewellyn H. Rockwell, Jr., “Medical Control, Medical Corruption,” Chronicles, June 1994; on the rise of medical licensure, see Ronald Hamowy, “The Early Development of Medical Licensing Laws in the United States, 1875-1900.” 1979, Journal of Libertarian Studies: 73–119.)
Even in the AMA Journal of Ethics they acknowledge that they EXPECT [full} autonomy, monopoly, and self regulation.
I have always maintained; "Power tends to corrupt and absolute power corrupts absolutely." (- Lord Acton)
The AMA is only concerned about the AMA (and their monopoly). Read what they did to
chiropractors.
Search "George H. Simmons," "Morris Fishbein," "Abraham Flexner," and the "AMA seal-of-approval program."
Perhaps the best description is found in the medical sociologist Paul Starr wrote in his Pulitzer Prize-winning book: "The Social Transformation of American Medicine."
-- Banterings
I have reported on this blog that many years ago a bathroom in the nurses station had full nude male foldouts from play girl
magazine covering every square inch of the walls. That this particular intensive care unit only employed female nurses. I
suppose that if the pictures were of elbows then that would have been a bad thing. I agree with you A. Banterings that it
is a Hugh lie!
PT
I reject any objectifying a patient by anyone working within the medical profession. And that applies to office secretaries, clerks and anyone with a graduation title after their name. And even those who come to the patient as a student, a volunteer or whomever who interacts with a patient. Patients are not a carved stone statue. Patients are not a hospital room number. Patients are not a named disease. And for whatever reason that a patient is seen as an object, there can be no excuse or rationalization.
At no time should the personhood of the patient be trumped by any excuse. To do so diminishes the humanity of the provider of medical services. Certainly, objectifying the patient clearly will easily lead to the issues described here with ignoring patient modesty and tearing down the dignity of all humans regardless of gender. This is what we teach our medical students.
By the way, this philosophy of a human being can extend both within life and after death. A week ago I took a group of second year medical students to our county coroner's office for their first experience there to watch autopsies in progress. It is clear in our discussion after their visit and based on a student writeup of the experience which I read, they did not look at those unclothed bodies as objects (in their case "teaching objects") but as human persons who had recently died and even in death should be treated with dignity. Hopefully, this concern will continue to be
remembered and applied to their living patients in their future experiences and careers. ..Maurice.
I must do this in 3 parts:
Maurice,
Just because you reject any objectifying a patient by anyone, the medical profession embraces it. By your own words in other volumes on your blog, you state that you do not know if your students retain or practice the ethics that you taught them beyond their second year.
Look at this 2016 PubMed article, Talking about persons--thinking about patients: An ethnographic study in critical care. It finds justification in objectifying patients being essential to delivering safe effective care:
Analysis of these data led to the identification of seven Discourses, each of which was characterised by a particular way of talking about patients, a particular way of thinking about patients, and a particular pattern of practice. Four of these seven Discourses were of particular significance because participants characterised it as 'impersonal' to think and talk about patients as 'routine work', as a 'body', as '(un)stable' or as a 'medical case'. Although participants frequently offered apologies or excuses for doing so, these 'impersonal' ways of thinking and talking were associated with practice that was essential to delivering safe effective care.
Here is a 2012 article from The Lancet,
How do you feel?: oscillating perspectives in the clinic. Again it promotes the objectification of the patient, and SUGGUSTS a reconciling of the patient as an object and a person at the end of the encounter.
ND Jewson's seminal paper of 1976, The Disappearance of the Sick-Man from Medical Cosmology, 1770-1870, examines the objectification of the patient based on the Marist theories of the philosopher Michel Foucault.
Jewson points to the power that the physician wields in the patient-physician relationship and technological advances in medicine (the rise of pathological or hospital medicine as the causes of patient objectification. He also justifies patient objectification as a necessity.
This was—and remains—an important paper. His analysis provided a context for understanding medical history. (Jewson's paper is widely cited by medical historians) especially that fertile period of revolution around the end of the eighteenth century. It also provided a context for understanding [justification] the emphasis on and limits to patient autonomy.
Continued...
Part 2:
David Armstrong's commentary on Jewson's Disappearance of the sick-man from medical cosmology observes (about Jewson's paper):
In Paris in the late-eighteenth century, poor people were provided with access to health care through new public hospitals. This changed the relationship between doctor and patient to one in which the doctor was dominant. At this point, clinical medicine became focussed on a new way of thinking about illness that located it in a pathological lesion inside the patient's body. In this model, the patient's symptoms were only preliminaries; the real task was to apply the newly developed skills of the clinical examination in an attempt to uncover the ‘signs’ of the underlying lesion.
The emergence of pathological medicine was not therefore the result of ‘scientific progress’ or advancement, but rather the direct expression of a doctor–patient relationship that placed the doctor centre-stage. The patient might feel ill and experience all sorts of symptoms but it was only the trained physician who was able to look beyond these outward manifestations of illness to identify the real disease of which the patient had no necessary awareness. This new-found medical dominance also found expression in the Collegiate form of professional identity that accompanied the rise of this new medical theory. Yet, Jewson went further. This new medical paradigm, or cosmology as he called it, had meant the disappearance of the ‘sick-man’ in that the patient's voice was now relegated to a minor role in the clinical task, a role further reduced with the beginnings of medical investigations (or Laboratory Medicine) later in the nineteenth century. In the latter, the role of the patient was further reduced as in many cases it was simply a tissue sample, a few of the patient's cells, taken to a distant laboratory that provided all medicine needed for an accurate diagnosis and choice of relevant treatment. For all its claimed benefits, medical ‘progress’ has resulted in the subjugation of the patient and a loss of their status as ‘person’.
The paper, Embodying the Patient: Records and Bodies in Early 20th-century US Medical Practice shows (and justifies) the (necessity of) objectification of the patient in reference to modern medical record keeping.
Continued...
Part 3:
The Oxford Journal's paper, Hermaphrodites on Show. The case of Katharina/Karl Hohmann and its Use in Nineteenth-century Medical Science, also justifies the objectification of the patient to allow the physicians to safely study the physical sexual aspects (i.e. genetalia) of Katharina/Karl Hohmann.
(In 2013, The UN Special Rapporteur on Torture, deemed this treatment ["medical display"] as a form of torture.)
The 2008 article, The wounding path to becoming healers: medical students’ apprenticeship experiences, goes on to absolve medical students from patient objectification doe to the complexities and stress of the medical education and (due to the demands of a medical education) does not see that the elimination of patient objectification is possible.
A 2009 South African study demonstrates the disjunction between what these students were taught about human rights and ethics and what they witnessed in clinical settings. Patient objectification is alluded to the cause and justification of such abuses.
Another article in the European publication, Mind the Body, goes on to further support patient objectification as a necessity of modern healthcare and vilify philosophers who seek to defend human rights and human dignity.
Finally, the 2015 Israeli paper, The Israeli Patient's Rights Law: Evidence for Deprofessionalization?, it shows how the erosion of professional power protects patients. This law is a response to the medical profession NOT meeting society's expectations of all it's members (including medical professionals). The major shortcomings of the medical profession are in regards to the diffusion of knowledge, consumerism, and values that emphasize human rights, human dignity, autonomy, and democracy.
-- Banterings
Excellent, Banterings! I cannot stomach the idea that any human being is not a person and that as the medical profession we cannot proceed in our work and responsibilities by keeping the patient as a distinct person. Also, I don't agree that it's OK to keep the patient as some "thing" and then afterwards apologize to the patient that now that you have been properly diagnosed and effectively treated then apologize and say to the patient "Now
you are like me---no longer a disease."
That argument that the only way to provide effective diagnosis, treatment and nursing is to treat the patient like a disease is ridiculous!
And, yes, this attitude denying a patient their personhood because of the fear of failure is, to me, a failure in the ethical behavior of the medical system. ..Maurice.
Feminism has made nurses too grand to care
PT
If only everyone in the medical world was like you Dr. Bernstein. The hardest thing to understand about doctors, nurses, and techs that choose to not see the patient as a real person with feelings is that they must know that their own loved ones are being treated the same way. How can a nurse who is being cavalier about her male patient's exposure not see her own father/brother/husband/boyfriend/son in his eyes?
Note that I used the word "choose". We all choose how it is we interact with people in our jobs.
The other thing is that most people are not so socially inept as to be unable to pick up on the body language of the person they are interacting with. That being the case, the question then is why medical staff so often choose to ignore signals from the patient that they are embarrassed. Again the operative word is choose.
I've seen many many examples of how female nurses exploit the male patient's physical privacy. As if they are putting the
patient on display in a voyeuristic manner. State nursing boards consider this sexual misconduct and rightly so.
PT
Untold stories of the ER
" Man gets his penis caught in a stove". The story is fake and never happened. This show enjoys casting men in a poor light
particularly involving their penis.
PT
Hello Everyone.
I can across this site while researching for all male clinics . I think you may find it interesting. Type ( Bhekisisa male only clinics ) http://bhekisisa.org/article/2015-07-09-man-to-man-sexual-health-needs-are-better-met-at-male-only-clinics . They conducted a survey and found that 99% of men referred to get their care from males . Close to half avoid health care because of female staff. They didn't like these answers so they will continue looking until they find something that they like. They even started a clinic with one evening a week with a all male staff. How many here would like to see that . Anyway , I hope it gives you idea's . Later...........AL
Al, I read the article about the all-male clinic in South Africa and found it interesting that despite its success that it is not a concept that the govt. wants to expand upon. Women dominate health care delivery there too so men are clearly not a priority.
Anyone who has read my my blog knows that I believe that the medical education destroys empathy and makes physicians unable to distinguish right from wrong, AND more importantly socially acceptable from socially unacceptable.
Here is a 2005 story from the Seattle Times about Dr. Bill Schnall. He was accused of sexual misconduct, but charges were dropped by the victims.
Now comes the VERY interesting part (note what the detective writes in his notes that Dr. Schnall told him when interviewed):
...Schnall’s statements to sheriff’s investigators earlier this year came in response to a complaint filed by a young man named by the state only as “Patient One.”...
...The state board alleges that in addition to giving him money, Schnall forced the young man to participate in a process Schnall called “oathing,” in which the young man was to undress and masturbate, sometimes after taking the impotence drug Viagra.
