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Patient Modesty: Volume 79
Yes, the current discourse continues to follow the issue of "speaking up" to the medical system regarding patient modesty and patient dignity. The image above speaking up by way of the bullhorn appears to be a female. It is this gender which appears to have taken the lead in the past regarding insisting that the system attends to their desires and needs. It appears from the conversations going on in the previous Volumes of this thread that it is now the requirement of men to take hold of another bullhorn and bellow out their personal desires and needs. Go to it!! ..Maurice.
Graphic: From Google Images. Courtesy of
Pixabay
NOTICE: AS OF JULY 1 2017, NO FURTHER COMMENTS WILL BE POSTED ON THIS VOLUME 79. COMMENTS WILL RESUME NOW ON
PATIENT MODESTY VOLUME 80
176 Comments:
I thought it would be worthwhile to start off this Volume with a comment written by a female visiting my well-received series of thread "Chapters" on "I hate Doctors", in this case Chapter 3. How men as well as women relate to physicians is much more complex than simply physical modesty issues. ..Maurice.
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The search words that brought me to your blog were "ambivalent about doctors" and I seriously doubted that I would find much on the topic, so this is an interesting thread. Hate seems like such a strong feeling to have toward someone providing a service to you, depending on the health system you are treated in. If you're not happy go somewhere else. But this ambivalence has followed me through the years and to different doctors. I have moved to so many when I have become upset. Now I am at the same clinic for two years as I am forcing myself to own up to whatever problem it is that I have with your profession. Unfortunately, my doctors have to stick with me too until I can sort these feelings out. I try to be fair and apologize when I have over reacted to things. As I get older I realize that it is going to be in my own best interest to establish a rapport with my doctors. Maybe the need for that causes anger. It's hard. I hate feeling observed like a specimen and I hate feeling like I'm being processed and needled around in a petrie dish. I hate the need for that "relationship" with all its boundaries and I both feel for those who have to maintain them on a daily basis with multiple patients. I also wonder how they could be so emotionally controlled. I've considered some more personal causes for this love/hate thing I feel. Maybe it has something to do with watching my mother die at a very young age and no one being able to save her. Maybe it's because no one saved me in the horrible years that followed. Now that I am older I consider that it's because you belong to an exclusive group and have access to information which I often do not. The world works around you to support you in delivering care to others and what a wonderful thing to be a part of, but this puts you at the center of everything with everyone catering to your needs. Perhaps this is deserved with all you have to face. Perhaps that could be the problem. You and those who work around you are the hopeful solution and as a patient we are part of the problem and to some, but not all physicians... a bit of an inconvenience. I think this is an important thread. What a wonderful topic to discuss especially with all the changes that have taken place in healthcare with mergers and acquisitions and the corporatization of medical facilities and employment of previously independent physicians. I know this thread has been open for many years, but I felt the need to add. I'll look forward to going back through the thread to read more.
Renee
Dr. Bernstein, I took a few minutes and read some of that "I Hate Doctors" thread, and I don't relate to it at all. Perhaps the difference is that I don't expect doctor's to be all-knowing and perfect. As a child I paid dearly for a missed emergency room diagnosis and so I know the downside of medicine. We say the art of medicine rather than the science of medicine. We use the term medical practice, not medical perfect. There are often going to be multiple possible diagnoses, and the wrong one is sometimes going to be chosen. Get a second opinion if your belly twitch says the doctor missed something.
Many of the posters in that thread talked of doctors that don't listen to what the patient is saying. Find another doctor if you can if that is the case. I love my primary care doctor in part because he is such a good listener. The urologist I recently left after many years was top notch technically but the ego was such that I was afraid to even ask him questions. That's not why I left him but it did feel good to have an actual conversation with my new urologist. After one visit with a cardiologist that wasn't listening to what I said, I heard one of his partners speak at an info session and switched to him. He does listen and puts effort into explaining the options instead of just telling me what he is going to do. I'm sticking with him.
Generally speaking women are better listeners and/or connecting at an emotional level and perhaps that in turn drives their having different expectations of their doctors. For me however I will continue to only go to male doctors for anything that involves or might lead to intimate care. That variable is more important to me than their listening skills.
In response to Biker's comment above, it's been my experience that women providers tend to be good listeners and are often more sympathetic to patients' feelings -- with the egregious exception of my own "chaperone" experience, recounted in vol. 78. But my (male) PCP has strongly recommended that I stick with male providers if I want to avoid spectators for my intimate care.
BTW, I'd like to repeat my "plug" for folks to try commenting on the following articles:
This one relates to the issue of men's gender preferences in health care:
https://insight.athenahealth.com/new-data-suggests-male-patients-less-likely-return-women-doctors
This one is an abstract for a presentation advocating for a universal law requiring "chaperones" for intimate exams. The speaker (who has "MD" after her name) makes the ridiculous claim that required witnesses would actually increase patient participation in intimate screenings like DRE's:
http://jdc.jefferson.edu/mphcapstone_presentation/135/
Biker and I have both tried unsuccessfully to post responses, but maybe a barrage of them would get through.
Thanks again to Dr. Bernstein for sponsoring this venue for all of us.
RG
@Biker in Vermont, Which variable are you saying is more important than listening skills? You said you love your primary care because he is a good listener and left your urologist who was not someone you could communicate with. Which thing did you find more important? Their "technical" or diagnostic capability? Another factor for me that plays out at the cardiologist is just how much I am ready to hear about what is wrong. I like my cardiologist but the truth is he doesn't explain things in great detail. He doesn't put the problems he has found into context for me as far as prognosis is concerned. And the truth is I think on some level I'm not ready to hear it and I think he knows that. Maybe that seems silly, but for now or until I'm ready to hear it all that works for me. I have chosen to just trust what he says and I do hope that is the right decision. I think when the time comes that I am ready to hear more he will answer any specific questions I have, but I get the feeling also that there is a reluctance to give a prognosis because of how that may affect the outcome. ie. he likely knows I will stress a great deal over it and that I could potentially make things worse. What a tough call. Even though as a woman I am expected to be a better listener and connect on an emotional level, I don't want the same from the cardiologist. The thought of it scares me to death. I don't want to know the intimate details of the problem. I keep him at arms length. I say do what you have to do and I don't really care to share my symptoms because to me they feel like something personal or something I need to protect. I hope over time I'll become more comfortable and have more open discussions with him. For now, I'm glad to let him worry about it instead of me. For now I'm glad he's willing to take that responsibility.
Renee
Renee, I left my former urologist because he was 4 1/2 hours away in Boston, which is OK for a once per year cystoscopy, but it occurred to me that what if it came back again (doctor said I have a 3% chance in any given year), then I'd be looking at dozens of trips for treatments and such. I figured best to get established somewhere closer while I am healthy. Fortunately there is a world class teaching hospital less than 2 hours away where I was able to get established with one of the senior urologists. An added bonus is that the culture at my new hospital was such that it was OK to ask for a male nurse for my recent cystoscopy, and get one no questions asked. I'd of been afraid to ask at the other place, but I already knew the answer anyway being they didn't employ any male staff in urology other than the doctors.
To more specifically answer your question, if I had to choose I would go for competence over communication style if choosing between two male physicians.
If looking at a good communicator female physician vs a poor communicator male physician, I will go with the poor communicator male for any specialty that might lead to intimate care. The issue for me is less a female physician on a standalone basis but rather the additional female nurses, techs, or chaperones she's going to add to the equation.
I recently had a female surgeon for a minor finger surgery and very much liked her but I knew ahead of time that there would not be any intimate contact. She was a wonderful communicator and her reputation ranges far and wide in this region. It takes months to get an appt.with her.
Good Afternoon all.
The athena health website RG gave here has finally posted some responses from people.
Regards,
NTT
The web address that NTT just noted is:
https://insight.athenahealth.com/new-data-suggests-male-patients-less-likely-return-women-doctors
and then scroll down to the Comments section
..Maurice.
Thanks for pointing out the InsightAthena article, question. The question of course is flawed because the male experience is always different than the female experience. But it is good they are trying to learn why the males don’t return as often. They may actually think about the comments. Will they do anything though? - AB
Good Morning Everyone:
Hope everyone is well.
AB if enough men can find their voice & speak up, they will have to listen. Just like they did with the women.
If they don't listen, they will be perceived in the eyes of the public as trading dollars for men's lives. Something that won't go over very well.
It's up to men everywhere to search deep down inside themselves and ask, "It's bad enough for me now, but do I really want to see my kids struggle through what I am going through? Especially when I have the power here and now to change things."
If the answer is no, then you have to look past any perceived male frailty and speak loud and clear that you want things changed.
It's up to US to derail this train NOW and put it back on the right track so our kids don't have to deal with this crap.
It's time to speak now or forever hold your peace.
Choice Privacy Respect.
CPR for ALL not just some patients.
Haven't we waited long enough?
Regards to all,
NTT
@Biker in Vermont, regarding
"The issue for me is less a female physician on a standalone basis but rather the additional female nurses, techs, or chaperones she's going to add to the equation. "
I had never considered what this must be like for men. I probably wouldn't care for that much either.
I have always gone to a male gynecologist. For me, it's just weird to have a woman down there. I know alot of women feel differently. But it's true, there is always someone to chaperone the visit and for men I suppose there is little choice sometimes when there are intimate interactions by mostly female nurses. I hadn't considered that either. In fact, I always thought that doctors would be more likely to listen to and be more responsive to a man since they are less likely to visit the doctor. ie. I figured once a man is in the office that the doctor would do all they could to be sure you returned.
I recently had an abnormal brain MRI. One Neuroradiologist said it was abnormal and when I went for a second opinion at the ACO I treat at, their Neuroradiologist said the lesions on my brain were age related. I just turned 46! I said no way.. If I was a man they would have made a different call. They would have at least called for follow up images at some point and time. Now I'll be getting a third opinion. Funny what factors can play into the interactions and probably the judgments made by doctors as well. Although I can't say for sure he would have said something different for a man, I couldn't help but question it. I just don't see ovoid and diffuse periventricular white matter lesions as age related.
Thanks for answering my question too. I think expertise is important, but I think for me trust comes first, then expertise, then bedside manner. Maybe the trust and expertise go hand in hand for you though.
Renee
Hello Renee,
I'm sorry to hear of your "abnormal" MRI. Although many posters here are concerned with intimate care, I think we all appreciate the fact that the best medical care is achieved only when one is her/his meticulous advocate. I realize that insurance, finances, availability, etc. somewhat determine what medical care is available to us; however, please expend all of your energy obtaining the best medical care that is available to you. See as many specialists as necessary until you're satisfied that you have been diagnosed correctly. At 46, you have many years of life ahead of you, if you are perseverant in securing quality care for yourself. Sometimes this requires being very "adamant" in the health care setting. I wish you well; and, please keep us informed of your progress. There are many listening and compassionate ears on this blog.
Reginald
Renee, I'm glad what you've read here has helped you understand what men face. Women suffer indignities too in the OR and ER where they don't have the kinds of same sex options generally available to women otherwise, but men rarely have options anywhere. For reasons most of us here don't understand it is very difficult to find a urologist that has any male nurses or techs on their staff when in fact the majority of patients are men.
It is OK for a woman to prefer a male doctor or for a man to prefer a female doctor. Except for ER and OR settings, we usually get to make that choice. It only becomes an issue when there is no choice, which is just about all the time for men at the nursing & tech level.
Men can choose to speak up but are usually too embarrassed to. That embarrassment carries over to organizing to speak with a unified voice, because men are afraid to confide in other men their discomfort in intimate medical settings. Women are far better at speaking up and in working together for change, and so the medical world is more oriented towards the needs of women. I suffered in silence for most of my life before I finally found my voice and started speaking up. It has been liberating.
Whereas men can empower themselves to speak up, boys can't. These days I understand most parents take their kids to their own doctor for sports physicals, but not every family can do that for a number of reasons. For girl sports physicals, schools will hire female NP's and female nurses to do physicals in private that do not include intimate exams. For boys, schools will hire female NP's and female nurses to do physicals (sometimes in quasi public settings such as gyms) and perform intimate exams of the boys. The mistreatment begins early.
Coming back to choice of doctors, yes trust and expertise go hand in hand for me. I can only think of 3 times that I didn't trust a doctor, and in those cases I just didn't go back. Two were men (specialists) and one was a woman (primary care). She had replaced a primary care doctor that I had been seeing but who left the practice. In her case that one visit was an annual physical which didn't go well on account she was so nervous she skipped all the intimate parts. My guess is she was fresh out of medical school. That visit also told me I really wasn't comfortable with female doctors for intimate matters, even if she didn't do those parts of the exam.
Thank you, Reginald!
Fortunately, I have good insurance through my employer. I'm so grateful for that. I appreciate the support to push or as you said be "adamant" because sometimes I feel a little guilty for that. But I think you're right. I have to advocate for myself or no one else will. I will have a repeat MRI this Tuesday with and without contrast, so I'll let you know when I hear what I hope is just good news.
Thanks also for making yourself available. That's very kind of you.
Renee.
I see that someone was finally successful in getting a dissenting comment posted to Dr. Amanda Kay's presentation recommending a universal legal requirement for chaperones. Here's the URL for comments if anyone else wants to try their luck:
http://jdc.jefferson.edu/mphcapstone_presentation/135/
RG
Not modesty related but worth sharing as an example of speaking up. I had a transesophageal echocardiogram (TEE) this morning without sedation. Versed will leave me nauseous and with a headache for the rest of the day and so starting with a colonoscopy last year I decided to just say no to receiving it anymore.
Though there is no intimate exposure for a TEE, the topic of conscious sedation has come up in the past in that it allows medical staff to disregard a patient's modesty. It is often used for staff convenience for that very reason. That's why I am sharing this.
When the cardiologist said he wanted to do a TEE I said fine but no Versed or other sedation, and explained why. He was cautiously receptive and I agreed to have an IV set up just in case I needed to change my mind.
The cardiologist who is only a year or two beyond his residency, the two nurses (one in 50's the other 60's), and the tech (30's) had never done a TEE without sedation before. They were all a bit nervous but were supportive, and in the end I could tell it was a learning experience for them.
As an aside, whereas doing a colonoscopy without sedation was a total non-event, I will admit that swallowing the ultrasound device for the TEE was not easy or pleasant. Once it was all the way in it wasn't a big deal. Taking it out was a little tough but it comes out much faster than it goes in.
Initially it was just me and the two nurses (female) and then the tech (female) came in to get the equipment set up. The older nurse then tells the tech that I won't be sedated so we can't be talking about how cute he is. She was joking of course but at the same time there was a grain of truth in admitting that they do talk.
Biker in Vermont
I can see the Cardiologist performing the TEE, the Echo tech of course performing the procedure with the Ultrasound equipment but
I don't understand why there would be two nurses present. In many cases a contrast agent called Definity is injected into the patient
to enhance heart structures but why does it take two nurses? It shouldn't. Something greatly wrong with this picture as well as the
comments they made, highly inappropriate.
PT
Hello again. I know there is another purpose for this group but at least one of you suggested I could update you on my MRI results. Reginald, you're last post was so very validating and made me feel better about pushing for another MRI and a 3rd opinion so to speak. The 3rd MRI done last Tuesday with T2, FLAIR and contrast they say is "stable". Ie. Originally MRI with periventricular WMH one confluent area and another ovoid. Subsequent MRI says hyperintensities on T1 an FLAIR are confluent with involvement of the corpus collasum. Yes I had to look that up. Important part of the brain but creates its own work arounds when damaged.... fascinating! Well they called with the "stable but confluent" response and neuro wants me in the office in two weeks. Note: I'be chosen not to stress over this until that time. So yesterday I have an episode at work. Weak in the arms and legs, my head very heavy. Slightly wobbling in the hall. Confused ie. Putting my cereal box in the refrigerator as I try to hurry to put food in my stomach. It was shocking and after it subsided I cried for 20 min and it took several hours before I felt somewhat normal again. I called the neuro and was advised no driving, swimming alone, climbing ladders etc. seizure protocol. I don't know if this is so bad (it doesn't sound good) or if he's just covering to be safe. I wonder how it's stable if the original MRI didn't reference the corpus collasum. Perhaps that is assumed with periventricular lesions and this guy was just more specific? So that's where I'm at and if you have any insight (diagnosis not expected) I'd be glad to hear it. Otherwise, I'm taking it easy until I see the neuro on the 16th! Great weekend to everyone! It was a lovely day hear in FL yesterday. ~Renee
PT, I had that very conversion with my wife about there being 2 RN's. The best I could come up with is that they had more RN's on duty than patients to tend that day and so spread them around.
Interestingly in March I had a minor surgery on a finger to remove a cyst and bone spur at the same local hospital. It was a 10 minute procedure in which it was only my finger that was numbed up. In addition to the surgeon there were 2 RN's. The surgeon even commented that she was surprised that she had 2, but that she liked it. Again, I thought they must have had more RN's that day than patients to tend.
This hospital is licensed for 144 beds which makes it the 2nd largest hospital in the State. I would think they'd be more efficient cost-wise than what I experienced.
Again, I know the nurse was just joking about talking about me. It is just that such a comment carries with it the proverbial grain of truth that they do talk.
Hello Renee,
Is there a reason that your doctors don't seem to elaborate on your condition IN PLAIN ENGLISH w/o the medicaleze? At your subsequent meetings, please ask all medical personnel to discussion your situation in terms understandable to you. Do not complete the conversation until you are satisfied that you thoroughly understand your condition. Ask questions and take notes. Bring a friend or family member, if necessary. You'll, no doubt, feel rushed and, you may feel that you're keeping the doctor, nurse, etc. from more important duties. At the time of your conversation, YOU are the MOST IMPORTANT topic. Let them know of your concerns. Ask about your prognosis. What will be your limitations? What lifestyle changes can you anticipate? How can you and they achieve the best outcome for you? If your doc is available via e-mail, write him/her about your concerns. If you're awaiting test results, call the lab or doctor's office DAILY to ask if the results have been obtained. I once waited for half a year for results from a specialist. They had been on the GP's desk for 6 months. Only when I asked the GP, did I get the specialist's written comments dated six months prior. I think that others on this blog will agree that we've all joined the SPEAK UP BRIGADE. This is not a condemnation of the medical profession. Most medical personnel are "swamped", underpaid and under-appreciated. They have to be TOLD OF your concerns and of your desires. Often they will be happy that you are interested in assisting in your care. Let them know that you realize that they may not have all the answers; nevertheless, you'd appreciate their considered judgements regarding your situation. BE COURTEOUS. BE PERSEVERANT. But, most of all, BE HEARD.
Again, I wish you the best of health. Know that you are in our prayers.
Reginald
WOW! Here is a Comment which I received today from an E.O who wrote on a thread which was inappropriate for the context but certainly would be appropriate for Volume 79 of this thread. This presentation seems to be an angered dissertation attempted to protect a male friend and describe a generalized medical system misbehavior..perhaps a bit more forceful that what was previously written here by out regular visitors.. What is your response? ..Maurice.
__________________________________________
Time for male clients (no, we're not patients) to be treated the SAME AS FEMALE CLIENTS! My male friend was AMBUSHED by the female NP he saw, she slipped in TWO more FEMALES to “PRACTICE" the genital/rectal exam - yep, 3 intimate exams 3 times in a row! My male friend was COERCED - HE WAS NOT OFFERED A MALE, HE WAS NOT ASKED, HE WAS TOLD WHAT THE HAGS DESIRED! THIS IS A SERIOUS VIOLATION OF PATIENT RIGHTS - LEGAL RIGHTS UNDER FEDERAL LAW - AS WELL AS AN ETHICAL ONE! IT’S TERMED DISCRIMINATION! HIGHER COURTS CONTINUE TO RULE THAT BOTH SEXES HAVE EQUAL RIGHTS RE: INTIMATE CARE/PROCEDURES IN CHOOSING A SAME SEX PROVIDER.
