Bioethics Discussion Blog: Patient Modesty: Volume 78

REMINDER: I AM POSTING A NEW TOPIC ABOUT ONCE A WEEK OR PERHAPS TWICE A WEEK. HOWEVER, IF YOU DON'T FIND A NEW TOPIC POSTED, THERE ARE AS OF MARCH 2013 OVER 900 TOPIC THREADS TO WHICH YOU CAN READ AND WRITE COMMENTS. I WILL BE AWARE OF EACH COMMENTARY AND MAY COME BACK WITH A REPLY.

TO FIND A TOPIC OF INTEREST TO YOU ON THIS BLOG, SIMPLY TYPE IN THE NAME OR WORDS RELATED TO THE TOPIC IN THE FIELD IN THE LEFT HAND SIDE AT TOP OF THE PAGE AND THEN CLICK ON “SEARCH BLOG”. WITH WELL OVER 900 TOPICS, MOST ABOUT GENERAL OR SPECIFIC ETHICAL ISSUES BUT NOT NECESSARILY RELATED TO ANY SPECIFIC DATE OR EVENT, YOU SHOULD BE ABLE TO FIND WHAT YOU WANT. IF YOU DON’T PLEASE WRITE TO ME ON THE FEEDBACK THREAD OR BY E-MAIL DoktorMo@aol.com

IMPORTANT REQUEST TO ALL WHO COMMENT ON THIS BLOG: ALL COMMENTERS WHO WISH TO SIGN ON AS ANONYMOUS NEVERTHELESS PLEASE SIGN OFF AT THE END OF YOUR COMMENTS WITH A CONSISTENT PSEUDONYM NAME OR SOME INITIALS TO HELP MAINTAIN CONTINUITY AND NOT REQUIRE RESPONDERS TO LOOK UP THE DATE AND TIME OF THE POSTING TO DEFINE WHICH ANONYMOUS SAID WHAT. Thanks. ..Maurice

FEEDBACK,FEEDBACK,FEEDBACK! WRITE YOUR FEEDBACK ABOUT THIS BLOG, WHAT IS GOOD, POOR AND CONSTRUCTIVE SUGGESTIONS FOR IMPROVEMENT TO THIS FEEDBACK THREAD

Saturday, December 10, 2016

Patient Modesty: Volume 78





HERE WE ARE AGAIN!  This graphic was published in Patient Modesty, Volume 4, June 26, 2008.  And the following is from Avram on that date:

MER is absolutely correct. As 
I've been posting here for over a year, nothing is going to change until the issue of a double-standard in modesty considerations for males ends up in court as a
class action test of DISCRIMINATION Law-- unequal treatment by gender. We have had BFOQ provisions in law which manditate that health insitutions use them to protect the patient modesty(read privacy) of ALL patients, regardless of gender.

The right to privacy and modesty were linked in BFOQ legislation to include what would be viewed as intimate pelvic care. 

Everything that is currently status quo is outside the law and it will change if it is challenged because it can not be upheld within the existing law. 
Female nurses, male doctors, HMOs 
all have a vested interest in 
maintain high levels of female 
staff. They will stonewall to
their advantage at every turn
until a judge rules in class-action that males must be treated equally with females or BFOQ be
removed from law. If that were to happen, then all female patient modesty requests would also be
ignored and male staff could rushed into OB/GYN and L&D, etc. What's good for the goose is 
good for the gander.

I'm not a lawyer but I know you 
can not discriminate against
either sex in a straight forward
manner. To respond "you are 
not a woman" is all an American
Civil Liberties attorney would need to make something out of this. Have any of those posting here, who are being denied equal rights to medical privacy/modesty, attempted to do this? MER, have you sent highlights of your extensive and well organized research to any legal body for an evaluation?


So my question is: ARE WE ANY FURTHER ALONG IN THE DISCUSSION AND SOLUTION?? 
Hate to be pessimistic..
 ..Maurice.


95 Comments:

At Saturday, December 10, 2016 4:20:00 PM, Blogger NTT said...

Dr. B:

Dermatology has made strides in trying to address the issue but that's about it.

Three things have to happen before we can see real change.

Men have to be willing to shed the "macho" label & stand up for their rights.

Lawyers need to take this issue seriously and be willing to take on the system to help enact change that is long over due.

Our criminal justice system must stop looking at female healthcare personnel as defenseless girls and start seeing them for the predators that they are.

They've started seeing female teachers in a different eye and when they catch a predator preying on a male student, they've started handing out prison sentences instead of just probation like they have been.

They need to do the same in the healthcare industry. Males are not the only gender doing the preying on patients.

Parents are tired of teachers preying on their kids. They won't tolerate these predators getting a hand slap anymore. They want them to serve time.

When enough men and women are tired of having their dignity violated, change will come and the reforms needed so badly, will be put in place.

We need an earthquake so as to generate a tsunami wave to flow thru the industry and move out the old ways so we can right this ship and get it on course.

Regards to all,
NTT

 
At Saturday, December 10, 2016 6:14:00 PM, Anonymous Anonymous said...

Dr. B: Yes and No.

No because:

—there still are not enough male nurses, medical assistants and techs available to be hired by medical centers, clinics, and physician offices. Nursing schools are turning out ever higher numbers of male graduates (in my region about 17%). Nebraska has about 20% of its practicing nurses that are male. MA schools have increased male graduation but not near to nursing yet,
—most hiring Managers are still female,
—unless the hospital, clinic or physician office has had complaints or regulatory trouble or legal action they have really no incentive to change their practice. And let’s recognize that physician offices that have all the patients they can handle have little incentive to change even from their male customer’s complaints (unless they actually have decent ethics and want to do the right thing for all patients,)
—males, who society labels as the more assertive and aggressive sex, seem to have real problems speaking up for their rights when their “pants are down” and frankly most men don’t know their rights anyway which plays into #3.

That said:
—at many medical centers and larger hospitals there now is a better awareness and willingness to try and accommodate requests for same gender care. I think nurses are getting more used to this, as more male nurses and male CNAs enter the hospitals (requests come from both genders),
—Hospitals all know the current CMS requirements for Patient Rights, patient involvement in their plan of care, and that they must respect a patients culture, beliefs, etc. to the extent reasonably possible,
—Medical centers, which tend to see plenty of patients, end up getting complaints and their service evolves as a result. My experience from working at large medical centers is that the medical center evolves much faster than private clinics and physician offices.

Since there are not enough male nurses, MAs, CNAs, etc. available right now so that all hospitals, clinics and/or physician offices could staff diversely to accommodate patient requests associated with intimate care we can’t think we would have systemic changes. One would be better served trying to get one or two providers in their home area to staff diversely. Once one provider gets an economic advantage from a change, the others will follow. To this end another thanks to *Misty* who tries to keep a list of facilities that accommodate same gender requests

To those that favor a lawsuit to effect change, I certainly agree this is a valid approach. But remember, litigation can take a couple years and if successful the court will specify that corrective actions can be accomplished over a multi-year period of time (to give the institution(s) time to hire adequately diverse staff for example). That could end up being 5-7 years. And that would be for the one provider or one system of providers sued. Doesn’t mean others will adopt too. Look at ADA guidelines and requirements - hospitals and other providers still are not compliant with all those. Consistent complaints by patients to a variety of local, state, federal entities and to the institution probably can accomplish changes faster.

A related note, by accident I just learned about RateMD. https://www.ratemds.com

Great site for checking out physicians and rating them and adding comments. They have a LARGE physician database. Great way to provide detailed factual comments about the doc and your experiences at that facility. - AB

 
At Sunday, December 11, 2016 4:49:00 AM, Blogger Biker in Vermont said...

Have things changed? Maybe a little bit.

There have not been any major court cases that support intimate privacy equal rights for men. The long-standing rulings allowing women reporters in male locker rooms and putting female corrections officers rights above that of male inmate intimate privacy rights still stand unchallenged. In legal terms men's rights have not advanced at all these past 8 years.

Few of us are inmates or professional or college athletes and so for the vast majority of men the key metric is staffing mix which has only changed very incrementally.

That said, I think there has been some forward movement in medical settings. Few men complain but cumulatively over time awareness of the issue has increased. I use as an example my recent conversation at the dermatology office. I did not get a "we've never had that question before" response. They were aware of the issue and spoke to it when I raised it. I've had preliminary conversations with the urology practice that I am changing over to and those conversations have gone well. I was not the first person they'd heard from on this. I am not guaranteed to get a male nurse for my prep but I can ask and they will accommodate me if the one male nurse they have is available. One isn't much but it is one more than my present urologist employs. Part of the increase in awareness likely also came from this blog and others like it. Thank you Dr. Bernstein for what you have done.

The other thing concerning awareness is that I think female nurses & techs have gotten better trained in being respectful, minimizing exposure etc. The timeframe of the reference Dr. Bernstein posted is 8 years. I've had at least a dozen cystoscopies in that timeframe and other than there not having been a male nurse available to do the prep, there is nothing I can point to that any of them can have done differently to reduce my exposure or treat me in a respectful manner. It is not the individual female nurse's fault that no men are employed there. Going into the way-back machine I could point to instances where female medical staff were less than respectful or the procedures were inadequate in this regard.

So, some progress has been made, but we're nowhere where we need to be. Men shouldn't have to settle for just being treated in a respectful manner by female staff. That is an improvement from the way it used to be but we should be able to have male staff for intimate procedures.

 
At Sunday, December 11, 2016 6:18:00 PM, Anonymous Anonymous said...

I apologize for this note off target but I was perusing the 2016 OIGs list of criminal, civil and state actions and was stunned to see just how many females (RNs, LPNs, CNAs, citizens) were involved in State level crimes, including physical abuse of the elderly in nursing homes. The physical abuse crimes were caught because of facility cameras. Not all facilities have such invasive cameras, so needless to say these represent but a fraction of abuse occurring to elderly males and females in senior homes. Frightening.

https://oig.hhs.gov/fraud/enforcement/state/index.asp

Senior homes I’m familiar with, as you would expect, are staffed mostly with females. The point is I don’t think one can conclude one caregiver (say, female) is more caring or less likely to abuse than the other (say, male). Type of abuse may be different by different sexes, but it is despicable either way. Heaven help us… - AB

 
At Monday, December 12, 2016 9:51:00 PM, Anonymous Anonymous said...

Banterings - I don’t know what you are looking for in terms of other research that I’ve found. Here are two references that, to no surprise of anyone participating in this blog, show that college football players and college athletes (both male and female) prefer same gender athletic trainer for their intimate injuries/treatment. FYI.

https://www.ncbi.nlm.nih.gov/pubmed/17597951/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2902033/

That is, there is a compelling body of evidence across the board in the US that males and females prefer same gender intimate care.

One final point - read just about ANY medical school or nursing text book teaching about caring for or performing exams of the genitalia and they almost invariably start the discussion with a statement like this: “examination of the patient’s genitals can be UNCOMFORTABLE and EMBARRASSING for both you and the patient.” My question is if just about every textbook that trains clinical providers in the US to perform these exams acknowledge intimate care can be “embarrassing” and “uncomfortable” why don’t the clinical professionals take reasonable steps to minimize these feelings for each patient? I mean, it is right there in their training - patients are uncomfortable and embarrassed by such care/treatment. So much for the patient experience… - AB

 
At Tuesday, December 13, 2016 9:46:00 AM, Blogger Maurice Bernstein, M.D. said...

I think the reference below from the New England Journal of Medicine which I put up on my new thread "All Pain: Treat It or Accept It" is most appropriate also for the discussion going on here on this Patient Modesty thread. What do you think? ..Maurice.