In the earlier interview with sheriff’s investigators, Schnall acknowledged the “oathing,” but said he did it because the young man suffered from various psychological disorders and needed to be punished for not keeping agreements with Schnall, the sheriff’s report says.
The sheriff’s report says Schnall agreed he had asked the young man to undress. He said he once threatened to make him “stand there with an erection.” But he said he didn’t carry through with the threat.
The sheriff’s report says Schnall also acknowledged giving the young man Viagra, but he said it was intended to be passed on to one of the young man’s college friends.
Schnall also told the sheriff’s investigators that he never ordered the “oathing” for sexual gratification. “It had never dawned on [Schnall] that it could be viewed as unusual,” a detective wrote...
So this physician, a PROFESSIONAL, did NOT think it unusual to make a patient stand naked and masturbate???
Really, what more can I say?
-- Banterings
Banterings, you can say that the example which was described was rare (lightning striking a human) and is no way related to being propagated by medical education.
The behavior described is pathological and doesn't fit with the medical system behaviors toward patient desires that have been previously discussed here. ..Maurice.
Maurice,
Do I really need to post links to individual stories?
...and at what point are they not considered outliers?
Let me post these links that aggregate incidences of such:
The Paramedic Heretic's MEDICAL MISCREANTS
AJC: Doctor & Sex Abuse
Annals of Internal Medicine, Our Family Secrets
Then there is the fact that in the early 2000's ALL physicians learned pelvic exams on anesthetized women WITHOUT consent.
Ethics versus education: pelvic exams on anesthetized women.
Unauthorized practice: teaching pelvic examination on women under anesthesia.
And the practice continues to be widespread in 2012:
Practicing pelvic examinations by medical students on women under anesthesia: why not ask first?
How could a person with conscience and empathy NOT know this is wrong, entering the operating theater AFTER the person is unconscious, lining up to conduct such an exam, leaving, and not seeing that patient again?
Don't get me wrong, I am not saying that all graduates of med school are Dr. Josef Mengele's, but there is a spectrum of diminished empathy and conscience.
There are many good physicians out there that respect the patient's wishes for the level of care that they wish to receive. (Articles with titles like "don't forget to undress the patient" are aimed at these forward thinking physicians.)
--Banterings
Bantering, there is something like a million doctors in the US, maybe three million nurses, and a vast number of techs too. In any population that large there are going to be more than a few bad apples. They are not representative of the vast majority of medical staff. The larger problem that should concern us is the reluctance on the part of doctors, nurses, and techs to report the bad actors, or to at least call them out when they witness inappropriate behavior.
That said I am less concerned about the statistically inconsequential deviants that find there way into healthcare careers than I am with the widespread cluelessness or indifference to patient modesty and intimate privacy. Better education and regulation could make a huge difference there.
Biker, Maurice, et al,
Up to 2005 just about EVERY medical student learned pelvic exams on anesthetized women. (see previous citations) The problem was still widespread in 2012. It was SOP in France and Israel in 2016. (are there no international conferences?)
That encompasses the entire profession!
The blogger, the Skeptical Scalpel confirmed "Our Family Secrets" as "Unfortunately, the stories are quite credible."
By Maurice's own admission, the hidden curriculum has been a major problem and continues to haunt the profession.
The AMA's ethical principle of putting the patient first is second to last on the list.
Haug's predicted process of deprofessionalization is the automatic process to force the profession to respect human rights, autonomy, and patient dignity.
These examples are signs of that pathology across the entire profession. These are on the lower end of the spectrum.
It is NOT cluelessness (as biker asserts). If that were the case, then they would treat the genitals just like an elbow and show you "their elbow." It is about power.
Even the AMA acknowledges that the profession expects status and rewards (prestige and power).
-- Banterings
Banterings, early yesterday I had sent another post elaborating a bit on my differentiation between deviants and cluelessness. I must have done something wrong causing it not to go through so I attempt it again. If the first post does come through Dr. Bernstein you can just delete it as I better elaborate here. I didn't speak directly to the student exams matter but will do so now.
Absolutely I agree that students doing intrusive intimate exams on patients without specific consent is absolutely wrong. It is unethical and immoral and shame on the medical community for thinking it was/is OK. Signing the general waiver in no way constitutes specific consent when those exams have absolutely nothing to do with the patients care. I am guessing that I may have had such prostate exams when I had my bladder cancer surgery being 5 medical students showed up to "observe". Four women and one man. At the time I had no idea of this exam process even happening and would not have thought to speak to the issue. Now I know to do so should I have surgery again. Ask me politely and tell me why this would help you and maybe I'll say OK. Don't ask me and do it anyway after I specifically asked about it prior to surgery and at a minimum there would be a whale of a lawsuit filed. If rape charges are possible I'd pursue that too.
As reprehensible as that practice is, and acknowledging that it does serve to teach students that the patients are not worthy of being treated in a respectful and ethical manner, it is not the same as deviant behavior. To me deviant behavior is essentially purposely using patients to somehow satisfy your sexual impulses. I really don't think this group is statistically significant, but yes they exist and the medical community does us all a disservice by not being more proactive in weeding them out. I do include here medical staff that purposely leave patients exposed with the intent being to embarrass the patient. This is most often going to be the feminist on a power trip acting out some perceived grievance against men.
What is common and which is what we here have most often encountered are the clueless who either don't think patient intimate privacy matters (especially for men), or just never learned proper protocols. I include in this for example the female sonographer who knows a male sonographer is available to do a testicular exam but doesn't offer that to the patient. This group can be educated and trained to do things right. The problem is that most of them don't realize that they aren't doing it right currently. This is where we as patients need to speak up on even the minor lapses. I believe most would take it to heart and not do the same thing again.
Biker,
You stated:
...As reprehensible as that practice is, and acknowledging that it does serve to teach students that the patients are not worthy of being treated in a respectful and ethical manner, it is not the same as deviant behavior...
What is the difference if someone batters (unlawful touching) another for their own sexual gratification or to advance their career?
What if someone batters another to advance their career as a porn star?
Would it make a difference if their career they were advancing was more altruistic such as sexual surrogate (psychologist)?
If a medical student commits a sexual assault and claims it was for the advancement of a medical education, does that excuse the crime?
You are falling in to that trap of "I am a professional": It is NOT about the point of view of the actor (perpetrator), but the point of view of the victim (patient).
Let me give you other analogies:
-- The torture of prisoners is acceptable if it gains intelligence.
-- Police brutality is acceptable is it garners a confession.
You seem to be using the justification of utilitarianism (Machiavellianism).
Do we excuse Dr. Josef Mengele because he advanced medical science?
Human rights AND the law must apply to ALL.
-- Banterings
Bantering, for the patient the end result may be the same regardless of whether the cause was deviant behavior or cluelessness, but if we are trying to fix the system, the intent does matter. Deviants can't be fixed and must be weeded out. Cluelessness can be fixed with training and regulation. One complaint has a good chance of teaching a doctor or nurse that the curtain must always be pulled or a door always be shut. No amount of training or regulation is going to stop a Twana Sparks from doing what she did. People like her just need to be weeded out. That the medical world (both her employer and the Medical Board) did not speaks to part of the problem.
Medical students do not do those exams to satisfy some sick sexual impulse. They are not Twana Sparks wannabes. The student exam problem can be solved overnight with regulation, or as is occurring currently, more slowly through public outrage. When women's groups finally latch onto this issue in earnest, regulation will come quickly. In either event the practice is on its way out and in another generation students likely will be incredulous that it ever happened.
Threatening an individual's dignity in the medical system-patient relationship may also go both ways. In this case: race-religion:
http://www.cnn.com/2016/10/26/health/doctors-discrimination-racism/index.html
..Maurice.
Thank you Dr. Bernstein for the illuminating article on discrimination TOWARDS medical personnel. Incredible! Who would not want someone like Dr. Ben Carson for their brain surgeon? Hopefully, with exposure, prejudicial attitudes will change. Seen from another perspective, maybe the medical personnel will be happier NOT having to deal with this type of patient. Biased attitudes will probably permeate the perceptions of every aspect of their (the patients') care. Reginald
Good article Dr. Bernstein. People shouldn't be that way but it doesn't surprise me. Some people live a sheltered life and don't understand the rapidly changing demographics of our society, including amongst physician ranks. That said I've known of older people that wanted a Jewish or Asian or Indian doctor specifically on account of "they're all so smart". Stereotyping for sure, but at least with positive attributes.
I was glad that the article didn't venture into the "men are discriminating against women if they express an unwillingness to receive intimate care from women" type of claims that some feminists have made. The same women that would scream discrimination against themselves if a male was sent in to do their mammogram.
Currently on allnurses called "operating room disappointments" with a cartoon caption. I always see a hidden message
in these nursing cartoons and this once certainly portrays the feminists always on a power trip as this male patient is
wheeled into the operating room for a vasectomy.
PT
Morning All:
Hi PT.
Men that have had prior experience with the medical community & know of that website, know this kind of garbage & worse always spews from there. Men know they will never get the respect they deserve from there.
Regards to all,
NTT
Hello Everyone.
I came across this youtube video . Google https://www.youtube.com/watch?v=N4EDOE1XfvY or prohealthcare cry babies . It shows 6 men crying like babies before their colonoscopy . Notice there are no women featured , just men . I guess they figure they can shame you by calling you a cry baby . Is this another example of their hidden agenda or them just being clueless . You decide . AL
AL, I think it is just another example of it being fair game to make fun of men. Women's groups, and their male supporters, would never tolerate women being cast as crybabies. Media knows they can get away with casting men that way because they know there won't be any meaningful backlash.
I probably shouldn't put current U.S. politics into this discussion but as moderator I think my question is pertinent to the overall topic.
Do you think that Trump and his male supporters takes a view that men are solid men who should be expected to be "manly" and accept whatever intrusions into their privacy they are subjected to as part of the medical system?
Just wondering. ..Maurice.
Dr. Bernstein, I doubt it. It is more likely that the full cross section of the population on this issue are found in both camps. Regardless of who they are supporting, what it seems you are suggesting is that "manly men" can't be modest and that men with modesty concerns are somehow feminine.
Maurice. In my small world being " manly " means standing up for yourself and others. To try to right a injustice when encountered . To not except things just because that is the way it has been. To leave this world a better place than you found it. If you came across a woman being molested , would you try and help her or walk away because that would keep you safe ? AL
I agree, you probably shouldn't.