As well, this female NP DEMANDED he have a colonoscopy even though he was asymptomatic & she only versed the so-called positive aspects, but deliberately withheld the 70,000 annual injuries & deaths from this procedure; depending on one’s age group, one may be 3 times more likely to die from the screening procedure than disease itself! Less greedy & more ethical medical practices offer the safe FOBT for regular checkups. But of course she was pimping more $ for her organization! & here's the kicker, &, COUPLED WITH 3 PROSTATE EXAMS, is why my friend has avoided this corrupt practice: this same female NP, at his last visit, addressed him this way, verbatim: "You're dirty!" TO SAY ANYTHING OF THIS NATURE IS CLIENT ABUSE, & AMBUSHING MALES FOR GENITAL/RECTAL EXAMS CONSTITUTES SEXUAL BATTERY!
These 3 females violated my friend by making him a GUINEA PIG, A LAB RAT;THEY TREATED HIM AS A THING, AN OBJECT- NOT AS A HUMAN strictly for their own benefit & the primary goal of (NAMED INSTITUTION DELETED) sloughing in the $s! Med schools pay $65 an hour to “professional patients” so that students can learn to examine hands on. But, this greedy group saved $ by subjecting a client to multiple exams;HE RECEIVED NO HEALTHCARE! This group DEMANDS THAT ONE SUBJECT ONESELF TO ALL TESTS THAT THEY DESIRE, & THAT ONE MUST BECOME A DRUGGIE- ID EST - ONE MUST TAKE THE NUMEROUS BIG PHARMA POISONS THAT THEY PUSH! OTHERWISE, THEY’LL THROW YOU TO THE CURB!
An ethical physician would not treat clients as fatted pigs to the slaughter, & throw the less desirable (the clients they can’t make the big $s on) ones in the dog meat grinder!
YOU'D NEVER SEE 3 MALE NPs OR PAs GIVING A FEMALE THREE VAGINAL/RECTAL EXAMS IN A ROW WHILE ALL 3 VOYEURED! No wonder males avoid "health" care in this sickcare industry.It's all over the web!State Boards of Nursing are flooded w complaints by male clients against female nurses/providers re: sexual voyeurism & Sexual battery. BTW, these crimes are Third Degree Felonies!That's why former Gov. Schwarzenegger fired 6 out of the 7 so called professional nurses sitting on that board-they protect they own!
TO DATE, MY FRIEND, THOUGH HE HAS HEALTH ISSUES, HAS REFUSED TO SEE ANY PROVIDER! IF HE IS FORCED TO SEEK MEDICAL CARE I’LL BE RIGHT THERE BY HIS SIDE TO MAKE SURE THIS KIND OF ABUSE & BATTERY IS NOT INFLICTED UPON HIM AGAIN! WHAT A SHAME THAT WE HAVE TO PROTECT OUR LOVED ONES (MALES THAT IS!) FROM FEMALE PREDATORS! THIS SPEAKS VOLUMES OF THE CORRUPTION THAT IS THE UGLY, CORPORATE SICKCARE INDUSTRY TODAY!
E.O.
I wish E.O. had better described the actual sequence of events. A NP does not do colonoscopies so that part must have been a forced referral, perhaps for $ as E.O. suggested, perhaps because something was indicated. Given colonoscopies have to be scheduled & prepped for, the guy would have had time to think through whether he really wanted to go through it. Part of the story seems to be missing.
It is clear the guy had 3 prostate exams but again E.O. wasn't clear on whether he wasn't asked if it was OK or whether he was bullied into agreeing. Neither are acceptable ways of going about it but it would help in understanding what happened. I am guessing the other two people were NP students perhaps?
E.O. doesn't describe the nature of the patient but him being dirty enough for the NP to have commented on leaves me wondering what else is going on here.
Regardless, it was presumptuous of the NP to think subjecting the guy to 3 prostate exams by 3 different women was somehow acceptable. When they go for their mammogram, I suspect they wouldn't think it was appropriate to have 3 successive mammograms by a male tech and his two male trainees.
Biker et al: Do you think I am unrealistically cynical and simply a protector of my medical profession as a whole to surmise that E.O. and even some milder dissertations on this thread provide and paint a totally unrealistic picture of what medical system behaviors and patient experiences are: a common and totally un-rare (i.e.-common) practices and resulting patient consequences. If the arguments are valid and common it is absolutely disgusting for me to think that this is what has turned out despite our medical ethical and behavioral teachings regarding the proper treatment of patients. Is this the example of how poorly students are screened before entering medical school to become and how poorly they are monitored once they leave their formal medical education? And this question applies to all the other professions in medicine education including those entering schools of business who later sit behind the desk of a health institutions. If what is written is commonly true, it is alarming and disgusting. ..Maurice.
Dr. Bernstein, regretfully I have been a frequent flyer in the medical world when it comes to intimate procedures. Most has been bladder cancer related (two surgeries, a year's worth of treatments and a couple dozen cystoscopies) but I've also had a testicular ultrasound, an abdominable ultrasound, 3 colonoscopies (and a 4th coming up later this month), a vasectomy, and as an early bloomer 11 year old in the hospital(am now 64) a traumatic bed bath by a female (don't know what she actually was) that utterly and needlessly embarrassed me. She yanked my gown off and left me there totally exposed for anybody and everybody to observe my pubescent nakedness.
Only two of my many adult experiences have been unprofessional. Most medical staff do conduct themselves in a professional and clinical manner. The norm has been only exposing me to the extent and for the duration necessary and clearly communicating what would occur and asking if it is OK before exposing me. The couple bad experiences I have had have left me permanently leery of female medical staff, but the bad ones are the exception, not the norm.
That most female nurses & techs conduct themselves professionally and in a clinical fashion does not justify men rarely having a gender option.
I would add that conducting oneself in a professional and clinical manner does not guarantee that there is not a sexual component for them. For some it might mean they just kept their game face on. I say this because if there was not a sexual component for them, they wouldn't insist upon only female mammographers, female sonographers, and even if they go to a male GYN, only female staff assisting.
Perhaps nurses maintaining a good game face is enough for some, but it bothers me nonetheless because I have experienced what I call the "attraction reaction" while they are otherwise following professional protocols. Some might say its a good problem to have but I don't like it when I'm the one who is intimately exposed on the table. It is partly why I know there is a sexual component for some nurses & techs.
The true failure is simply that men rarely have a gender option. That is where the medical world has erred. Being professional is not enough.
Good Evening:
There are a lot of bad men and women out there in the medical profession right now.
Weeding them out & rebuilding the clients confidence in the medical community won't be an easy task.
Especially if the perpetrator is in a position of leadership.
People think twice these days before becoming a whistle blower and possibly losing their job and being black-balled throughout the industry.
Many female doctors are losing their male clients and they're scratching their heads and asking themselves why this is happening.
Many doctors don't believe men have modesty issues so they pass off a clients physical to their female PA's & APRN's without checking with the client first.
Then the PA or APRN brings in a female chaperone for the intimate exam to make matters worse.
Female doctors have a chance here to take the lead and right the wrong doing of the community by advocating for their male patients. Show everybody you really care about a man's dignity by hiring male staff. Then talk to your colleagues and put pressure on the hospitals they do business with to do the same.
Healthcare is in a state of disrepair right now.
Let's work together and rebuild the system using these five words. Do No Harm and CPR.
Choice to each client without always questioning why.
Privacy, given to the highest level no matter the circumstance.
Respect. Give every client the respect they deserve and you will get the same back.
Do No Harm and CPR go hand in hand. You can't have one without the other and successfully build a healthcare system everyone will be proud of.
Regards to all,
NTT
Biker in Vermont
I'm always more than happy to remind our readers that there are no male mammographers employed let alone trained in the
United States. Furthermore what E.O has stated is only the tip of the iceberg.
PT
As with Biker, I'm a male patient who has no problems with female health care providers on their own. I actually preferred them, until my own unsatisfactory experience with a "chaperone" ambush (see vol 78). It has caused me genuine sorrow to accept the advice of my male PCP to "stick with men" in order to avoid the threat of a witness and the ensuing loss of control over who is allowed to see my unclothed body.
I'm surprised and actually puzzled by what appears to be a growing trend for female providers to insist on witnesses when administering intimate care to male patients -- despite mounting evidence that male patients overwhelmingly DO NOT want a third party (of EITHER sex) in the room. I would be very curious to know what their reasons are, what has caused this phenomenon. I've been looking unsuccessfully for a study of women providers' reasons for requiring witnesses (I refuse to dignify the euphemism "chaperone" by using it). If anybody knows of such a study, please direct me to it.
And to address Dr. Bernstein's question above, you have seemed to me to be passionately on the side of patients in this matter -- you are eloquently critical of the existing system, not a defender of it, and I'm grateful that you are.
RG
RG, yes, as you expressed, I remain "on the side of the patient." This orientation is based on my individual medical practice but also what I and the other instructors in the "doctoring" course (how to take a history and how to perform a physical examination) teach medical students in their beginning years.In addition, my understanding of this same view of vast majority (consensus) of world wide medical ethicists who participate on a university bioethics listserv to which I subscribe.
Gone are the days where physician paternalism was the accepted relationship with their patients. It is no longer acceptable either by physicians, nurses and should be unacceptable also by the entire medical system itself. We should all be "looking to the patient and the voice of the patient" and only secondarily, but with th patient in mind, attempting to integrate other factors and requirements into patient management.
Maybe, part of the solution to everything unpleasant and unwanted discussed on this thread we need a single and unified health care system directed by our federal government oriented solely to the healthcare of everyone and with attention to the everyone's individual needs and not biased toward one business or group of people.
The ethics, I think, has already been established: patient autonomy over paternalism. Now how about changing the politics of healthcare. What do my visitors here think? ..Maurice.
Dr. Bernstein, I'd personally be in favor a Medicare for all or single payer type system if they could figure out the mechanics of paying for it, but I can't see how such a govt run system would address the issues we have discussed here.
Federal and State govts currently mandate female-only intimate care for female prisoners but see the opposite as discriminatory against female prison staff. Female reporters are allowed in male locker rooms (including school newspaper reporters at the college level) while the guys are dressing and showering, but the opposite is not allowed. Middle and High School boys who for whatever reason do not get the mandated physicals by their own physician and instead get school provided physicals are still subjected to genital checks by female NP's with their female assts. Female student athletes do not get intimate exams. Female medical staff that sexually assault or otherwise violate male patients anecdotally seem to get slaps on the wrist compared to male medical staff that do the same to female patients.
Federal and State govts put much effort into getting women into historically male career paths. At the same time they do nothing to get more men into nursing and medical tech careers. Govt funds Women's Health initiatives but Men's Health Centers are more or less non-existent.
Federal and State govt does not yet recognize male privacy or male modesty as an issue. Though medical staff at all levels are far more professional in this regard than used to be the case, in some ways as a society we are still in the 1960's and earlier decades where the only consideration of male exposure was that it not offend females. And women are the ones who get to decide what is offensive. A man who requests female staff is suspect. A man who refuses female staff is suspect. Men are instead expected to just quietly go along with whatever exposure female medical staff demand of them.
How about attacking the issue of gender inequality of privacy through the 14th Amendment to the U.S. Constitution?
https://www.law.cornell.edu/wex/fourteenth_amendment_0
Anyone want to give that a try? In the U.S. we do have our Constitution. ..Maurice.
Hello,
My experience re privacy issues with the GP was "Oh! What?" I don't think he had ever considered the issue. He wasn't hostile. It's just that this had never entered his head for consideration. Moreover, he is an individual with over 40 yrs. in practice. My feeling is that the medical profession treats the illness or the procedure with little consideration for the privacy feelings of the patient, unless they are made aware of these feelings. At that point it's either, institute a creative alternative to accommodate the patient or indicate that this is the standard operating procedure that the patient must accommodate. Depending on the practitioner there may be accommodation, bewilderment or downright hostility. Until the male privacy becomes mainstream, I'm afraid that the status quo will remain. Reginald
Dr. Bernstein, there is no doubt but that a major court case based on the 14th Amendment would set in motion gender equality in the medical world. It would have to be a carefully selected case.
My take is that societal level court rulings tend to happen when there has been an ongoing public debate or controversy which the courts finally take a stand on. It is typically a very slow boil.In the case of patient privacy/modesty, at least as pertains to men, society is not yet debating the issue in any substantive way.
The stranglehold that women hold on the medical world at the nursing & tech level is such that they would be a powerful vested interest fighting such a court challenge. They would likely come at it from the perspective that it is discriminatory against themselves and that their professionalism adequately addresses patient concerns. They would maintain that there is not a problem to be solved. Women's groups in general would join the fight using the employment discrimination claim. At issue for them would be maintaining the status quo that advantages women.
I think a parallel could be drawn on the female prison guard court cases and perhaps to a lesser degree the women reporters in male locker rooms case. Courts have been consistent that the employment rights of women outweigh the intimate privacy rights of men. This is why the selection of the right case is so very important. Society didn't much care about male prisoners or athletes. The question is then what kind of male patient scenario might society care about?
Going in the other direction for a moment, the transgenders in boys/girls, men's/women's locker rooms issue is interesting in that the mandates are not differentiating between male/female rights to intimate privacy. Both sexes are being treated equally. That hasn't happened before. A smart legal team might be able to build off of that somehow.
Biker,
I think you've zeroed in on the problem here:
Society didn't much care about male prisoners or athletes. The question is then what kind of male patient scenario might society care about?
Regarding the current trans issues, it seems that while males and females are being treated equally, the decision seems to lean toward neither having privacy rights.
I personally doubt the governments ability to produce anything satisfactory on this issue (see the VA), but I realize many will have differing opinions.
Mike
Mike, how about "town hall" meetings (are they over for the immediate season?). I mean, how about including gender equality with regard to privacy issue, perhaps as part of the political healthcare revision or augmentation? When you think about it, this equality in patient's desires for privacy is bears not only Constitutional significance but can be just as worthy of political consideration as attempts to keep drug prices down and reasonable, keeping insurance companies participating, insurance support of existing medical conditions. With regard to the latter, if PTSD to some degree is a valid complication from exposure to modesty-indignity injury (as many times described on this blog) certainly that should be considered within healthcare legislation. I'm just trying to figure how my visitors here can have their voices heard by the government and medical systems for those "listeners" to develop systems to resolve this "existing medical system" condition. ..Maurice.
Good Evening All.
Dr. B as long as I’ve been participating on your blog, you have ALWAYS stood by the client not the healthcare industry. You are a special breed of doctor.
The medical community claims to the country they are “gender neutral”.
To the medical community I ask, “How can you claim to be gender neutral when male x-ray technicians are not allowed to give a woman her mammogram? “Gender bias” would be the more appropriate term.
Again, How can you claim to be “gender neutral” when male nurses are not allowed in Labor and Delivery? More “gender bias”.
You cannot claim you are gender neutral when qualified men are not allowed in these areas. Same goes for the sonographer technician field. More “gender bias”.
If the healthcare system is not going to freely give men the same gender choice they freely give women, then there is a strong case for discrimination. Some male nurses are tired of the healthcare industry’s dog and pony show and have filed discrimination suits against some facilities because they are not allowed in L&D.
In order to build a better healthcare system that will work for all, it must be built with Choice, Privacy, and Respect as its core values for ALL patients not just some.
Congress is currently in the process of coming up with a replacement for the Affordable Care Act aka Obama Care. As they have their own medical plan, they have absolutely NO CLUE how bad things currently are for men who require healthcare services.
I’ve had contact with a couple of senators. One tells me you’re at the mercy of the luck of the draw & the other never responded. They are CLUELESS. Told them don’t expect my vote next election. We need new blood in Washington.
It’s up to us the voters to get our message across to Washington. The new healthcare bill must include Choice Privacy and Respect for all patients when intimate care, tests, and procedures come into play.
If the healthcare industry won’t come to terms with what patients really want and make the changes willingly, it will be up to Washington to make them see the light in the new healthcare bill.
Regardless of your gender. If you want gender choice, NOW is the time to speak up loud and clear & let the people in Washington know, you want gender equality and privacy protections for patients built into the new bill.
Put your fears aside. Stop thinking and saying “It is what it is.” That’s NOT the way it has to be.
A patient centered healthcare system cannot truly be patient centered without Choice, Privacy, and Respect for all built into it.
Change will only come when men and women have the courage to take a stand and force the system to change.
Speak up NOW if you want change.
Regards to all,
NTT
This comment is drifting a bit off topic but it shows how throughout society, without intervention, there is little regard for men’s health or men’s health issues.
US funding for medical research to solve diseases, cancer, etc. I list the numbers directly from the National Institutes of Health site for FY16 for ALL categories that are GENDER specific (there also is funding at the NIH for categories that benefit all genders, like Lung Cancer, but that is not shown below). You will see that males get about 5% the funding for gender specific research, females get about 95% of gender specific research funds awarded by Congress in the US. Note Breast Cancer alone gets more than Men’s Prostate Cancer funding. This is been true for MANY years. How is this equitable? How is it our Congress feels females are more equal than males?
NIH Research Funding ($ Millions) - FY16
Breast Cancer - 699
Cervical Cancer - 103
Endometriosis - 11
Estrogen - 201
Fibroid Tumors (Uterine) - 10
HPV and/or Cervical Cancer Vaccine - 32
Ovarian Cancer - 123
Uterine Cancer - 54
Violence Against Women - 32
Vulvodynia - 2
Women’s Health - 4140
Prostate Cancer - 299
And yes, the ONLY male specific category funded was Prostate Cancer…Nothing about the higher rate of Male suicides, violence, accident prevention, higher rates of some diseases in males, etc.
FYI.
— AB
Maurice,
As Biker mentioned, the push back on trying to include something like this would be overwhelming for the politicians involved. Women's groups are already up in arms over any changes, this would merely add fuel to the fire. Cynic that I am, I don't see us getting anyone involved willing to take any kind of chance for us.
Mike
This months issue of GOLF has an article called locker room talk. The article centers around women reporters in male locker rooms
and of course is written by a female. Her comments are biased and leans toward the female reporters as the ones being victimized.
PT
NTT
Great comments and I'd like to expand on the subject.
Mammograpy is an on the job training only. You must be at least a licensed medical radiographer then be taught to perform
mammograms. It's not that male radiographers are not allowed to perform them, they are never taught. Male sonographers
are fairly restricted in their employment and are not expected or at least hired in many OB practices. Male nurses are overlooked
as far as employment in female correction centers and L&D suites. If you are a male cna do not expect to be hired at any private
physician's office, although your best job prospects are at a hospital on the night shift. Poor job prospects for male cna's as some
claim on the cna forums that they have been looking for 10 years! There are great job prospects for females at all urology offices
as that seems to be the only gender that's employed there aside from the physician. I fully expect the field of obstetrics and gynecology
to be fully feminized by 2040 not that I disagree, it's just that many women prefer females. The concept of gender neutral was
coined by female hospital administrators, secondly due to the body habitus of many female nurses today, wearing a dress is just
simply not an option and it buys into the gender neutral concept. Thus a hood has been rolled over the eyes of all male patients
along with the false pretense that all male nurses are gay as propagated by female nurses and female hospital administrators.
The growing trend is to hire more female physician assistants to replace aging male physicians and soon there will be female
scribes taking notes at all physician offices, urology too!
PT
So
With what I've said about gender neutral look at the 4500 or so hospitals in the United States and ask yourself for those hospitals
that provide mammography and L&D suites with no males employed in those areas how can they be called gender neutral when
those facilities don't provide some kind of equivalent privacy for male patients. Now you see how and why the concept of gender
neutral came to be and why female administrators created this phrase and why.