N Engl J Med. 1982 Mar 18;306(11):639-45.
The nature of suffering and the goals of medicine.
Cassel EJ.
Abstract
The question of suffering and its relation to organic illness has rarely been addressed in the medical literature. This article offers a description of the nature and causes of suffering in patients undergoing medical treatment. A distinction based on clinical observations is made between suffering and physical distress. Suffering is experienced by persons, not merely by bodies, and has its source in challenges that threaten the intactness of the person as a complex social and psychological entity. Suffering can include physical pain but is by no means limited to it. The relief of suffering and the cure of disease must be seen as twin obligations of a medical profession that is truly dedicated to the care of the sick. Physicians' failure to understand the nature of suffering can result in medical intervention that (though technically adequate) not only fails to relieve suffering but becomes a source of suffering itself.


 
At Wednesday, December 14, 2016 1:21:00 PM, Blogger A. Banterings said...

Notice in this NEMJ post about surgery in the UK ( Welcome to the Theatre … the Operating Theatre ), the heading "Full Team Brief", it states:

This is a practice that was adopted somewhat recently by National Health Service theatres. In NHS hospitals, before the start of the day, the OR team meets for a team brief. The whole team — including the attending surgeon, anesthesiologist (or anaesthetist, again if you want to be properly British), residents, circulating nurses, scrub techs, students, etc. — all meet in a circle. The group then proceeds to introduce themselves and go through a checklist that outlines the cases for the day, reviews any surgical/anesthetic concerns, enumerates any potential patient or safety concerns, and outlines the work flow for the day. I think the full team brief is a great way to make sure everyone on the team is on the same page and also drives home the message that avoiding errors and keeping patients safe is everyone’s responsibility.

What about introducing themselves to the patient?

This is a good time to address patient preferences about gender and students.

These (similar) occur here in the States as part of safety/risk management.


-- Banterings


 
At Wednesday, December 14, 2016 2:08:00 PM, Blogger Biker in Vermont said...

Dr. Bernstein, I may be misunderstanding what you are asking when you say that thread on pain is appropriate for this thread. My apologies if I have. On that thread you say:

Maybe, physicians and patients should look at some pain as an intrinsic and spiritual part of life and that, well, those experiencing pain should understand that and live with it.

Are you suggesting that the parallel between the pain and modesty topics is that patients should just live with undignified or disrepectful treatment as concerns their modesty, that patients should just live with it?

Speaking for myself, I do accept physical pain as just part of illness or injury and avoid taking any pain medication if at all possible, but at the same time I don't expect my doctors or anyone else in the medical world to do anything that needlessly creates pain. For example I expect to be given the numbing agent before having a catheter inserted but if it still hurts going in or afterwards, I just accept it as an unavoidable part of the procedure. It is what it is.

On the modesty side of the equation, I accept that having a catheter inserted requires rather intimate exposure and touch. It is an unavoidable part of the procedure, but just as the nurse should not needlessly create pain by avoiding the numbing agent, they should not needlessly expose me more than was absolutely necessary. This includes the amount of my body exposed, how long it is exposed, and to whom it is exposed. In a patient-centered system, it would also include not forcing male patients to be prepped by female nurses as there is nothing about the procedure that requires a female do it. A male could do it just as well. Forcing men to submit to such procedures by females is thus akin to medical procedures needlessly creating pain, such as my example of skipping the numbing agent before inserting a catheter.

 
At Wednesday, December 14, 2016 3:05:00 PM, Blogger Maurice Bernstein, M.D. said...

Biker, you write "Are you suggesting that the parallel between the pain and modesty topics is that patients should just live with undignified or disrespectful treatment as concerns their modesty, that patients should just live with it?" No, but patients do need to weigh the modesty against the immediate need and potential benefit of the examination or treatment and as with pain and suffering the physician should be aware or made aware by the patient regarding the concern of the patient and contribute to its resolution. Resolution of the physical modesty issue in a clinical situation, like that of patient suffering in general, requires participation of the patient as well as the doctor. ..Maurice.

 
At Wednesday, December 14, 2016 4:44:00 PM, Blogger NTT said...

Good Evening:

It’s up to the patient to take & hold on to the lead position in respect to giving up their dignity.

A patients PCP should know from day one what their privacy issues are & in turn the doctor should tell the patient from the get go if they cannot or are not willing to work with the patient on this issue. There are doctors out there that if you have dignity issues, they prefer you take them elsewhere.

In a hospital situation where you might be dealing with someone other than or in addition to your regular PCP again, it’s the obligation of the patient to make their wishes known at the time they are admitted that they have special needs.

People (both healthcare personnel & patients), are not mind readers.

If the patient doesn’t take the lead and speak up from the start nobody is gonna know how they feel or what their wishes are and because the patient did not speak up, they more than likely will wind up in a situation they weren't expecting. A situation that may not have had to happen if the patient SPOKE UP in the beginning. A negative situation which could very well lead to a negative patient outcome.

Without question, it’s a two-way street where communication lines on BOTH sides needs much better clarity.

Question is, when if ever are we going to have some meaningful dialogue (without lawyers getting involved), between the healthcare industry & the patients who pay for their services.

They say we have a patient-centered care system.

I don't see it.

Patients for the most part are still considered cattle as far as the healthcare system goes. Get’em in get’em out and worry about the human side later if at all.

Regards to all,
NTT

 
At Wednesday, December 14, 2016 5:33:00 PM, Blogger Biker in Vermont said...

Dr. Bernstein, I personally don't disagree with anything that you said in your last post, but I am not so modest as to avoid medical care. Some men are as has been discussed many times. I have accepted extremely intimate care from female medical staff members dozens of times in settings where there was no alternative.

For me there are two primary issues, though both boil down to not treating me as a second class patient simply because I am a male. As someone who fully supports women's rights and the rights of all, it hurts to know that the medical world views men as not being entitled to the same respect and dignity considerations routinely afforded women.

The first issue is that while I don't fault any female medical staff for doing their job, I expect to be treated in as respectful a manner as the procedure allows. This is the basic close the door, keep me covered as best possible, no extra spectators etc. kind of stuff. The other aspect of this is to inform me of the option for a male nurse or tech if such an option exists. Yes I should ask myself but most men are too embarrassed to ask.

Years ago being treated respectfully was the exception. Now it is the norm, at least in my experience. However, past experiences still make me wary of any and all female nurses and techs until such point as they prove themselves otherwise. Some things you never forget.

The second issue is the lack of male staffing for intimate procedures. If the medical world values the lives and well being of men to the degree it values women, there would be a concerted effort to get a lot more men into the nurse and tech ranks. I find it increasingly difficult to accept that the medical world is unaware of the issue or that they believe simply acting in a respectful manner (my 1st point) is enough.

I really do not think my stance is unreasonable, yet here we are with men rarely having the option for anything other than female staff for intimate care.

 
At Wednesday, December 14, 2016 6:29:00 PM, Blogger Maurice Bernstein, M.D. said...

NTT, you write "Patients for the most part are still considered cattle as far as the healthcare system goes. Get’em in get’em out and worry about the human side later if at all." I can tell you and others here that this view of patients is not what I am teaching my first year medical students and I have never heard of other teachers teaching that concept. I don't see from reading a medical education listserv that other medical schools are teaching that kind of trash. However, through the "hidden curriculum" in the later years when the personal pressures on interns and residents gets tough as well as pressures on their supervisors, the "hidden curriculum" enters the education process and while "cattle" may not be the expression used there may often be a unethical "rush" which makes communication with the patients much more difficult or at times impossible.

I see the obvious solution is to get much more people, both men and women, into the medical profession, physicians as well as physician's assistants and nurse practitioners and others to assume responsibility in the attention and care of the increasing patient loads and to see to it that these professionals are given the time to interact with their patients and receive a worthy salary. ALSO-- I THINK IT IS VERY IMPORTANT THAT ALL TEACHERS OF MEDICAL STUDENTS AND NURSES AND SUPERVISORS OF INTERNS AND RESIDENTS AND PROGRAM AND INSTITUTION ADMINISTRATORS GET SICK AND HAVE TO BE EXAMINED BY OTHERS, GET SICK AND END UP IN THE HOSPITAL AND BE TREATED BY THE DOCTORS AND NURSES BUT NOT AS VIP BUT AS THE USUAL PATIENT. I have been hospitalized twice as a physician without VIP treatment and I have already been well educated of what it is like to be a patient. Yes, patients should "speak up" but also professionals should get their own personal experience in the life of a patient in our current system. Agree? ..Maurice.

 
At Wednesday, December 14, 2016 6:32:00 PM, Anonymous Anonymous said...

Dr. Bernstein - reducing patient suffering is one of the tenants of patient-centered-care. I think numerous publications state to have the optimal exchange between the provider and patient, and enhanced chance of favorable outcomes the patient should have their comfort needs and preferences met as reasonably as a possible.

Unfortunately this doesn’t happen in practice in the US. Our healthcare system of payment ensures that patient volume will forever more take priority in the physician office, speciality clinic, and hospital. Volume imperatives certainly temper the ability to implement patient-centered-care.

Further, our existing health care system is and has been for decades organized to be female-centered, not patient-centered. Healthcare recognized the embarrassment and discomfort of females in some of their intimate care. They designed Women’s Imaging Center (have you ever seen a Men’s Imaging Center?), Women’s Health Centers (staffed only with females), and Ob/GYN clinics staffed only with females (have you ever seen a Urology clinic staffed only with males?). And Healthcare intentionally propagated the factually incorrect stereotype that no male patients have modesty, or feel uncomfortable with intimate care and if the male patients do feel uncomfortable they are males and thus (stereotypically) it is OKAY for them to endure some suffering.

So what I hate about any article like the one cited above is they assume a perfect gender-neutral health system out there. And that is farthest from the truth. Conclusions and opinions based on an assumption of a perfect gender-neutral healthcare system are just not relevant to our current situation in the US. They are just thought experiments without utility.

Changing topics - unnecessary exposure in the physician’s office. It just occurred to me today (while thinking about how poor the positive predictive value of the PSA test is) that the value of the digital rectal exam for reducing prostate cancer mortality must be poor too. Turns out its positive predictive value is WORSE than the PSA test, which both the NCI and USPSTF don’t recommend for prostate cancer screening (unless there is full discussion of risks, benefits and alternates because of the high over diagnosis and harm done to men.) So men, be sure if you REALLY need that digital rectal exam next time.

https://www.cancer.gov/types/prostate/hp/prostate-screening-pdq#section/_7

https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/prostate-cancer-screening

- AB

 
At Wednesday, December 14, 2016 6:42:00 PM, Blogger Biker in Vermont said...

DR. Bernstein: Yes, patients should "speak up" but also professionals should get their own personal experience in the life of a patient in our current system. Agree?

Absolutely. Reality trumps theory every time. I know some would disagree with it, but at some point during the educational process, all medical/nursing/tech students should have to endure an intimate procedure by opposite gender staff, such as being catheterized. It doesn't have to be their classmates doing the exam and could perhaps be nursing staff from an area hospital that does it. Otherwise they could be working in their careers for decades before they ever experience it themselves, if they ever do.

 
At Thursday, December 15, 2016 11:37:00 AM, Blogger A. Banterings said...

Maurice,

May I ask how long ago your hospitalizations were?

You have stated that you have never had complaints by your own patients about modesty concerns. Have your hospitalization experiences changed your perceptions of your view of your patients and their experiences?


-- Banterings

 
At Thursday, December 15, 2016 12:47:00 PM, Blogger Maurice Bernstein, M.D. said...

Banterings, I was hospitalized 18 and 12 years ago. As far as any change in my benign consideration of how medical practice is actually practiced based on my personal hospitalization experience, the answer is "no". Times, though, may have changed and certainly what I have read all these 11 years on this thread has enlightened me on the subject of the physical modesty upsets of my visitors here as patients. ..Maurice.

 
At Thursday, December 15, 2016 4:01:00 PM, Anonymous Anonymous said...