Maurice,
Let me weigh in on Trump, Hillary, and all the politicos...
First off, the US Congress is exempt from the ACA (Reference: Congress’ Obamacare self-exemption OK, judge rules ) What that means in practical terms is that they do NOT get the same healthcare that most other people get (they get much better).
That leads me to point 2: VIPs. So whether they are wealthy like Trump and Hillary, OR they have the best healthcare in the country (the US Congress), they can pay their physicians the prices that they (the physicians) demand. That being said, their physicians respect and cater to their autonomy.
If Trump wants an all male care team, he gets it. If Hillary wants an all Bolshevik female care team, she gets it. Look at Prince's physician and Michael Jackson's physician. They only get in trouble when their celebrity client passes and the family files a lawsuit and pushes for criminal investigation. That is usually driven by greed.
VIPs are treated very different. Although many physicians wil say they treat everyone the same, follow guidelines, etc., there are many who will treat a patient with respect, dignity, and respect their autonomy as long as they are compensated to do so.
Do not confuse these with the likes of Dr. Farid Fata (Patients give horror stories as cancer doctor gets 45 years).
Also do not for get thet healthcare, pharmaceuticals, and related is the largest lobbying group in Washington DC. So yes, if a lawmaker is coming in for something, they are going to get better care than us members of the proletariat.
Interestingly enough (and based on the information that has been released), I do not fault the celebrity's physicians in cases like Michael Jackson and Prince for their deaths. I actually believe that these physicians were providing superior care to their patients. I fault the patients.
I also do NOT agree with the position that a physician is unable to (although it is USUALLY worded as should not) treat family and friends. Are they not professionals? (Is that NOT what they always tell us? In the article Maurice referenced about discrimination (Racism in medicine: An 'open secret'), there was a link to the AMA's code of ethics: "OPINIONS ON PATIENT-PHYSICIAN RELATIONSHIPS" which addresses this(specifically Section 1.2.1 Treating Self or Family).
Note: This piece, "OPINIONS ON PATIENT-PHYSICIAN RELATIONSHIPS," is NOT ETHICAL at all. That is for another post that I will address the non-ethics of the AMA. If anyone knows the academic discipline of ethics (and not specifically medical ethics), they will find many problems with these "opinions."
--Banterings
Not to get us away from Dr. Bernstein's question, but I do have a comment on Bantering's comment about physicians not treating their family. Certainly a prohibition is in order for things like prescribing narcotics, but otherwise it is interesting indeed when you come to the modesty issue. If a penis is no different to a female nurse or tech than is an elbow, then they and their Dads, brothers, and sons should all be comfortable having them catheterize or bath them in medical settings. Just another elbow, so what's the big deal? Except a penis isn't just another elbow even for a perfect stranger and they know it.
A female breast is viewed as an elbow as is a vagina. Then why do they block males from mammography and L&D? What has
become of patient centered care? Whatever the views are of men and manly men whatever. All patients should be treated with
privacy and respect despite whomever is in office.
PT
Just an observation from a dermatology visit this morning. The small details can tell you a lot and best to learn things when it is more academic than real. There are only two dermatologists in my county, a woman at the hospital and a man with a private practice. He has an all female staff (NP, 3 RN's, a MA, and office staff). My appt. was with the NP for a myxoid cyst on a finger so nothing intimate but having never gone there before it was an opportunity to observe their operation. I bring with me the new patient form they wanted and the woman says I need you to sign one more document, handing me the form acknowledging I have read the HIPAA form. I tell her I haven't seen the HIPAA form and she tells me she used to have a copy but doesn't know where it is. Alrighty then I think.
From the waiting room I could see through the glass partitions over to the examination rooms. I see one of the RN's bring a man into a room and then a bit later the doctor just walks in without knocking or saying anything. A minute later the RN just walks in without knocking or saying anything.
The MA comes for me but doesn't introduce herself or say what she is. I knew she was the MA because their website identifies who the staff are (by 1st name and title). She doesn't have the form I gave them and asks me the same questions I had already answered. I tell her as long as I am there I want the NP to also look at something on my chest. She tells me the NP will look at my finger and then I'll need to strip from the waist up for the second item. "Strip from the waist up"? Why not just say "remove my shirt" instead? I'm guessing patients having full body exams are told to strip rather than remove their clothes. She leaves and a moment later the NP comes in without knocking and then introduces herself. She starts with my finger and while that was happening the the MA just walks in without knocking or saying anything, and still she isn't introduced or identified as to what she is.
Perhaps the staff were all keeping track of which rooms have unclothed patients in them and knew that with me and the other man that we were clothed, but my gut feeling was that nobody ever knocks and waits for an OK to enter rooms. That the MA was there for my very minor thing today and the fact that there are 3 RN's and an MA for just one doctor and one NP tells me their norm is for a woman to be present for any male exams. I have to go back in a month to check on the cyst and am thinking I'll come out and ask the NP.
I don't doubt their medical competence but I suspect they're stuck in the 70's as concerns patient privacy. Most of the staff looks to be in their 50's/60's and sometimes old habits die hard. Should I need a full exam or other intimate procedure I will do the 2 hour drive to get to a more modern operation that has in it's Code of Conduct "Respect the privacy and modesty of patients".
In rural areas, the medical world doesn't have to modernize because they don't have any competition. In my county we have one male urologist with one female NP. Heart issue? One practice. Colonoscopy? One practice. Pretty much there is a choice of one for most specialties. It is one to two hours in any direction to get to alternatives. Most people just go with the flow with the local practitioners.
Hello Biker,
Your recent post seems to indicate that you are a very perceptive individual; albeit, rather reticent. I'd like to offer you the following sentences.
"Hello, I'm Mr. Biker. What's your name and how are you going to assist me today?" (Said to unknown medical staff who enter the room)
"Oh! I didn't hear you knock and ask permission before entering! The other office I visit does this." (Said, with a feigned surprise, when someone enters the room w/o knocking)
"I noticed that patients' procedures are observable from the waiting room. Are these patients aware of their lack of privacy?" (Said to waiting room personnel re the observability of patient from that area)
These are "subtle" ways of indicating to medical personnel that you've noticed what you consider protocol breaches. Making these statements to various individuals, over time, may affect change. If this approach seems to forthright to you, you may wish to consider printing 5 or 6 requests that you'd like to have appended to your file (preferably on the front cover). These could be as follows:
Please knock and ask permission before entering Mr. Biker's exam room.
Mr. Biker asks that you identify yourself (and your function)to him upon entering the room.
Please be certain the Mr. Biker's exam room door is closed at all times.
Etc.
Hopefully, once your file is view by all concerned, the personnel will be apprised of your wishes.
Sitting in the office or exam room and observing "inadequacies" in protocol is of little value unless you voice your opinions, orally or in writing. Expect some mumbling or grumbling similar to, "Who does he think he is?" This may be disheartening in a small community; however, it's a small price to pay for welcomed changes.
Finally, personally, I refuse to accept the idea that individuals 50 and older cannot change their ways of providing care. I feel that failure to adapt, at any age, is a matter of laziness, satisfaction with the status quo or ignorance of needed changes.- my opinion. Reginald
I hope you are successful affecting the changed you desire. Please do not be reticent in expressing your desires.
Biker in Vermont
Good observations and I'll tell you why, I believe you. Let's reverse the roles, assume the physician was female. What if she had all
male rn's and ma's which would never happen, but that they walked into patients rooms without knocking and not identifying
themselves? The double standards are substantial. Do healthcare people appreciate this and do they not care?
PT
PT, in answer to your comment, I don't think most healthcare people do grasp that male modesty is an issue. Societal norms are that men are not supposed to have any modesty. The training of medical staff in turn believes just maintaining a professional demeanor is the goal.
This past week I had a dialog with a female primary care physician. This is someone widely recognized for her work. She is very empathetic to patient issues and their experience trying to navigate the healthcare system. She was unaware that many men had modesty issues and the difficulties they face. She thanked me for opening up her eyes and will help spread the word. Much of the issue is that men just don't speak up. She was not defensive or hostile to the discussion at all but was instead simply unaware it was an issue. As someone who wants to be an advocate for her patients she was glad I spoke with her. What changes she will make in her own practice I don't know, but I am guessing at a minimum some of the details will be better tended.
Reginald, one clarification. I could see the doors to the patient examination rooms and the staff entering them, not inside them. No patient was visible to me while they were in the exam rooms.
You are otherwise right that I am a very perceptive but reticent person. In my corporate career I learned one picks their battles if you want to have maximum effect. In this case I knew there was no intimate exposure potential. I contrast that against my colonoscopy this past spring where I politely stated my expectations and asked my exposure-related questions before undressing. With the urology practice I am switching to for my cystoscopies I have similarly already begun asking the pertinent questions and alerting them to my preferences for male staff. When I go for my first visit I will speak up on any protocol violations given we're talking a very intimate procedure.
Catching up on this blog. To PT about his comments in September that entities like the Joint Commission (JC) do not care about male modesty, but rather eating free donuts. True - the JC has a certain approach, and the largest segment of their surveyors are nurses, most of which are female. That said, they do have an obligation (to the federal government) to determine if their standards are followed. So if I had an adverse experience in a JC accredited medical center and I wanted to submit a complaint to the JC I wouldn’t whine about it using “modesty”, instead I would use words that reflect their standards that would address the modesty issue. For example, I might point out the organization failed to respect my religious or cultural values, or I was not afforded the same privacy rights as other patients or I was not afforded the same patient centered care and dignity that other patients received. Let the defending organization and the JC sort out how compliance was or was not met. But at least it forces both organizations to acknowledge there may be an issue.
This past summer I used my own healthcare experiences of the past year to send a lengthy letter to the JC pointing out how they appear to not be enforcing their own standards with regard to patient privacy, dignity, patient centered care, etc. I was not directing a complaint about the medical center where I currently get healthcare, but rather about the Joint Commission. I did go through all of their standards and the CMS standards and l discussed how in my recent personal experience they failed at identifying these (rather obvious) standard deficiencies. I did get a response back, they said they would trend the issues. Not sure what that really means - perhaps they will ignore, or perhaps they will be more aware. Only time will tell.