My next challenge is this, find me a hospital, doctors office, outpatient surgical center or any medical facility where a female nurse,
medical assistant, cna is employed that wears a skirt. You won't!!! That is how deeply entrenched the gender neutral concept is.
Even the medical scrub companies have bought into it hook, line and sinker!
PT
Hello:
When women start losing their loved ones sooner than they should because gentlemen will no longer just hand over their dignity just to be embarrassed and humiliated in return, maybe just maybe women will realized there’s something wrong with the system and they better listen to their loved ones and stand with them against the medical community before it’s too late.
Sure, they can replace retiring male physicians with females but that doesn’t mean men will chance going to one just to risk being ambushed by her female staff.
The entire Urology field should be ashamed of itself for their treatment of male patients.
They show men the least respect of any field of medicine.
With more and more male medical procedures moving out of the operating theater into the office surgical suite, I feel it’s going to continue to get worse.
Each procedure will come equipped with your doctor, his female nurse, and of course at least one maybe more female chaperones. All done without even asking you the patient if your comfortable with it.
What’s worse, before you even get to the embarrassment of the surgical suite, you have to sit down first with a female and tell her your entire medical history which may include sexual history then, you get to answer any of her questions no matter how personal she gets.
Finally before you are left alone, you get to listen to HER instead of the doctor tell you all about your MALE related procedure. Including how your female nurse will prep you.
Heaven forbid at some point you ever have to self-cath. Guess who’s gonna teach you how to do it? You got. A female nurse.
It never ceases to amaze me how they manage to influence an intelligent man to cave in and allow this garbage to happen. They do it to men on a daily basis.
Yes, our esteemed urologists and their female staffers have done a bang up job to give all their male patients all the warm and fuzzies you’ll ever want.
Men everywhere need to wise up, put their male insecurities aside for a while and speak up against this crap or it will never end.
If not for yourself, do it for your brothers, sons and grandsons. Do you want to see them have to endure what we have?
Nobody should have to put up with the crap men endure when they are in need of medical services.
Gender EQUALITY for ALL.
While the coals are hot, write or talk to your representatives both local and in Washington and tell them, the next healthcare bill MUST specify gender EQUALITY for ALL patients.
This is 2017 not 1917. It’s time the healthcare industry to stop their willful ignorance towards male patients.
No more trading men’s lived for the almighty dollar. You’ve spent too many of those already.
Talk to your family, your friends, anyone who will listen. It’s time to slam on the breaks and stop this runaway train before it’s too late and you are the next guy that needs to visit your provider.
Regards to all,
NTT
Perhaps pertinent to the discussion here, the following is California law signed by Governor Brown last year and has become effective last March 1. ..Maurice.
Justia US Law US Codes and Statutes California Code 2016 California Code Health and Safety Code - HSC DIVISION 104 - ENVIRONMENTAL HEALTH PART 15 - MISCELLANEOUS REQUIREMENTS CHAPTER 2 - Restrooms ARTICLE 5 - Single-User Restrooms Section 118600.
View Previous Versions of the California Code
2016 California Code
Health and Safety Code - HSC
DIVISION 104 - ENVIRONMENTAL HEALTH
PART 15 - MISCELLANEOUS REQUIREMENTS
CHAPTER 2 - Restrooms
ARTICLE 5 - Single-User Restrooms
Section 118600.
Universal Citation: CA Health & Safety Code § 118600 (2016)
118600. (a) All single-user toilet facilities in any business establishment, place of public accommodation, or state or local government agency shall be identified as all-gender toilet facilities by signage that complies with Title 24 of the California Code of Regulations, and designated for use by no more than one occupant at a time or for family or assisted use.
(b) During any inspection of a business or a place of public accommodation by an inspector, building official, or other local official responsible for code enforcement, the inspector or official may inspect for compliance with this section.
(c) For the purposes of this section, single-user toilet facility means a toilet facility with no more than one water closet and one urinal with a locking mechanism controlled by the user.
(d) This section shall become operative on March 1, 2017.effective March 1,2017.
Let's see the ethics and consequences of the California law noted above.
Sounds ethical- meets the justice ethical criteria.
Consequences- oh! Instead of only women lining up outside a toilet room to be emptied, men intending to enter the room will have to enter the line too along with the women. Got the picture?
Actually, Governor Brown has shown his interest and desire to, in this one respect, make California, gender "equal".
A first step. Or is it? I would appreciate the comments of my visitors here. ..Maurice.
Vermont just passed a similar law concerning single occupancy bathrooms. The stated purpose here was so as to make things easier for transgenders. There's not been much public reaction to it. The cultural norm here is live and let live and bathrooms are not an issue folks are going to get worked up over.
Being the impetus in California is different than it was here in Vermont, it will be interesting to see if they view men as the equal of women in the context of patient privacy/modesty, or does he see gender equal as meaning female nurses/techs can equally serve male and female patients.
Promoting more follow-through on the concept of the California law regarding single-user toilet facility being neutral to the two genders (or better should I say "all sorts of genders", a more diverse term)---how about getting rid of the urinal itself. Wouldn't that create a better environment for either gender to enter one room with multiple closed-door water closet compartments--also less expensive for businesses or places of public accommodation?
You may wonder why I am belaboring this topic but I see this toilet issue a way the government could demonstrate an intent to follow up even further in providing gender equality both to toiletries but might extend, as a first step, to the concept and laws seeking full gender equality for all the other issues of modesty and dignity that have been long discussed here. ..Maurice.
Maurice
The bathroom issue has always been about transgendered people and no way ever will that rabbit be pulled out
of the hat. For any hospital that provides mammography services and or L&D any male patient that is not provided
an equivalent privacy for intimate procedures is guilty of discrimination. It is not about embarrassment nor humiliation
but rather being treated the same as any other patient. It's worse than being told to sit at the back of the bus, worse
than using a bathroom being labeled as for colored only, I put it almost as bad as slavery, you are treated as a 3rd class
citizen. State nursing boards have as their bylaws that any patient that is left exposed or inadequately draped is considered
sexual misconduct and subject to license revocation. We know this happens to most male patients. I can tell you for certain
it happens to ALL male level 1 trauma patients and most patients in icu's as well as ER and floor patients. Therefore not only
are you mistreated due to your gender but the rules they set aside for patients don't apply to male patients, not applicable.
PT
Mammography has been around since the 1950's and has always been performed by women in the United States. It is the only
occupation in this country that is held exclusively by women. As a male in this country you will not be allowed to train nor perform
in that occupation. If you are a male who had the unfortunate luck with hereditary and environment factors that led you to have
cancer in your breasts be aware that many imaging centers prefer that you not be a patient there. There are many Women centers
for Radiology that employ only women radiologists and they prefer you not be a patient there. Your best option would be to choose
a somewhat lower socioeconomic area that has an imaging center where you would fit in better for your imaging study.
PT
PT, your statement " As a male in this country you will not be allowed to train nor perform in that occupation" is not supported by the Joint
Review Committee on Education in Radiologic
Technology (JRCERT)
http://www.jrcert.org/sites/jrcert/uploads/documents/MammographyRotationsforAllStudents.pdf
So if a radiologic teaching program for techs wants certification of the program to continue the program must follow the Objective 1.2. ..Maurice.
Oops! The Objective 1.2 was not posted in my last post. Here it is. ..Maurice.
-------------------------------------
JRCERT Objective Addressing Equitable Learning1
Objective 1.2 Provides equitable learning opportunities
for all students.
The provision of equitable learning activities
promotes a fair and impartial education and
reduces institutional and/or program liability.
The program must provide equitable learning
opportunities for all students regarding learning
activities and clinical assignments. For
example, if an opportunity exists for students
to observe or perform breast imaging, then all
students must be provided the same opportunity.
If evening and/or weekend rotations
are utilized, this opportunity must be equitably
provided for all students.
Maurice
I'm fully aware of JRCERT and just like the joint commission it means nothing. Absolutely nothing! There are no male mammographers
in this country, period. As I said, mammography is on the job training only and males are not given the opportunity to train. Male cna'a
on the one hand can train but do you see them employed in urology offices. Do you see any male medical assistants or an Lpn, Rn
at any urology clinics.
Do you believe me when I tell you that I know of several males with suspicion of breast cancer but were turned away from a
mammography clinic. They had 1) health insurance 2) a valid physicians order for a mammogram. The mammo clinic told them to
seek out their mammogram in nice words another mammo clinic that's not too upscale. Why? The center they initially sought gave
their female patients a pink robe to wear while they waited for their mammogram.
Ask some male nurses what their opportunities were when or if they were expected to do rotation through L&D, not! Regarding
mammography the ARRT in Minnesota regulates the licensure as well as each states radiation regulatory agency. Ask them if
they have any male mammographers employed or licensed. They can tell you. If you want the real lowdown on this practice
you can call the ASRT in New Mexico.
PT
Maurice
Forgive me let me explain.
JRCERT only is concerned about the educational programs in radiography, or I should say medical imaging. Which would be
radiography, nuclear medicine and radiation therapy. ( At the educational level). JRCERT has no control once a student has
graduated and receives on the job training. This is what mammography is , strictly on the job training.
Therefore as I have said JRCERT means absolutely nothing in this regard. As you know I've mentioned some years ago that
I researched this subject thoroughly for 6 months calling every licensing agency in the U.S. From the state level to the national
Licensing agency. At every state licensing agency I'm told there are no male mammographers. I looked into the educational
requirements with the ARRT, ASRT. They too have no control when a discipline such as mammography is taught as on the
job training at a hospital or mammography clinic. But that those who receive the on the job training must be a licensed
radiographer registered with the ARRT. Male radiographers are never give the opportunity to perform on the job training.
In conclusion, if someone at a hospital is able to recite the core values of that institution and one of those core values states
" we respect your dignity" and some core values state that. If that hospital has a mammography suite and an L&D suite what
exactly does that core value mean, who does it apply to? How does it apply to the male patient?
Maurice, can you answer this question. I'll let you know that I have already researched this ahead of time by calling the
administration of one hospital and posed this very question. They were speechless at first and could not answer the question!
PT
PT, thanks for your response and no I cannot fully answer your institutional "core values" question unless it applies to "patient gender specificity" and some of the values are set by and benefit to the institution itself. If a mammography service (which in reality serves only women and very rarely men) of an institution wants more "customers" certainly, the institution would would look to servicing patients with male mammographers as a possible potential hindrance to maximum "business interests". On the other hand, for men needing general nursing care for significant illness, which would be the most common scenario, there is less statistical risk of "losing business" if the nursing of the male patient is by a female. Of course, some may say my above answer is cynical but I truly believe that financing the institution to be a reasonably considered "hidden core value".
What I would like to know from any women visitors here is whether there is a difference between a male physician performing a female breast exam with (as we teach our med students) a careful and systematic palpation (hand on and "manipulation" the one exposed breast after breast inspection.) Surely, there is less discreet palpation and inspection by a male mammographer. Is the difference related to the more professionally developed relationship in terms of the duration and the prior and current professional interaction of the male physician compared with the brief anonymity and relationship to the male mammographer? The probable major consideration of the woman undergoing mammography is "who is this man? I know my male doctor but who is this man?"
By the way, another factor may be the anticipation of physical discomfort (pain) superimposed on the uncertainties of the character of the male tech. ..Maurice.
Maurice
This is what is wrong with healthcare today, secret core values, semi-private core values, people who don't know what their own
core values are and " hidden core values". Now I have to admit I've never heard of that one before, that's a new one on me. So
where is the transparency in all of this? I would say there would be a statistical risk of losing business if medical facilities were
transparent and promptly reported to the news media any case of immpropriety, such would be the case of the female ent in New
Mexico. Do we know what her total financial risk was? What about the hospital?
Since the inception of mammography there has never been a male mammographer and therefore no cases of sexual impropriety
and as I mentioned the strict implement of female techs was always at the discretion of female hospital administration. Thus, posing
your question to our female readers is about 68 years too late.
Now on the other hand I could say that the more professionally developed relationship say between myself and the urologist I
chose compared to a brief interaction with his medical assistant. " I know my doctor but who are these women". Yes, there are
statistical and real risks of losing business and this should not be the basis upon how patients are treated!
How many physicians are arrested, prosecuted and undergo license revocation each year due to sexual impropriety and what
are the statistical risks there. What about nursing and sexual impropriety, it happens every day I assure you. Do you see this
impacting the type and quality of care patients receive. Has a secret core value ever been implemented in any of these cases.
PT
PT, part of the difference with managing risk as concerns male vs female matters is that the media, courts, and public opinion is far harsher when females are abused or otherwise poorly treated by males than occurs in the opposite scenario. Hospitals know this. Hospitals also know that females will be quicker to complain and that there are well organized women's groups that will support those women.
Risk manager focus more on women's issues because that is where the risk is greatest. They know that few men will speak up to ask for same gender care and even fewer will pursue a complaint.
Those men who vote with their feet do not necessarily cost the hospital any revenue either if ultimately they present with more advanced and costly conditions.
Until such point as men organize in the manner that women have and press court cases against the medical system, the risk management structure is not going to change. Forcing men to have intimate care by female nurses & techs does not currently pose a risk to hospitals.
I would add to the other part of this discussion that it likely does make a difference to patients that they know and trust their opposite gender physician but are apprehensive about that nurse or tech they've never met before. I can't speak to this myself because I've never gone to a female physician for anything that involved intimate exposure. However I can speak to having learned to be apprehensive about female nurses & techs that I've never met before.
Biker in Vermont said
" Risk manager focus more on women's issues because that is where the risk is greatest"
Why would you think the risk is greatest with women's issues and define those issues. Risk managers spend virtually all of their
time investigating poor patient outcomes. Wrong medication given, wrong surgery, wrong site surgery, nursing error, physician
error. Patient falls, and my favorite, joint commission surveys. Deaths in the operating room etc.
There is no risk with female related gender issues. I've never heard one presented. Why would there be when 95% of all nurses
are female. You won't see female gender issues in the neuro intensive care units. Those are all female nurses there. All female
nurses in L&D, The ICU's in general are all female. All the cna'a on the nursing floors are female. The operating rooms are all
females as well as the scrub techs.
Biker, do you or have you ever worked in a hospital before. You need a tour, but then a risk manager would never sit down with
you and tell you all the problems that occur in hospitals because they don't want you a potential patient to know that. That's why
they are called risk, to reduce the risk. Their real and correct titles are called Quality assurance managers by the way.
The last headline I've read within the last year or so ago regarding privacy issues was a female nurse who took a cell phone pic
of her male patients genitals at a hospital in upstate Ney York. She sent that pic along with a text to all her colleagues. I can only
imagine the nightmare was to that Quality assurance manager investigating that incident. Those employees by the way are all
females too. Why? Because they start out usually as nurses!
PT
PT, I'm not talking medical risks or outcomes. I'm talking the risk of a female patient making a claim against a male employee. This is why male staff often must have a witness present if doing an intimate exam or procedure with a female patient. Male patients are far less apt to make claims against female employees, hence a win/win for the hospital in primarily hiring female staff. Fewer male employees reduces the risk of claims against them, while more female employees carries with it little to no risk of impropriety claims.
Hospitals as well reduce their financial risk in catering to female patients in this regard. Women will go somewhere else if faced with male staff for certain matters such as mammograms, whereas men just quietly accept female staff for intimate procedures in urology and elsewhere.
Why do men quietly accept it? It is only in the past few decades that the medical world and society as a whole have begun to recognize men as being deserving of any respect as concerns their exposure. Older people dominate the patient population and older men know they are being treated better than they ever were, thus being less apt to complain. The medical world knows this.
Older guys grew up accepting as normal that which is unthinkable today. For example in the mid-60's in Middle School all us boys were told to strip down to only our tighty whities in the boys locker room, then marched single file up the stairs and down the main hallway of the school where we stayed in line waiting our turn as the line slowly made its way into the nurses office for what included an intimate exam by a female nurse with a female asst. That office was separated from the main office by a half glass wall and an open door right into the main office. It was in front of that open doorway that we were told to drop our underwear. There was no shielding us from view by whoever happened by while standing single file in the hallway in our underwear, nor any concern about the women in the main office seeing us as our underwear was dropped, or any other female (parent, student, or teacher) that happened to come by the office. All those boys are in their 60's now and hospitals know they aren't going to complain about how they're treated.
Conversely, the girls did not have public intimate exams back then and generally have much higher expectations of how they are treated in the medical world.
As I have said in the past the only way to effect change in healthcare is through legal intervention. You can't effect
change from the outside in. Rather from the inside out and medical institutions currently benefit current gender staffing. I
always get the impression some on this blog I believe enjoy the current staffing, that some enjoy reading about the
dismay many male patients have in this regard. It's my opinion that it would only take a change at one hospital for
a legal precedent to be set. That a hospital in question would need to have a mammography suite and a L&D suite.
Furthermore, there are enough examples on the web that indicate male patients experience unprofessional behavior
in every medical setting and unsettling as it is will never in itself effect change. In fact complaining will do nothing on a broad
scale as this volume implies. Patients may realize that patient satisfaction scores are important and becoming a
relevant factor in reimbursements but probably won't have the broad impetus to do any good in this regard.
PT
PT, I agree that legal action is the most likely way to get meaningful change that gives men gender choice at the nursing and tech level. At issue is the right case materializing, and that case not quietly being settled out of court. I think it would need to be a class action type case.
I do differ on the impact of complaining though. I doubt the kinds of changes that brought us to where we are today versus the old days such as I described in my last post did not entirely come from the goodness of their hearts. At some point either boys starting complaining in school settings or their parents did. When I was a kid no boy dared complain and if he did the school staff and their parents would have called him a sissy.
Somewhere along the way the small minority of men that did speak up did nudge the medical world into the many small changes that were made which cumulatively resulted in men today generally being treated in a respectful manner, even if it remains undignified and embarrassing. The mantra that maintains a system of undignified and embarrassing care is that medicine is gender neutral.
I doubt anyone that posts here enjoys the current staffing scenario. The point I have tried to make is that older men who represent the majority of patients, especially in urology, remember the old days and know that they are generally treated in a respectful manner, albeit to many of us undignified and embarrassing. Older men as well were raised to believe that stoically suffering indignities is what a man is supposed to do. It is hard to shake that which was ingrained from a young age. It took me far too long to find my own voice and say enough is enough, I want same gender nursing & tech care for intimate matters. Our hope for change likely lies with younger men who don't carry the deeply ingrained stoic mindset.
I will add another example of the mindset we grew up with. I recall a family picnic when I was 9. It was a hot day. My father was barefoot wearing only shorts. My brothers and I were dressed the same as him but I noticed my 3 year old sister fully dressed. I asked my mother why my sister didn't take her shirt off too. The reply was that she was a girl and girls had to remain covered, but boys didn't. Fast forward a couple decades and it never occurred to me to let my own daughter play outside without a shirt on whereas my son was free to wear as little as he wanted. This speaks to how ingrained the differing standards were.
Hello,
I understand that the UK's health care system is a tiny speck compared to the US leviathan; nevertheless, the following quote (albeit 3 yrs old) is rather instructive. It begs the question, "Why not here?" I've attached the URL so that you might read the entire article.
Promoting a Patient's Right to Dignity · January 2014
https://www.researchgate.net/publication/272472522_Promoting_a_patient%27s_right_to_dignity
“Measures to help promote patient dignity are evident in some NHS Trusts [i.e. hospitals]. For example, some operating departments try to arrange female staff for female patients, with the justification that this is good practice for certain intimate procedures. This can also help to prevent potential accusations against male members of staff when performing intimate care. However, it could be argued that men coming for urological surgery are not offered any choice between having male or female staff [Surely, there's a male nurse, tech somewhere]. Clearly, it is important to manage each situation based on individual circumstances. The key to managing such situations may commence by asking the patient if they have a preference….” [ ] are my insertions.