I came across the term “shared decision making” a couple years ago when my PSA level was rising and I was doing research. For better or worse for many years I happened to have had a sequence of primary care physicians that all did the prostate rectal exam and tested the PSA each year, so for many years I had that “score” that I grew to fear. Now of course the recommendation in the US is no screening for prostate cancer unless you are in the 55 - 69 range and then only with “shared decision making”.

“Shared decision making. Shared decision making between clinicians and men is a strategy for making health care decisions when there is more than one medically reasonable option. Each choice has different patterns of outcomes, and the values a man places on those outcomes need to be considered in order to make an optimal decision. Such decisions are said to be ‘preference sensitive.’”

https://www.auanet.org/education/guidelines/prostate-cancer-detection.cfm

I am sadly amused by this recommendation because, first, for about the previous 20 years there was no patient preference involved, the testing was just done because I was the patient and each physician had their training and practice/defensive medicine beliefs and routines and that was it. Secondly, even though medicine should be listening to the patient and his/her preferences this historically has not happened. Finally, usually male patients are generally given very little leeway for their “preferences” when they are in the healthcare system, not only because of the healthcare system design but also because they are male and stereotypical beliefs of what males need or should have from healthcare last for several generations.

I think the concept of shared decision making and preference sensitive medicine is a fine concept. I think it is quite close to another healthcare initiative: patient-centered-care. - AB

 
At Friday, December 16, 2016 5:27:00 PM, Blogger Biker in Vermont said...

AB, shared decision making makes abundant sense for prostate cancer given how complicated that scenario is both the treatment options and in the implications of those treatments. Generally speaking patients should always understand the options for any serious medical situation. In many instances there really aren't any options as concerns the treatment itself but even then patients should at least understand what the nature of the procedure is rather than be surprised.

With my bladder cancer the only option was to remove the tumors before they progressed further. Quite honestly I was still in shock over the diagnosis and didn't ask questions. It is likely I didn't hear much of what he did tell me. I went into surgery knowing what the entry point was but not a whole lot else other than I'd have a catheter that had to stay in for a week. When the biopsies were done, the doctor initiated an aggressive treatment plan. He did give me a good explanation as to why that was in order. I don't think there is anything more he could have done but being the treatments were via catheter I would have appreciated knowing before showing up for the first one that it was going to be a female NP doing them all. Again, back then I didn't ask questions so I own most of that.

On a related topic, yesterday I initiated the process of getting scheduled for a follow-up colonoscopy at a different facility. Expecting push back, I said it had to be done without sedation. No push back at all. The answer was just a simple OK, not a problem. This is an example where maybe it is time for shared decision-making. The 1st two times I had them I didn't know there was an option to not be sedated. The last time I had to push hard to get it done without sedation. Think of how many men with modesty concerns might get colonoscopies if they knew they didn't have to worry about their exposure being they'd be awake.

 
At Saturday, December 17, 2016 4:39:00 PM, Anonymous Anonymous said...

Biker in VT - the colonoscopy is a good example. Most authentic medical websites explain the procedure with sedation (and don’t mention one can do it without). My last colonoscopy I was not informed there was a sedation free option and frankly I should have known better. The fact that the GI docs all approach this mass public screening test with the intent of sedating (many using deep sedation) is actually a bit disturbing. For informed consent one is to be informed of the risks, benefits and alternatives. So intentionally shady informed consents are being given.

And yes - it pays to speak up, ask questions, and advocate for oneself. — AB

 
At Monday, December 19, 2016 1:43:00 PM, Blogger Maurice Bernstein, M.D. said...


Speaking about professional gender differences in outcomes, a current study published in JAMA and reviewed by an NPR article ..Maurice.

 
At Monday, December 19, 2016 5:09:00 PM, Blogger Biker in Vermont said...

Interesting article Dr.Bernstein.

I have never chosen female doctors, not because of any perceived skill difference, but because female doctors are more likely to bring in a female chaperone for something that a male doctor would not bring any chaperone in for. The other thing is that if there is an intimate procedure that requires a nurse or tech present, it would then mean I have two females present which is many times worse than just one. Of course it is always possible she'd bring in a male nurse or tech, but I suspect female doctors are even less likely to hire males than are male doctors. I can't say that for sure though.

The other thing, and I am not in a position to do anything more than hypothesize, is that having two females (doctor/nurse) rather than one(nurse) increases the chances of any modesty concerns I might have being dismissed in a who am I to question them power dynamic. That may not be true at all, but given the dismissive nature of male modesty concerns by women in medicine presently, it seems plausible in my mind at least.

The sad part about my thinking here is that if I am wrong, I have no way of knowing given the medical world refuses to talk about these issues.

 
At Thursday, December 22, 2016 7:16:00 AM, Anonymous Anonymous said...

Two weeks ago I contacted a serious case of the flu and my PCP urged me to spend a few day in the hospital. I reluctantly agreed; so my wife drove me home to pack a few things for my stay and then I checked into the local medical center.
A nurse showed me to my room and handed me one of those backless, cloth gowns and instructed me to remove all my clothing, put on the gown, and get into bed and that she would return shortly. I did remove my outer shirt and undershirt so there would be no problem with medical personnel listening to my heart or lungs, but I not only did not remove my underwear but I also put on a pair of light, cotton sweat pants as well.
When the nurse returned, I was already in bed and she told me she was going to perform a new patient assessment. She proceeded to ask me a number of question and check my vital signs and then she asked to roll over on my side facing away from her so she could do a skin check. After I turned on my side she pulled the blankets back and for the first time she could see that I was wearing sweatpants. I was ready for her to give me an argument about that but she said nothing. She observed and briefly touched my back and then she said, “Well, I guess we can skip the rest.” And then she left.
My assessment as to what happened is that by ignoring her request to remove all my clothing, she realized that I was making a tacit statement that I valued my privacy and modesty and that I was not a person who was unquestioningly going to do whatever the medical staff said I should. So to avoid conflict she simply omitted part of the exam which I imagine would have required me to remove my sweatpants and underwear. I continued to wear sweatpants throughout my hospital stay.
As I thought about this later, I came to the conclusion that for a great many hospital patients there is simply no reason why they can’t wear sweats, scrubs, or pajamas instead of a humiliating gown. I imaging the hospital staff would justify requiring gowns because they provide ease of access to the patient’s body for examination but in reality, if an exam below the waist is needed, it would only take a matter of seconds to lower a pair of sweat pants or pajamas. I suspect the real reason for the insistence on gowns is mostly due to habit although on some level there may also be an understanding that gowns tend to infantilize and disempower patients thus making them easier to control.
So my advice to anyone faced with a hospital stay is that, unless your illness makes it impossible, insist on wearing your own comfortable clothing. I’m not certain, but I doubt that a hospital can forbid this as long as your attire does not interfere with your medical treatment.
MG

 
At Sunday, December 25, 2016 7:54:00 AM, Blogger Biker in Vermont said...

MG, I think you are exactly right. In a situation such as yours where the ongoing medical treatment does not involve anything below the waste, in the off chance that they do need access, you can easily comply by temporarily lowering your pants. The rest of the time you can be more comfortable such as you were.

I think it really is just habit formed over many years of staff finding it easier to have all patients naked rather than have to think through what is needed on a patient by patient basis. This was then reinforced by most patients just automatically complying.

 
At Tuesday, December 27, 2016 9:03:00 PM, Anonymous Anonymous said...

Thread under general nursing on Allnurses Family Feud, what would a nurse like to do to a hot male patient

PT

 
At Thursday, December 29, 2016 2:35:00 PM, Blogger NTT said...

Good evening:

PT, patients must always be on their guard when dealing with the medical community.

Allnurses shows how really immature some nurses really are.

May you all have a happy, safe, and healthy new year.

Regards to all,
NTT

 
At Friday, December 30, 2016 9:39:00 AM, Blogger Biker in Vermont said...

NTT, yes patients need to be on their guard for immature or unprofessional nurses or other medical staff. Most of us here have experienced it somewhere along the way.

However, as a frequent flyer in urology matters, I can attest that the vast majority of nurses & techs are professional in their demeanor and that they do try to minimize our exposure to that which is necessary.

The larger problem is not the few rogue nurses/techs that either are not respectful or that enjoy their job in ways they shouldn't but rather the system itself that makes little effort, if any, to bring more men into its nursing & tech ranks.

As has been said many times, the only way in which we will bring about change is by speaking up. Maybe some landmark lawsuit will come along or a piece of legislation but quite frankly neither are likely to happen anytime soon. Society isn't there yet.

So, yes to having your guard up, but at the same time we must be ready to speak up. The more who do the more it will be taken seriously.

 
At Wednesday, January 04, 2017 6:03:00 AM, Blogger Biker in Vermont said...

For some, any opposite gender intimate medical exposure is not acceptable. For some it doesn't matter at all.

For the majority I suspect the issue is more the manner in which it is done. By that I mean the degree of professionalism on the part of the medical staff and whether the exposure was kept to the minimum necessary for the procedure. This group might prefer same gender staff but will accept opposite gender rather than forego treatment.

In opposite gender medical scenarios communication is the key to meeting the above noted criteria. Taking the high road in an "I'm OK, you're OK, but we have this issue to address" manner is always the way to go. One can express themselves clearly without becoming argumentative, even if the other party isn't responding in the same I'm OK, you're OK manner. Not doing so surrenders your power in that dynamic. It is hard for one party to argue if the other party doesn't respond in kind.

A very straightforward way to express yourself can be along these lines. "Nothing against your qualifications or professionalism but I'd of preferred same gender care. I know you are not the one that chose not to hire any male staff, but you can make this less uncomfortable and embarrassing if you can assure me my exposure will be minimized as concerns what is exposed, how it is exposed, and to whom it is exposed. Can we proceed on that basis?"

The response will assuredly be something to the effect that absolutely it is how she does things, because in her mind it likely is.

It is then your opportunity to help define your actual expectations (assuming you know the basics of the procedure beforehand, something we all should make an attempt at).

If for example, it is a cardiac cath, you can say "I take that to mean then that my groin shaving will be one side at a time with my genitals being kept covered and then when it is time to apply the disinfectant and drape me in the lab that I will put the towel covering my genitals in place before you lift/remove my gown". She then knows your expectations are that there will be no genital exposure being the procedure doesn't actually involve your genitals.

Using bladder cystoscopy as an example where genitals are part of the process, when it is your turn to define your expectations, it can be along the lines of "By minimizing my exposure I mean my gown will not be lifted until you are ready to immediately put the cover cloth (a cloth with a hole in the center for the penis) to cover the rest of the genital area, that nobody other than the doctor will enter the room once the prep process has begun, and that when you are done with your prep you will offer me the kindness of maintaining eye contact while we wait for the doctor."

Approaching things in this manner is way better than complaining about it in arrears. Understanding what the procedure might entail really helps as otherwise you are at a disadvantage in defining your expectations other than in the most generalized fashion. This is now part of my routine.

 
At Friday, January 06, 2017 3:20:00 PM, Anonymous Anonymous said...

Obamacare and associated CMS initiatives scheduled to take effect this year and future years would have placed increasing pressure on health care providers to meet certain value based goals. These value based goals, depending on the setting, included a patient satisfaction component. This has been frustrating to physicians and hospitals - probably because for most of their existence they were not accountable for patient satisfaction or quality of care. For patients wanting a better healthcare experience, these CMS imposed requirements were becoming more helpful.

Such requirements may not survive the healthcare reform in the coming months. Initially I was concerned about this but now that I’ve reflected more I think all of the upheaval and discussions about our US healthcare system may actually help effect change for the better of the patient. If indeed as Pence and Trump would like, we go to more of a market driven system, the customer (the patient) ultimately will have more choice in which physicians and clinics they choose to receive care from. I would think healthcare providers and insurers would need to be responding to patient choices and needs if they care to survive and thrive. Perhaps we do need more “market” and less “status quo” in healthcare.