I did NOT file a complaint to the JC about my current healthcare provider because I had already submitted a letter to that medical center and had a phone call with them and changes were happening (portions of the letter were posted previously on this blog). In addition to changes in urology, I recently went to my PCP in internal medicine and was pleased to see that in one year’s time they had changed from all female MAs to about half male, half female now. So this particular medical center seems to be making an effort to get better staff diversity.
To Biker in VT - your efforts to educate your various healthcare providers are admirable. Like you I always get the healthcare I need and use any adverse experiences to seek improvements from the provider. I must say the rural environment is the toughest. Small private practices are not covered by many regulations and cannot be forced to provide equitable treatment of all patients. Great you can make the drive to Dartmouth. From what I know of them you have a chance of getting treated with dignity and respect there.
Finally, patients should realize they don’t have to say they want same gender caregivers for “modesty” reasons. Staff usually have been trained to understand that religion or cultural background are valid reasons for requesting same gender care givers, as is a previous “negative experience” which could mean an assault, etc. So if you don’t feel comfortable using the “modesty” reason, and feel you must give a reason, than use another. And by the way, if you are going to be admitted to a hospital, the hospital should be asking YOU if there are any religious or cultural preferences. You can answer yes and specify only same gender intimate care. This will help with your inpatient care, however currently it probably cannot be accommodated in the OR if you need surgery (simply because of the skewed gender ratios of staff the hospital may have). - AB
This may seem very controversial, but based on what providers tell patients and their actions historically, this is a very palatable solution, and as more patients request their dignity be respected under the ACA, this will also offer opportunity:
Because providers are trained professionals, and recognize the benefits of allowing students to participate, then providers that enter as patients should have no problem with this either.
As a matter of fact, those entering the healthcare system as patients who are currently or at were time were a licensed provider should be flagged in the system to allow students a maximum opportunity to learn. Having been a trained professional, they will have no issue with student gender and will allow a greater number of students and more invasive procedures than the average nonprofessional patient.
One could even argue that as a professional, going to a teaching hospital guarantees student participation. So for providers as patients, informed consent beyond signing the initial papers is not needed and for this special population informed consent should be opt out.
Ethically this arrangement is acceptable because this is exactly what non-professionals who are patients have been told. There is also the debt that providers owe the patients that they learned on, and this is a way to pay that back. It also creates the obligation of future providers to allow students in such a manner in their healthcare.
I think that patients should write to different institutions with this recommendation, and these institutions will seize upon this as a way to provide training without the liability or all that extra time for explanations and trust building.
I am sure that if they adopt this policy, they will do it with all the sensitivity and respect for dignity in the care that they provide for patients now.
-- Banterings
Banterings
I've suggested this all along. All female nurses, female physicians, cna's and ma's immediately should have a mammogram
performed by a male with at least one onlooker.
PT
AB, excellent idea to use "cultural" instead of "modesty" and to otherwise use the language that the regulators use.
I have recently upgraded my healthcare plan from Gold to Platinum, whatever that means in terms of quality. Perhaps it
pays more I don't know but I can say I probably wouldn't see any difference. The reality is the U.S. spends three times
more per person in healthcare dollars than any other developed nation. My opinion is that I'm the consumer, I'm paying
for my healthcare, never was a freeloader and I've always had health insurance. In that regards this blog shouldn't even
exist because there shouldn't be the kinds of problems we read about when we are the ones paying the bills for our health!
PT
PT,
Wait until you see the new direction that the country is going to take with the election of Donald Trump to the presidency. His election was a backlash against the overeducated elites that tell (us) the proletariats how to live our lives. Look at the Washington Post's analysis of the Trump victory:
...Trump ran against the elites and won... He defined the election as a people’s uprising against all the institutions that had let them down and sneered at them — the politicians and the parties, the Washington establishment, the news media, Hollywood, academia, all of the affluent, highly educated sectors of society that had done well during the time when middle-class families were losing their bearings...
He took advantage of that shift in culture and turned himself into a human vent, blasting the country with a stream of frustration and anger that many people had either kept to themselves or spewed about only anonymously...
Trump had a lifetime of resentments that he had reacted to with searing attacks against his enemies and often-successful revenge plays against those who believed they were better than he...
Source: The Washington Post
Both parties feared Trump because he was NOT beholden to the special interests and the power they wield. The parties (both Democratic and Republican), the powerful professions (institutions) in our society fear the loss of power and control they had over society.
This is definitely going to carry over into healthcare too. Society will break the establishment and hand the power back to the people (patients). Obamacare demonstrated the frustrations of the people. Even though it benefited the insurance (banking) industry by requiring that ALL citizens become health insurance purchasers AND government in making for an easy, systematic way of collecting and processing medical records, it was sold to the populous on their fears and frustrations.
It promised to address among other things keeping one's doctor, being treated with dignity (Section 1557 of the Affordable Care Act), and putting the power back into the patient's hands.
This gives me hope that what is happening on this blog will spread throughout society and no one will be able to stop it.
Better days are coming for patients...
-- Banterings
Folks, you are setting yourselves up for disappointment if you think somehow the issues discussed here are going to be resolved in whatever changes are made concerning Obamacare. There is no national dialog on patient modesty or medical system staffing models. The debate next year is going to be on how is healthcare funded and accessed. It will not go beyond that.
Last week I watched the original Code Black documentary. I assume it is what the current TV series is based on. The setting is the emergency room of the Los Angeles County Hospital, starting off in the old hospital and then finishing a couple years later when they are in the newly built replacement hospital. The new hospital is as you would expect a facility with private spaces for each patient. The old one just had patients lined up in one room with each patient, their family members, and their medical staff in plain sight of each other. Patients lying there naked as occurs in trauma situations had no privacy from other patients, their family members, and the staff working on that other patient. Once in the new modern facility, medical staff admitted patients had no privacy in the old hospital but at the same time they preferred the old hospital in part because it they liked the atmosphere of working cheek by jowl as a team in that crowded space. Their comfort was apparently perceived to be of higher value than patient privacy. The medical world still does not get it.
Biker,
Obamacare, other legislation, and all other strategies will NOT bring patient dignity into healthcare. It is the courts that will bring back dignity! Read Court Rules That Transgender Patient Tortured By Doctors Is Protected Under Obamacare, you will see that the legislation was there, it was NOT until the courts "enforced" it that changes get made.
-- Banterings
I was in healthcare in the early 90’s when mammograms became covered by Medicare and the MQSA regulations were passed and women’s imaging services lept forward. There were plenty of male radiology technologists but women who got mammograms complained about males doing their testing or assisting with their breast biopsies. This quickly led to the creation of women’s imaging centers (staffed only with women) and the extinction of male mammography techs and the blockage of males entering this service line. The point is women complained about their intimate exam experiences and healthcare reacted.
Now I was quite surprised to learn after our recent presidential election that a majority of people in the US are now getting their “news” from Facebook. In addition, the “news” of choice seems to be “micro news”. I have never used Facebook. I have only used Twitter once and don’t really follow it. But since these forms of social media seem to be so powerful and pervasive in the US now my question to contributors here is how are the discriminatory aspects of healthcare (discussed in this blog) being discussed on social medial like Facebook or Twitter? Has anyone raised the issue that female patients have more privacy rights than male patients on Facebook or Twitter? Has anyone pointed out that female patients have thousands of dedicated imaging and treatment centers and male patients maybe have a couple dozen nationwide? Has anyone on Facebook or Twitter or other rapid social media pointed out the disparities in personal privacy that exist in healthcare? Is there is discussion about how well nursing pays so that more men can learn that they might be able to make a lot more money if they went into nursing or healthcare in general? Anyone have suggestions of who to “follow” or “like” or whatever to start constructive dialogs in these other forms of social media? I’m just saying, if these forms can help a presidential candidate get elected, it might prove useful in getting healthcare to realize they need to change too… AB
As you note AB, women advocated for themselves and got results whereas men rarely advocate for themselves on this topic. It is worth noting though that women did this within a societal context that women were deserving of having their modesty and privacy protected. All they really did with things like mammograms was point out specific areas where they saw change needed. They did not have to justify what they were asking for.
Society still does not take male modesty seriously, again because men don't speak up. In fact, men do quite the opposite. They make like it doesn't bother them when it is happening in medical settings, and then they make light of it with their buddies afterwards. I've done it myself.
For example after my initial bladder cancer surgery when I was recounting the experience to my buddies, I made it all into a big joke when in fact I felt mistreated and taken advantage of. When in pre-op I was ambushed by 5 medical students, 4 being female, who said they'd be observing the surgery and then just before being put under the OR nurse said she looked forward to seeing the goods. So how did I tell the tale? Being the surgery was in Boston I told my friends word had gotten out there was going to be a country boy being operated on and women tired of city boys had a lottery to get a spot in the OR to see a real man. It was good for laughs, and sadly it just served to reinforce the societal norm that men who show vulnerability are weak.
At that time I was still in the mode of not advocating for myself because I did not yet realize it was even an option.
In previous volumes Maurice has encouraged patients to do more than just complain. Biker has talked about not standing up for one's self.
I just took the first steps in a very long journey that will change how people like Biker are treated in situations like he described.
I will update you (all) more as this develops.
Happy Thanksgiving!
-- Archie
Archie, will the outcome of what you are planning to do provide beneficence (a good) to all genders (male, female and trans)? Everyone should remember that in our society ethical beneficence also should require consideration of ethical justice. ..Maurice.
AB
There were never male mammo techs in the 90's as you say. What you have said is not factual. There never were male
mammo techs essentially anywhere working in healthcare in the U.S. I have researched this extensively for months through
each state licensure, national ARRT registers as well as with state radiation inspectors and mammogram equipment repair
sites. For example, in the state of Arizona I found evidence of one male mammo tech in a 55 year history. He had licensure
yet that does not necessarily mean he worked in mammography as they are also employed as medical radiographers.
If a female patient required a breast biopsy I can tell you that the majority of the time it was performed as stereotactic biopsy
on equipment specifically designed for that purpose and due to the low dose required, " Xeromammography" only trained
mammo techs used that equipment. Only the presence of the Radiologist and the mammography tech were involved in these
procedures. There may have been times whereby the biopsy was performed in surgery by a general surgeon.
There are many reasons why mammography centers became free standing and it was never to exclude males because male
techs were never in the equation in the first place. It primarily involved money and regulation. You need state of the art
equipment, trained and licensed staff, board certified Radiologists who do nothing but reading mammograms and perform
biopsies all day long. That was a tough proposition for a hospital to provide these services and make a profit as well as conform
to the very heavy state regulation required.