Reginald
Reginald, thanks for the linked article which is most appropriate in the continuing discussion here.
Looking back to earlier Volumes of Patient Modesty I think is very informative. I mean "way back"...how about for example 2009, Volume 16?
http://bioethicsdiscussion.blogspot.com/2009/05/patient-modesty-volume-16.html
Much more "moaning and groaning" and less discussion of approaches to resolutions. Many more women writers to our thread then presenting their personal modesty experiences as patients but not supporting men patients and men's concerns. Oh, and PT was there to provide us with the ins and outs of what goes on behind the curtains. Thanks PT. Where did all the women go? Or are they all are now satisfied with the approach to the current female gender medical system attention in 2017. (To all current female visitors here, please be welcome to resume participation by writing.)
It is interesting to go back in time to the early versions of this thread and compare. Do all my current visitors agree with my above comparisons of 2009 and 8 years later? ..Maurice.
Hello:
Pt. 1
Why Not Here?
Like women, men pay their healthcare premiums. Why shouldn’t they get same gender care for intimate care, tests, or procedures? Guys are paying for the use of same gender nurses and techs. Maybe they should get a refund om part of their premium since the providers aren’t providing the service.
Because the Healthcare Industry doesn’t want to change their ways. They hate change when it comes to their way of thinking or it’s going to cost them money.
Their way of thinking right now is that men are these strong, heartless, emotionless warriors expected to put up, shut up, and take anything thrown their way by the healthcare industry. The medical community figures if they shame and humiliate men enough, they can do what they want with men, and when men get tired of being embarrassed and humiliated they will just stay completely away from care. Hence they trade men’s lives for dollars.
The cost to the industry for respecting a man’s dignity and his right to privacy, would be female jobs and/or money they don’t want to spend.
Because many of the personnel decisions are made by women who are influenced by their female subordinates throughout the system, that would leave a foul taste in their mouth and start rumblings through the mostly female rank & file.
Unless they are persuaded to, a female personnel director will always hire a female tech or nurse over a fully qualified male every time because they (like men who won’t open their mouth & just say no), want to go with the status quo.
The current staffing scenario is the way it is simply because men are afraid to say something. Men are scared to rock the boat and look weak for a minute. Even if in that one minute of perceived weakness he might just gain some respect and protect his own dignity at the same time.
Maybe it’s because of repercussions they fear will come their way during their visit for opening their mouth & saying no, this isn’t right.
Men won’t speak up when they should which in turn hurts the rest of us that are talking until we’re blue in the face and pushing back at the system in place.
If something is happening and you are not comfortable with it, you have the right and the duty to speak up and stop what it going on. For instance, if you’re unnecessarily exposed in an uncomfortable manner and you don’t want to be, SPEAK UP & say NO.
Women found their voice mostly I would think without the use of lawsuits.
They didn’t like what was happening so they spoke up. They kept speaking up until they were heard.
Hello:
Pt. 2
Why Not Here?
If men feel they have to wait for a male healthcare worker who feels his talents are being wasted to file a lawsuit to change the way things are done, then men have a long road ahead simply because the medical community will buy whoever’s silence they have to, to keep this issue from going mainstream.
The only way this will go mainstream is if men who don’t like the system as it is today stand up for themselves and put a stop to it.
If men are going to stay silent, then the medical community has no reason to change their ways. Is that what you really want? I don’t.
Men just want their privacy protected and their dignity kept intact.
Nobody’s asking for the moon here.
Lawsuit or no lawsuit, men don’t deserve to be treated the way we are being treated. Look at how they treat male patients in the urology dept. of your local hospital.
It’s time to stand up and JUST SAY ENOUGH is ENOUGH. Time to change your ways.
Just like the women, if men keep up the pressure as a GROUP, they WILL have to listen and make changes.
Start asking question like why doesn’t your facility destroy some men emotionally and psychologically by embarrassing and humiliating them for an intimate test or procedure that could be done by another man?
Ask if they let male techs and nurses do mammograms and work in L&D. If not, why not? They claim to be gender neutral. They let female techs do male related intimate tests.
Why aren’t you protecting a man’s dignity and giving him a Choice by asking him first and foremost does he wants same gender care for intimate care, tests, and procedures rather than forcing opposite gender care on them all the time?
Tell them that forcing female attendants on men for male related issues is simply wrong and it’s GOT TO STOP.
Tell them how you are gonna let everyone you know how wrong they treat their male patients. Then they will tell everyone they know and so on and so forth.
WE cannot wait for a lawsuit that may never come to fruition.
WE have to take the bull by the horns on this issue and ram it back down the throats of the same people that have been ramming it down our throats for years on how men have to hand over their dignity and privacy at the door as the cost of admission.
Men are human beings and they just like their female counterparts have rights.
It’s time to see if men have it within themselves to stand up, reclaim their dignity, privacy and respect.
I’ve written to many legislators and spoken to many ordinary men and women. Many don’t think this is happening to men.
I just tell them, you don’t believe me. Okay, wait until it’s your or your loved ones turn then you’ll see what I and others have been saying is really happening.
They you’ll be the one embarrassed and totally humiliated by the very system you thought was protecting you and your loved ones.
The system is broke. Are we going to fix it for everyone? It starts with one patient in one hospital saying NO. From there it goes to another facility, then another, until the push for change is so strong, the healthcare system can no longer deny men their well-deserved changes.
Men and women have been embarrassed and humiliated long enough.
Regard to all,
NTT
Hello Dr. Bernstein,
You're right. There seem to have been many more female posters in 2009. Many also seemed to post re "very serious" modesty violations. It would be interesting to be informed why few women are not presently posting. You may be right again when you say that women's complaints seem to have been heard; whereas, men's modesty issues have still not been recognized. However, I'm really puzzled that after hosting this blog for 13 years, you haven't seen some resolution to the issues raised. The same suffering continues. The same trite responses are given ("You don't have anything I haven't seen, etc.,etc.) Medical personnel still don't seem to realize that there's even an issue with male modesty. The "speak up" mantra is about the only progress that seem to have been made. If this works to procure the necessary modesty for the individual male, that's great. Nevertheless, this leaves each individual to confront the issue alone, often without the knowledge that he has a voice in the matter. It would be so nice to enter a medical facility and be asked if one preferred same-gender care, instead of expecting to be scoffed at, ridiculed or dismissed when one presents with the request. Possibly, the medical system is too entrenched to accommodate something as "trivial" as male modesty. This is sad, since many of us are "broken" physically and we eschew health care because we fear being broken emotionally, spiritually or psychologically.
Reginald
To All My Current Readers and Writers to this blog thread: I really do appreciate all your ongoing support of now looking for and writing about approaches to change the behavior of the medical system so that the system will pay equal attention to the modesty and dignity aspects of ALL genders (and that means also LGBTQ).
I have been aware, as you have also, that there has been commentaries currently mainly from apparently male writers (for example as compared with Volume 16) and so I wanted to publicize this blog thread a bit more to the world. Therefore, in the past week, for the first time, I put up my first such messages to Facebook with the link and the with the associated current thread display on 2 days. I clicked on "public" which I assumed went out beyond my "friends". However, as I screen my responses to this act on a statistic site, I see only one individual actually came to our thread.
I am, therefore, asking for the first time, assistance from my current participants who may be more familiar with the operations of Facebook and even Twitter, if you could, through these and any other media you are familiar with, help publicize this Patient Modesty Volume 79 thread. In all these 12 years of this thread, I have never asked this of my participants previously.. maybe I should have.
Of course, my request is based on my assumption that all the participants here recognize the need for more and continued constructive input.
Any help that you can provide for our important blog thread will be most appreciated by me and hopefully by the others here.. (and as you known this is not in any way a commercial blog and that is not a factor in my request).
So feel free to disseminate our interest here by means you are familiar with and let's see if some constructive ethical good can be further developed. ..Maurice.
A few things.
Reginald, that UK article you posted a couple days ago indicating some awareness that maybe even men might want some gender choice is encouraging. It is at the same time discouraging in that while they know it is an issue for women they are only speculating with men.
Dr. Bernstein, though I wasn't with you back in 2009, I have read some of the old material and do see some shift towards solutions versus just grousing. Grousing is a very necessary first step though if for no reason to validate one's feelings with others who will understand where you are coming from. It can be therapeutic.
I too would like to see more female voices, and very much would like to see some nurses & techs join in the discussion.
I am not on Facebook or any of the others and can't help there but do encourage those who can.
A small non-modesty but speaking up for oneself tangent here. Yesterday I had a follow up colonoscopy, but at a large teaching hospital vs the small regional one that did it last year. I had pre-arranged for it to be without sedation and nobody hassled me at all, yet had I not spoken up I would have automatically been sedated. More pertinent to the discussion, as noted at the time when I was there a couple months ago for a cystoscopy, when I stated I wanted a male nurse for the prep, I got one no questions asked. Had I not spoken up, odds are I'd of gotten a female nurse given most of the urology nurses are female. I wish I had started speaking up long ago.
As a follow-up to a discussion a few months back, I checked the website for the local college nursing program, and there is now a photo with a male student. Just one but that's one more than they used to have. A small step but a step nonetheless.
Hello again,
I recently reviewed an article from the UK's Nursing Times titled, "Design agency and trust apologise for error over ‘sexist’ nurse job adverts", 24 May 2017. I would attach the url; however, I don't think it can be read w/o a subscription. The full article may be available somewhere on the internet. I've attached an edited excerpt below. In light of the my previous post re deference to UK females requesting same-gender care, this article is "interesting". It decries sexist, unenlightened views of nursing but, seems to miss the sexist (male) prejudices alluded to in the previous post. Additionally, the UK's protection of nurses as NOT playthings seems something that isn't even considered in the US. The edited article follows:
Design agency and trust apologise for error over ‘sexist’ nurse job adverts
A design agency and hospital trust have apologised after two nursing recruitment adverts were used in error that went on to attract heavy criticism on social media for being sexist. The two adverts were developed by Strawberry Design for Hull and East Yorkshire Hospitals NHS Trust, as part of its “remarkable people” nurse recruitment campaign. They featured two of the trust’s current emergency department staff, newly-qualified nurses Emma Gray and Izzy Davis. However, the trust noted that what had “caught the attention of social media users, print and broadcast media over the past few days” were the captions accompanying the pictures. One caption stated: “As soon as Emma looked at John she knew it was serious. A full fracture of the tibia.” And the other said: “Before lunch, Izzy made Roy’s heart flutter. It’d stopped for 10 minutes.” The adverts, which appeared in the healthcare management publication Health Service Journal on 16 May, were greeted by a torrent of criticism on the social media site Twitter. Regarding the new adverts, Victoria Daley, deputy chief nurse Surrey and Sussex Healthcare NHS Trust, said: “Oh dear, have we gone back half a century? Will it be Carry On Nurse characters next?” Picking up a similar theme, Dr Iain Beardsell, a consultant in emergency medicine at University Hospital Southampton NHS Foundation Trust, said: “Seriously? Where are they hoping they’ll work? The 1970s? Are we not in more enlightened times?” Elaine Maxwell, associate professor in leadership at London South Bank University, questioned whether the Yorkshire trust used “Mills & Boon style ads for other staff”, and whether it only wanted to employ “young blonde female nurses”. Dr Lynne Stobbart, a nurse and senior research associate at Newcastle University, described the adverts as “patronizing, demeaning, insulting and offensive”. In it she noted: “Gender prejudices are alive and well in public images of nursing, and these prejudices are evidenced in portrayals of nurses characterised as sexual playthings, beautiful young and sexy, defying danger to find romance. “It’s one of nursing’s biggest issues professionally and it is deeply troubling that employers should exploit this as a recruitment tactic,” she said. In the statement, the trust’s executive chief nurse, Mike Wright, described the incident as “deeply regrettable”.
[PS Please note that the executive chief nurse, Mike Wright, is apparently male.]
Reginald
Hello again,
Please excuse my repetitive posting. I'm somewhat flabbergasted at the article below from UK's Nursing Times titled "Do We Need More Men In General Practice Nursing?" Q - How fast can this idea cross the pond?
http://lp.plexusnetwork.com/index.php/email/emailWebview?mkt_tok=eyJpIjoiTVRJMlpETTFZemN3WVRrNCIsInQiOiJWelRDa3FjbUdHdUpvRzhldkpLM0xzUk01aG0wbTkrTFhlQ3dkNG1odU40QUpkZlV4M2ZZYWt0VU5SdGVSQXQrc2pzaU9xZUVoSTErODJLNWQ3R1U4U1JSaEUxZjNJN1wvV2kyOVZtV3d2ZE1CTXVZeVYzTTV1ZHBZWWM3d1MyOVkifQ%3D%3D
Reginald
Again, thanks Reginald.
You know, in attempting to dissect the issue presented by the visitors to this blog thread "Patient Modesty", like all investigative work both forensic or medical, everything should be looked at and decided whether to be further investigated.
Based on this premise and with the slant of the explanation of the experiences of the patients writing to this thread, I looked back on my blog to an August 5 2004 posting which presents a different view of the patient-doctor relationship as written by a physician ethicist, perhaps tongue-in-cheek or perhaps not. Is there anything in this poem which helps us better understand what is going on with our patient modesty-dignity issue? Here is the link but a reproduction of the posting follows.
http://bioethicsdiscussion.blogspot.com/2004/08/why-cant-patient-be-more-like-doc.html
================================================
Why Can't a Patient Be More Like a Doc?
Continuing with the consideration of the ideal physician and ideal patient…
Here is a satirical takeoff by Steven Miles, MD,Professor of Medicine and Geriatrics,Center for Bioethics,University of Minnesota on a familiar My Fair Lady lyric.
Thanks Steve.
A HYMN TO HIM
Why can't a patient be more like a doc?
Docs are so honest, so thoroughly square;
Eternally noble, historic'ly fair;
Who, when you win, will always give your back a pat.
Well, why can't a patient be like that?
Why does ev'ryone do what the others do?
Can't a patient learn to use her head?
Why do they do ev'rything other patients do?
Why don't they grow up- well, like their doctor instead?
Why can't a patient take after a doc?
Docs are so pleasant, so easy to please;
Whenever you are with them, you're always at ease.
One doc in a million may shout a bit.
Now and then there's one with slight defects;
One, perhaps, whose truthfulness you doubt a bit.
But by and large we are a marvelous lot!
Why can't a patient take after a doc?
Cause docs are so friendly, good natured and kind.
A better companion you never will find.
Why can't a patient be more like a doc?
Docs are so decent, such regular chaps.
Ready to help you through any mishaps.
Ready to buck you up whenever you are glum.
Why can't a patient be a chum?
Why is thinking something patients never do?
Why is logic never even tried?
Questioning me is all that they do.
Why don't they straighten up the mess that's inside?
Why can't a patient behave like a doc?
If I was a patient who'd been offered a cure,
Hailed as a miracle by one and by all;
Would I start weeping like a bathtub overflowing?
And carry on as if my home were in a tree?
Would I run off and never tell where I'm going?
Why can't a patient be like me?
==============================================
So.. does anything in this expression of the relationship between patients and their physicians or even their nursing staff help us to understand anything about the topic and the approach to mediation of the issues long presented here? ..Maurice.
Dr. Bernstein,the poem is surely tongue in cheek, though humor typically seeks to amplify stereotypes and prejudices. If so, then the link to our modesty discussion is that when a doctor says medicine is gender neutral we're supposed to agree that it is gender neutral.
The primary problem with doctors is the extent to which they influence staffing mix decisions rather than their own behavior. Except for certain OR & ER scenarios, we all generally get to pick the gender of our physicians. Yes that is harder in rural areas, but those who feel strongly about gender choice do generally have the option of traveling to where their needs can be met.
For men the issue is far more at the nursing and tech level as has been discussed many times. Its not the doctors. So long as the nurses & techs conduct themselves in a clinical and professional manner, including not bullying or being dismissive of patients who express a gender choice, it isn't their fault that they are who was assigned to us as patients. They were hired to do the job and they are doing it.
The problem then are the people, be they physicians staffing their practice or hospital administrators staffing their facilities. Neither can hide behind the "we don't get male applicants" excuse if they don't convey their needs to nursing schools. If nursing programs were told that the local hospitals and private practices will be prioritizing the hiring of male nurses in order to meet the needs of their patients, and that if they can't get them from that nursing program they will seek them elsewhere, you can bet that nursing school will start promoting nursing careers to boys at the area high schools. Yet physicians and hospital administrators don't make requests. That is where the problem lies.
Neither physicians nor hospital administrators can truly believe the medicine is gender neutral mantra so long as the very concept of male mammographers is unthinkable. They know gender matters.
Just a piece of positive trivia from today's paper. The local hospital has two employees of the year each year, one clinical and the other non-clinical. The clinical employee of the year is a male RN who works in the OR, and with his photo in the paper to go along with the article. Hopefully local high school boys see this.
I found an excellent article about the issues involved in the nursing education of male students. Although it was published in 2004, I suspect, unfortunately, it is still "up to date" 2017. The article was published in the Nurse Educator
http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.473.9065&rep=rep1&type=pdf
The Introduction reads:
Contemporary nursing literature,
both research-based and popular
press, is replete with examples of gender
bias and its impact on males seeking
to pursue a nursing career. The
outcomes of gender bias are harmful
to the profession and create a cycle
that perpetuates bias and limits the
role of male nurses. This cycle results
in different learning experiences for
males and females as nursing students,
limits recruitment and retention
of males into the professions and
perpetuates traditional male/female
stereotypes that make the profession
irrelevant to the diverse population
that the profession claims to represent
and serve.
Unfortunately, male nursing students and then as male nurses in practice are bucking against the very concept begun "150 years ago as the profession began to be organized around principles espoused by Florence Nightingale and concurrently became accepted as a legitimate option for unmarried Victorian women who sought employment."
Worthy reading even though the RN writing this encouraging article is a female. (By the way, in the article she does encourage male nursing students to be educated by male nursing instructors... and I would agree, wouldn't you?
What we need to encourage men io enter the nursing profession is for men, as patients, to ask, request or even demand care also by male nurses. This gender inequality with regard to education and public demand must change and if it ever does, a blog thread such as this one may end up becoming moot. ..Maurice.
With the school year over for me and my year 1 medical students, I find now I have more time to review my blog and review my Patient Modesty threads to see where we've gone and where we might go further with this topic and now even writing to the thread a bit more.
I found the graphic for Volume 5 produced very interesting discussion of the gender sensitivity of personal nudity which may play a role in the considerations discussed here in Volume 79. Below is the link to that Volume. It may be of interest for our current visitors here to return and respond with your views on the issue presented. (There is no further posting available on Volume 5.) I would be interested to read what our current visitors think about the subject.
http://bioethicsdiscussion.blogspot.com/2008/07/patient-modesty-volume-5.html
..Maurice.
I went back to Volume 5 and found the male vs female nudity in the media discussion interesting. It is ironic that whereas the media is much quicker to have female frontal nudity than male, the medical world emphasizes female modesty while often ignoring the same for males.
The look back machine raises a question for me. Has anything changed? Are men treated differently now versus 10 years ago? 20 years ago? We've all had bad experiences but is the same stuff still happening now? By bad experiences I mean inappropriate behavior by female staff in whatever form that takes, or simply just the kind of casualness and carelessness with our exposure that occurred in the old days. I know having nursing/tech gender choice is still a rarity and that nothing has changed there, but are the female nurses/techs we are forced to have behaving better as concerns our exposure?
