Bioethics Discussion Blog: Patient Modesty: Volume 80

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Sunday, July 02, 2017

Patient Modesty: Volume 80




This Volume's graphic is another example of an attempt to "speak up" when informing the  medical profession of the patient's desires for attention of the system to the patient's modesty and dignity issues. (Thanks to Readers Digest. u.k. via Google Images).  As you may have noticed in the graphic, the patient, while speaking into the stethoscope diaphragm, the ear pieces are not in the doctor's ears.
What I am trying to emphasize is that it is important when telling your concerns to the doctor or the medical system, verify that they are listening!! And, of course, then responding.

For those just joining this blog thread on Patient Modesty, you might want to get introduced to the current discussion by looking at Volume 79 first.. or 78, or 77 or, if you have the time and interest all the way back to 2005 "Naked" which started this blog thread discussion. ..Maurice.

169 Comments:

At Monday, July 03, 2017 4:09:00 PM, Blogger Maurice Bernstein, M.D. said...

For those first time visitors to this Volume of "Patient Modesty" and there are a few, I want to write some words in further introduction and a request.

All these years the thread has been published, the topic has been roughly the same and unchanged, essentially, a patient's right for privacy when undressed either in the operating room, procedure room, office exam room or the patient's hospital room. The thread is about the ethical and perhaps legal right for the patient to be able to request and hopefully receive the medical attention by professionals of the patient's desired gender when undergoing a medical examination or procedure. That request to whatever part of the medical system is made should be expected by the patient to be listened to and carried out. If the system is unable to do so, there should be detail information and explanation to the patient provided by the medical system representative. Final decisions through the process of informed consent or informed dissent should be made by the patient and conflicting issues should be attempted to be resolved by and through the medical system involved.

The persons representing the medical system or in part involved in the issue of the patient's need for privacy in medical examination or procedures or nursing involve not only physicians but also nursing staff, scribes, physician or hospital selected chaperones, medical students or even other "guests" in operating or examination room who are "shadowing" the doctor as a "guest", not of the patient but of the system.

Earlier Volumes of this topic contained concerns by patients of both genders but in recent Volumes mainly male patients. Are women now satisfied with their gender requests being followed or what?

For this discussion to be of further value to all, we need more input from our yet "hidden" visitors of all genders and even those whose views are perhaps "conflicted" with those already published and certainly we need here members of the medical profession to present their views. All can be written anonymously but with the use of a pseudonym ending the message.

Please, all "new" visitors here, please participate by writing Comments, it will surely "broaden" the important discussions here.

If the old or new visitors here want to write to me personally, here is my e-mail address:
Doktormo@aol.com

..Maurice.

 
At Tuesday, July 04, 2017 4:54:00 PM, Blogger Maurice Bernstein, M.D. said...

For those visitors "new" to the topic, here is a reference article from the "Chicago Tribune 2015,"The Naked Patient: The Modesty Movement won't take it lying down" ..Maurice.

 
At Wednesday, July 05, 2017 6:02:00 AM, Blogger NTT said...

Good Morning:

To all those people who may be lurking in the shadows, please please come out and join us.

There are no personal attacks here.

We’re just people like you who are tired of the medical community’s lack of respect for our modesty concerns.

People trying to effect change that is LONG overdue.

We need ALL the voices we can bring to bear on the healthcare industry regarding this issue so that they not only listen, but make the changes necessary so everyone can have peace of mind and not be ambushed by the medical establishment when they need healthcare assistance.

WE need YOUR voice.

In our case, silence isn’t golden.

Silence in our case is a license to the medical community to leave us unnecessarily exposed in front of people for no good reason, for staff to gossip to their colleagues about us, to basically treat each patient without dignity and respect.

That’s the license you give to the healthcare industry by keeping your mouth shut and staying in the shadows all the time.

If everyone just keeps their mouth shut and hands over their license to their dignity and respect at the door, the medical community will never learn nor change and that is unacceptable.

If you the shadow dwellers here don’t like what’s happening when you visit a doctor then it’s time to come out into the light and put your voice with ours and take a stand.

The more bodies we have, the better the chance to change the system so it’s fair for everyone not just the medical community.

Join us. Let’s make a REAL difference.