PT
I have been a reader of this blog for all the years it's been published, but never commented before.
I want to thank all of the contributors here for the confidence you have given me to stand up for myself.
My doctor recently prescribed a testicular ultrasound for a painful varicocele.
I made an appointment at a local imaging center, specifying a male sonographer, to which they agreed. When I arrived, not only was he not available he wasn't even scheduled to work that day, but the female tech would take me immediately. Needless to say I left. The manager called me, apologized, assured me I was a valuable customer & rescheduled me. I arrived the 2nd time, the male tech was in, but I wasn't on his schedule, I was on the female tech's schedule. I walked out again, called the manager later, received another apology (sounding like a practiced customer service line the 2nd time around) & rescheduled again.
Today I had the ultrasound with the male tech. He did the best he could to make an uncomfortable test comfortable. As I expect to have this test annually for the next few years I am a lot more confident about it, having been able to arrange it on my terms.
Thank you all for teaching me that I am allowed to ask for a health care provider of my gender choice for an intimate test & to be persistent when trying to get one.
TNJ
TNJ,"Speak up" has been a repeated bit of advice presented on this blog over the years and I am glad that it was used and finally worked for you. ..Maurice.
A visitor, today, signed in as Mitropopulus and signed out as "DJP" wrote the following. ..Maurice.
At age 20 in 1976, I was brutally sodomized by and RN and elderly female aid because I wouldn't let the aid insert a rectal suppository within the presence of a female nurse to teach me who was in charge. The resulting settlement was reached quickly. However I am very to the point dealing with doctors that I will not work with female staff other than meds,temp or pulse. No female doctors either and no female staff for intimate care. Most specialists I have worked with are agreeable. However dealing with chauvinist male urologist at who was verbally demeaning and abusive about the issue was floored when I pointed to the door and said, "Get out!" When I called to complain I had such a sweet lady who was so understanding on the ;phone who would investigate. When her letter of conclusion arrived it sated that I disagreed with the doctor's evaluation; a diagnosis he never made. The doctor actually falsified records and never stated he was dismissed at once. So much for ever believing or trusting the medical system which is like all "good old boy systems". Stand up for yourself if you have limitations, stick to your guns, tell them to take a hike and always remember that there are thousands of medical staff better trained than the negative person who you have dealt with and move on. No is never an option. I have found a real physician will work within your requirements to achieve an excellent out come for you. Even in a situation of a duodenal ulcer bleeding which required 20 1/2 hours of transfusions during a 10 day hospital, I did not have 1 doctor who could not or would not work within my requirements and made sure charts were clearly marked to such and female staff were honorable and respect my directives. Be strong you are the paying customer and if the situation permits go elsewhere. Money talks! DJP
Reading the latest post from DJP points out an aspect of the male modesty issue that is worth noting. Many men here formed their aversion to female caregivers for intimate procedures based on something that happened when they were roughly 10 to 20 years old. There have been many posts of that nature. In my case it was at age 11, though I had already started puberty and more had the body of a 13 year old at the time. Now here I am these many years later and I still wonder if she thought leaving me lie there naked for anyone/everyone to see didn't matter because I was only 11. The male orderly who had shaved my little bit of peach fuzz before the surgery didn't leave me exposed nor did he do anything to embarrass me like she did. That I never forgot how he treated me vs how she did says how long lasting those first encounters are. I wonder if modern day nursing training emphasizes anything concerning the modesty of children.
PT - I like your passion. Just a few points — prior to the early 1980’s there was no licensure for operators of x-ray machines (darn near anyone could operate them and often nurses or other personnel did. When I was a small boy there even was an x-ray machine in a shoe store I went too!). In the 1980’s licensure for radiologic technologists (RT) was created. In the 1980’s an RT could perform a variety of x-ray procedures, including mammo. In 1992 Congress passed the MQSA that went into effect in late 1994. It specified for the first time in the US training requirements for those performing mammo. So not until the mid-90’s were there any certified mammography technologists in the US. So state and federal certification agencies really do NOT have any data on who performed mammography procedures prior to the mid 1990’s. It is true that women have always been the predominant group of RTs. Medical centers I worked at in the 1980’s had about equal numbers of male and female techs but nationally I think it is more like 75% of rad techs are women. Regardless, the important point is ANY RT can become a certified mammo tech by completing the required number of supervised mammo exams (75), a small amount of education, and passing the certification test. That is, any medical center or women’s imaging center in the US could move towards a gender-neutral mammography center within 6 months, if they were so motivated. Of course that is never going to happen. But as we know, if a medical center than insists on hiring, training, and employing only females for these intimate exams they are tacitly relying on the BFOQ exception to the Civil Rights Act and thus indicating to patients (of both sexes) you have a right to privacy for your intimate exams.
As for the proliferation of women’s imaging centers and women’s clinics there are many factors - you definitely mentioned some. Also remember for mammography it was not until the early 1990’s that HCFA (now CMS) decided to PAY for such exams. That is, the government ruled they were in general medically reasonable and necessary in the early 1990s. This meant suddenly a large number of (Medicare and Medicaid) women were covered. This meant other insurers followed suit to cover these exams. Suddenly it because viable and financially attractive to private physicians, imaging companies (sometimes owned by physicians) and to hospitals/medical centers to provide these services. And as you can imagine, it is money that drives many healthcare decisions.
One very prevalent school of thought circulating in the trade magazines in the healthcare business in the 90’s was that women select the health care providers for the FAMILY and thus medical centers could increase their business by tailoring services to attract women. I was stunned by assertion at the time because it portrayed men as basically being mindless and compliant and of no concern. Clearly since there have been few attempts to create men’s health centers, men’s imaging centers, and/or to treat male patients with equal dignity the concepts must live on… AB
Though the gender of the visitors who post on this tread are suggested by the text to be male with a couple or so females occasionally appearing, I think it is important that we hear more from the female visitors, even those who have never written here before, to speak about this provider gender "inequality" in the patients' request for their provider.
Would female patients feel simply satisfied with the attention to their wishes and feel that men should work out their dissatisfaction on their own? I think I have asked this before but are there a host of female visitors here who feel otherwise and will speak out against the gender inequality as written on this thread? ..Maurice.
Maurice,
Ethical beneficence and ethical justice are offered to patients only when convenient. Just look at the section on chaperones in the AMA's code of ethics: "OPINIONS ON PATIENT-PHYSICIAN RELATIONSHIPS" which I had referenced previously. There is no mention of a chaperone being a joint decision between the physician and patient. There is NO mention about a patient declining a chaperone. Nothing about gender choice.
Look at any "patient rights and responsibilities." They say the patient has the right to participate in medical decision making but the responsibility to follow the physician's orders. (Some do say to follow the agreed upon course of treatment.)
Is the lack of male nurses ethical beneficence?
The ethical beneficence that healthcare offers is that of John Stuart Mill's Utilitarian Theory.
In Utilitarianism, Mill declares the principle of utility, or the “greatest happiness” principle, to be the basic foundation of morals: Actions are right in proportion to their promotion of happiness for all beings, and wrong as they produce the reverse. Mill and subsequent utilitarians mean that an action or practice is right (when compared with any alternative action or practice) if it leads to the greatest possible balance of beneficial consequences (happiness for Mill) or to the least possible balance of bad consequences (unhappiness for Mill).
Mill also holds that the concepts of duty, obligation, and right are subordinated to, and determined by, that which maximizes benefits and minimizes harmful outcomes. The principle of utility is presented by Mill as an absolute or preeminent principle, thus making beneficence the one and only supreme principle of ethics. It justifies all subordinate rules and is not simply one among a number of prima facie principles.
Thus Utilitarian Theory would support a system of justice where most bad guys will be convicted along with a small number of innocent people. Society has rejected this idea. Society would rather that a guilty person go free rather than an innocent person be wrongfully convicted. Hence, "innocent until proven guilty" and a host of other legal practices that protect the innocent.
Would you reject requiring facilities have an equal number of male nurses because it provides a much greater benefit to males?
What I am interested in is justice for the individual.
We often hear the expression "the stick or the carrot." What I am attempting to do is give patients who have had a violation of their person, dignity, or rights a new, never-used-before, big stick.
What usually happens in these cases is that medical boards conclude that a slap on the wrist ia all that is necessary because they don't see the history of serial abuse and they deem that it is a greater harm depriving society of a physician than preventing potential future abuses that have not happen yet.
I do apologize if this post seems harsh, but just last week a very good friend wants to go back on hormonal birth control (new relationship after many years being single). Her gyn said that PEs are their policy for BC despite guidelines. She called other offices and none are taking new patients in her area.
I could hear the pain in her voice. I tried to help. It broke my heart. There is some past trauma that has kept her away from gynecologists.
-- Banterings
Dr. Bernstein, re your post asking for more female voices, I agree that would be a good thing. More specifically, I would love to hear women speak to why so many women don't think men are entitled to the same considerations in medical settings that women are. Female posters here have generally been sympathetic to our plight but odds are that is not a universal sentiment amongst their friends, relatives, and/or co-workers. Being women talk amongst other women about things they don't speak of to men, maybe they can offer some insight here. Men to do the same so it is not a criticism at all.
My site on StatCounter shows that I am getting fairly often visits to my Patient Modesty thread from Seward Alaska, home of my long time contributor Doug Capra but whom we have not heard from for a very long time. If it is you, Doug, peeking at what is going on with this thread, I wonder if you could give us your current opinion about the "gender inequality" issue "2016 version" and what you think of the current comments about solutions. Thanks. ..Maurice.
AB
I'm afraid I'm going to have to correct you again. Medical Radiographers were able to become registered as far back as 1922. That
is when the first R.T became registered. The mammography certification became available in 1980, however, strict guidelines and
training were always in place and I assure you they didn't just let anyone waltz in the mammo suite and start taking mammograms.
PT
Folks, when and how mammographers came to be licensed really doesn't matter. They are now 100% female positions regardless. I am glad that is the way it is for women. I don't begrudge them generally having the option of all women caregivers for most intimate procedures.
The problem instead is that men don't have the option and perhaps more importantly that women apparently don't seem to want men to have that option. For me the double standard that considers me a lesser being simply because I am a male bothers me more than the actual exposure. This is what I am weary of and it is why after a lifetime of of "manning up" I am now speaking up instead.