With regard to behavior of nurses which has been criticized on this thread, do you think that it would be wise for hospital nursing staff (most likely female) be involved in teaching and assisting 3rd and 4th year medical students in performing what is often primary nursing activities such as changing Foley catheters and other technical but intimate care which procedures medical students at this stage of education are expected to learn and perform? (long sentence!)
Here is the experience representing one 3rd year medical student and written in KevinMD but with a perhaps controversial title "Why Nurses are the Best Teachers for Medical Students".
http://www.kevinmd.com/blog/2017/05/nurses-best-teachers-medical-students.html
If not the patient's nurse on the ward, practically who else? Or do some of my visitors think this may be a route for "contamination" of the final acquired behavior of fresh "to be physicians"? What is your opinion? ..Maurice.
Until I get a discount in the same manner dental schools provide, I'll never serve as a training aid no matter how innocuous the procedure; and never for anything considered intimate!
Ed
I am very passionate about reducing unnecessary urinary catheterizations due to modesty reasons and complications such as UTIs. I cannot help, but wonder if the lady in the article Dr. Bernstein mentioned really needed an urinary catheter. The truth is most urinary catheters are actually unnecessary. They are often done for staff convenience. There are so many alternatives to urinary catheters. For example, look at this new technology, TIMO at http://dignitymedical.net/testimonials/. A doctor shared how TIMO worked well for him when he was on complete bed rest.
For those new on this blog, check out an article I wrote about unnecessary urinary catheters and lack of informed consent.
Misty
Maurice
Would your 3rd year medical student be able to shadow a mammographer performing mammograms? Not that medical
students are ever going to be performing mammograms and will probably never insert a Foley catheter unless he/she
trains as a urologist, what's the point? Secondly, why would anyone think nurses make the best teachers for anyone
let alone med students. It's a fairly known fact that female nurses hands hold more bacterium than male hands, that
female nurses are responsible for 100,000 deaths each year due to hospital acquired infections. Factor in all the wrong
medications given, wrong dose, lack of respect for privacy of their male patients and a bevy of other competent issues I
haven't listed, why would be go backwards and start a negative trend!
PT
Ed, how about a patient being and performing "altruistic" when in a relationship with a fresh student learning to become a physician? Does modesty, for example, trump the altruism involved in being one to aid in the development of a physician who will remember and put to a humanistic use and benefit from what was learned from that patient--you? Just wondering. ..Maurice.
Maurice
To suggest that a nurse who was on the 10 year plan initially as a cna took years to obtain a 2 year certificate at a community
college. Struggled with elementary algebra that was normally offered in her 7th grade class is now entrusted to teach a 3rd
year med student who after 7 years of comprehensive study will expect to be fully competent from her instruction. This is part
of what's wrong with healthcare today.
PT
PT, I was referring to Ed's comment about the patient being paid for participating in the teaching of a medical student and instead of payment: the understanding of altruism as practiced by the patient and the appreciation by society of the sacrifice. Altruistic behavior by the nurse is another matter. ..Maurice.
Most of what physicians do, nurses don't. Most of what nurses do, physicians don't. Most, not all. There is a small overlap and to the extent there is at least some basic ability at that crossover point is a good thing. In the examples given, inserting a foley and starting an IV, why not let nurses who do those tasks the majority of the time help teach medical students? They are most likely far better at it than medical school instructors.
No matter what the subject matter is, when teaching someone else, few of us are going to take shortcuts or breach standard protocols in front of our "students". In the case of foleys I'd be surprised if nurses weren't more respectful of exposure issues than they'd normally be if someone weren't watching them. The downside of course is now you'd have an audience.
As for altruistic patients, I say it depends. Asking me politely will get you further than just telling me you are going to do it. While I don't like the thought of an audience for intimate matters I might be willing to exchange a bit of my modesty for the opportunity to directly give feedback to a student. My thinking is that direct patient feedback at that stage of their career could have a lasting effect, moreso than a theoretical statement provided in a lecture hall.
In an effort to NOT further impact the medical education of doctors, how about requiring every doctor to work one (8-12hr) shift PER YEAR assisting (or shadowing) a nurse? This would be a great way to learn some of the nuances of nursing and to appreciate their efforts.
Reginald
Altruism, really? What benefit to society are you thinking of while simultaneously running the country bankrupt. Medicine is nothing more than a for profit business enterprise! I'm relatively confident there are enough patients who are either okay with this practice or are simply ignorant; exhibited by blindly signing boilerplate admissions documents that grant medical personnel a blank check to administer healthcare in a manner that they choose.
I am no longer one of them.
Ed
Ed, I am all in favor of patients or their surrogates (if necessary) read and appropriately accept or reject entry or pre-op documents.
The benefit to society of a patient permitting interaction with a medical student under properly disclosed and supervised circumstances is what creating physicians out of a pool of "the interested" to keep society healthy.
Look.. as a teacher of first and second year medical students and knowing full well that "standardized patients" are an ever-growing teaching resource in medical education, I can firmly state nevertheless, "standardized patients" value has limitations and there is no substitute for student education by interacting with a "real patient". ..Maurice.
Got it and I see your point but it's either your way or the highway. Tell me, what happens if a patient refuses to sign the admissions documents at your teaching hospital that permit this practice?
I presume the last post was from Ed. To answer your question, I really don't know except I can't imagine LAC-USC hospital rejecting an admission for such a refusal. My experience has only been with first and second year students utilizing the hospital patients to take a history and perform a physical examination and nothing more. As I have said on this thread many times before, each visit with a patient involves first the student identifying him or herself, what their educational requirement and goals were for them for that visit with explanation and finally requesting the patient's understanding and approval. Otherwise, the student says "thank you for listening" or something to that effect and will leave the room. As the physical exam is performed, the student narrates to the patient as to what to expect or what the student is attempting to learn. Every step of the way through a physical exam what is done is based on acceptance of the patient. And yes, in the writeup description of the history and physical which I review for feedback, at times there is an explanation by the student why a part or entire system was not examined and while it may be that the patient was removed from the room to be taken away for a procedure by the hospital staff, it occasionally may be a simple patient refusal at the time. This is my only experience regarding this matter. To us..the patient is "the boss". ..Maurice.
Yes, the comment on Monday, May 29, 2017 2:42:00 PM is mine; my apologies.
Based upon my limited experience at a different non-teaching hospital, I'm confident they're not admitted unless they sign the blanket authorization. Additionally, what you describe is fundamentally different than nurses and residents who fail the basic ethical obligation of asking permission. I'm truly appreciative of your dedication to this blog but you live in an academic world; I don't mean that disrespectfully either!
Ed
Ed, actually I look at all medical practice as part of an "academic world" for everyone of the "practitioners" (and that's what they are called since they are just practicing their occupation) who work in that world. It is day in and day out a learning experience even for those of us many years into the profession. And I believe all in the medical profession from those who directly attend a patient and to those who operate a clinic or a hospital or other medical system should be listening to those whom they serve.. and learn from them. ..Maurice.
Dr Bernstein, just for clarification, do the kinds of practice exams medical students do with patients that you are referring to include prostate, hernia, and testicular exams? I realize some patients may limit the extent, but is the intent to do a total exam in this manner if the patient allows it?
I think the larger issue isn't a clearly consented student practice exam but rather actual patient treatment such as doing a foley per the article. The reality there my more be nursing students doing their clinical practice than it is residents or medical students. At issue is how honest are hospitals in identifying students (nursing or medical) as students. I pushed the local hospital on that concerning their high school students in an LNA program at the local tech school. You only have to be 16 in VT & NH to work as an LNA.
Misty, sorry for the delay in posting your comment dated Monday May 29 at 11:55am-- it got buried in all the other comments.
Biker, in our school there are NO genitalia or rectal exams performed on real patients during the first and second years. They only perform these exams in the second year on paid instructor subjects as I have previously described here. Learning technique on real patients await their third and fourth years of training. I have never attended these 3rd and 4th year experiences so I can't detail it further here but I can't believe that those performing the exam are not identified as students by themselves or by their supervisor instructors and I can't imagine patients are threatened to accept the procedure against their wishes. Biker, I also no nothing about any LNA activity or protocol at our medical student teaching hospital. ..Maurice.
It's 1984 and you are in a 1000 bed level 1 county hospital. This facility provides mammography with an all female staff, L&D services with an all female nursing staff and an MICU ( medical intensive care unit) all female nursing staff. The staff bathroom is covered from the floor to the ceiling with full male nude fold outs from PLAYGIRL magazine. No one, not even their charge nurse (female) nor the director of that unit female, can see a problem with it. Why should they? After all the hypocrisy extends throughout the entire feminine healthcare industry.
Fast forward to 2017, what has changed? Nothing, absolutely nothing. Business as usual only that what you may not see is that it's only gotten worse, compared to 1984. Now you have scribes in the er following every provider in the patient's rooms and during exams, by the way most scribes are female. There is now an abundance of cna's in hospitals, icu's and step down nursing floors. Nurses in the industry which is about 95% female have according to state nursing boards are at an increasing level exhibiting criminal records and a hx of drug addition. Over 95% of cna's medical assistants are female as you know. Historically, er physicians were typically male yet their types are being replaced with a new provider, enter the physician assistant over 75 % female. Obgyn residents now are at 50% and increasing.
Don't expect anyone in administration to care about your concerns as the typical CEO who used to be a male MBA graduate is now a nurse and female. Patient satisfaction scores only present surveys to the patient asking " how did the hospital food taste or did your Doctor take the time to answer all your questions. Nothing about privacy because the CEO of that company is a female nurse. It's just pointless to complain to your insurance company about the care you may have received since all the people who answer the phones are female. Go ahead give them a call, you'll see what I mean. Even with most of the hospital staff being female and certainly so in the suites that provide mammography even the female hospital nurses will say they do not prefer to go to the mammography suites in the same hospitals where they work??? Ask if male patients have a choice even if they decide to go for care at any facility, you know what's the point, it's all the same.
Even the scripting is all the same at every facility you go. Oh we're all professionals, you don't have anything we haven't seen before. Do you think female mammographers would say that to their female patients ( female nurses) who are afraid to use the same facility where they work to get care?
PT
Not that it matters perhaps to animals, I don't know. Even vet techs are all female from what I've seen. Looks like this problem is persvasive throughout the animal kingdom.
PT
PT, the staffing mix still being predominantly female is true. There are more male nurses but not enough to make for a material difference. My question from a few days ago remains however. Have their protocols and behavior changed for the better? Would you still find a staff bathroom with male nudes plastered in the walls?
My healthcare life experiences are limited to Massachusetts, Vermont & New Hampshire which is but a small corner of the country and perhaps culturally not totally in the mainstream. Maybe things are different elsewhere but I think it has changed here vs decades ago. It is still mostly female, but I think they have improved their protocols.
I'm 64 and remember the utter lack of regard for male privacy/modesty growing up. I recall being humiliated in the 1980's by an RN when I had a vasectomy, and at the time just suffered it in silence because I had only ever known being treated disrespectfully. I have had several dozen intimate procedures over the past 13 years and though it is still mostly women doing it, their professional protocols have been extremely respectful. This is why I think the problem today is primarily lack of male nurses/techs and lack of choice rather than being how the individual players behave.
I doubt any hospital administrator would tolerate male nudes in a staff bathroom if for no other reason fear it would become Exhibit A in a lawsuit by a male patient over a female nurse being sexually inappropriate.
One new issue vs 1984 that you raise is a good one. We didn't use to have scribes, nor were chaperones as prevalent. That scribes are mostly female and chaperones almost exclusively female adds to the gender mix problem and perhaps makes the situation worse in circumstances where they are used.
I'll clarify the nude foldout in the staff bathroom of the intensive care unit. They appeared to have been installed professionally, it was wallpaper perfectly covering every square inch including the ceiling. It went around the sink, toilet etc. This wallpaper appeared to have been on the walls for a very long time. But then it was 1984, who cared. Just exemplifies the double standard for people who describe themselves as professional. My point is this, if you see this level of disconnect at one facility in a major city, then the mentality exists everywhere else. This isn't just one isolated place, after all it was 33 years ago, why wouldn't it occur now. The mentality is already in place, what's to stop the physical description of their mindset. Furthermore, the patients on that type of unit would never know about what was in the staff bathroom due to their high level of acuity.
If anything it would be considered sexual harassment by a male employee, but if you have all female staff who is there to complain? I'll say there is no such thing as a protocol when a procedure is performed. No individual will perform exactly the same, no nurse, surgeon nor anyone for that matter. You can have a protocol, process and doesn't necessarily guaranteed it will be followed. What behavior modification have been used between 1984 and today in as far as intimate procedures are concerned. Basically, the textbooks on medical-surgical nursing have changed very little since 1984 with the exception of inflation.
It's difficult to fully evaluate behaviors of staff in the healthcare industry from the patients perspective. As a healthcare worker with decades of experience and having been a patient myself, reading and hearing others experiences, what I read about online I can say wholeheartedly nothing has improved in this regard since 1984. It's only getting worse. Over the course of this blog I have honestly relayed behaviors I have seen day in and day out. Nothing is improving!
PT
In conclusion, when I bring up the issue of the nudity in the nurses bathroom, it's not as much about the double standard, it's not about the lack of professionalism. It's not about what if male patients on that unit knew about it. It's not what if an administrator knew about it and it's not about what other staff said or would say about it wether they knew or not. Obviously, I'm sure most people in that hospital knew about it.
It's about their AUDACITY and they could do it without repercussions!
PT
Good Morning All:
PT, the nurses tell their patient's they've seen it all before because they see it every time they use the ladies room.
If I were a patient on a floor where I found out the women had wallpaper or nude male pinups in the woman's room, I would NOT trust a female on the floor and I'd do whatever I had to in order to be transferred to another hospital.
Afterwards, I'd find a way to embarrass the hospital. A little bad press goes a long way these days.
Regards,
NTT
The person below is going to go to medical school. Maurice, I'm afraid nothing you could say to this person in medical school would dislodge what she's already learned in the "real world". That the dignity and privacy of male patients is a non-issue. Zero formal training, zero on the job training. "trial and error" with only the goal of making herself comfortable. And gossiping about patients is fun.
Imagine if you would a young male writing something similar. Of course a young male would never have been in a room with a female getting an intimate exam now would he?
https://thetab.com/us/2016/06/14/like-medical-scribe-14881
Sorry forgot to sign the medical scribe comment.
Mike
Mike, you were already identified by your posted Blogger name. It is those visitors whose Blogger name is "Anonymous" who should put a consistent pseudonym after their comment.
With regard to your referenced article by a female scribe, she writes as what I would expect from any first year medical student. It seems she was trying to follow the "scribe rules" and what she wrote was expected from someone trying to follow the rules and then challenged by circumstance.
I am not in favor of scribes. There must be a better way to get around bureaucratic documentation, much of which is just part of a bureaucratic system. Doctor-patient relationship should be patient-doctor and not scribe-doctor-patient. ..Maurice.
Dr. Bernstein, what I found most disturbing about the scribe article is when she says she likes gossiping about the patients. To me that says her instincts are just all wrong. Though I never worked in a healthcare setting, in my professional life nobody ever had to tell me to keep confidential matters confidential. It will be a sad day for patients if this young woman becomes a doctor. That she puts her name and photo out there for prospective employers (and medical schools) to see speaks to a level of cluelessness.
Though I tell myself that most nurses/techs do behave in a professional manner, at the same time I hear what PT and others who work in healthcare say really goes on. That gives me pause.
In the old days when women weren't allowed into "men's" jobs, there sometimes was a locker room middle school culture that was very disrespectful of women. Once integrated the men cleaned up their act. Perhaps if nursing/tech areas were better integrated, the "old girl" culture would get cleaned up too.
Biker, the sentence is "I’m basically in love with my job; it is as close as I can get to being a doctor without actually being one, and I’ve learned that gossiping about patients is one of my favorite past times."
Identifying a patient's history, physical or condition by name as part of "gossip" is not only unethical but illegal as per HIPAA law in the United States.
However, one could express feelings and describe incidents in ones occupation which could also be termed "gossip" without identification of the focus of the description which is perfectly acceptable as long as no institution or individual is harmed. Gossip does represent a form of "ventilation" of experiences which may not on all circumstances be disclosed.
What do you think? ..Maurice.
Maurice
I'll add my two cents to the comments the scribe made. First, she obviously needs attention as you can see she has posted numerous pictures of herself, thus she is extremely insecure. Secondly, she is playing the " men are all perverts card" that justifies her presence
during intimate exams of male patients. Female nurses make the same comments all the time thereby appearing as the victim. She says
" oh I've learned to look away when male patients are told to lower their pants " but we know better.
I've always as a healthcare worker wondered why in the world do people gossip about their patients. It's obviously a female trait and there is NO such thing as good gossip. You can speak about your empathy for the patient but the gossip, nasty, irrevelant, unnecessary gossip and much of it again directed as a result of insecurity. Most gossip does involve hipaa violations as its spoken to coworkers who would ordinarily not know specifics of the patient. Looking at this scribe tells me she has some body habitus issues which most likely explains the source of her insecurity. Rather than gossip about her patients it would behoove her to think about the Krebs cycle if she
truly is interested in medicine!
PT
If you pay attention to the comments the scribe makes she mirrors behavior like Kathy Griffin. I'm nasty but now I'm not nasty because the man ( patient) was nasty and made a lewd comment to me.
PT
"...which is perfectly acceptable as long as no institution or individual is harmed."
Only if you believe acceptable is the same as legal.
"...she writes as what I would expect from any first year medical student."
Maurice, I mean no disrespect, but that's pretty low bar. I would expect more respect for others from anyone and I would have a higher standard for someone aspiring to be a doctor.
P.S. Thanks for the tip on commenting. I obviously don't do this often.
None of us know that scribe and so all we can do is speculate based on her comments. She is not working in a high pressure fast paced ER environment but rather with a physician doing routine exams of patients. If she needs to vent to release pressure in that setting she really is going down the wrong career path.
In many settings patients are not anonymous. If she speaks to anyone other than the physician himself about a patient she is out of bounds. None of the other staff have any need to know anything about the patients she has served as scribe for. What she doesn't know is maybe the other staff know who these patients are outside of their office.
Here is an example of the above. The daughter of one of my friends & co-workers was a newly minted RN working at the nursing home my father-in-law was at. She comes home and starts telling her mother about this old man that she thought was adorable. She never said his name by my friend knew it was my father-in-law. What if instead of saying how nice he was she was venting about his behavior or talking about his interesting medical condition? Leaving someone's name out of the conversation doesn't mean it is still an anonymous reference.
PT, I like your Kathy Griffin analogy. It is the male patients that are sometimes needlessly being exposed to her by the simple fact of her presence, yet she is the victim. Again, immaturity.
To our Volume 79 group: I just want to substantiate my comment that in certain circumstances gossip may be therapeutic, ventilatory and of socially functioning benefit. So here is a series of articles I found and I am sure you will find a few more which tends to support what I previously wrote here.
http://journals.sagepub.com/doi/abs/10.1177/0956797613510184
http://news.berkeley.edu/2012/01/17/gossip/
https://www.psychologytoday.com/blog/sideways-view/201311/gossip-is-good-you
https://www.theatlantic.com/health/archive/2014/11/have-you-heard-gossip-is-actually-good-and-useful/382430/
Now, gossip can be improper and also harmful but so can other "ventilation" of feelings: those criminal behavior against Jews, Muslims, blacks ..and yes ventilation about someone's personal sexual identifications.
Think of this: from my experience, those who enter medical school (even those whose parents may be physicians) are about to experience something they have never handled before--a career involving other persons private and detailed history and body and the challenge of protecting these persons comfort and lives. It is personally emotionally challenging for those just entering from a social college life "full of gossip" but without such responsibilities.