Regards to all,
NTT

 
At Wednesday, July 05, 2017 11:43:00 AM, Anonymous Anonymous said...

In an attempt to give truly informed consent, knowing what will happen during medical procedures would be extremely beneficial. Is there anywhere on the web where "complete" procedures can be seen? There are videos of operations, etc.; however, I can find little that shows step-by-step medical procedures from the minute the patient enters the prep room through the entire procedure. Any suggestions?
Reginald

 
At Wednesday, July 05, 2017 2:36:00 PM, Blogger Maurice Bernstein, M.D. said...

This may be of interest to new visitors to this blog thread but also I ha"ve a feeling that the majority of those "old" visitors who have written here are not aware of a thread consisting of a series of 3 "Chapters" each with way over 100 responses to the title "I Hate Doctors". The subject is physicians. I am not sure that those who read and write to the Patient Modesty thread would necessarily readily agree with all that is written by visitors to the "hate doctors" thread since I have a feeling that the tone of what is written here is more concerned regarding the medical system itself and not necessarily specifically their own physicians (of course, with some exceptions!). However, I don't think I posted this information previously on "Patient Modesty", so I thought I should do it now for those interested. Here are the links:

http://bioethicsdiscussion.blogspot.com/2005/06/i-hate-doctors.html
http://bioethicsdiscussion.blogspot.com/2008/12/i-hate-doctors-chapter-2.html
http://bioethicsdiscussion.blogspot.com/2010/08/i-hate-doctors-chapter-3.html

You certainly are permitted to write your comments regarding "I hate doctors", in general, in Chapter 3 but let's keep the specific issue of patient modesty and dignity issues of the medical system going on the present "Patient Modesty" blog thread..though you can contrast by writing here what you gleaned from "I Hate Doctors" thread.

By the way, the reason I can write more to this Patient Modesty thread is that I have more time available in my day: no student teaching until mid-August! ..Maurice.

 
At Wednesday, July 05, 2017 5:19:00 PM, Blogger Biker in Vermont said...

Dr. Bernstein, the 3rd link is to Volume 80 rather than the 3rd page of the I hate Doctors thread.

 
At Wednesday, July 05, 2017 5:54:00 PM, Blogger Maurice Bernstein, M.D. said...

Biker, you are correct. Thanks. I obviously made an error in composing the link, however, the link itself is correct for Chapter 3, so instead of clicking, simply copy the link and paste in address field and then click. ..Maurice.

 
At Friday, July 07, 2017 8:07:00 AM, Blogger Maurice Bernstein, M.D. said...

I see, via my reader counter program, that a number of visitors who have come to Volume 80 have taken my advice and looked at the "I Hate Doctor" Chapters which link addresses I provided.

What I would like to know is whether the upsetting views of the patient's physicians as described on that thread is really accepted by those who are participating on this "Patient Modesty" thread. Are my visitors looking to their physicians as ignorant and uncaring with regard to the modesty and dignity issues or is it really other parties within the medical system who are really the ones to be accused and upset about? ..Maurice.

 
At Friday, July 07, 2017 10:11:00 AM, Blogger Biker in Vermont said...

Dr. Bernstein, I have never fallen into the "I hate doctors" group. I did have one with an ego that made it difficult to ever ask a question but I continued with him out of faith in his competence. Never have I had a doctor that explained to me beforehand what a procedure entailed when sending me off for something that proved emotionally uncomfortable or embarrassing. For example when my doctor suspected bladder cancer he sent me off for an ultrasound. At the time I had no idea what an ultrasound was and was shocked to find out it meant a female tech telling to remove all clothes from the waste down, put on a johnny and get on the table, and then her promptly lifting the johnny and putting a small towel over my genitals before she proceeded to do an ultrasound of my entire abdomen right down to the base of the penis. Did the doctor not care what my experience would be or did he think it would not be an issue?

I have generally avoided female doctors so as to avoid the female chaperone issue. I have also done so in recognition that even when a nurse is needed to assist, that being exposed to two women just feels far worse than just one as would be the case with a male doctor needing a nurse to assist. I am guessing that in most cases female doctors are just clueless about the 2nd female in the room issue. If they are aware, life is then made easier if they convince themselves that medicine is gender neutral and that it is the male patient that has the problem.