Biker in Vermont
The subject is important as it tends to paint the picture as to exactly how broad the double standard really is. As I
recall several years ago there were folks posting on this site who thought for some unknown reason that male
mammographers are everywhere. I knew there were none as I've worked in healthcare for many years at numerous
hospitals. As a genealogist with over 20 years of experience I used that skill to dig for information and what I found
was that in the entire United States there were 3 white unicorns, rumors of 3, that's right ( three) men who supposedly
worked as male mammographers. One did not exist, one retired and he held a mammo license but I found no proof
that he actually performed mammos with the license and the third was again no where to be found.
Furthermore, this can be used by patients to illustrate the double standard as currently many hospitals continue to
maintain mammo suites. I further believe that it can be used against hospitals in a class action lawsuit that discrimination
exists against male patients. You are exactly right, they don't want men to have the option and why is that?
PT
FROM Unconscious BUT Conscious
This topic is of very high interest to me; however, I've noticed that many comments refer to "women have much less of an issues with getting same gender care than men" and "women don't think it's an issue for men too" and other remarks of this nature. First, none of these comments are reality. As a female, I have found that medical professionals within hospitals, etc. do NOT want to hear the request for 'same gender care'...'modesty/dignity'...privacy, etc. whether you are female or male. As this is best for the medical institution; i.e., to objectify all patients so that they can treat them as a 'thing/number' since this makes the 'assembly line' stay on time. Sad but true. So, to Biker in Vermont and others who make the aforementioned comments on this blog, FIRST, please stop harping that men are treated differently than women and that women don't sympathize with men on this issue - we are all in the same boat without paddles since no one in the medical or legal or political community, who has the power to effect change seems up to the task. SECOND, when I found this blog, I was excited because I thought there was a community out there, who was working together to do something about this; however, it seems that the same issues are just rehashed without any action. The latter is not meant disrespectfully to anyone on this blog or the blog leader; yet, I'd like to know IF ANYONE, here on this blog, has the necessary knowledge and skill-set OR connections to organize people like us, who know that the medical community MUST change and STOP objectify people for the sake of convenience. There are viable solutions (e.g. medical institutions should begin by implementing a trial program as follows: ONE DAY PER QUARTER, ALL surgical staff (anesthesiologists, nurses, medial residents, scrub techs, etc. - anyone caring for surgery patient pre/during/post operation) and their backups to be female with an alternating day each quarter with all surgical staff and their backups being male; this way patients could opt for this type of care without disrupting the 'robotic supply chain or patient care' provided by medical institutions; i.e., one the initial first few trial programs are underway! NOTE: the proposed program would not pertain to surgeons as, in most cases, surgeons are chosen by patients and frequently same gender surgeons with a particular surgical expertise/record/etc. are just not feasible). So, is there anyone on this blog, who has the expertise or connections to start the process in getting something done about this versus all of us - me included - just continuing to gripe and swap stories about it? If so, I'm on-board - let's get something done about this already!
Unconscious but conscious, I am glad to see a woman join the conversation here. Thank you.
Men are treated differently if for no other reason that it is all but impossible for men to receive intimate care from anyone but a woman most of the time. Medical venues may not go out of their way to ask women what their gender preference is and they may not like it when a woman makes a request but women are not generally bullied when they do. More importantly, the answer is almost always going to be "no males nurses or techs work here". A woman is never going to hear "no female nurses or techs work here".
You are right that griping does little good, though it can be therapeutic knowing that others understand. In my case I have begun speaking up. I also very recently had an article published on a female physician's blog. I hesitated to cross-post it here on account it is under my real name but also because in this physician I found a new ally and didn't want her to get flamed by anyone calling her a pervert because in her practice she examines male patients. In the past some guys here have attacked empathetic female physicians or other medical staff rather than engage them in respectful dialog. They quickly get chased away. I am willing to cross post it here if people are willing to be respectful.
My site on StatCounter shows that I am getting fairly often visits to my Patient Modesty thread from Seward Alaska, home of my long time contributor Doug Capra but whom we have not heard from for a very long time. If it is you, Doug, peeking at what is going on with this thread, I wonder if you could give us your current opinion about the "gender inequality" issue "2016 version" and what you think of the current comments about solutions. Thanks. ..Maurice.
Yes, it's me, Maurice. I follow the blog but really don't comment anymore. It's interesting, but so much of it is either repetitive, merely therapeutic or very academic. But it's all interesting. As you know, I'm more directly involved with patient advocacy these days, but I don't want to get into that. I may comment further with my thoughts about working with the health care system.
Doug Capra
Doug, I know what you are writing about and I appreciate your decision. I was just checking since you have been a thoughtful contributor in the past.
I still work in the healthcare system both as a physician and as a medical school instructor and this long standing thread and its content over the last 11 years has made me much more aware of patient concerns. And without a doubt I can say that my reaction to those concerns and my responses are playing an even greater role as I see patients or instruct students about interacting with their patients. ..Maurice.
Maurice et. al.:
I still follow the blog with interest, but I find that in many past threads here -- and on the blog Dr. Sherman and I have -- I've pretty much said what I've wanted to say. People need to get involved in health care. Try to become a member of a local health advisory board. But a caution -- health care is dealing with many issues today, and if you join a board you've got to take note of all the various issues -- especially the metrics of safety and quality. Patient experience has become an essential metric. You can have influence. But if your only issue is patient modesty -- if that's your only agenda -- you'll alienate yourself. The issues of patient modesty most often fit right into the mission statements of hospitals and directly into their patient rights and responsibility documents. They are also often part of policy statements. Make not of this at appropriate times. You can become part of the culture change going on within hospital systems today. Now -- I can hear the critics already. If you want, go the lawsuit way, but I don't recommend it. Get on the inside and work from there. You'll find that most hospital folks care about patient modesty and try their best. The other suggestion I have is to focus more on patient eduction, especially with men. If they speak up, civilly, and make their needs known -- people will most often listen. If they don't listen, work your way up the food chain. Hospitals take written complaints very seriously esp. if they make their way to professional organizations like the Joint Commission. I know this as a fact.
Now -- agree or disagree with me -- but I don't have time to debate this on the blog. These are just my thoughts having been involved the last several years working within the system.
The patient experience, that's a joke. Quality metrics, it's a farce. Patient centered care, really. Why do I sound so negative,I'll
tell you why. Hospitals are trying to clean up their act, transparency, not really. It all boils down to money and money is the only
true way to effect change with this industry. Personally, I couldn't care less what women think when they visit this blog. That goes
for nurses, physicians whatever, the industry is feminized and they will keep it that way. The only solution is from a legal
perspective and it's going to happen.
PT
Unconscious but Conscious:Capra's comments troublesome.I agree that this blog has ‘beaten the proverbial dead horse to a pulp,’yet,it is disturbing that no medical professional has opted to lead the way to change!At the same time,Capra states, “PEOPLE should get involved in healthcare” while,also,condescendingly stating “PEOPLE” need to understand that there are more important issues than patient modesty/dignity.My response–any medical professional,who OPTs to follow the pack and turn a blind-eye then do nothing to effect change should be ashamed of themselves for finding excuses to not be involved and/or trying to pass the responsibility of change to patients! No patient denies that there are other issues,such as compliance but the ‘compliance issue’has been/is the medical communities'long-standing and convenient excuse to do whatever [objectify patients…disregard patient’s individual reasonable NEEDS].Most understand that it is convenient[for the medical community]to treat every patient the same…efficient supply chain mode…smooth/quick assembly line…streamline effort…maximize profit.WHO is medical professionals kidding–patients or themselves? Capra says,“You'll find that most hospital folks care about patient modesty…try their best…often listen…patient modesty…fits into mission statements… policy“These statements are out-of-touch with the reality of patient rights/care;i.e.,for those who are neither of the medical community,connected,and/or wealthy.People are neither imagining the stated problem nor opting to not speak up regarding their needs.In the real world, medical professionals listen then either bully patients into accepting the 'standard' versus accommodating reasonable needs (e.g. same gender staff for pre/during/post as well as no OR ‘observers’]OR advise “we are all professionals…seen one body, seen them all.Heads-in-the-sand for convenience sake at the expense of the patient.If the medical community is truly UNaware of this/related issues,research it.ANYONE can find,not only,the unnecessary disrobing of unconscious patients in same/mixed gender audiences plus documented sexual abuses by those same medical professionals,who “see patients as only bodies.”Are we on the same planet? I am so tired of medical professionals making these statements and/or choosing not to be leaders in effecting long overdue/necessary change.This is the reason why this problem still exists!SHAME on each/every medical professional,who has turned a blind-eye…adhered to groupthink…talked the talk but not walked the walk on this issue.Also, this problem is getting worse because of technology(personal/institutional)in operating rooms.Do medical institutions mandate no personal cameras in the OR? NO(e.g. NY nurse lost license for taking photo of unconscious male patient’s penis then sharing it; surgeon caught sticking his hand in an unconscious female patient’s vagina then ‘dancing with her'yet keeps his license.’Both documented cases;there’s many more.Are patients advised that surgeries are filmed including when patients are prepped [naked] and provide the right to refuse filming?NO to both.Look online at videos(youtube etc.)of surgeries,preps,etc.Are medical institutions responsive when patients-males/females–state they want all staff in OR as well as for pre/during/post care to be same gender with no others(e.g. vendors, etc.)allowed?NO! PATIENT safety PLUS OPTIMAL care SHOULD BE any medical professional's/institution's top concern.Patients are not a show!Must we organize and get politicians involved to effect federal mandates for REAL patient focused rights?To date, NO ONE IN THE MEDICAL COMMUNITY has stepped forward to effect this very necessary change, which can work for all;NOT ONE doctor/surgeon/nurse/etc.has cared enough.What does this tell us,the patients?I feel sorry for the medical community-they have lost their basic humanity…lost their connection to the very people to whom they took an oath to provide care.
Unconscious but conscious, yes the medical community can effect change if they wanted to, but they instead allow themselves to make believe all is OK if the female sonographer is being polite to the guy she's doing a testicular ultrasound on. To medical providers being polite has been deemed the equivalent of providing respectful and dignified care.