Yes, telling their experiences and feelings as a new medical student (or even as a "scribe" or "shadowing pre-med" (yes, my students give that personal background experience) to friends or family is certainly reasonably expected "ventilation". As long as this "gossip" protects patients'or teachers anonymity such "gossip" should not be struck down simply because of the word.
PT, remember that disclosing your observations or documentation of sexy pictures on the wall of female nurses rooms is also "gossip". But it is important what you write and it is written appropriately since you have behaved properly as I expected: you presented no identification of the named source of your disclosure. You simply "ventilated" your opposition to what you understand was the nurses environment and which was upsetting to you.
To all: read the above references and find more. You may feel that "gossip" has but one direction: "destructive" and those description of the expression are in error but let us read your views. After all--
what has been the content of much of these 79 Volumes simply personal "gossip" but it must be of some therapeutic value for these Volumes to be able to find writers. ..Maurice.
Dr.Bernstein, living in a small town it is the anonymity part that concerns me when it is medical staff doing the gossiping. It is hard to be anonymous in small settings and at the same time you may not realize who is related to who or otherwise knows that person you are talking about. You may not have to say their name for someone to be recognized.
I otherwise understand your point about gossip not always being negative, but in the case of the scribe the manner in which she wrote her article makes me think her patient gossip might lean towards the salacious, or at least painting the patients in a negative light.
Most people mature with time and so there is always hope for the young and immature, but pretty much every article written by a young woman in the medical field reminds me why I prefer that older medical staff tend me.
The old phrase " Loose lips sink ships ". You have gossip and then you have viscous gossip, neither I believe is beneficial in healthcare cause where do you draw the line. It only tends to jade staff, becoming judgemental towards other staff and physicians and worst of all,
patients. Viscous gossip tends to be rampant in medical facilities for it is the cause of failed careers, distrust among staff and in my opinion
a New tool for the young and enabled to draw attention to themselves. " you are not going to believe what I did today " . Who Cares!
Is the suggestion that as a patient you can't go anywhere for healthcare without someone feeling the need to gossip about you. Gossip
sells. It's one of the reasons Hipaa laws came to be, everyone just wants to know your business. They will pry into your health records
without authorization to distribute it and possibly use it against you and even for monetary gain. I see no therapeutic value in gossiping
in healthcare. Cell phones, Facebook and the Internet is simply a new medium to distribute gossip and why should it have a place in
healthcare at all. Could we put a price tag on gossip as it affects medical institutions? Has any of those sites mentioned the eventual cost.
PT
Maurice
There is gossip, free speech and the right to petition the government for a redress of grievances as listed in our constitutional rights. That's exactly what I'm doing now, petitioning the healthcare industry for all the inequities, discrimination and wrong doings that have been done to male patients. Have I really behaved properly as you stated? I don't feel I have. I don't feel that I have championed enough, worked hard enough nor written enough to convey all the information so that readers can form a fair opinion of the big picture, big problem. Maybe none of us have for that matter. Gossip is cheap and should not be free for it is harmful, deteriorates trust, disruptive and serves no one.
PT
Good Evening All:
As if things weren't bad enough for men, urology according to Urology Times, is starting to use verbal anesthesia in the office surgical suite as more and more procedures are moving out of the hospital OR and into the office surgical suite.
The object of verbal anesthesia is to combine the use of a local anesthetic for the procedure and have someone talking to the patient at the same time getting their mind off of the procedure while the doctor is working.
On the day of your procedure, first they adjust the temperature in the surgical suite to make it comfortable and then they turn on what they determine to be soothing music. All this to make you their patient, feel at ease.
Now. When you arrive at the office, an “assistant” will be assigned the role of “verbal anesthetist” for your case and this person’s job will be to set the tone for your day by using calming conversation with you from your arrival at the office, until your procedure is done.
So, after they’ve taken you to the “ready room”, they take you to the procedure room where they position (put you in the infamous stirrups), and prep you on the table. Lastly, a surgical blinding screen may or may not be installed to keep the patient (not the verbal anesthetist of course), from viewing the large unfamiliar instruments the urologist might use along with “other” things. When all is complete, the doctor comes in and the procedure begins.
So as the doctor begins their work, it’s then the job of this verbal anesthetist to start up a conversation about anything other than what’s going on in the room with the patient. The more personalized they make the conversation with the patient, the more their mind will be off what’s going on.
During the procedure the urologist will interrupt the conversation with positive coaching type comments. Any type of stress-inducing phrases will be avoided.
The goal of this method is to have a calm environment in the room throughout the procedure.
Now, this sounds like a good idea for urologists to try with those patients that don’t mind opposite gender caregivers.
The reason I say that is this “verbal anesthetist” will more than likely be a female who should have no problem relating to female patients but, she’s going to have trouble relating to male patients unless the gentlemen prefer opposite gender care.
That way the guys won’t care when instead of talking to the patient the whole time like she’s supposed to, she “sneaks a peek” as to what’s on the other side of the blind.
For those gentlemen that prefer not to hand over their dignity and privacy at the door, this scenario will be a nightmare.
Adding another female in the procedure room of a male patient who prefers male caregivers to start with will only serve to aggravate not calm the situation.
I strongly urge those urologist’s that want to incorporate this method into their practice to sit down and think the entire process through. Ask yourself “What am I going to do when I have a patient who has modesty concerns”?
Better yet, before you implement this process ask your patients what their thoughts are on having yet another person in the treatment room. Especially if this person that’s added will be of the opposite gender.
Adding a “verbal anesthetist” of the opposite gender to a treatment room of patient who has modesty concerns won’t have any bearing on the physical outcome of the procedure however, emotionally and psychologically speaking, that patient will come out of that procedure changed forever.
I liken this idea to adding the scribe to the room. No matter what anyone says, if the scribe and/or “verbal anesthetist” aren’t the same gender as the patient, THERE WILL BE PEEKING. And nobody will do anything to stop it like they should.
Regards to all,
NTT
Dr. B.,
Your statement of current societal norms [gossip may be therapeutic, ventilatory and of socially functioning benefit] is the current culture today. Today's social media, e.g. Facebook, certainly reflects that privacy is even disclosed by the subjects themselves. The trend has been getting worst. Gossip is somewhat minor compared to the disclosure of classified data. Politicians [Are they role models?], and even worse their staffs, have no problem disclosing classified data if it suits their politics. Our mores in the past placed limits on disclosing private and classified information. I'm sure the young female scribe had no thoughts that her gossip violated any societal values. If I thought that she had broad experience within the medical community, I would say that she would be quite comfortable with gossip about patients.
BJTNT
BJTNT, I agree with your estimation of the extent of "gossip" in our society and its increased frequency and dissemination. But, based on how one wants to define "gossip".As a form of "ventilation" or
"curbside consultation" it may benefit providing an ethical "good" to the medical system and its patients. In this definition, I don't think that professional gossip need be thought of as harmful to the patient. Nurses can gossip the issues they have observed which should be remedied for the benefit of the patient. And physicians, well..there is even "curbside consultation" which some may term as "gossip".
I have a 2013 blog thread
http://bioethicsdiscussion.blogspot.com/2013/02/medical-curbside-consultationsare-there.html
about "curbside consultations" in which our PT wrote something positive and constructive about this professional "gossip".
"At Sunday, February 10, 2013 8:19:00 PM, Anonymous said...
No new concept here,happens all the time. In fact, I
believe it is more acceptable and leaves the responsibility
with that physician for the care of his patient. It is a well
known fact that when you have two or more physicians
caring for you, one will assume the other assumes
responsibility. The old saying, too many fingers in the
pie so to speak.
My point being that two physicians assigned to your care
rarely communicate with each other. They often resent
the competition and shun responsibility, rarely does
the care complement one another.
PT"
So "gossip", with attention to privacy, can be looked upon as constructive in medicine. ..Maurice.
Here is a gossip example I witnessed. My neighbor has a mid-20's daughter who has a friend that is a nurse. My neighbor and I are both elected officials in our small town and so occasionally we'll be at the Town Hall at the same time. The women do as women typically do and they talk about personal things in a way that guys don't. One day my neighbor blushed as she referred to some of the stuff she'd heard the young nurse telling her and her daughter she sees and does. To my neighbor's credit she didn't go into details, perhaps because there was a guy (me) present.
In what way could that nurse gossiping with her friends about intimate patient matters possibly be of value or even be considered therapeutic venting, especially when it was something she apparently enjoyed rather than found stressful?
Done anonymously there is no harm to the patient in real terms, yet it is utterly disrespectful to the patient. Many nurses profess that a penis is no different than an elbow to them, yet I doubt they ever talk about a patient's elbow.
Biker, the very words you have last written to the thread is itself a gossip communication and yet it provides a constructive insight to your own experience and interpretation of the event as you know it. That is what I am trying to emphasize is that the activity of gossiping may not necessarily be improper and harmful to others but provide that insight yours into an issue not appreciated by others. If one finds the expression of another termed gossip is disrespectful or unnecessary, then the listener should speak up. ..Maurice.
Maurice
I know exactly what I have said in all my previous posts. Maybe we are talking about two different matters here. You have communication
which is absolutely necessary to make the world go round, then you have gossip. This issue was raised with the scribe and her comments she made. I will tell you right now when I leave work I neither have the energy nor the time to talk about patients. It's like Las Vegas, what happens in Vegas stays in Vegas. I just don't care. I have more important issues to think about or worry about in my personal life. I just absolutely do not understand the mentality of many people in healthcare. They just can't get enough of the Drama and as you know or should know Drama = Gossip.
Example, medical shows ER and all those other stupid medical shows. How can anyone who works in healthcare go home and for hours
watch those shows? Which gender in healthcare needs the drama and needs to watch those shows which further provides the need to
gossip. If you ask me how would I define gossip in healthcare. I define it as viscous, deliberate and unnecessary ugly side of communication that depicts patients in a negative light. Behind the patients back negative comments. I don't care that nurses are the biggest bullies toward other nurses. That is a well know side of nurses eat their young and with that is the gossip and the backstabbing.
It's a fact at any company, business etc. I'm strictly referring to patients and the ugly comments made about them. I hope I have
clarified myself . Let me give you examples of the kind of communication in healthcare that I define as ugly gossip. Comments
female nurses make about their obese patients male or female. Comments nurses make to other nurses about piercings in their
patients genitalia. Comments female nurses make to other female nurses regarding their male patients genitalia. Comments nurses
make about wether their patients are drug users or not. Comments nurses make about the patient's family and or visitors. The list
goes on and on and I could write volumes on what I've heard. That's my definition of the bad and the ugly gossip.
PT
I hear you Dr. Bernstein.
We all gossip to an extent but what medical and nursing schools need to caution students is that when the rest of us hear stories of medical staff talking about intimate patient matters it can make the exception be perceived as the rule. Surely there is enough gossip to go around without going down that road. Even if they think they are talking only amongst their peers, all it takes is one of them going outside their circle repeating the conversation.
NTT, I found and read the article you referred to. What it sounds like is they have refined a technique for what they really have been doing for a very long time.
The several dozen BCG & inteferon treatments and cystoscopies that I had at a major teaching hospital in Boston were done using a precise protocol that never varied no matter who did it. It included the RN or NP doing the treatment or prepping me for the cystoscopies asking me leading questions about kids, where I lived, my employment etc to get me talking about that stuff while she quietly and expeditiously did her job, interrupting the conversation only to ask permission to do the next step. My very last time there (last year) the doctor was delayed after I was prepped. She stood right at my side maintaining eye contact and keeping the conversation going in an attempt to not have me focusing on the fact that I was lying there was my penis exposed for a lot longer than was necessary. Maintaining eye contact for the entire wait also made clear she was doing her best to maintain my privacy during that delay.
PT, you are correct that protocols vary for the same procedure. My cystoscopy at a major teaching hospital in NH this spring followed a very different protocol than what I had done dozens of times at a major teaching hospital in Boston. By protocol I mean the manner of draping was different, the extent of my exposure during the prep was different, and the thoroughness of asking permission before doing each step was different. I was also lying flat on my back so that I couldn't see any of the prep process rather than being in a reclined position where I could see the entire process. That being my first time there I don't know if that was his way of doing it or whether it was their standardized hospital protocol.
PT, I agree. We should eliminate all emergency room or hospital videos, ER or OR whether they be a TV story series or a real life documentary. By eliminating are we hiding some realistic occurrence which benefits public viewing? I doubt it. I think this elimination will prevent exaggeration of ER life to the public and avoid incidental photography of real patients or staff who have never given permission to be photographed and just incidentally included in the video. Also, with regard to the issue of necessary and true privacy, I would like to see all ward rooms eventually contain only one patient and not two or more.
I think most every patient wants privacy both in terms of visibility and communication with staff and family and but also environmental (such as lighting, TVs, odors, etc.)
Yes, maybe some patients are happy to have a chance to communicate with a roommate but likely the roommate does not.
HIPAA is one law to prevent widespread dissemination of a patient's medical history and status. However, additionally the patient should also be protected from infringement of personal privacy as occurring in rooms containing more than a single patient. And I have been attending in so many patient rooms over the years, I know exactly what I am writing about.
..Maurice.
Maurice
And my all time favorite ( actually a pet peeve) is when nurses, cna's whatever they want people to think they are, wear their scrubs to the grocery, Starbucks, other coffee shops etc. don't you think that is a form of gossip, I do!
PT
PT, I have eaten in a restaurant which is in a neighborhood one block from a hospital and on a few occasions I have witnessed male surgeons eat there wearing scrubs. Maybe they are too lazy or in too much of a rush to change to civilian clothing or what, I just don't know. I don't think what they are doing is "sanitary" at the least.
By the way, what I just wrote is "gossip" or it may be constructive observation. Maybe some surgeon reading this thread will explain. ..Maurice.
Here is a timely article on KevinMD that touches upon the medical staff gossip issue where the author talks about staff discussions in the back room.
http://www.kevinmd.com/blog/2017/06/5-ways-make-connection-previously-unreachable-patients.html
Even more timely is a comment to the article:
Let's please add that the 'backroom' commentary can have a profound effect on the people you serve. In other public-contact settings this effect can be measured. And you don't need the experience of having a longtime, beloved patient/client/customer yelling at you because of something they OVERHEARD you say when you didn't know they were there ... and you weren't talking about them specifically ... and you didn't think it would matter.
Biker, a worthy read. I agree. Yes, backroom discussions between hospitaists or residents "taking over the next shift" about the pathophysiology and the approaches to therapy is appropriate and necessary. Talking about the patient's behavior is not. Backroom conversations of nursing staff change of shift discussing the patient's clinical physical status and management is appropriate but discussing personality may not be appropriate since how a patient reacts to either a physician or nursing staff may be a reflection of the attitude and behavior of that healthcare provider. ..Maurice.
If anyone really wants to see just how bad the problem is regarding hospital gossip do a yahoo such for " nurses who gossip about their patients".
PT
Gossip Town
Author Unknown
Have you ever heard of "Gossip Town"
on the shore of "Falsehood Bay?"
Where "Old Dame Rumor," with the rustling gown
is going the live-long day
It isn't far to "Gossip Town"
for people who want to go
The "Idleness Train" will take you down
in just an hour or so
The "Thoughtless Road" is a popular route
and most folks start that way
But it's a steep down grade and if you don't look out
you'll land in "Falsehood Bay!"
You glide through the "Valley of Vicious Folk"
and into the "Tunnel of Hate"
Then, crossing the "Add-To-Bridge," you walk
right through the City Gate
The principal street is called, "They Say"
and "I've Heard" is the public well
And the breezes that blow from "Falsehood Bay"
are laden with "Don't You Tell!"
In the midst of the town is "Telltale Park"
you're never quite safe while there
For it's owner is "Madam Suspicious Remark,"
who lives on the street "Don't Care"
Just back of the park is "Slanderous Row"
twas there that "Good Name" died
Pierced by the dart from "Jealousy's Bow"
in the hands of "Envious Pride"
From Gossip Town peace long since fled
but Trouble, Grief and Woe
And Sorrow and Care you'll meet instead
if ever you chance to go!
Regards,
NTT
NTT, you made your general point with the poem, though what is missing is a more specific connection with what has been written here. Not that I fully believe what I added to the poem below, nevertheless I suppose I should keep an open mind to all possibilities. ..Maurice.
....
In the midst of the town is "Telltale Park"
you're never quite safe while there
For it's owner is "Madam Suspicious Remark,"
who lives on the street "Don't Care"
If injured in the Park, avoid the tall building to the south
This hospital is named "No Privacy"
Since a stream of patient stories flow out from the nurses mouth
With obvious unwarranted stridency
This is to all the female visitors to this blog. How do I know you visit here, PERCEPTION. I'm stopping in the intensive care unit some years ago as I want to find out what the blood sugar is on this particular patient. To my dismay as I approach the patients room I see the patient nude from the waist down, comatose and on a ventilator attended by three female nurses. They are all laughing hysterically about this elder female patient''s vagina. Due to the patients illness she has not been able to maintain good hygiene, exactly the point of the nurses laughter.
Should I ever secure a book deal with Simon and Schuster about what I've seen and heard I would tell them the book deal would require volumes regarding this subject. For there is no other industry in the world that enshrines Gossip as much as healthcare does. How can the nursing industry EVER claim that they are the most trusted profession when when they TRASH talk down their patients at every turn. There are three levels of gossip I've read and been told about the subject content of nurses. The third is comments about male patients genitals, thus 33% of all nursing gossip is about genitalia. No patient is immune from it and there is no cure.
PT
Hello All:
I’ve been going through pages upon pages of information about gossip and our healthcare industry.
PT I agree with you in that gossip, is something we will never be rid of.
It’s part of being human. We as human beings really need to think about what you are about to say, as it may do harm to someone else and come back to bite you also.
After all my reading, I am truly amazed at how Gallup can year after year proclaim that nursing is the most trusted and ethical profession. They must be talking to people that haven’t had to use the system.
Once upon a time, people went into healthcare with the honest intention that they wanted to help people and improve the human condition.
The same cannot be said about people entering the field today. Today, it’s not about answering a call to help the sick or improve the human condition. Today, it’s about a paycheck.
These days, there are very few “real” Florence Nightingale’s left in our healthcare system.
Nurses freely admit they are the “world champions” of gossipers.
It comes as no surprise that their third most gossiped about category, is the male appendage. If you’re “normal” sized, they don’t bother with you. However, be thee on the large or small size, now that’s something to gossip about and they will gossip about you.
An outsider would ask, what happened to nurses advocating for their patient? One cannot be a true advocate and a gossiper.
Gossip has become so ingrained into the nursing culture now, that many have completely forgotten why it is they became a nurse in the first place and the sad thing about that is, their patients are paying the price.
Florence Nightingale once said “The very first requirement in a hospital is that it should do the sick no harm.” She also believed that a nurse's ethical duty was first and foremost to care for the patient.
That being said, why nurses do you feel that you must gossip so much about the patient you are supposed to be caring for? Do you realize the harm YOU are doing not only to YOUR reputation but more importantly to your patient? Is it therapeutic for you or your patient?
The "Practical Nurses Pledge" states that every nurse will not reveal any confidential information that may come to their knowledge in the course of their work.
Aren’t people’s body parts considered confidential information? So why are you gossiping about peoples body parts? You’re in direct violation of the pledge you once told everyone you’d live by.
End p1.
NTT
Part 2.
The ANA revised the Code of Ethics for Nurses with Interpretive Statements and declared 2015 as the year of ethics in nursing. Too bad that year didn’t carry forward to subsequent years.
Interpretive Stmt. #1
Sub-section 1.1 Respect for human dignity.
Respect for the inherent worth, dignity, and human rights of every individual.
Interpretive Stmt. #3
The nurse promotes, advocates for, and protects the rights, health, and safety of the patient.