At the same time life is similarly made easier for male physicians who also convince themselves that medicine is gender neutral. How could my former urologist (and his several male urologist partners) otherwise manage to never have had so much as a single male nurse or tech in their rather large practice in a major teaching hospital over the course of 11 years? If they tell themselves there isn't a problem then they don't have to solve it.

Generally speaking the medical world seems to equate being polite to the patient with being respectful. That's easy to convince oneself of and hide behind. They are not one in the same. Being respectful would be having at least a minimum contingent of male nurses/techs on staff for modesty reasons. In a small practice, just one might suffice. Being respectful would be at least trying to steer men to where there are male sonographers for testicular ultrasounds.

I can't say whether doctors (male or female) don't think there is a problem to solve or they don't care, but the end result is the same. That said the larger problem lies in the nursing/tech ranks where male patients receive the majority of their intimate care and where men have little choice as to who is providing that care.

It is also where men come into contact with minimally educated people who are not professionals and who have little at stake in protecting their careers. Teenage CNA's/LNA's, Medical Assistants and such are empowered to provide intimate care after 100 hours or so of training, in some States Medical Assistants sometimes receiving no training beyond how to answer the phone, wear scrubs, and look like they are helping when they chaperone. It is at this lower end of medical staffing and also the younger end of the nursing ranks where the most egregious inappropriate behavior anecdotally seems to occur, likely out of lack of maturity.

Coming back to my ultrasound example, lack of respect also manifests itself in her lifting the gown fully exposing me before putting a towel down rather than giving me the towel to cover myself before the gown was lifted. If the medical world cared about modesty issues she'd likely have been trained to do it without fully exposing me.

I suppose I have to say that I don't think the medical world cares about modesty overall. Many individuals within the system may very much care and do what they can, but the system as a whole doesn't.

 
At Friday, July 07, 2017 1:47:00 PM, Blogger Maurice Bernstein, M.D. said...

Biker, I would agree that physicians as physicians are not fully day to day, moment to moment attentive to patient physical modesty since as it has been my experience from my professional beginning and even to my present interaction with patients, no patient (and I mean, as I have written here previously) no patient has discussed their personal issue or concerns about any physical modesty issue they have. Unlike you and the others writing here, the patients have been silent about this to me their physician. The fact that I didn't hear anything in this regard from my patients has never meant that I was unaware of the concept of modesty especially when applied to genital/rectal areas of the body and breasts in the female. And certainly that is why I always had a female chaperone present with female pelvic exams. But, in my mind, since I got no warnings from my patients, was that they looked at the examination value for their diagnosis and health as trumping any personal modesty issue and accepted that as such. Looking back I am not sure that for some of the requests noted on this thread I would have been able practically to fully accommodate the patient's directive.

And finally please don't think that physicians themselves (including my experience with surgical prep by two women) are unaware of some degree of modesty. However, in my case, I saw the need for their thorough and standardized behavior and accepted, without words, their essential activity.

Believe me, if physicians were made aware of their patient's decision of personal modesty distress vs clinical necessity and if the physician could practically accommodate the patient's desires, most physicians would eagerly follow the patient's request. But the patient must, as my patients have never done, SPEAK UP.

By the way, the most easily performed act the physician can do if reminded that an exam door or window is open for access for viewing or entry by the uninvited is to close the door and cover the window. No additional cost to provide that service! ..Maurice.

 
At Friday, July 07, 2017 6:55:00 PM, Blogger Biker in Vermont said...

Dr. Bernstein, yes patients need to speak up but that can only occur if the patient even knows there is something to speak up about. It was just 12+ years ago but in my ultrasound example all I knew was my doctor called me at work, said I had blood in my urine and that he made me an appt. at the hospital for an ultrasound. At the time I didn't even know what an ultrasound was let alone that a procedure like that on a man would be done by a woman. I was like a deer in the headlights when a woman came to get me and then told me to undress. I was also unaware at that point that it was even an option to ask if there was a male sonographer available. Now I am far more aware, know that I can speak up, and I will research what any procedure entails before it ever happens, but how many patients are that aware?