I also think constant discussions about healthcare may be helpful in attracting more men into this line of work. Regardless, we can use the ongoing healthcare discussions to advocate for more diverse staffing in physicians offices, clinics and hospitals and for meeting the needs of not only female patients, but male patients.

So I’m more optimistic that the turmoil in healthcare we face in the coming months may actually be beneficial in the long run. In the meantime, advocate heavily for your care preferences. — AB

 
At Saturday, January 07, 2017 11:18:00 PM, Anonymous Anonymous said...

Biker in Vermont

Your suggestions when communicating a preference, way too nice. Why? I don't care whose toes I step on. It's my money, I'm
paying for a service, I'm the patient and it's my body. Believe me, when they are the patient it's an assumed expectation.

PT

 
At Sunday, January 08, 2017 12:23:00 PM, Blogger NTT said...

Good Afternoon:

Biker's way looks to try & promote goodwill rather than an adversarial atmosphere between staff and patient from the start. Stepping on toes right away is gonna make the staff not want to work with the patient whereby creating a lose lose situation instead of a win win that everybody wants.

Regards to all,
NTT

 
At Monday, January 09, 2017 10:13:00 AM, Blogger mitripopulos said...

It's all very nice to approach matters in a polite and socially acceptable manner. Nevertheless, many times the response is rude,nasty and insulting. I have made it a matter of practice that when this happens to me I will take the individual off at the knees and then speak with the department manager, supervisor or doctor involved before proceeding. In all cases when going over someone's head for their difficulty the response is accommodating and respectful and the person involved is either removed or has a sudden change of attitude after their superior deals with them. I can never stress enough that health care is a service industry and you are the paying customer whom they must please and who's money they desire to pay their salaries and expenditures for overhead or face complaints being filed with insurance companies,dept. heads, managers and CEO's.

 
At Wednesday, January 11, 2017 11:48:00 PM, Anonymous Medical Patient Modesty said...

I just came across this guest post, Why Men Patients are Forced to Man Up in the Medical Setting that I believe Biker in Vermont wrote. I thought it was a good article that addressed male patient modesty.

Misty

 
At Thursday, January 12, 2017 4:36:00 AM, Anonymous María said...

"The same respect and dignity cosiderations routinely afforded
to women" (or words to that effect) "values the lives of men as
they value women" HA HA HA HA HA HA HA HA HA HA HA HA HA HA HA
I have trouble taking seriously or even believing someone that
believes women are treated with dignity when it comes to health-
care. If you start on those flawed premises, you're on the wrong
foot, folks. Get into your thick skulls: the respect you think
is there is i fact nonexistent. It's only due to skewed gender
ratios in the nursing profession as a result of paying the lower
skilled lower wages, and nursing was not a skilled line of work
at the very beginning. It's regarded as a caring profession, thus
more fit for females. Have you ever read a female modesty thread?
It's full of violations, if not downright physical and sexual
assault. Not to mention that many tech jobs and anestesiologists
are male. Need a female Ob-gyn in rural areas? good luck with
that.

 
At Thursday, January 12, 2017 1:55:00 PM, Anonymous Medical Patient Modesty said...

Maria,

We definitely have gotten many female patient modesty violations over the years. In fact, we have a listing of some female patient modesty violation cases on MPM’s web site. It is definitely a challenge for women to find a female ob/gyn in some rural areas. I have noticed that it is harder for male patients to find male nurses in rural areas too.

Misty

 
At Friday, January 13, 2017 6:59:00 AM, Blogger NTT said...

Hello Maria:

Yes abuse is still happening to both men & women.

Problem is when these abusers get caught, our criminal justice system doesn’t see it as a “real” crime and never really punishes those people to the full extent of the law. The prosecutors are allowing these people to plead a felony offense down to loss of license, suspended sentence, with community service. So as long as there is no real deterrent in place, why should these people stop?

However, you have the power to change that. Next time your elected states attorney or their colleagues gets a healthcare case of abuse & gives the defendant a suspended sentence with probation & community service, vote them out of office next time they run.

Patients also have a responsibility to take the bull by the horns & if they feel they have been abused, SAY SOMETHING to someone in authority so thee people can be punished.

Regards to all,
NTT

 
At Friday, January 13, 2017 10:10:00 AM, Blogger NTT said...

Good Afternoon:

One way you might get more people to speak up about their modesty concerns is by having the doctor that orders ANY test for procedure having to do with an intimate area sit down in the privacy of their office with their patient & fully explain to them what is going to happen when they go for the test.

Some would say, "well they don't have a clue what goes into one of these tests".

Well maybe it's about time they did.

The sit down in the doctors office would lessen the anxiety level and potential humiliation factor the patient would suffer.

In the privacy of the doctors office the doctor explains to their patient about the test prep, the test itself, and the fact that someone of the opposite sex may be giving the test.

The patient who doesn't want to be exposed in front of the opposite sex can calmly explain their position to their doctor.

If the doctor can't help them out, the patient then under no pressure has the choice of going through with it or just saying no thank you.

If more men & women new ahead of time the prep, procedure, & possibility of the opposite gender running these tests, more people would speak up.

The healthcare industry knows if they can get ya in without you knowing ahead of time what's involved, they've got ya & whatever needs to be done they will do because most people don't want to rock the boat so they won't speak up & say anything.

Another possible benefit is if the doctor has enough of their patients saying no due to gender concerns, maybe it becomes an eye opener for them & maybe they try & do something about it at the facility they send patients to or find a facility to work with that is more gender friendly.

Having people walk away from needed healthcare is not the answer. The system is broke & we ALL need to fix it.

We have to have hope & we can't stop talking about this to anyone who will listen until such time that parity comes to the system.

Regards to all,
NTT

 
At Friday, January 13, 2017 12:47:00 PM, Blogger Biker in Vermont said...

Maria, nobody is saying that women don't experience modesty violations. They do. What is being said is that the relative lack of male nurses & techs in combination with societal norms that men should not be modest make for a very different scenario than what women face.

OR and ER scenarios are in a world of their own where it seems nobody can get same gender care and with staff concern for patient modesty being a somewhat lower priority than it might be in other settings. Fortunately for most us most of our medical interactions are not in the OR or ER.

As Misty says rural areas sometimes have few options when it comes to specialties and that might mean a woman who wants a female GYN will have to drive further to get it. However, when she does get to that female GYN she is virtually 100% guaranteed than the nurses & techs involved in her intimate care will be women. Conversely, men can fairly readily find a male urologist, but when he goes to that urologist, he is pretty much guaranteed that all of his intimate care will be done by female nurses & techs. Been there done that dozens of times.

When a woman goes for a mammogram, she is guaranteed it will be done by female staff. When a man needs a testicular ultrasound, he usually has to search far and wide to find a male sonographer.

In a nursing, rehab, or hospital setting a women patient is never going to have a teenage boy CNA come into her room to bath her or help her take a shower. Teenage girl CNA's will be sent in to bath or shower male patients.

When a woman does express concern over male staff for intimate matters, she generally will not be bullied or belittled. Not so with men who express concerns.

So yes, women can and do have modesty violations but the situation is not comparable to what men face. Society recognizes women often have modesty concerns. It does not recognize the same for men.

 
At Friday, January 13, 2017 1:11:00 PM, Blogger mitripopulos said...

General information for men: if having a scrotal sonogram/ultrasound at a hospital or medical university hospital request a male DR. of radiology to do the test. When the institution calls to make the appointment again clarify the request for a male radiology doctor and again when showing for the appointment verify the request. I found in Utah after being told by ultrasound clinics that they were professionals, I called the university hospital radiology dept. if they could accommodate my request which they verified that they could. Then I went back to my Dr. and told him to clearly state my condition when placing the exam order. Learn to circumnavigate the system and make it work. Only you can look after your best interests and way would anyone trust a stranger despite what they say.

 
At Friday, January 13, 2017 5:36:00 PM, Anonymous Medical Patient Modesty said...

The medical industry is becoming increasingly gender neutral and this poses a serious problem to both male and female patients. As the founder of Medical Patient Modesty, I have learned a lot things that surprised me for the past few years. I personally have never heard of male mammogram technicians. However, I have heard of male technicians doing transvaginal ultrasounds on women. I was shocked to learn that one female gyn employed a male technician in her practice to do transvaginal ultrasounds. Many women do not realize that they must choose an all-female ob/gyn practice that does not rotate with male doctors in order to be guaranteed that they would have a female ob/gyn deliver their baby. You can see the article I wrote about same gender maternity care. Notice Dr. Sherman’s comments about how easy it is for a woman to get an all-female ob/gyn team in the office, more difficult in the hospital unless the woman takes steps.

Most Labor & Delivery units at hospitals in many states do not employ male nurses. But many of them allow male scrub technicians that could participate in prepping a woman for C-Section and gynecological surgery.

Unfortunately, I have learned that more male CNAs are even giving women a bath today. In fact, a male CNA at a local nursing home was charged with raping some female patients and he is in prison. The Labor & Delivery unit at a nearby hospital does not allow male nurses to treat female patients, but their heart center (another department) has male nurses who bathe female patients.

It is true that it is much easier for a woman to get an all-same gender care than male patients in many cases especially in doctor’s office. It is very disappointing that many urologists are not sensitive to male patient modesty like many female ob/gyns are. I was disappointed when I talked to a female doctor about male patient modesty and how she seemed to think female patient modesty was more important. I think I opened her eyes how important it was for male patients to have the option of male nurses.

I find it very sad that the all-female ob/gyn directory is much bigger than the all-male clinic directory. I find it shocking that many urological practices even in big cities such as Detroit are hostile to male patient modesty and won’t hire male nurses or assistants. We need more all-male urological practices similar to this one in San Antonio.

Misty

 
At Saturday, January 14, 2017 1:49:00 PM, Blogger NTT said...

Hi Misty:

There’s a couple places I know of that call themselves Male Clinics however, if you look at the employee roster you’ll find female nurses, doctors & other staff members on the list. I called one of the places on it & they just hung up on me.

Because the public in general has no idea what goes on behind the “hallowed walls” of the healthcare industry and many don’t really want to know unless they have to, this disparity will continue to exist and get worse until such time as enough people who have had dealings with the system & see for themselves how bad it really is and demand change.

A place to start is at your PCP’s office. Some physicians refuse to deal with patients with modesty issues & force you to find a new doctor. Hopefully, yours isn’t one of them.

If your doctor requests a test or procedure, ask them while you’re there with them to explain in detail what it is they are asking you to get done.

If what they’re asking has any type of intimate exposure on your part and you have reservations about going through with it, explain your position to your physician. Don't be shy about it.

If your physician knows your concerns up front & will work with you, that would give them the ammunition they need to then go up the chain to the facility & say, “Hey, my patients are uncomfortable having opposite gender staff doing intimate type tests & procedures on them. We need to correct this situation as I don’t want my patients needlessly dying when the problem is with the system not the patient.”

If enough PCP’s get the message that their patients are unhappy, maybe just maybe something may change.

Let’s face it, if you haven’t had to deal with the issue you don’t know what it’s like therefore, you’ll just go with the flow so to speak. People need to know what’s really going on.

On a side note. Usually if a male healthcare worker assaults a female patient, they are going to go to prison over 95% of the time. Not so with female workers who assault their patients especially males. Usually they lose their accreditation & wind up with probation & community service. The justice system just doesn’t see it as a crime against men.

It wasn’t a healthcare worker but a 24 year old female school teacher from Houston TX who was convicted of assaulting her 13 year old male student and she thought she’d get off with probation got her eyes opened for her.

Yesterday, the judge in the case decided he’d had enough of women assaulting men and getting a pass on it & decided to make an example of this woman to the nation & sentenced her to 10 years in prison of which she has to serve 5 of those years before probation becomes available.

Maybe that tide has begun to turn now & other judges will follow suit & start putting female abusers behind bars. That in turn, might start making female hospital works think twice before snapping that picture.