Sub-section 3.1 Privacy
The nurse safeguards the patient’s right to privacy.
Nurse have an obligation to protect patients from undue exposure or unwarranted invasions of privacy.
Maintaining the patient’s privacy is essential to preserving the trust developed in the nurse-patient relationship. Actions demeaning the dignity of the individual could destroy this relationship and jeopardize the patient’s welfare.
Sub-section 3.2 Confidentiality
Associated with the right to privacy, the nurse has a duty to maintain confidentiality of all patient information.
So, every time you needlessly expose your patient and then go gossiping about your patient you are in direct violation of your own code of ethics.
Maybe it’s time for nurses to stop, take a look in the mirror and ask yourself this question.
Do I belong in nursing?
The nursing profession right now reminds me of a patient with amnesia.
Both are looking for their identity.
There is so much in fighting between nurses (older maybe wiser generation and the young know-it-all generation), and nurses and their administrations that they’ve lost focused on why they entered the profession in the first place.
They’re constantly gossiping to one another about one another. Then, if a patient comes on to their floor that is in any way out of the ordinary, they’ll gossip about that patient at the sick patient’s expense.
Could nurses be gossiping about their patients as a coping mechanism to offset their frustration with each other and their administrations?
One nurse who is tired of all the bullying that is currently running rampant through the profession hit the nail on the head when they said.
“How can one demand respect when we don't treat our patients with respect?”
Nurses are out there demanding respect from one another and everyone else. They don’t seem to get it.
Respect isn’t given.
Respect is EARNED.
The only way gossiping in the healthcare industry is ever to be curbed or stopped is from the top.
It’s up to the administrators to set forth a zero-tolerance policy on gossiping and bullying. Then back up that policy with teeth so the message gets across to all personnel no matter their pay grade or title.
To any nurse be thee male or female that reads this.
Each and every time you feel the urge to gossip about an interaction between you and your patient remember, you are do the following.
1. Disrespecting and compromising your patient.
2. Weakening the nurse-patient relationship.
3. Violating your own professions code of ethics.
4. Ruining your own reputation.
Is that really what you want to do? Is it really worth it? If you said yes to either question then nursing isn’t your calling, please find another career.
Regards to all,
NTT
NTT, when you talk about maybe nursing not being the right calling for some of them, you miss the possibility that some may choose to go into nursing because of the patient access it gives them. Some nurses want one of the pediatric specialties because they want to work with kids, others with L&D because they want to be with women and babies. I have wondered at times how those in the urology related arenas picked those specialties.
In my private life I have observed that women talk about personal things with other women in a way that guys do not talk with other guys. Where I worked we had locker rooms & showers. During lunch some went for runs, other played basketball on a court we had, some used the fitness room, others rode bikes. For years I was part of the running group then I switched to mountain biking. Sometimes in winter we snow shoed or cross country skied. I did these things for 23 years there. The locker room and shower area was such that we all routinely saw each other naked. As you would expect in any sample group most guys were roughly average, a few were porn star material and a few were on the other end of the spectrum. Never ever did any guy comment to or about another guy. What we saw in the locker room stayed in the locker room. Never was there gossip about another guy's genitals or his body, because guys don't gossip about stuff like that. This is partly why it is hard to accept that female nurses gossip about patient genitalia and bodies in this manner.
And before someone brings it up, yes I know there are exceptions to every rule. My comments here are "generally speaking".
NTT
Very well written and I'll add this to your comments. Female patients should know that they too are not immune from female nurses making derogatory comments (gossip) about their body. I'll say that I seriously doubt most nurses cannot recite any articles regarding the nurse practice act. Nothing has improve as far as their behavior between nursing now compared to the behavior I've seen in the 70's. The most relevant comment I'll make as far as gossip is this. Nurses in general DO NOT seek medical care where they work, not emergency nor elective and for that matter mammograms, child delivery, why? You guessed it. They don't want to be gossiped about. It's OK to gossip about their patients but they will seek care at another facility and they will admit it as well, to avoid the gossip.
PT
PT, a question for you. Do male medical staff also typically go to other facilities for their own care so as to avoid the gossip or are the guys not as aware of the extent of the gossip?
It says volumes that nurses don't trust their co-workers to treat them in a respectful manner in this regard.
Another question for you PT. You sound like you have worked in multiple facilities over the years. Have you worked in small town or rural settings? If so, is it any different than urban/suburban settings when it comes to nurse gossip?
In small town and rural areas, it is hard to be totally anonymous and as I have noted even if the nurse doesn't know the patient, they run the risk that the people she is gossiping with are the patient's relative, neighbor, or friend. In non-hospital settings that possibility tends to make people more cautious in talking about others, but does that hold true when it comes to hospital gossip?
Scary, yes scary behavior by medical professionals as described here in their relationship with patients and the professional colleagues or others. What is described on this thread is infringing on the rights of patients, their dignity and modesty and their right to reasonable privacy. And if this is a "common" behavior or even "uncommon" it should be acknowledged by the professionals themselves and those who have had the responsibility of teaching the profession.
I am going to start teaching another group of 6 first year medical students in two months and I would appreciate comments about how to introduce and support ways to educate and condition students to be aware of and avoid the "scary behavior of medical professionals".
Students are taught to evaluate the patient by inspection (student's eyes, ears, without a stethoscope, and even nose for odors, auscultation (listening to body sounds via stethoscope) and the laying on of hands on the patient's body as palpation and percussion. The goal of this attention to the patient is primarily for the patient's benefit and, if secondary, for issues of public health and safety. If the findings of interest extend beyond this, it is for the medical education of the examiner and, presented anonymously, for the pertinent medical education of others in the profession. Nothing more.
What I would like to read from my visitors here is specifically what to say to my students beyond the need for patient privacy both in history and physical examination (which is what I already go over with them). Anything more you would suggest? How about starting out their medical education by having at the outset simply reading all the postings on "Patient Modesty: Volume 79" followed by a discussion at the next group session? Would "Volume 79" be itself a good teaching tool to start? As I have mentioned zillions of times on this thread from the outset, could it be that those writing here over the years might be statistical outliers in their experience or opinion? Though, even if they were true, wouldn't still student review of these visitors writings tell the students something in what they will face as being responsible for patients in the future? Thanks for any comments on my presentation here today. ..Maurice.
Good Morning Everyone:
Bike, you said you thought that maybe urologists might have refined “verbal anesthetist” a technique for what they really have been doing for a very long time.
If they won't be smart & use same gender care, you would think rather than put another stranger in the mix & if the patient has a husband or wife that they could be asked if they'd like to be the “verbal anesthetist”.
Who better to hold a conversation with the patient than their spouse.
Urology doesn't have the added expense of hiring another person & the patient gets a better outcome.
A win win situation for everyone.
If I'm the patient I'd just tell the doc let me talk to my spouse. I don't open up & talk to strangers.
Have a great rest of the weekend all.
Regards,
NTT
Dr. Bernstein, I believe most medical providers equate being polite with being respectful and that most (if not all) have the medicine is gender neutral mindset. Most today do understand the closing the door, draping the patient kind of basics but that is not enough. What is thus needed is being clear that being polite is not the same as being respectful and that medicine is not gender neutral.
How many articles have we seen written by young female physicians who take offense that some male patients object to intimate care from them? They see it as sexist, and then they admit they only want to see female GYNs themselves. So telling the students that patients do not see medicine as gender neutral is a good start. You will get push back from feminist types but they need to know it is not just about them.
Another thing the students need to learn while they are still impressionable is that
patients will hold them accountable for their staffing choices. I don't care how polite their female nurses/techs are or how well they maintain their game face, you as the physician are responsible for who gets hired to work in your office. Even a single male nurse would go a long way. As a patient I don't care if it is harder to find a male nurse. It does not give you a free pass to not even look for one.
In the same vein you as a physician can influence the local hospital in matter such as having both male and female sonographers.
Otherwise whether it is this volume or one of the past ones, exposing the students to real life accounts of patients who had bad experiences as concerns intimate exposure is a great idea. I personally learn more from personal accounts than I do from straight lectures. They will feel the patient's pain in some of the accounts. Much of the problem is that the young healthy students have not experienced the medical world in the way we here have. Reality often feels far different than theory.
A way of making it real for the students is to arrange for some of your colleagues to give private physicals to the students, including genital checks. Or it could be a full body dermatology check. The twist is it would be a female physician with a female nurse chaperoning for the males and a male physician with a male chaperone for the girls. Then afterwards you can talk in class about how they felt about it. Again, reality feels different than theory. The female students might dismiss it as something that would never happen in the real world, but it might make an impression on the male students.
Thanks for asking.
One more question for you PT on the same matter. You said female nurses often do not go to the same hospital for their care as where they work. Do they steer their husbands, boyfriends, sons, brothers and fathers to other facilities too so as to avoid their co-workers talking about the men in their lives?
Dr. Bernstein -- Regarding suggestions for your upcoming crop of students, I was just going to post the same idea that Biker mentioned above: select some of the STORIES, the personal accounts, from this thread, going back into previous volumes. They illustrate the practices we are arguing against, and they express the real emotional distress that those objectionable actions and policies have caused.
I also like Biker's idea of having students submit to "chaperoned" intimate exams themselves. He suggests making it a cross-gender experience, but if time and resources permit, perhaps adding a same-gender experience (and/or non-chaperoned) would bring home the point by comparison. Students could then discuss their reactions with each other. You as the instructor could call attention to differences in those reactions, which in turn would bring home the need to defer to individual patients' sensibilities instead of adopting universal policies.
RG
Biker, your suggestion for exposure of students of one gender to a professional examiner et al of the other gender has already been suggested here over the years and I have to repeat this may sound an appropriate experiencing tool in theory but it will never be part of the standard medical school curriculum. Teaching medical professional behavior does not demand shaming or embarrassing the student. In fact, as I have written here previously, though students practicing physical examination on each other of the respiratory system, cardio-vascular system, abdominal system in their first two years, the "on each other" is limited by the voluntary exposure of "body parts" by each student who is being examined. It is school policy that if a certain student does not wish to be the "subject" of an examination, they are not compelled by the school to do so. But that is a rare student disclosure since most students have no objection to being examined by another student and though often they pair at first in same gender pairs, many times later in the learning session they end up with one gender examining the other. Bare breast exams, if performed on students, have the male student as a subject for the laying on of hands but the most detailed and realistic practice is carried out by all students on paid female standardized patients. The genital exams are carried out also on paid standardized teacher patients.
There is enough emotional trauma in medical education for each student to suffer and to subject a student for a physical examination only as a personal demonstration of patient modesty is a wrong approach and is not part of the medical education curriculum. ..Maurice.
p.s.- I may have noted here on a previous thread posting long ago that I was aware of physician residents in training in Long Beach California years ago having to spend a few days in a hospital bed with a simulated illness and be subject to life as a hospital bed patient. I don't know what happened to that program and I can't find any info about that by Googling. ..Maurice.
Dr. Bernstein, if medical schools feel that opposite gender intimate exams of students by licensed medical professionals in a private office setting will shame or embarrass them, then it would seem that students should be taught that medicine is not gender neutral. At issue is how do you get medical students to truly understand this when it is purely theoretical.
I read a response to an article at KevinMD where a female medical student bemoaned the fact that a 15 year old boy who had a rare infection of some sort on his penis would not remove his pants for the physician until she left the room. She saw it as a great opportunity to see something she had not seen before (and likely it was a great opportunity) but had no understanding of why the boy did not want for her to see his genitals. My guess is she only saw the condition and knew nothing of 15 year old boys. She shouldn't be anywhere near patients if all she sees is the condition. I would add that the doctor clearly did not ask the boy if it was OK for her to be in the room but rather just brought her in. That's pretty disrespectful in itself. Medical school failed to teach both of them anything about treating patients in a respectful manner.
If high school boys can be subjected to such physicals in order to play sports, then perhaps it is time to rethink medical students having some real world patient experience. It'll make for a much greater impact than just getting a lecture. What I am saying is that the current system is not working and maybe something new needs to be tried.
Biker, "real world" clinical experience begins in the 3rd and 4th years.
I would say that the 15 year old is capable of providing assent or dissent to this exposure, despite any consent provided by the parent. In the case where the 15 year old's medical condition would be significantly dependent upon the procedure to which the parents consented, then it is likely that the dissent of the youth would not be followed. But having a medical student inspect a penis of a 15 year old would not meet criteria for ignoring the 15 year old's rejection of assent.
I am strongly against students "shadowing" a physician without the patient's specific informed consent. And that includes activities of those 3rd and 4th year medical students who may be doing more than "shadowing" again only after obtaining the patient's or surrogate's (if necessary) informed consent. Medical students are not employees of hospitals in this education setting and are not expected to be expected nursing or physician service providers.
What patients (and employees) within a hospital or clinic need to be made aware is that it is the patients or their surrogates (if necessary) are the ones who provide the consent or dissent to activities related to the patient's bodies and their health. Period. And it is this point upon which medical students should be educated and subsequently reinforced but not hoping an episode of unconsented embarrassment would do the job. . ..Maurice.
Dr. B -- Please excuse me for telling you your business. I've been a teacher myself for over 20 years, so I got a little carried away. Hope I didn't offend. (you needn't post this unless you want to)
RG
" ...if medical schools feel that opposite gender intimate exams of students by licensed medical professionals in a private office setting will shame or embarrass them, then it would seem that students should be taught that medicine is not gender neutral. At issue is how do you get medical students to truly understand this when it is purely theoretical."
This. Is it "shameful and embarrassing" or is it "we are professionals"? Or does it just depend on whose body it is?
I wonder if this discussion itself, about teaching these issues, would be worth having your students read. If the very idea of cross-gender "chaperoned" exams is embarrassing to them, and something their instructor wants to protect them from, doesn't that clearly demonstrate how embarrassing they can be for anyone?
In my discussions with my clinic's medical director, she said that chaperoning is universally taught and encouraged in medical school, to the point that it becomes an unquestioned policy by the time one is licensed to practice.
RG
RG. chaperones for female pelvic exams by a male physician is certainly taught. Chaperones for a female pelvic exam by a female physician is not considered necessary. Chaperones for a genital-rectal exam for a male patient by a male physician is not considered necessary. Chaperones for a genito-rectal exam by a female physician is suggested. The gender of the chaperone and whether the chaperone be a family member of the patient is not settled, however the purpose of a chaperone is for "protection" but the issue is legal but unbiased protection of all parties involved but can the protection be considered biased by one of the parties is an issue as well as the availability of a chaperone of a needed gender. I would agree, the gender of the chaperone should be the decision of the patient. When the second year students learn by their teachers about the pelvic/male genital exams the issue of chaperones in practice is part of the learning at that time and I recall introducing the subject to my first year students as an ethical issue.
In my own practice, I 100 percent used a female chaperone for all female pelvic exams and no chaperones for genital or rectal exams on males or any other portion of the physical examination of a woman. I have never had any problems with such a decision. ..Maurice.
Maurice -- Thanks for your response. You may recall my post in vol. 78 about my testicular exam with a female NP who brought in a female "chaperone" with no notice. According to their medical director, chaperoning for ALL intimate exams -- regardless of patient's or provider's sex -- was taught as universal policy in her med school training. From what you said above, I'm guessing that that training varies from region to region throughout the country, but everyone I spoke to at my clinic seemed surprised at my complaint. I don't rule out the possibility that they were only pretending to be surprised, of course.
Regarding your observation that chaperones for a male patient with a female physician are "suggested," can you tell me why that is? What specific reasons would a female physician have for requiring a witness when doing intimate procedures on a male? I understand the history of male physicians abusing female patients, but the reverse is vanishingly rare, as are sexual misconduct lawsuits by male patients against female physicians. Some of the reading I've done suggests that many female physicians simply feel uncomfortable around male nudity. What's your understanding?
RG
RG, there is always the potential possibility of a male patient sexually misbehaving in the presence of a lone female physician so the presence of a chaperone could be protective. So I used the expression "suggested" as probably the appropriate advice. Nevertheless, the patient should have the right to select the chaperone's gender.
May I strongly suggest, in the regard of the current discussion, that our readers here read the very interesting topic of "the seductive patient"
http://bioethicsdiscussion.blogspot.com/2007/08/sexually-seductive-patient-how-should.html
and the back and forth of my visitors responses to that blog thread from 2007. ..Maurice.
Maurice
May I remind you the chaperone is there to protect the patient and the provider. Obviously, with all the operating room staff in the case of the female ENT who grouped her male patients that didn't happen.
PT
Dr. Bernstein, I read those posts and want to note that while yes there are some creepy guys who will be inappropriate with female medical staff, much of what might be considered inappropriate comment or behavior is simply a nervous reaction to the man's embarrassment.
Given the uneven power dynamic, one of the ways men compensate is by making believe they aren't embarrassed and they do that by joking about their exposure. Regretfully, a joke said by a nervous or embarrassed man may not be perceived to be a joke. Other men (like me) more typically react by staying silent and trying to ignore what is happening.
In the end, the path of least resistance for modest men is to avoid female physicians. This is what I do. It also brings with it the benefit of avoiding the female chaperone issue.
What modest men have an extremely difficult time avoiding are female nurses & techs, and regretfully most intimate care for men comes from nurses and techs rather than physicians. As noted I err on the side of silence in such encounters and as such would never be accused of being inappropriate, but several times I have been the recipient of nurses that introduced a sexual component to the conversation when I am exposed.
I apologize if this Ethics article already has been discussed, I don’t think it has:
http://journalofethics.ama-assn.org/2017/04/ecas2-1704.html?utm_source=TWITTER&utm_medium=Social_AMA&utm_term=934761313&utm_campaign=article_alert
(Just search on AMA Journal of Ethics, April 2017, "How Should Physicians Respond When Patients Distrust Them Because of Their Gender?")
In years past I’ve had full physical exams by medical students. There never was a chaperone with the medical student, although it was in an era when chaperones were not as common. So Dr. Bernstein, if a male (3rd or 4th year) medical student is sent into an exam room to conduct an intimate exam on a female patient is there a chaperone present with the medical student? Similarly, if a female medical student performs a detailed physical exam on a male patient, is a chaperone provided then? Any consideration of the gender of the chaperone used with medical students in teaching at your medical school and/or places of service?
The article acknowledges there are many reason why patients prefer a certain gender for intimate exams but once again stops there. No consideration of the unisex staff that also may be present and/or perform intimate exams. Why can’t physicians connect A to B? — AB
I'm with you AB. I don't understand why female physicians (or medical students) cannot grasp that it is the female chaperone/nurse/tech that they bring into the room that pushes what might be a tolerable situation into something unacceptable. It is almost as if they think that additional female is somehow invisible to the patient, or that if the patient is OK with one female that the patient is OK with several females in the room.
Again, this is why many of us just avoid the issue by not going to female physicians or wanting female students in the room.
Biker quote: I'm with you AB. I don't understand why female physicians (or medical students) cannot grasp that it is the female chaperone/nurse/tech that they bring into the room that pushes what might be a tolerable situation into something unacceptable. Unquote.
AMEN.
BJTNT
I agree. Unless the situation for professional attention is emergent representing immediate and life-threatening, the most appropriate and ethical approach is for the patient, after being informed is to first "speak up". ..Maurice.
Maurice: I think you've just articulated an important lesson for your students: "Unless the situation [is] immediate and life-threatening, the most appropriate and ethical approach is for the patient, after being informed, to first 'speak up.'"
End the ambush. Simple respect dictates that adult human beings have the final say over who sees their unclothed bodies.
Announce, explain, and then provide an opportunity for informed consent or dissent.
Good Evening:
In regards to the chaperones, scribes, and same gender care issues.
“Ostriches don't bury their heads in the sand” but most of AMA still does.