We the patients also own part of the problem in that we rarely speak up. We make it easy for the medical community to ignore the issue. Yes, many don't speak up because of the classic bullying & shaming techniques (we're all professionals here, don't be silly, you don't have anything we haven't seen), but in the end we let them get away with it. We don't call them out when they bully or shame. We don't write letters such as Doug Capra suggests.
I know that which I speak of because I didn't speak up for many years throughout many intimate procedures nor did I complain when subjected to blatantly unprofessional conduct. Now I do speak up, but most people still don't. That is much of the problem.
What we have historically seen change come from is when the status quo becomes too expensive to continue doing business in that manner. That is why one of my outlets for change is working with personal injury lawyers and educating them on how healthcare really works and should work. I show them new angles for lawsuits.
I also look for potential potential criminal wrong doing that can lead to an investigation as well. Just like a thorough physical exam, a thorough legal exam should include both civil and criminal review.
I know that there are physicians that will denounce this, but I can assure you that all the people involved are trained professionals.
--Banterings
Unconscious but conscious, I understand better now where you are coming from. The OR (and ER to a great extent) is where men and women are equally subject to mixed gender care, with the OR being the worst of the two given medical staff think patient exposure doesn't matter when the patient is out, when in fact it matters even more. I don't argue your points about the OR.
Where I have been coming from in my comments are the routine care scenarios for inpatients and outpatients which account for the majority of medical interactions. It is relatively easy for women to pretty much always have same gender intimate care in all of those non-OR non-ER settings. For men is extremely difficult to get care from other than female nurses & techs. This is where reality differs greatly for men and women. I have been catheterized several dozen times for bladder cancer treatments and follow-up cystoscopies, every single time by women. I have had an abdominal ultrasound and on a separate occasion a testicular ultrasound, both times by women. I've had a vasectomy with the prep & assistance being by a woman. And all this is when I only choose male doctors. I had surgery for the bladder cancer in an OR with 4 female medical students observing in addition to whoever else was in there, one being the OR nurse who moments before I was put under told me she looked forward to seeing the goods. Believe me I understand your OR experience. If you are unaware of how bladder cancer surgery is done, it is through the penis. Then a couple months later another OR procedure for bladder biopsies which is basically the same process, except they also did prostate biopsies, another extremely intimate procedure. Heck, it is hard for a man to even get a full body skin exam without a female nurse or medical assistant in the room observing the procedure. Look up urodynamic testing if you are not familiar with it, and for men it is usually going to be two women observing them urinate in addition to catheterizing him. Guys with prostate cancer? Lie there exposed while women do the treatments. It goes on and on and the medical world thinks it is OK so long as the women are polite to the male patients.
It was much delayed but I have found my voice (and I do keep it very respectful and professional) but few men speak up, and even if we do, we usually still can't be accommodated.
To Biker in VT - I read your article published in early November. Very well done. I also am following on Twitter the physician who hosted your article. Twitter I feel is another place to “discuss” the deficiencies in current health care practices. Any - kudos to you for publishing your experiences and recommendations.
To Doug Capra - I second your thoughts about getting involved, submitting civil and factual complaints, and working with the system to effect change. Great that you are constructively involved in you community. And from my experience in healthcare I agree that Hospitals/Medical Centers do pay attention to complaints - the key is too make sure the hospital understands what regs or standards they are not meeting and why and how much more problematic it could become.
Of course a lawsuit would get a hospital’s attention, if you can find the right situation. But every one participating in this blog can accomplish just about the same thing by complaining to their State Civil Rights Office or Attorney General, by complaining to the Office For Civil Rights, by sending the same complaint to the Joint Commission and to CMS, and perhaps even complaining to the local licensing agency and local medical boards.
And please realize those surveys you get after a clinic or hospital visit actually are quite important. For example, I go to hospital based clinics so I get the (federally mandated) Press Gainey surveys after just about every visit. I make sure every survey has fully completed comment sections addressing the lack of staff diversity in the clinic, the fact I can’t recommend the clinic to others until hiring discrimination and patient discrimination is addressed, etc. The survey scores impact the Hospital’s federal reimbursement. So Hospitals/Medical Centers pay close attention to poor scores and comments associated with those (my old medical center where I worked broke down scores and comments by service line and unit and pressured each unit to address). It affects their bottom line. Don’t miss such an opportunity to convey how your provider failed to treat you with dignity and respect and how they may have violated your patient rights.
I had my colonoscopy last week. This time I decided to do it sedation free. The staff wanted to place an IV just in case I couldn’t stand the pain but I told them don’t even place it. I had read that males tend to have less discomfort on average from sedation free colonoscopy. Regardless, it was only minimal cramping like discomfort for just a couple seconds three times during the procedure and that was it. I was able to have a nice conversation with the physician (and the female nurse and the female tech). Since I was alert there was no issue with privacy (plenty of blankets provided and of course the gown open at the butt). Would highly recommend this approach to a colonoscopy. - AB
Thanks AB, That blogger seemed to show empathy for patients and providers trying to navigate their way through the healthcare system and so I approached her on this topic. That it had never occurred to her before speaks to how little the medical world understands their male patients. I'm not on Twitter or Facebook and so don't know what replies she might have gotten from those sources.
My last colonoscopy this past Spring was without sedation too, though I had the IV in place as a compromise with the doctor who didn't want to do it at all. He only agreed when I said Dartmouth Hitchcock already said they'd do it my way if he didn't want to. My experience otherwise parallels yours; only a little cramping and no modesty issues at all being I was awake and well covered the whole time. Based on the results from last Spring I will have another one done this winter but it will be at DH being I'd rather go to a world class facility than my small local hospital now that I know I had a pre-cancerous situation.
I agree on the feedback to hospitals via those questionnaires. Last August I had a visit to the ER of the local hospital, my first ever visit to it. There was nothing intimate involved, just an EKG, an MRI, and an otherwise basic exam. Interestingly the doctor and both nurses I had were all men. I was there for a few hours and the ER staff male-female ratio seemed to be about 50-50.
Rather than a written questionnaire I got a phone call. I told them my only complaint was that the doctor brought a female scribe into the exam room and neither introduced her or asked me if it was OK that she was there. I said I was fully covered while she was present but had there been an intimate exam the onus would have been on me to speak up which can be difficult when one is in the middle of a medical emergency. I could tell that the woman who called took my comments seriously. She agreed with what I was saying and said she would bring it up at their weekly staff meeting in hopes of changing the protocol. Whether they did or not I don't know but that particular issue at least had been voiced.
We need to seize opportunities to educate the medical world where and as we can.
I had an opportunity to have a modesty discussion with an NP and her medical assistant this morning and thought I would share how easy it was. This was a follow-up appt. with a dermatology NP for a myxoid cyst on a finger is all, but I seized the opportunity nonetheless.
I first established somewhat of a personal rapport with them by talking about how treacherous is was to get up and over the mountain from my hamlet in the snow this morning. That quickly surfaced the NP saying she lives in the next valley over and saying "oh you live in Dr. B's old place" (20 some years ago, got to love small town memories) and the MA saying she drove by yesterday and loved the Christmas tree in my gazebo. Friendly rapport established I'm ready for the real discussion.
I keep it light and respectful by saying to the NP I have a future reference type question for you and will phrase it in a way that you'll know what the right answer is. She laughs and I know I have her attention. I then ask if should I need a full body skin exam by Dr. M (the dermatologist) would he do it by himself or is the patient forced to have someone else in the room? She says usually there would be a 2nd person but if the patient wants only the doctor present that's OK too, that they do it that way frequently. I say good as to me it is disrespectful to expect a man to have an intimate exam with a woman there observing it. She said she understands completely, that other men have felt the same way and that she does many of the melanoma exams for women who don't want a male doctor and that even then some of the women don't want another woman in the room assisting her. I say
I understand women have the same concerns but that its even harder for men in that we face a sea of women wherever we turn. They both acknowledged that.
If nothing else the concept of male modesty was reinforced with the two of them, and I learned that I can get an exam with just the doctor and myself if I need it. He is the only one for at least an hour in any direction so that is good.
Biker in Vermont
Question is, do they offer this option to men or only if they voice their concern? I'm willing to bet they don't and I can only wonder
what her thoughts were about your topic after the conversation. You see their opinions are insincere as they don't employ male
medical assistants. What are they doing about it, nothing therefore the conversation was meaningless.
PT
PT, I purposely kept this discussion non-confrontational as I wanted them to actually hear what I was saying rather than them focusing on defending themselves. Neither of them own the practice. The male doctor does. I don't expect either of them to quit their job as part of a plan to hire male replacements. For the NP there literally is nowhere to go for at least an hour in any direction if she wants to work as a dermatology NP. She is the only one in this county and then some. Except for that MA, all of the other staff and the doctor are older. That either means they've been with him for a very long time or that they were willing to accept less income in the latter years of their career in exchange for the easy pace of a dermatology office vs the demands of a hospital setting. One of the realities I have read is that most male nurses & techs gravitate to the better paying roles and facilities, and that typically doesn't include private practices. I doubt they've ever specifically looked for a male MA or RN but I also doubt many, if any, have ever applied.
I agree that all patients, male and female, should be asked the question but in a medical system that puts medical staff efficiency as a higher priority than patient comfort, I understand where the default is coming from. It doesn't make it right but I understand it. Having an RN or that MA in the room when a full body exam is being given must allow the doctor and NP to see more patients in the day because the RN or MA is taking notes and handling the paperwork for them. I was told that were I to need an exam to let them know I only want the doctor when it is scheduled. That must be so that they can schedule a longer time slot as the doctor will have to take his own notes.
The conversation was useful to the extent it demonstrates how easy it can be to have these conversations. That's why I shared it here. It was also useful in that it reinforced what they have already heard. Each person that speaks up chips away just a little bit more at the underlying culture and protocols.
Biker in VT - great story about your Derm visit. It emphasizes just how important it is that patients politely and firmly speak up for their rights! You seem quite adept at this now. Sadly most patients either don’t know they have bodily privacy rights or they (in the case of men) feel they must “man up” and just accept what happens. But I get PT’s sentiment above. This small practice clearly knows they must agree to a patient’s preference to not have the second (really medically useless) person in attendance for the nude exam. But unless the patient brings it up, this practice, like many, are not OFFERING a more patient “friendly” exam. So, even though we live in the US and all of us are quite familiar with capitalism, it still bothers me that these licensed providers ethics are such that they value the potential revenue from seeing an extra patient or two a day over providing dignified respectful care for all of their patients. I don’t begrudge them for trying to maximize their earnings, I do find it disturbing they are willing to do this at the expense of patient privacy.