Regards to all,
NTT

 
At Friday, January 20, 2017 7:47:00 AM, Blogger Biker in Vermont said...

I observed a forum discussion elsewhere that boiled down to feminism vs men's rights. Lots of varying viewpoints of course but there were a couple excellent points raised that are pertinent to this discussion.

Some men complained that women have ignored seeking equality with men in areas where women are advantaged. Things like Family Court, Military (have the right to be anything they want in the military but not the obligation to register for the draft), Education (boys don't graduate high school or college at the same rate as girls yet there are many education initiatives aimed at girls) and healthcare (Women's Health Centers but not Men's Health Centers, women live longer than men but much focus and funding of women's health rather than men's), and so forth.

The response? Women organized and advocated for themselves to eliminate discrimination and other wrongs, why in the world do they need to take on men's issues too, if men feel disadvantaged then they too need to organize and speak up for themselves, don't just sit back and blame women where men are disadvantaged.

So why don't men organize and advocate for themselves? Men Are From Mars, Women Are From Venus. I'm stereotyping here and any one of us can come up with examples to the contrary, but generally speaking women are more collective in supporting each other and sharing their feelings with each other whereas men tend more to be solitary on deep matters. Women seemingly share everything, and I have often been shocked at some of what I have heard women sharing, but perhaps this is what allowed women to organize and advocate for themselves.

Men talk sports, weather, work, projects, politics, and so forth, but rarely do men share actual feelings or emotion with other guys or talk about truly personal matters. It is too risky in that it can make them appear vulnerable which in turn calls their masculinity into question, their alpha status if you will.

Bring that over to the healthcare settings that we discuss here and the result is people like me who has joked with my buddies in a bravado kind of way about intimate exposure that actually embarrassed me, but I dared not say so out of fear of being called a wuss or subjecting myself to jokes that maybe I was ashamed of what the nurses/techs were seeing. So it is all presented as a big joke, I was their treat for the day kind of thing, they got to see a real man etc. It is likely some of them are also embarrassed and/or just unhappy with the double standard but they're not going to say it either for the same reasons. This being the case, of course men aren't going to organize and advocate in the way women did to advance their causes. And so nothing changes unless men get a free ride on changes women made happen.

 
At Friday, January 20, 2017 8:44:00 PM, Anonymous Anonymous said...

Biker in Vermont

What you say is true. Men are from Mars and women are from Venus, however, that mentality stops at the door and what I mean
by that is that regardless of the gender we are still patients. Men may not advocate for other men but it is the job and responsibility
of those in healthcare to advocate regardless of the gender of the patient.

On another note I want to remind everyone of the patient whose genitals were photographed by a chief resident at a notable
hospital and as a result awarded $ 250,000. The resident was terminated and reprimanded by the Arizona state medical
board. What do you think his disposition of those in healthcare is. Do you think he could ever trust anyone in healthcare and
rightfully so. How many people are there like him in society? What those in healthcare continue to say to him that, " we are all
professionals". He most likely would think, what a joke. It's laughable that phrase is even used.

Here is a hint. I have worked in many industries and I'll say most of the people I know in healthcare are the most Lazy, ignorant
fake people I have ever met. They are there for just a paycheck.

PT




 
At Saturday, January 21, 2017 10:05:00 AM, Blogger Biker in Vermont said...

PT, you say "but it is the job and responsibility
of those in healthcare to advocate regardless of the gender of the patient."

For the most part they don't see it as a problem that needs solving, so change will be slow coming from that front. I will say (and have said in the past) that recent decades has seen a tremendous improvement in staff professionalism in this regard. They are better trained and protocols have improved. What hasn't changed is that women still provide virtually all of the intimate care. The mindset that medicine is gender neutral as concerns at least male patients continues to rule the day.

 
At Sunday, January 22, 2017 8:17:00 PM, Anonymous Anonymous said...

Hi Everyone .
Just came across this bit of info . Bogus doctor performed physicals at high school.
http://www.philly.com/philly/education/20170121_DA_probing_fake_doctor_who_examined_Phila__school_students.html
Notice how cavalier everyone seems to be . The school say's they will give the students another physical for free . No one stepping up to explain what happened . No one arrested . The doctor was female but no mention of the gender of the students .
AL

 
At Sunday, January 22, 2017 9:29:00 PM, Anonymous Anonymous said...

She needs to be charged with sexual assault - the question is whether she will be or not. These were student athlete physicals, so likely included hernia checks on males. Who knows what else. I hope some of the parents file lawsuits also. And once again another school assumed it was best to have only one gender of “provider” doing school physicals for teenagers. Maybe there will be enough discussion to change school district policies there. — AB

 
At Tuesday, January 24, 2017 11:45:00 AM, Blogger Biker in Vermont said...

I had responded to the Philly fake doctor thing but it seems to have gotten lost. My internet service leaves much to be desired.

Anyway, I had looked up the forms they use, and yes it does include a genital check for the boys (not the girls). Whether this "doctor" was just looking to make a quick buck or she was a pedophile/voyeur or both we can't know but yes she was given access to naked teenage boys.

 
At Wednesday, January 25, 2017 9:53:00 AM, Blogger A. Banterings said...

Yes, but no harm was done...

She was wearing her magic white coat.


--Banterings

 
At Wednesday, January 25, 2017 6:19:00 PM, Anonymous Anonymous said...

If this were a male he would be on the FBI's most wanted list

PT

 
At Thursday, January 26, 2017 5:07:00 AM, Blogger NTT said...

Good Morning:

Without a doubt PT. I sincerely hope the parents of those kids come to their senses & sue that school district.

If they should find the perverted individual that perpetrated this, she would be locked up & the key thrown away. They'd do it if it was a male.

Regards to all,
NTT

 
At Thursday, January 26, 2017 10:29:00 AM, Blogger A. Banterings said...

Just think how this is going to change their view of healthcare. Do you think that these children are going to want to undress ever again for another doctor or nurse?

These people must be treated as survivors of sexual assault. Healthcare needs to earn their trust again. The worst thing that can happen to them is another physician insisting (instead of politely asking) them to undress for something and not fulfilling (the physician's) fiduciary duty by respecting their answer and NOT denying them services.


--Banterings

 
At Friday, January 27, 2017 6:11:00 PM, Anonymous Anonymous said...

The sexual objectification of male patients

Recently, a medical conference was held at a popular restaurant with the conference room being partitioned. The
subject of the medical conference was priapism, a medical condition whereby the erect penis does not return to
the flaccid state within 4 hours. This condition if untreated can result In gangrene of the penis and ultimately death.

There were among the group some female nurses, interventional radiology techs and physicians. When the subject
of the conference was announced some of the female attendees laughed and giggled. Not sure why anyone would
think the subject was funny, particularly a potentially fatal illness. Someone among the conference should have said
to those who laughed and giggled, " what is so funny". This was relayed to me by a physician who attended the
conference.

A male patient was having abdominal surgery at a major teaching hospital. The male surgeon continually commented
during the surgery about the penis size of the patient. The discussion centered initially about the patients occupation,
which as I recall was some kind of manual labor on an oilfield. The discussion then returned to the patients penis size
and why anyone with a large penis would work in an oilfield. During the surgery there were several female nurses in
attendance. This story was relayed to me by the a male staff employee in the surgical suite.

PT


 
At Saturday, January 28, 2017 6:35:00 AM, Blogger NTT said...

Good Morning:

These people should stop & think before they open their BIG mouths.

What if it were a relative of their own in the situation? How would they feel then knowing everyone is talking and laughing about one of their own relatives?

The US healthcare workers are losing more credibility with each passing day.

Until workers that see these infractions occur and report these people, the entire industry will continue to take a hit (which in the current state of affairs is well deserved).

Workers that see these things happening know they are wrong so why not DO THE RIGHT THING and report these people.

The industry DOESN’T NEED these kind of people.

Who cares if it’s a hospital administrator, doctor, nurse, or lowly tech. If they abuse a patient whether it be physical or mental, IT’S STILL ABUSE.

If they can do it to one patient, there’s no reason to expect your loved one won’t be next.

Do you really want these kinda people taking care of your loved ones in their time of need?

If not then it’s time to DO SOMETHING about it & report these people.

Regards to all,
NTT

 
At Saturday, January 28, 2017 8:41:00 AM, Blogger Biker in Vermont said...

A question for you Dr. Bernstein, not to put you on the spot but rather on account you are the only physician here that I know of. If there are other physicians, nurses, or med techs here, please jump in too.

The two examples PT gave of medical staff sexualizing patients is not the first time such examples have been given. Within my experience of having had maybe 40 extremely intimate procedures by female nurses & techs, 2 of those experiences were ones in which I was sexualized by nurses who behaved unprofessionally. Based on that my unscientific conclusion is that the bad apples represent maybe 5% of the total. That doesn't include those who maintain the proper decorum with patients but then sexualize them when the patient is out of earshot or is unconscious. I have no way of knowing whether that has happened to me and thus am not counting that in my 5%

The question then is why do the professional 95% tolerate the unprofessional 5%? In PT's example why wouldn't even one person there have called out the nurses who found priapism something to laugh about? Why wouldn't at least one person in that OR have called out the surgeon who found the patient's penis size a worthy topic in a prurient way?

 
At Saturday, January 28, 2017 11:20:00 AM, Blogger Maurice Bernstein, M.D. said...

Biker, As I may have noted in many previous Volumes, I am not a surgeon though I have been in operating rooms in the last few decades with my medical students as observers of the professional activity there. And all we have seen was professional activity and nothing unrelated to the surgical purpose for the presence of the patient in the operating room. Actually, the only gross misbehavior I have ever witnessed (and I may have noted it on these Volumes in the past) was when I was an intern standing at the operating table and watched the orthopedic surgeon get upset and throw a scalpel toward the instrument nurse. I have seen no sexual misbehavior either verbal or otherwise. I have repeatedly seen after necessary anti-bacterial preparation of the skin, the exposed penis would be covered promptly.

I think that medicine and surgery these days sets a time limit burden on all professional participants and there is no time for sexual distraction and professional misbehavior either in the operating room, exam room or hospital ward.
Yes, I appreciate that documentations of behaviors of specific "bad guys and gals" are present and are probably valid but this is not what characterizes medical or surgical practice today.

Yes, if you see "bad actors" then speak up and do something about it. My job currently is to teach patient and professional dignity to my medical students and later it will be up to them and up to their patients and the visitors to my blog thread to keep my teaching alive. ..Maurice.

 
At Saturday, January 28, 2017 1:11:00 PM, Anonymous Anonymous said...

Maurice

Many years ago I recall seeing a whatnot ( dust collector) in an antique store. It was three monkeys with each monkey
either covering their ears, eyes or mouth. The engraved caption read see, hear or speak no evil. I think at one point
everyone has seen one of those or had one in their house. There is no excuse for bad, unprofessional behavior in
healthcare and from what I've seen nothing has changed. Yes, I too have seen surgeons throw scalpels, hit the surgical
techs with a heavy mallot, call them a bitch and just about every name in the book. I've seen a heart surgeon and the
anesthiologist get into a fist fight during open heart surgery case.

The worst case of sexual objectification I've seen was the entire staff bathroom of a MICU unit ( medical intensive care
Unit) covered with full nude foldouts from play girl magazine. Every square inch of that bathroom in the nurses station
was covered with nude male pics and all the staff were female nurses. So you can say that every male patient on that
unit was sexually objectified. I've seen many male physicians purposely sexually objectify their male patients particularly
when female staff are present, why? Perhaps to somehow get a rouse out of them.

PT



 
At Saturday, January 28, 2017 3:04:00 PM, Blogger Biker in Vermont said...

Thanks Dr. Bernstein. Certainly I will speak up. We all should. To any medical staff out there who read this, remember that you are our advocates when we are at our most vulnerable, and we are most vulnerable when we are unconscious, incapacitated, or otherwise not physically present to demand we be treated with respect.