Regards,
NTT
In our concern of lack of male nurses, I found this article in the Fall 2014 Journal for Leadership an Instruction titled "Men in Nursing: Their Influence in a Female Dominated Career" by two female nurse educators. The full article is located at
http://files.eric.ed.gov/fulltext/EJ1081399.pdf
Here is the section on Social Concepts. Go to the full article to read more including the full references. It is interesting to read the concept that including more men in the nursing profession would make it more of a profession and that more men could boost benefits in employment for both genders. Hmmn. Obviously, the profession wants to make changes. ..Maurice.
Social Concepts One of the main reasons for the shortage of men is the societal stereotype that portrays nursing as a female profession (Cook-Krieg, 2011). Prior to Nightingale's reform which was instrumental in creating nursing as a predominately female occupation, men had a historical role in nursing. Cook-Krieg, (2011), goes on to say: When asked about the public's perception of male nurses, the female students indicated that they perceived the public's view of nursing to be accepting of male nurses in general; however they felt that society sometimes considers male nurses as homosexual or feminine. The male students felt that the public's image of nursing was changing and that they were more accepting of men, however, they were viewed as odd or special (p. 27). Cook-Krieg, (2011) identified the following barriers to nursing education for men: social isolation, refusal to address individual learning needs, and reluctance of other nurses to acknowledge men as a vital part of the nursing profession. Brown, (2009) "They assert that nursing schools do not address the differences in communication styles of men and women, and do not prepare them to work primarily with women " (p. 121). However, when men engage in the profession, Wingfield (2009) "jobs predominantly filled by women often require 'feminine' traits such as nurturing, caring, and empathy, a fact that means men confront perceptions that they are unsuited for the requirements of these jobs" (p. 5). This includes "encounters with patients, doctors, and other staff, men nurses frequently confront others who do not expect to see them doing 'a woman's job" (Wingfield, 2009, p. 11). Many nursing problems have been attributed to the predominantly female composition of the profession: sexism and oppressed group behavior in nursing have been blamed for its low pay, low status and esteem, and lack of being identified as professionals. Cottingham (2014) noted that these problems could be eliminated by actively recruiting men into nursing. Their presence in large numbers alone could increase the recognition of nursing as a profession, as well as to aid in improving wage and working conditions by their ability to bargain competitively and in the perception of their having greater coalition strategies as compared to women. In short, men in nursing are less likely to adapt to poor salaries and working conditions without campaigning for more and better (Cottingham, 2014). In a study of the transition of Licensed Practical Nurses to Registered Nurses, the two male participants perceived themselves as being looked up to and admired by their peers, whereas the female participants did not express similar feelings. Even though men are the minority in the nursing profession, they still viewed themselves as leaders and being highly respected by their peers (Henle, 2007).
According to female nurses from the Allnurses forum it is perfectly acceptable for the nurses to cover the walls and ceiling with full foldout nude pics of males from Playgirl magazine. Now as I recall the staff bathroom was 8 by 8 by 9 thus I'm certain many magazines were required as was the paste to adhere this new wallpaper. According to hospital policy all staff bathrooms are considered public.
Thus according to these nurses it is acceptable to post, exhibit and display pornographic material in areas where the female nurses may find it desirable. No one can question their motive as nursing is the most trusted profession according to the ANA, American nursing association.
This means Maurice that nurses as an industry are more trusted than physicians! Does this mean that it's acceptable for your nurses to display such material should you employ female nurses at your office. I should say so because, refer to second paragraph, they are more trusted than you. Now don't shoot me I'm just the messenger and no this isn't hearsay cause nurses on Allnurses said it was OK. I am in no way suggesting that men can display pornographic material cause you know that would mean your job, a sexual harrassment lawsuit and a whole lot of other drama cause all men are perverts.
Perhaps NTT has a point when suggesting the AMA has their head in the sand. I would say there are a lot of other. ASS ( ociations) who
have their heads in the sand. How long has this blog been going on for? Almost 10 years and our readers think they have heard it all. No,
our readers haven't heard anything. The people reading this blog have not heard anything yet.
Maurice, in conclusion since the nursing industry is the most trusted profession and yes ( I get sick just typing that) it appears you put much emphasis on your medical students as if they are the sole problem. Do you think they are the sole problem since they cannot be trusted and yes the American nursing association says physicians are not the most trusted profession.
We have had this blog now for 10 years, perhaps we need a presence of those from the nursing ASS ( ociations), AMA, ARRT, and other
ociations as well as some from the legal bench. Therefore, maybe just maybe the word gets out about the abuse patients endure, the double standards, sexual assaults, countless hipaa violations etc cause it's all tied into this one theme. A real genuine lack of respect and privacy.
I am going to write and I encourage everyone who feels this needs to write to these organizations and invite them to this blog. There needs to be real attention and legal intervention in this matter.
PT
PT, I can, from reading your postings and those of others here, understand your dismay and anger with the medical system as you and others have read about or witnessed that exist. And I would be angry and upset too if I had personally experienced what has been written here by you and others.
My experience is medical practice and medical education is that all participants in the diagnosis, treatment and care of patients must be equally trusted by the patients and trusted by each of the participants. No one participant in the care of a patient should lack the trust of the other participants since diagnosis, treatment and care of patients is and must be multi-disciplinary for the overall best in care to be attained for the patient. And, by the way, that also includes the staff in the front office and the various administrators of the hospital or medical system. One can easily pose examples where ignorance or failure of any of these human components of medical care can lead to failure, injury or clinically unnecessary lack of comfort for the sick patient. We, in medicine are all pertinent and essential to patient care and it is this concept and really a "truism" which we teach our medical students. In this specific regard, the development of skills to "work with other professionals" is actually part of the curriculum and yes grading which is begun in the first year of medical school (and hopefully is the same in schools teaching the other professions involved in patient interaction). If some of the public or some of the participants in patient care sets some finite, immobile scale of value or patient trust for those participants who attend patients, those individuals are wrong and sets a misleading and unrealistic picture of what is necessary for patient care.
..Maurice.
Interesting article Dr. Bernstein. It is always good to see anyone advocating for men in nursing, though I'd of preferred it be because it would be good for patients rather than it being good for female nurses.
I have seen the "nurturing, caring, empathy" label for female nurses many times, though honestly I wonder where they get the empathy piece. It does not seem that female nurses have any empathy for their male patients when it comes to intimate exposure.
Maurice
Once a week I would like to enclose an address of an organization in which our readers can write to, invite members of the organization and openly discuss concerns related to this blog. I encourage our readers to keep with the narrative and focus on the shortcomings of what I feel related to the discussion.
Society of trauma nurses
446 east high st. Suite 10
Lexington Ky 40507
American trauma society
201 Park Washington court
Church falls VA. 22046
Discussion: It is a known fact, statistically speaking that the vast majority of trauma patients are male, aged 15 to 24 years. When these
patients are brought to Level 1 facilities they are stripped nude and examined by the trauma team. The concern is once the team has
completed the examination patients are not always covered. Often these patients are left nude for a considerable time and I should mention it is the nurses responsibility once the team has completed the exam to cover their patients. Furthermore, most trauma nurses
are female, 95% of the time. Their female patients are covered up quickly, yet their male patients are not. I'll remind you that according to
state nursing boards leaving patients unnecessarily draped is considered sexual misconduct. In addition, this aspect of care is nowhere on their radar.
PT
First, PT has good ideas and I appreciate his desire to improve medicine for all patients.
Secondly, when you have time check out this NY Times article from yesterday and ESPECIALLY the comments by readers.
https://www.nytimes.com/2017/06/24/opinion/sunday/men-dont-want-to-be-nurses-their-wives-agree.html?action=click&pgtype=Homepage&version=Moth-Visible&moduleDetail=inside-nyt-region-1&module=inside-nyt-region®ion=inside-nyt-region&WT.nav=inside-nyt-region
— AB
I agree with PT's offer but it means that those reading and writing here and who agree that change is important that they all participate in contacting these systems and even encouraging a representative to come to this blog thread (provide address) and express (even anonymously, if necessary) the organizational's response to these contact issues. We really need input on this thread by physicians and medical system managers including those institutions who promote students to enter their professions. ..Maurice.
Interesting article AB. I wonder what the critical mass of male nurses needs to be for the "nurses are female" stigma to dissipate.
What strikes me as odd is that nursing offers a far better career path and stability than does most blue collar occupations, especially in small town/rural areas. Where I live I am told nurses start at the hospital at about $66K with most making about $75K. That is well above what most young guys can hope to make at just about anything else around here. It is far above the median household income here, let alone for an individual.
I want my visitors to know that, via his website, I invited Dr. Atul Gawande, M.D. to read and hopefully contribute his opinion regarding the discussions here. It was Dr. Gawande who wrote the August 2005 article "Naked" in the New England Journal of Medicine that stimulated me to use what he wrote as the basis for a topic posting that month on my blog also titled "Naked"
http://bioethicsdiscussion.blogspot.com/2005/08/naked.html
and which led, through so many visitor responses, to the series of Volumes of Patient Modesty thread.
Here is his biography from his website http://atulgawande.com/about/:
Atul Gawande, MD, MPH, is a surgeon, writer, and public health researcher. He practices general and endocrine surgery at Brigham and Women’s Hospital. He is Professor in the Department of Health Policy and Management at the Harvard T.H. Chan School of Public Health and the Samuel O. Thier Professor of Surgery at Harvard Medical School. He is also Executive Director of Ariadne Labs, a joint center for health systems innovation, and Chairman of Lifebox, a nonprofit organization making surgery safer globally.
Atul has been a staff writer for The New Yorker magazine since 1998 and has written four New York Times bestsellers: Complications, Better, The Checklist Manifesto, and most recently, Being Mortal: Medicine and What Matters in the End. He is the winner of two National Magazine Awards, AcademyHealth’s Impact Award for highest research impact on healthcare, a MacArthur Fellowship, and the Lewis Thomas Award for writing about science.
It is my opinion that Dr. Gawande would be the best source for understanding the medical system regarding the modesty and dignity issues written here and perhaps help in publicizing the needs of many of the visitors to this blog thread. What do you think? ..Maurice.
Dr. Bernstein.
Great idea. The more healthcare personnel that read this blog the better the chance word will spread within their ranks that patient care isn't where they thought it was.
Regards,
NTT
Dr. Bernstein, yes it would be good to hear Dr. Gawande's take on this topic. I found his Naked article. It was focused on male physicians with female patients as is typical of medical community concerns, so it would be interesting to see if he is even aware of male patients with female doctors & their female chaperones and of the general issue of men facing a sea of women nurses & techs whenever they need intimate care. His father was a urologist and so it would be telling if he never thought about what men face in urology offices that haves 100% female nurse/tech staffing.
About a month ago my wife mentioned that a local scholarship recipient she was working with who just graduated high school told her that she had been a volunteer at the hospital for 4 years and that when she was in 9th grade a surgeon (that she identified by name) had allowed her to observe a knee replacement. I verified that surgeon does work there and that he does do knee replacements. I had previously thought it was bad that patients were potentially intimately exposed to 16 year old LNA students but then I hear from my wife that 14 year olds are being allowed in the OR as observers. This girl hopes to pursue a medical career which is where her interest came from.
Needless to say I shot off an email to the hospital saying what I had been told, but without mentioning the name of the girl, the surgeon, or the nature of the surgery other than to say it was significant. I didn't see a need to drag others into this years after the fact.
Basically I asked what were their policies concerning the minimum age for students to be allowed in the OR, whether they were allowed in during patient prep vs only being allowed in after the patient is prepped and draped, and whether minors were allowed in the OR when the nature of the surgery involved intimate exposure. The answer was that students are identified as such, and that patients can refuse student involvement, including saying so at the time of registration and before going into surgery. My specific questions weren't answered, and it took 19 days to get the response that I did.
What follows is part of the response I sent the next day:
"Patients generally don't know to ask what is it you mean when they see "student" in the consent forms, assuming they even read them. Most of us assume that student means a college student working on their RN or someone in medical school. I did until I saw reference to high school kids at (tech school) being in the OR and otherwise doing clinicals with patients, and even then it didn't occur to me that kids as young as 14 are allowed into the OR and otherwise have access to patients. Patients being ignorant of a student's true status is not informed consent.
The other thing is that sometimes surgeries or other procedures such as cardiac caths are of an emergency nature straight from the ER and that patients coming into the ER, that are post-surgery, or just in a lot of pain may not be in a position to express their wishes concerning student involvement one way or the other. This is where policies are needed. (Hospital) not having any minimum age policies for students to be in the OR, ER or otherwise to be observers (or participants) when patients have intimate exposure is the issue. To suggest that 14 (or 15 or 16) is too young does not seem unreasonable, yet the only policy apparently in place is that a patient can say no to student presence or involvement. I believe you when you say they are well supervised but again, that's not the issue.
My apologies for making this a larger issue than perhaps it is in actuality but it seems that it should not be left entirely on the patient to manage student access, especially when the patient may not be capable of doing so or may not understand that some students are still in high school. At a minimum there should be some age limits for any patient access (as observer or participant) when there is intimate exposure.
Thank you for any attention you can bring to this."
It's been 3 days and no response thus far. I certainly hope I am triggering some internal discussion. Perhaps they do have policies in place that deal with this stuff, but if so they should have directly answered my questions. Instead I got "Safeguarding a patient’s privacy is of utmost importance to us".
I am all in favor of Dr. Gawande's participation in this thread. I've spent the last 6-7 months chasing down studies on male modesty and they are certainly not plentiful. Someone with his high profile could help to put a spotlight on the issue.
RG
Yesterday I visited a friend in NY who is a tech at a decent sized hospital. I told him about my dialog with my local hospital about minors being given access to the OR and elsewhere with possible patient intimate exposure. He didn't see why that would be a problem. I then thought to personalize it and asked him how he would feel if he was having surgery and they allowed a 14 year old girl to watch him being catheterized. He again didn't see why that would be a problem when the hospital wouldn't allow her to be there if they didn't think she could handle it. His perspective was it should be allowed if it would be helpful for the girl who wants to pursue a medical career, and that the hospital should be trusted to make those decisions. This just affirms that some in the medical world do not see patient opposite gender privacy as an issue.
Again, as I have noted here many times, it is the policy of the medical school course which I teach for first and second year medical students (and besides policy but ethical) for each patient to be interviewed and/or examined to be aware of the true status of the student and what the student is to do and the patient must give permission before the student sits down to begin the session. Yes, it is the medical school's responsibility to determine the educational value of the student-patient relationship but it is always up to the patient to understand that value and nature of the relationship and to give explicit permission.
Nothing written in the admission papers presented to the patient can ever trump this specific communication and request by the medical student.
Incidentally Biker, what does your tech friend tech? ..Maurice.
Dr. Bernstein, my friend does not interact with patients directly in his current role but rather works in the lab examining specimens. He has spent a lot of years in medical settings however which I why I wanted to see what his reaction to the topic was. I will admit that I was surprised that he couldn't see it from the patient perspective.
The problem with patient consent is twofold. Sometimes the patient is not in a position to offer up a yes or no to student observation or involvement. Often-times a hospital is going to let the patient assume "student" means someone in college or medical school rather than directly telling them that the kid is in high school.
My nature is that I would try to be helpful to medical students or RN students and let them observe or participate. That said, going forward unless the hospital makes it abundantly clear what the true status of the student is, I will not allow any student observation or participation. Under no circumstances would I allow a high school kid in the OR or any minor to be present if there was any intimate exposure anywhere in the medical system.
It amazes me that hospitals don't see the inherent liability given these kids are not subject to HIPAA and cannot legally sign any agreement with the hospital. A 16 year old LNA could lose their license for a HIPAA violation or other inappropriate conduct, but there is no recourse with regular high school kids.
A hospital cannot make a patient’s care contingent on the patient allowing observers to be present. Unfortunately Hospitals have made their Informed Consent documents quite broad when it comes to “educational programs and training”. The vast majority of patients do not appreciate what this may entail in terms of others being present during their surgeries or intimate care. Clinical staff almost NEVER proactively explain who may be present during an intimate procedure, surgery, etc.
Here is where the double standard becomes apparent with Hospitals/Medical Centers. A 14 y/o boy thinking of going into medicine (or any age male for that matter) is not allowed to spend a day observing Mammograms, Breast Biopsies and Breast Ultrasounds or OB/GYN ultrasounds. Never happened at the large medical centers I worked at. So the question is - why is that not acceptable? It’s medicine, its training, its education - so why does this not occur? Tacitly hospital staff think (despite claiming to the contrary) that a women’s privacy is inherently more important than a man’s. And it is okay for young girls to observe any type of procedure, but young males are limited. This type of *discrimination* is an offensive aspect of US Medicine.
Regardless, it is important that patients know they do NOT have to consent to have observers present, or chaperones present during their intimate exams. For surgeries, the surgical team needs to be present and that will include a mix of sexes usually. But additional non necessary personnel can be refused.
I will add that if you are having an invasive procedure, the more people present in the OR, the greater the chance of a communicable disease, the greater the chance of inappropriate photos and inappropriate disclosures, and the greater chance of a distracted physician, nurse or tech that leads to a mistake. If you want to enhance the success of your invasive procedure episode, decline the presence of unnecessary personnel. — AB
Good Morning All:
It's getting to be that patients need to see a lawyer before surgery and carry an addendum with them to staple to the hospital's informed consent form to cover all the no's to their consent form.
Regards,
NTT
NTT, those addendums wouldn't be necessary if only hospitals would adopt some common sense policies and be transparent with patients as to who everyone actually is. I don't think it is asking too much for hospitals to mandate that no children under a certain age will be allowed any access to patients (under 16 for example), that 16 and 17 year olds will only be allowed access that doesn't include any patient intimate exposure, and that patients must otherwise give express permission for student or observer presence (vs those purposely ambiguous consent forms). I think most would give permission for student observation or participation as may be appropriate.
I just don't understand how any medical professional can think it is OK for a 14 year old girl to be present when a man is being catheterized, yet apparently hospitals don't have policies against such, nor will they tell the patient that the student is 14 years old.
I remember some years ago when going for an annual physical that the doctor asked me if it was OK for a young woman to observe. I wasn't keen on her being there but I said OK being my impression was that she was in fact a doctor in residency. Then as the exam progressed she was clearly uncomfortable being there and left before we got to the DRE or genital check part. Now I wonder if the doctor mislead me as to what she was via using ambiguous terminology, and was she in fact a high school kid shadowing him.
How interesting would a blog thread be entitled "Where's the integrity?" in the medical community? Yes, it would be moaning and groaning, but just because your're paranoid doesn't mean you're not being followed.
BJTNT
BJTNT, I would say that "integrity is where you find it in the medical community" but also as a patient, integrity is how you find it and how you define it in your very own terms. After all, a patient has his own set of personal integrity, standards which he sets and which he intends to follow and carry out. And then he will look at the individual in the medical community and find whether that person's behavior parallels the standards which will meet those set by the patient.
Unfortunately, there are times in a patient's life that integrity to their own settings and values must be relaxed or opened up to maintain their health and life. The "moaning and groaning" is an understandable reaction to that break in integrity but sometimes it would be in the patient's own best interest in remain well and alive and thus allow "that break in self-integrity".
A takeoff on the bank TV ad: "What's in your integrity?" ..Maurice.
Dr. Bernstein, yes we all have to go with the flow on certain procedures which we may find uncomfortable in order to maintain our health, but that shouldn't extend to being purposely mislead into thinking that a high school kid is in medical school.
NOTICE: AS OF JULY 1 2017, NO FURTHER COMMENTS WILL BE POSTED ON THIS VOLUME 79. COMMENTS WILL RESUME NOW ON PATIENT MODESTY VOLUME 80
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