Coincidentally I had come across this article recently, it pertains to the whole body derm exams and patient preferences:
http://www.upmc.com/media/NewsReleases/2016/Pages/ferris-eliminating-patient-discomfort.aspx
Somewhat related is the controversial topic of “patient satisfaction”. I think discussions at this blog clearly fall under “patient satisfaction”, especially since so many patients seem to have their bodily privacy violated by the healthcare system.
Here is a link to a short AMA Journal of Medical Ethics article on patient satisfaction, giving some background to the national program (of “pay for performance”):
http://journalofethics.ama-assn.org/2015/07/ecas3-1507.html
Many private physicians, hospitals and health systems really would like surveys of patient satisfaction to stop. I can appreciate some of their reasons for this, but as a patient I much prefer that the health care provider feel some pressure to meet patients basic needs (compare to example above).
So, it would be unfortunate in the upcoming Health Care Reforms to lose another “stick” that helps “remind” providers that all patients are entitled to decency and respect. -AB
AB, sometimes it is what is not said that speaks the loudest. I read the dermatology article and while they noted women did not want male students in the room during their exam they never mentioned female students in the room during a man's exam, nor did they mention nurses or medical assistants being in the room at all. Their reference to students makes sense being it is a teaching hospital but in most dermatology practices it will be female nurses or medical assistants there.
Nonetheless, it is good they did a study to quantify at least part of the issue. I did find it interesting that when they referenced studies of colonoscopy patients they did not assume that those same gender sentiments automatically carried over to dermatology settings. I find that amazing that anyone in the medical world would compartmentalize in that manner rather than apply common sense and extrapolate that modesty concerns are modesty concerns regardless of the medical specialty.
Something of importance to folks here is that part of their quantification showed that 1/3 of the men that had a gender preference preferred opposite gender dermatologists. Though not mentioned in that article, some women prefer opposite gender care too. That is part of the reality and to the extent that medical professionals fall into those "prefer opposite gender" groupings themselves, they are going to be more likely to project their own preferences in assuming their patients feel the same. That's going to happen in the absence of this topic getting much of a public forum.
Regarding the article about full body dermatological exams referenced above - I think it is fair to say the study gave enough of a result to make these physicians aware that patients are uncomfortable being nude for a 5-10 minute exam and that they should modify their clinic practices. But at best the results of this study are a LOWER LIMIT of how many patients are uncomfortable with their nudity in front of one or more individuals in an exam room. The reason I say this is the authors note they administered the survey to patients “undergoing” a full body exam. Since they would not administer the survey while the patient was standing there in the nude, they administered the survey BEFORE the patients appointment, probably via paper or tablet in the waiting area (otherwise they would have stated the survey was administered to patient “who had received a full body exam”). Since many of the surveyed patients had NOT ever had such the full body exam, their answers were not based on first hand experience. I’m sure the percentages would be different if surveys were done AFTER the full body exam, and those numbers would vary depending on how many people were observing the nude patient and the genders of those observers, etc. So without reservation I think one would find even a higher percentage of patients who would prefer just the physician for the exam and to wear their underwear.
I very much liked their statement at the end of the paper:
“When we think about the relative risks and benefits of cancer screening, if we’re causing people discomfort, then we need to think of that as doing harm. Our study provides some easy ways to reduce that harm,” Ferris said. “In the age of personalized medicine, taking simple steps, such as offering a choice of physician gender and degree of disrobement during an examination, can allow us to personalize the skin cancer screening examination to minimize discomfort.”
Amazing that it is 2016 and prominent teaching institutions are just “discovering” the patient discomfort they create is harmful and needs to be minimized in a personalized fashion! How to get others to realize this? - AB
Amazing is right, AB. Also interesting is this (I believe ADA sponsored) video of a TBSE
https://www.youtube.com/watch?v=_uy8aWtguGs
Notice that the dermatologist makes reference to examining the genital area but doesn't even glance in the patient's nostrils. The probability of finding SCC in the nostrils is something north of 5 times that of finding genital skin cancer (though both probabilities are small). I wonder why. It's 2016 all right and time to look in the nose on the patient's face. REL
Here is an appalling example of disconnect between a teaching hospital and patient privacy. Earlier this year I had surgery and needed an overnight stay. I was placed in a semi-private room in a recently remodeled med/surg type floor. I was lucky, I had no roommate for the ~24 hours I spent in the room. I could see how they designed the room to meet all of the FGI Hospital Design Guidelines. The room was sufficient from an architectural perspective to get licensed.
However, they had chosen to go with a new style bathroom. The bathroom contained a sink, toilet and open shower area all in the same connected space. Three of the walls were solid wallboard. The fourth side, the door side, had an all glass door and all glass wall about 7 ft high (clear NOT frosted glass). That is, the ENTIRE bathroom was visible to anyone in the room. There was no curtain to surround the shower space or toilet. For toileting and showering the patient was on full display. (Do you know how many people come into a patient’s room throughout a hospitalization especially if there are two patients!!!)
I remember being propped up in my hospital bed tired, hungry and exhausted looking at the bathroom thinking how do they make that work? It meets licensing guidelines BUT I would argue vigorously such an open design does NOT meet the CMS Hospital Conditions of Participation:
§482.13(c)(1) - The patient has the right to personal privacy.
“Physical Privacy
‘The right to personal privacy’ includes at a minimum, that patients have physical privacy to the extent consistent with their care needs during personal hygiene activities (e.g., toileting, bathing, dressing), during medical/nursing treatments, and when requested as appropriate.
People not involved in the care of the patient should not be present without his/her consent while he/she is being examined or treated. If an individual requires assistance during toileting, bathing, and other personal hygiene activities, staff should assist, giving utmost attention to the individual’s need for privacy. Privacy should be afforded when the MD/DO or other staff visits the patient to discuss clinical care issues or conduct any examination or treatment. “
For a unit remodel the Hospital hires an architectural firm. The Hospital iterates with the architects to get the features they want consistent with their budget. In this case both the CLINICAL leadership and hospital RISK MANAGEMENT felt strongly “closed” bathrooms should be eliminated. Many reasons for this thinking but NONE sufficient to override patient’s right to privacy. Horrible thought process by this teaching hospital - I can only conclude they are clueless about patient privacy.
After I had been rounded on the next morning by the medical student, a change of shift of nurses, and then the resident I had learned I would be getting discharged later that day. I had not slept at all for ~36 hours nor eaten anything and I was just looking forward to leaving. A couple ours later in popped the CNA who said “would you like a shower”? I had been waiting to ask just how that would work, but by the time she presented I was too worn out to even try and discuss the Hospital’s policy and practice with her given the bathroom design. I suspected but never confirmed the CNA would have to stay during the shower and observe the patient and maybe? control room traffic. I just told her I was leaving soon.
If you have the misfortune to be admitted to a hospital with this design you can consider either insisting on no attendant (and perhaps a partner doing traffic control while you shower) or insist on same gender attendant if you are uncomfortable with opposite gender attendant. If I had had the full “shower experience” I know I would have filed multiple complaints regardless - simply not acceptable. - AB
AB, perhaps you did, but it would of been appropriate to send a letter afterwards asking the very good questions you raised about how they preserve patient privacy when using the toilet or shower. Do they really expect patients to be in there showering while their roommates kids and others are visiting, or even if medical or non-medical staff are coming into the room to tend the roommate? Or very low level non-medical staff coming in for you to deliver a meal for example? Or your own visitors such as your next door neighbor or friend from work whom you do not choose to have watch you shower? It is very reasonable to be asking these questions.
My guess is they'd have some lame patient safety response, but complaining about it may cause some change nonetheless.
Ignoring the clear glass shower area for a moment, an appropriate response to the female CNA asking about taking a shower might be "yes I would love a shower, how soon will the male attendant be available?" Throw it right back into their court.
AB,
This is incredible:
Easy Ways to Improve Patient Comfort During Skin Cancer Screenings
I would love to see what other resources that you have found!
Let me point out a problem with this research:
...so with 31 percent of women and 13 percent of men preferring not to have their genitals examined at all...
Physicians may these are outliers, but 14% is a significant number. But note that in the study, the researchers at three institutions, including UPMC, administered an anonymous survey to 443 adults undergoing a full-body screening for skin cancer...
Meaning that these are the people who have chosen to submit to a full-body screening. It does NOT take into account those who have opted out of this screening.
That means in the population as a whole, MORE people would NOT have their genitals examined at all.
The study gives credibility to these "HARMS"!
...another important message from the study is that physicians need to balance the benefit of occasionally finding a genital melanoma with causing a lot of people discomfort or anxiety...
As AB pointed out, this is 2016, and the medical profession is JUST figuring this out???
This has been pointed out for 10 years on this blog alone.
Forgive me for being so blunt, but is the medical profession stupid OR just doesn't care about patients (if it interferes with efficiency, power, etc.)?
All the above?
So why now?
I speculate that some in the profession want the autonomy, respect, prestige, etc. that the profession once enjoyed back, so they are looking at the problems as true scientists AND NOT as "doctors and nurses." They are willing to look at the possibility that the profession is NOT what the AMA says it is.
They are willing to be open to the possibility that just because one wears a white coat, it is not OK to look at another's genitals. They are willing to remove "being thorough" as an excuse. They are willing to give the patient what the patient feels is appropriate for themselves and NOT what the physician dictates.
As I said before, medicine exists within our society. AND must conform to society's expectations OR society will bend the profession to meet society's expectations.
This study may be borne out of not meeting "pay for performance" goals.
-- Banterings
Congratulations to the several posters who have prevented the violation of their modesty by the medical community. For me, a key question is "Can anyone relate systemic changes made during the past 11 years by the medical community that has improved respect and dignity accorded patients by the employees?"
BJTNT
At Saturday, December 10, 2016 3:13:00 PM, Blogger Maurice Bernstein, M.D. said...
AS OF DECEMBER 10 2016 THIS VOLUME 77 WILL BE CLOSED FOR ALL COMMENTS. DO NOT ATTEMPT TO WRITE ANY FURTHER COMMENTS HERE. PLEASE GO TO PATIENT MODESTY:VOLUME 78 TO CONTINUE COMMENTS. ..Maurice.
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