 
At Monday, January 30, 2017 12:09:00 PM, Blogger Biker in Vermont said...

Shifting gears away from the fake doctor discussion, I am starting to think that the conscious sedation (Versed etc) of patients that is in widespread use really is optional for patients that speak up. I do not react well to sedation or to anesthesia. They make me nauseous, give me a headache, and I have a hard time waking up from them. For many the issue is not knowing what is happening when they are sedated. I'm in that camp as well.

I had noted as did someone else here that I had a colonoscopy without sedation and that it was not a big deal. I'll do it that way again this Spring. The physician's office told me I had to be sedated but then yielded when I said I'd get it done elsewhere. I recently asked a cardiac cath lab if being sedated was mandatory for a cardiac cath. Going by their literature you'd think it was mandatory but I asked and was told that no it is not mandatory. Only patients that ask are going to know that.

If sedation is not as mandatory as most of us have long been told, then it begs the question as to why it is presented to patients as something that is mandatory. I am thinking the answer has two components. First, they correctly know that many patients really do not want to know how anything is done, that they want to be put under before the prep begins and then wake up when the surgery or procedure is over. Ignorance is bliss for the majority.

The second reason then must be it is easier for the staff to have a sedated patient who will have no memory of what was done. That way they don't need to be concerned with exposure issues in terms of what was exposed, for how long, or to whom. Using the cardiac cath example, for a sedated patient, at the end of the procedure they could just have the patient lying there naked while they clean off the incision area. For an awake patient they'd need to keep the patient covered except for that incision area. Said another way there is no reason for the genitals to be exposed at all in this procedure but it is likely sedated patients are exposed because that's easier for the staff.

Am I missing anything? Have others here been able to skip the sedation step and been able to remain awake for the prep? Or for the procedure itself for those procedures that don't require anesthesia? If so, what procedures?

 
At Monday, January 30, 2017 12:27:00 PM, Blogger A. Banterings said...

You are going to see more cases of whistle blowers like Edward Snowden and Chelsea Manning (who society celebrates as heroes). You will also see patients recording procedures themselves. (Reference: Dr. Tiffany Ingham,
Ethel Easter, and Phoenix VA cancer patient).)

More and more the law is protecting whistleblowers because the public wants to protect itself: National Whistleblower Center, Whistleblower Protection Act, and even OSHA.

You will also see social media to start naming names and showing faces. There has already been an outcry about physician rating web sites.


--Banterings

 
At Monday, January 30, 2017 7:01:00 PM, Anonymous Anonymous said...

A. Banterings

You are absolutely right! Anyone has the right to record any conversation as long as your voice is at one point in the conversation and
you do not have to state that you are recording. In some cases you can record others without your voice. Every hospital has cameras
and record in the halls, cafeteria and intensive care units without the patients knowledge. Turn the tables on them, what's fair is fair.

PT

 
At Tuesday, January 31, 2017 8:50:00 PM, Blogger Maurice Bernstein, M.D. said...

Well, late afternoon today arrived home from medical school teaching along with a male gynecologist two groups of 7 or so second year medical students how to perform a proper pelvic exam but today just on plastic models. And yes, we both went into details of communicating with the patient and how to carry out the examination with attention to provide the patient the least amount of pain and emotional upset. And, of course, all that has been written on this blog thread was in my mind (and by the way, also, by his statements to the students, the gynecologist, though I am sure he isn't a visitor here.) It was all a rather formal teaching session--and no goofing or jokes.

Coming up in the next few weeks for all the 2nd year students is the experience that we know creates anxiety and fear in medical students of both genders: the subjects will be "standardized patient-teacher" who will guide a series of students into the performance of the pelvic exam on the teacher's own body. (By the way, on another session the students will be performing a genital/rectal exam on male teachers.)

For those who might be interested in joining this standardized patient-teacher profession, here is a link

http://www.xojane.com/it-happened-to-me/it-happened-to-me-i-teach-pelvic-exams-to-med-students-on-myself

to an article written by one (and what she writes I know is the professional activity of those folks.)

The general "take away" from my posting here is that physical modesty with respect to intimate medical procedures is not something which can not be overcome. What do you think? ..Maurice.


 
At Wednesday, February 01, 2017 7:18:00 AM, Blogger NTT said...

Good Morning:

Dignity and modesty issues can be overcome but not until the medical community as a whole admits the problem exists across all genders and they are willing to do what it takes to put the issues to rest for all concerned.

One has to first admit there exists a problem before said problem can be resolved.

It starts with the patient.

If the patient has concerns about their modesty, it’s up to them to start the ball rolling & speak up in the privacy of the doctor’s office & tell their PCP about their issues.

If a doctor then has patients with dignity/modesty concerns the doctor, being their patients advocate should discuss the modesty issue in general with their peers and other professionals at the facilities they are affiliated with.

Ask how the facility handles patients with dignity concerns.

If the facility is ignorant to those types of concerns, the doctor should push for change or affiliate with another facility that doesn’t disregard patient concerns.

If patients & their doctors speak up about modesty/dignity issues, sooner or later the entire medical community will have to take notice & admit there is a problem that we had better solve.

The silent majority out there MUST SPEAK UP NOW for the greater good of all.

Believe it or not, this issue effects EVERYONE.

If the medical community ever admits they have a problem, one of the best ways to solve it is to encourage more men to enter nursing and med/tech programs. The nursing profession also needs to accept men with open arms into their once female only club. I know for some that’s very hard to do.

Hospital administrators.

Stop complaining about costs all the time & hire the staff necessary to make sure ALL your patients get the best possible outcome from their visit to your facility. People retire, people leave all the time. Don’t just hire a woman because nursing is a “woman’s” profession. If there is an equally qualified male why not give him a chance? And please don’t even think about gender wars. There’s no room for such pettiness in a hospital.

Facilities.

On your intake paperwork do you ask “Do you as a patient require same gender care”?

If not, WHY NOT? Why not ask up front when the patient first sits down with you to go over everything?

Staffing Mgrs. & Supervisors.

You are the people that set the schedules I suspect.

You have a patient coming in a couple of days for an invasive procedure requiring access to intimate areas.

You see by the name that the patient is female so without really thinking about it you schedule an all-female staff to be present for the procedure to make the patient comfortable.

What if the patient was a male? Would you give him the same consideration you gave the woman? Would you even bother to find out if he would prefer a same gender team?

I seriously doubt it. You’ve been taught women are the weaker sex men will take anything you throw at them & not say a word.

It’s that mindset THAT MUST CHANGE.

As Dr. B. says physical modesty with respect to intimate medical procedures is not something which cannot be overcome.

We can overcome it but not until the medical community admits they treat people differently on this subject & they REALLY want to fix the issue.

Have a great day.

Regards to all,
NTT

 
At Wednesday, February 01, 2017 10:48:00 AM, Blogger Biker in Vermont said...

Can modesty be overcome? It depends on the source of the modesty.

If people are modest because that's the way they were raised, then yes they can overcome that as an adult if they are open to change. Working up the courage to go to a nude beach or similar setting just once could be all it takes (assuming it was a positive experience). Or having a medical encounter where they were treated respectfully and the patient's interpretation was that their exposure was nothing sexual for the staff. Note that I say patient's interpretation.

If the source of modesty is body image, it is a maybe depending upon what their experience has been. If the body image is internal based on how they feel about their genitalia or weight say, they can get over it if they muster the courage to have exposure such as described above AND not get negative feedback as a result. In this scenario the person realizes that they're OK just as they are, that others aren't going to judge them. A more positive body image can then carry them forward.

If the reason for poor body image is because they have been mocked or made to feel ashamed at some point in the past, the odds of getting over that are slim. This is where a single bad experience in a medical setting can shape their approach to medical care going forward.

I fall into that last group. When at age 11 I lost a testicle to a bicycle accident the hospital staff and my parents unintentionally left me thinking I was now a defective and that I should be ashamed. And so I was but as an adult I slowly began to convince myself that I was OK. Then I had my very first intimate medical encounter as an adult (vasectomy) where I came away humiliated because of something the female nurse doing the prep said. Certainly she didn't mean to humiliate me but nonetheless it pushed me back to my 11 year old ashamed self. Ever since I have been leery of female nurses & techs despite dozens of totally professional experiences.

Dr. Bernstein, the standardized patient programs are a wonderful thing. Better students get their initial experience that way than with real patients. Kudos to the teaching staff willing to do it themselves knowing that they aren't so anonymous as outside standardized patients.

Now this is going to sound very odd given what I said earlier about myself but I would entertain being a standardized patient. Why? I am attuned to what constitutes respectful/professional treatment more than the average person. If I could help get students better cognizant of these things while they are still learning, perhaps I can save multiple patients from the couple bad experiences I have had. Additionally, my particular condition is not anything they are likely to encounter while still in school and better they learn how to handle it professionally as a student than unintentionally humiliating a patient when suddenly they encounter something they haven't encountered before. There aren't any medical schools near where I live though, the closest being 2 hours away. Locally there is a university with a BSN RN program and a tech school with an LNA program. Something to think about.

 
At Wednesday, February 01, 2017 12:44:00 PM, Blogger Biker in Vermont said...

Not to get off topic here but I am horrified at something I just learned. The technical school for my county is both a high school and an adult technical programs school. The high school has a health careers program for 11th & 12th graders covering several types of lower end health careers (LNA, Medical Asst etc). It includes clinical work in various area health settings. In 12th grade they actually work parttime in paid positions, including even in the OR at the hospital. My daughter was 15 years old for the 1st half of 11th grade and only turned 17 halfway through 12th. She was a year younger than many students, but she was not unique. Until they are 18 they cannot legally sign a contract and thus are not bound by HIPAA no matter what the school or hospital might tell them, and more importantly do kids that young have the maturity to be present with naked patients in the OR or elsewhere? I certainly don't want a 15 or 16 year old girl present if I am the patient.

How common is this putting high school kids in clinical settings?

 
At Wednesday, February 01, 2017 7:46:00 PM, Anonymous Anonymous said...

Maurice

Since you brought up the subject of a male gynecologist perhaps you might ask your female medical students or
better yet a female gynecologist if it would be appropriate to have as their chaperone a male whose entire arms
and upper chest were covered with tattoos.

As you know most hospitals have policies regarding their staff as far as visible tattoos. Apparently, one urologist
office doesn't care and did the exact opposite of what I just mentioned.

Quote from a patient making a comment on a review regarding his male urology visit. " This place is totally
unprofessional for a medical place. The worst is Dr ( male) 's nurse with murals of tattoos on her arms and
upper chest. If anyone is going here for a prostate biopsy don't ( expletive) do it.

PT


 
At Wednesday, February 01, 2017 8:25:00 PM, Blogger A. Banterings said...

PT,

As to recording, almost ALL facilities have a clause in the consent form that they (the patients) may be recorded in the course of their treatment. As mentioned on this blog, some facilities do not allow patients to cross out that section.

If there is a chance that the patient MAY be recorded, then all the providers obviously have been informed (and agreed) that they may be recorded (in the course of recording the patient. Therefore, they (the providers) have already CONSENTED to being recorded.

It would then be OK for the patient to record any provider WITHOUT asking them. This applies to calling any 800 customer service and they say "this call may be recorded," it is then OK for the customer to record as well.

Biker,

You forgot one other source of modesty; where the patient who had been previously abused in the healthcare system. This could be from being unnecessarily exposed, photographed, having repeated genital (or other intimate) exams. One of the best examples is how intersexed individuals are treated in the healthcare system. The United Nations and the World Health Organization have labeled this as torture. (Pay special attention to Section C. Medical display, genital photography, and excessive genital exams.)

Here are some other examples of healthcare that the United Nations and the World Health Organization have labeled this as torture.


-- Banterings

 
At Thursday, February 02, 2017 5:09:00 AM, Blogger NTT said...

Good Morning Everyone:

PT in regards to the female nurse with the tattoos.

Maybe they were hoping the male patient would be distracted by the tats rather than concentrate on the fact that it was possibly an intimate procedure being done in the presence of the opposite sex.

Regards,
NTT

 
At Thursday, February 02, 2017 9:24:00 PM, Blogger Maurice Bernstein, M.D. said...

Hey! I got a new concept which hasn't really been previously expressed here previously.
It was as I was thinking about the contribution of the "standardized patient(SP)-teacher".

Our second year medical students by the education actively given to them by their male or female SP teacher are having their appreciation of the important attention to patient dignity which must be attended to as part of the examination--and such dignity instructions as important as to how to insert the speculum into the vagina in the least painful way. And this, I know, is what the students are being taught.

Now, as a patient and faced with either a same or opposite gender examiner and you being subjected to a genital or rectal exam, it is my suggestion that you should look at yourself beyond that of a patient but also look and act like those highly appreciated SP teachers. There is no rules which prevent you from "educating" your examiner (even if he or she is decades away from being a 2nd year student) regarding how you feel physically and emotionally and how you should be treated otherwise if necessary. Please don't assume that a 40 year old gynecologist or family doctor shouldn't be educated at this point in their career or that they shouldn't be educated by a patient. They should have no personal feeling of "protection" against further medical education or of such education teachings by their own patients.

So yes, if you are not near a medical school to participate as a SP-teacher and even without that salary, still provide your doctor the appropriate medical education that you find is necessary.

How is that for an idea? ..Maurice.


 
At Friday, February 03, 2017 4:12:00 AM, Blogger Biker in Vermont said...

Yes it is a good idea, though not without risk. Human nature being what it is, some doctors are better listeners than others and there are some where ego gets in the way. My primary care doctor is an excellent listener and I can be very open with him. My urologist is in the top tier of the urology world and has given me excellent medical care but I think twice before I dare ask him a question about my care let alone his only hiring female staff. Fortunately to a one they have all been very well trained and never made what is an uncomfortable situation become an embarrassing one.

I will have new opportunities soon though as I am in process of transitioning to a new urologist at a major teaching hospital that is only 2 hours away vs me continuing to go all the way to Boston. The urology dept there has a number of Urology Residents, always half being male, half female plus possibly medical students from the affiliated medical school doing rotation and even nursing students. My wife was a urology patient there and she had like 4 or 5 people present for an appt. I'll let you know how it goes.

All in all, what you suggest is just another way of speaking up.

 
At Friday, February 03, 2017 5:42:00 PM, Anonymous Anonymous said...

NTT

She most likely was an medical assistant but then on the other I would wonder if she had ever been in prison and I
would pose that question to her.

PT

 
At Monday, February 06, 2017 4:18:00 AM, Blogger Biker in Vermont said...

PT, your mention that she was likely a Medical Asst prompts an interesting point. Why isn't everyone a patient comes in contact with wearing a name tag with their level of licensing? Given everyone wears scrubs these days it is all too easy for a patient to think that a CNA is an RN for example. Non-licensed staff such as Medical Assts will still be a mystery as to whether they are really a clerical person from the office or they were certified somewhere, but most of the time a name tag would add clarity. In the case of an MA, you might still get your answer by nicely saying something like "My niece wants to become an MA, what school did you get your certification at?"

While all medical staff needs to be held to the same standards as concerns treating patients with respect and dignity, as a patient it makes a difference to me. Someone who has invested 100 hours over the course of 3 months to become a CNA has much less of a personal investment at risk than does someone who has spent 4 years to get a BSN RN or maybe 12 years to become a physician.

I think the solution here is to ask any staff tending us what level of licensing they have if they aren't wearing a name badge. I did that last year when being prepped for my cystoscopy. Nobody wears name badges there. They introduce themselves as to who they are but not what they are. I asked her if she was an RN. She replied that she was an NP and that the practice generally only hires NPs rather than RNs. You'd think they'd want the patients to know that.

 
At Wednesday, February 08, 2017 5:59:00 PM, Anonymous Anonymous said...

They don't wear a name badge so they can go shopping in their stupid scrub ensemble. Just another reason why I fired my urologist. His all female assistant team don't wear name badges, they don't know how to knock before entering a patient's room and most importantly they
don't know how to take a blood pressure. Folks, it's simple. If whomever allows you to keep your arm at your side rather than holding it
horizontally while taking your blood pressure, then run like hell.

PT

 
At Thursday, February 09, 2017 1:07:00 PM, Blogger A. Banterings said...

Here in Pennsylvania it is a (recently enacted within the last 2 years) law that all medical personnel wear name tags with their position (licensing) and their name. The law also requires that the font be large enough to read and that they be visible at all times.

Note that it requires:

Employee’s title:
The title must be as large as possible in block type and occupy a one-half inch tall strip as close as possible to the bottom edge of the badge.
The title for a medical doctor or doctor of osteopathy should be "Physician".
The title for a registered nurse should be "Registered Nurse".
The title for a licensed practical nurse should be a "Licensed Practical Nurse".



Reference:

Pennsylvania’s Health Care ID Badge Requirements

Attention Pennsylvania Healthcare Facilities: Are You Prepared for the ID Badge Act Update on June 1st, 2015?

Other states such as TX, CT, UT, and WV have enacted similar legislation.


--Banterings

 
At Thursday, February 09, 2017 3:49:00 PM, Blogger Biker in Vermont said...

Interesting Bantering. On Monday of this week my wife had outpatient surgery at a large hospital in MA. The staff all wore name tags with their designation and photo on it, but they were the size of credit cards or driver's licenses. I had to strain to read whether the nurses were in fact RN's, and half the time the tags were turned around so you couldn't see anything anyway.

The 1st anesthesiologist to come into the pre-op room introduced himself and then indicated that he was a Resident. If he hadn't of volunteered that all I could have gone by was his name tag that said MD. I thought well of him for clarifying his status, though in fairness to the patient the name tag should be clear on that point.

 
At Friday, February 10, 2017 3:36:00 PM, Blogger Biker in Vermont said...

I recently posted something about my being horrified to learn that 11th and 12th graders from my county's tech school are doing LNA clinicals at the local hospital and working part time there in 12th grade, including in the OR. In retrospect I shouldn't have been so shocked being you can get your LNA license when you turn 16 in VT and NH. It's 18 down in MA.

Regardless, I contacted the hospital to pose a couple questions about the program. It took 4 business days to get an answer (from the Marketing & Public Relations Dept it turned out) which tells me they had to do some research as to what they were doing in order to answer me.

I asked about HIPAA being 16 and 17 year olds cannot legally sign contracts or be held liable for violations. The answer was "Our ability to enforce hospital policies and compliance with the law are not limited by an individual’s age.". I doubt that's true when it comes to underage kids, but I didn't pursue that one further.

I asked about whether these high school kids are doing the same clinicals as in adult LNA programs, specifically as pertains to patient intimate exposure. The answer was "All of the students are appropriately trained and supervised at all times."

I responded that he didn't answer my question and made clear that I would not agree to having any intimate exposure to high school girls. The answer was "Prior to any treatment or personal care the nurse or nurse assistant will always tell you what he or she will be doing. Students will always have a name tag that will clearly indicate intern or student, either a (school name) name tag or a (hospital name) name tag. You may decline services or care from a student if you are not comfortable and ask that they leave the room. You may also discuss your concerns with your nurse upon admission so that your preference may be honored. We want you always to feel safe, comfortable and well cared for during your stay at (hospital name)."

I thanked him for his response and wanting to get something in it noting same gender care I said "Most may not care about such things but some of us do. The demographics of the medical world are such that men who might prefer same gender intimate care usually have few options at the nursing and tech level, but for me at least I draw the line at teenage girls providing that care." I couldn't go further than that given the entire conversation had been about high school kids having patient access at the hospital.

If nothing else, I caused some level of discussion at the hospital about opposite gender care from teenagers. And I truly am horrified at the thought of a 16 year old LNA coming into the room to bath or shower me, check my catheter or do associated pericare, give me a bed pan or urinal, or help me dress or undress. LNA's do all of these things, including 16 year old LNA's.

Lastly I would add that I spent some time last weekend with my daughter-in-law's 17 year old niece from MA who will get her LNA license next month when she turns 18. She was just about to start doing her clinicals. She hopes to get into a 4 year nursing program and work part time as an LNA while she does that. She is a very nice girl but young for her age. She recently got her 1st boyfriend who is also young for his age. Her upcoming clinicals could well be the first time she has ever seen a penis and I can imagine her giggling about it with her girlfriends. Seeing her who will soon be 18 only has me shaking my head all the more at 16 and 17 year old LNAs.

 
At Saturday, February 11, 2017 5:38:00 AM, Anonymous Anonymous said...

Biker in VT - I agree, that is an age where maturity is uncommon. But I’m very curious to know if they also accept 16 and 17 y/o BOYS into the training program? They cannot discriminate on gender but experience tells me that stereotypical beliefs die hard, and I would guess they discourage teenage male applicants or at least don’t advertise to male teenagers. I’m also guessing it is females that run the program and they may not admit it but some would be appalled to allow teenage boys to perform the same tasks on women… Maybe you could call the hospital and tell them your 15 y/o son who is turning sixteen soon would like to join the program and see what they say. :-) —AB

 
At Saturday, February 11, 2017 10:49:00 AM, Anonymous Anonymous said...

Hello,

Others might be interested in this article New Details in How Female Impostor Gained Access to 5 ORs at http://www.outpatientsurgery.net/surgical-facility-administration/patient-safety/new-details-in-how-female-imposter-gained-access-to-5-ors--02-08-17. How seriously is patient modesty be considered, if the OR has become a side-show where anyone can enter with, apparently, no questions asked?

Reginald

 
At Sunday, February 12, 2017 7:06:00 AM, Blogger Biker in Vermont said...

AB, on the website all the photos for the high school LNA program are of girls and the instructor is a woman. No surprises there. Culturally up here a boy would not be discriminated against or discouraged from going into the program. The issue is how many 15 year old boys in 10th grade are going to be interested in becoming an LNA when it is perceived to be a program for girls. Without an actual outreach program that somehow tells boys it's for them too, few 15 year old boys are going to choose this option for 11th grade. The website does say that half the students do continue on to further education after they graduate. That speaks to a higher grade more serious student going into the program which is good.

I am sure that there have been boys in the program some years which I imagine would be very interesting when during their clinicals they must do pericare, bathing etc on female patients. Despite the double standard for such things the school still has to provide the boy the opportunity to complete those aspects of his clinicals for his licensing. Maybe they do that only with nursing home dementia patients?

Reginald, the article you posted begs the question as to whether there is anyone in charge in an OR whose responsibilities include making sure all the right people are in the room and that only authorized people are in the room. I found it interesting that the solution the one hospital put in place is saying physicians must verify that the students they bring into the OR are in fact students and that the practice of "tailgating" your way into an OR is hard to monitor. That does affirm that nobody is reviewing whoever is actually in the OR belongs there. It also seems to say that physicians are pretty casual about letting students shadow them if they don't even verify first that the person is in fact the student they represent themselves to be. For those of us here, it gives us yet another question to ask in pre-op. It wouldn't have occurred to me that nobody monitors who is in the OR.

 
At Sunday, February 12, 2017 10:49:00 AM, Anonymous Anonymous said...

Recently reading about two young men arrested who were caught peeping into a woman's bathroom after crawling through
ceiling duct at a local movie theatre has prompted some thought. Not only are they arrested but will have this arrest on their
records and may have to register as sex offenders. All for what, they see someone sitting on a commode and from their
perspective basically can see no nudity, yet there are countless female observers who have full access to full frontal nudity
of male patients in countless numbers for which they have absolutely no business being there. The two physician impersonators
at the high school and the operating rooms, why were they not arrested? Anyone see the tremendous double standard here?

PT

 
At Sunday, February 12, 2017 11:46:00 AM, Blogger Maurice Bernstein, M.D. said...

And continuing the discussion of who in the OR should be specifically described to the patient as part of informed consent:

https://www.washingtonpost.com/national/health-science/why-is-that-salesperson-in-the-operating-room-for-your-knee-replacement/2016/11/14/ab8172fa-78e6-11e6-beac-57a4a412e93a_story.html?utm_term=.31d141f3fbac

..Maurice.

 
At Sunday, February 12, 2017 12:55:00 PM, Blogger NTT said...

Good Evening:

How is one really gonna know who is in that OR after you are out cold even if you specifically stated on the consent form no students, company reps, video so on and so forth.

There's no way to really know unless you're having a local.

Regards,
NTT

 
At Sunday, February 12, 2017 2:36:00 PM, Blogger Biker in Vermont said...

Dr. Bernstein, I am not qualified to know if a tech rep being present is beneficial or not to me as the patient. As such I am happy to leave that decision to the surgeon, so long as the tech rep in question has been vetted by the hospital in the same manner they vet their own staff as being qualified to fill the roles that they do.

The other thing is that I expect to know that a tech rep will be there and I expect him/her to have introduced themselves to me beforehand. I am not looking to give them permission to be there, but rather the courtesy of them seeing that I am a real person and not some anonymous slab of meat naked on a table.

For any students or observers I expect to meet them beforehand and give my OK as their presence clearly adds no value to me but is rather a courtesy that I can choose to grant or not. My answer will depend upon what they are, why they want to be there and my perception as to whether they are professional enough/mature enough to be there.

 
At Monday, February 13, 2017 5:55:00 PM, Anonymous Anonymous said...

NTT

One of the surgical forms will list those present during each surgery such as the circulating nurse, the scrub tech etc. I'm now
not certain if if will list all of the names of observers, students etc. After your surgery you can request this form from your medical
records.

PT

 
At Thursday, February 16, 2017 11:50:00 AM, Anonymous Anonymous said...

Biker in VT - Thanks for the follow up on the LNA program. Your statement

“The issue is how many 15 year old boys in 10th grade are going to be interested in becoming an LNA when it is perceived to be a program for girls.”

gets to part of the problem. I think our society is failing to communicate to boys/men that there are not & should not be “women’s” jobs anymore, like there are not “just-for-men” jobs (example - look at the military). For decades there has been a push for gender equality in employment and as a result females have entered just about ALL lines of work. There has not been that same strong movement to get males into what were once viewed as women’s only jobs. In addition, the small percentage of men that do enter historically female jobs, i.e., nursing, medical assistants, dental hygienists, LNA/CNA, etc. do find discrimination and resistance from women (e.g., remember men had to sue for entry into nursing schools as late as 1982, when women already were well established in medical schools, & women to a large extent do not accept male techs doing their mammography and other intimate procedures and health care systems continue to support this double standard of care). So, despite the accepting beliefs of the State you live in Biker, I think stereotypical thinking dies hard & the LNA program isn’t going out of its way to communicate to teenage boys that medicine could be a career suitable for them or at the least a career stepping stone.

As for the reps in the OR, this was a constant at the large medical center I worked at. The article didn’t point out all of the issues with a rep being present. Here are some I had to deal with: documented evidence of HIPAA training for each rep, documented evidence they had an MMR vaccination, flu vaccination, TB screening, safety education, Competence, Infection Control training, that they only entered the OR for the patient needing the hardware/device (instead of hanging out in other rooms BS’ing with other MDs during surgeries), they did not perform the act of medicine (since they were not licensed for that) & that their presence was recorded in the medical record. The point is the rep just doesn’t hand the surgeon hardware, they could cause all sorts of issues if they entered the OR with an infectious disease, or they took cell phone photos, or they didn’t use proper infection control practice, or they were not safety conscious, or they touched the patient, etc.

Besides implant type reps, ORs may have an operator for the medical laser, if your surgeon is using one. There may be a photographer present because the surgeon wants photos of your surgery and/or wants it videotaped (yes, some surgeons do this). There may be additional reps present from a vendor because the doctor has agreed (for a fee) to make an “educational” video of the surgery or device usage. There may be observers that are part of the Hospital Boards, or Observer programs the Hospital runs. There often is a rad tech that comes in when x-rays/fluoro are needed during the surgery. There may be a biomedical engineer present if there are some equipment issues. Etc. etc.

So yes - everyone should definitely ask who truly will be present in the OR and know what your are authorizing and be clear what you do not authorize. It can be more people than the lay person has any idea about. - AB

 
At Friday, February 17, 2017 8:53:00 PM, Anonymous Medical Patient Modesty said...

I wanted to share another article, Declining Care From Physicians-in-Training: The Resident’s Dilemma with everyone. Look at the comments that Dennis made on February 4, 2014. It is sad about how he was rushed into signing a consent form without having the opportunity to decline medical students being present for his colonoscopy. This is why it is best to opt for local or regional anesthesia like NTT said as often as possible.

Misty

 
At Saturday, February 18, 2017 9:24:00 AM, Blogger Biker in Vermont said...

Misty & AB, the system very much counts on patients being uninformed. Most people (me included in years past) just sign whatever they give us. My wife has had a number of surgeries over the past year and a half and for one of them I asked in pre-op why she was just getting the forms to sign at that late stage. The answer from the doctors was that they want to make sure that the patient is fully informed before they sign. Being fully informed in that context meant the patient was given an opportunity to ask questions. The problem is patients don't really know what questions to ask because they have been told virtually nothing about what will happen in the OR.

For my colonoscopy last year I had asked for the forms ahead of time so as to read them, and lo and behold there was an additional one thrust at me after I was on the table. They just wanted me to sign it but I made them retrieve my glasses and then wait while I read the whole thing.

Back when I had my follow-up surgery to do biopsies following my original bladder cancer surgery it was only at my next doctor's appt that the surgeon told me he also biopsied my prostate that day. He hadn't told me that ahead of time but I surely consented to it on what I had signed.

Most people don't really want to know anything that happens once they are sedated. My wife is in that camp. I am not.

I would add that even if medical staff display proper identity badges, most people do not really understand the relative differences in training and skills within the nursing &tech world. A friend was hospitalized last summer and then moved to a rehab facility. I had to explain to him the difference between a NP, RN, LPN, and LNA. He had no idea.

On the article Misty posted, yes doctors, nurses, and others need to learn and it is part of the deal when you go to a teaching facility. This can be a good thing in that such facilities tend to be up on the latest and greatest and you may have the attention of 2 or 3 people rather than one. We just need to be prepared to ask pertinent questions to make sure our care is not being compromised or that we are being needlessly viplated.

 
At Saturday, February 18, 2017 4:39:00 PM, Anonymous Anonymous said...

Nothing precludes a patient from "changing" their mind, regardless of signed documents during the admission process!

Ed

 
At Saturday, February 18, 2017 4:42:00 PM, Anonymous Anonymous said...

Interesting comments in the recent Kevin MD article about chaperones during intimate exams.

http://www.kevinmd.com/blog/2017/02/victim-sexual-harassment-medical-student.html

Ed

 
At Saturday, February 18, 2017 9:30:00 PM, Blogger Maurice Bernstein, M.D. said...

Ed, what was described by that female physician is all part of the "hidden curriculum" which I have previously named here multiple times. Of course the patient was being mean and trying to upset the medical student through the sexual harassment. And then it was her superiors in the 3rd year medical student training program who added to the harassment by their behavior towards her. Unfortunately, it has, in the past, become "par for the course" as a medical student. At our school now we have curriculum staff whom the student can turn to and get personal support and investigation into the behavior of the student's superiors.

The patient's behavior is probably rare but still occurs and shows that defects in maintaining dignity between patient and caregiver is a "two-way street". ..Maurice.















 
At Sunday, February 19, 2017 6:50:00 AM, Anonymous Anonymous said...

Perhaps the 80 year old man at the link was practicing another form of speaking up. Might ultimately prove more effective at securing same gender care for a rectal exam than a more civil but a pretty-please-with-sugar-on-it discussion. I suspect that the treatment of the young resident was intended to show her the necessity of learning how to deal with all kinds of patients.

REL

 
At Sunday, February 19, 2017 7:55:00 AM, Blogger Biker in Vermont said...

Ed, I found the chaperone comment interesting too. The male doctor or nurse (not sure which) said:

I always make sure I have a female in the room when examing a female patient and I believe a female should have another person in the room as well.

So the male medical staff person wants a woman chaperone when he is with a female patient but he thinks a female medical staff member only needs another "person" as a chaperone. Clearly he means it is OK for a male patient to have a female chaperone. Why can't the medical world at least be honest and straight out say that they don't think men need the same level of respect afforded female patients?

 
At Sunday, February 19, 2017 10:15:00 AM, Blogger Maurice Bernstein, M.D. said...

REL, you posted a very interesting interpretation of the story presented by female physician about her experience as a 3rd year female medical student: That 80 year old patient's behavior towards the female who was about to do a rectal exam without chaperone was really a "speaking up" by the patient and a learning point for her. That could well be.
But what would you say about the behavior of her superiors and pointing fingers at her with the argument essentially "but it was your fault". As I said REL, "interesting". I wonder what my other visitors here think about the motivation of that 80 year old. Do you think this kind of "speaking up" to preserve one's modesty concerns is appropriate? ..Maurice.

 
At Sunday, February 19, 2017 11:43:00 AM, Blogger Biker in Vermont said...

Dr Bernstein, I think the 80 year old just didn't have much of a personal filter and was shocked at having a young female doctor of Asian descent more than he was purposely harassing her. I doubt modesty was a driving factor in his behavior.

My father-in-law never spoke an unkind word of anyone and was an absolute gentleman but he spent his life in a demographic bubble not representative of the modern world. In his late 80's he sprained an ankle and I had to take him to the emergency room. After a couple nurses had tended him an ER doc came in. It was a very young looking black woman who introduced herself as Dr so and so. Living where we did my father-in-law wouldn't have ever even seen many black people in his life nor would he have ever had a female doctor or a doctor that young, so he incredulously said "you're the doctor?". She surely knew that she represented something he had never seen before, and him being the kindly grandfather type everyone wished they had, she just graciously moved on, and fortunately he didn't say anything more.

The real problem for the young doctor was the lack of empathy and support from her superiors more than it was the old guy.

 
At Sunday, February 19, 2017 4:45:00 PM, Anonymous Anonymous said...

Physicians and associated staff are supposed to care for even the "lepers" amongst us! He was 80; give the guy a break! Plus, this happened fifteen years ago; they both need professional help.

Ed

 
At Monday, February 20, 2017 4:55:00 AM, Anonymous Anonymous said...

Maurice posted

But what would you say about the behavior of her superiors and pointing fingers at her with the argument essentially "but it was your fault".

Her superiors are guilty of having greatly overestimated her astuteness. They clearly demonstrated to her that running to a committee with situations like this in medicine is inappropriate. She should have reflected on their response and drawn the following take home message: If I can't even manage an in the office conversation with a very elderly patient, then I should look for another career. She didn't get it then and apparently, along with her husband, still doesn't after 15 years.

She still seems very focused on her own feelings. Wonder if she thinks much about how patients feel? Of course, If she needed emotional support back then, she should have looked to family and friends rather burdening busy colleagues facing many stresses of their own. Wonder if she thought much about their feelings?.

REL .

 
At Monday, February 20, 2017 6:05:00 PM, Anonymous Anonymous said...

The article is pathetic and twisted

I wish I had a dollar bill for every time I heard a nurse or physician refer to an elderly patient as " Honey or Sweetheart "

Who does this physician think she is kidding. Another feminist running amok in healthcare.

PT

 

Post a Comment

<< Home