Fast forward two weeks and I am in Boston in pre-op waiting to have bladder cancer surgery. I am sure it was buried in the forms being shoved in my face and the nurses telling me they just give permission to do the surgery and to bill your insurance, but I was utterly unaware that medical students observe surgeries until 5 of them appeared at my bed, 4 women and 1 man. Not only did I not know anything of such practices, I had no inkling that I had the right to say yes or no. They didn't ask me if it was OK to observe. Again I was like a deer caught in the headlights too shocked to speak.

The last piece of this saga is the nurse that would be taking me into the OR telling me moments before I was sedated that she was going to get to know me real well, and there was no doubt but what she meant by the way she said it. Again I was stunned silent for the few moments that elapsed before she put me under. Afterwards I was too embarrassed to say anything about it and back then I didn't really understand that men were entitled to be treated respectfully anyway. All I had ever known was that female medical staff treated males as if they had no modesty because society said men don't have any modesty. And so I had to make believe I wasn't modest either and accept however I was treated. How many men still think that way?

This is why this forum is so important. Men that come here can realize that they are not second class patients and that they can advocate for themselves. Women are much more aware in this regard.

It would be nice if doctors could at least pose a question or two to see if the patient understands what the procedure or protocols entail.

 
At Saturday, July 08, 2017 7:46:00 AM, Anonymous Anonymous said...

Maurice -- I have to agree with Biker: providers can't assume that patients will know what certain procedures will entail, or how their modesty might be compromised. I had literally never heard the term "chaperone," as applied to medical encounters, until several weeks AFTER my humiliating experience with one. I had absolutely no idea that such a thing existed until my NP used the word in her dismissive response to my complaint. Like Biker, I had no idea about staffing for testicular ultrasounds either. I've now had three, all of which were performed by female techs. Since they did NOT bring in chaperones, and were very respectful of my modesty (draping me before I disrobed, and allowing me to cover my penis before removing the drape), I have no complaints. My particular trigger is the spectator, rather than the sex of the provider per se.

To the extent possible, I would recommend that providers be continuously aware of modesty as a possible issue and make a point of introducing the subject whenever exposure of intimate areas is likely. Simply describing the possible exposure, then asking the patient if he or she has any concerns, could go a long way toward eliminating the nasty surprises that so many of us have suffered.

Thank you for posing the question.

RG

 
At Saturday, July 08, 2017 11:05:00 AM, Blogger Maurice Bernstein, M.D. said...

RG, I understand. You and the others should know that my teaching point to first and second year medical students (and I am sure the other instructors teach the same) is that the patient should be informed in advance regarding the details of the exam or procedure relating to the "personal experience" (what the patient might experience). That means to the woman patient "To examine your breasts properly, I will have to uncover, one at a time, for me to inspect and feel for abnormalities.. do you have any concerns about that?"

So this is what first and second year medical students learn.. now what happens later when as physicians as they interact with patients but having time limitatins and other responsibilities, well that is for the patient to observe and respond to.

I don't want any of my visitors here think that there exists limitations of students' communication with patient prior to history taking (e.g. "I am about to ask you some medically important questions about your sex life, is that OK with you?") or physical exam (e.g.-"I will now uncover your abdomen so that I can examine it. OK?"). They do just what I wrote since I am aware of what is going on because my responsibility is to as best I can, with 6 students working in separate hospital rooms, monitor this student behavior. But I virtually always find they follow this requirement.

Thus I am convinced they start their medical history and physical exam relationship with a patient with attention to this important communication matter.

If the limitation of the medical system later make the physician behave without the attention to this communication with the patient, it will be up to the patient to "speak up" which it appears from the postings many here are doing just that. ..Maurice.

 
At Saturday, July 08, 2017 1:47:00 PM, Blogger Maurice Bernstein, M.D. said...

Looking back at the previous Volumes of "Patient Modesty", for example..even back to Volume 67 a in 2014 and subsequent Volumes, I find writers who wrote and wrote but have stopped returning to write or maybe dropped back in briefly.
Remember names like "A.Banterings", "don","belinda", "Hex","Jason K", "Kevin", "Ray",
"BJTNT"
I am sure you can find more.
What does this tell us about the interest or value of either returning to this thread or even taking time to post a comment. Do you think we can reach a point when these Volumes begin to lose their interest or value. We are now at Volume 80 with perhaps 150-180 Comments in each Volume.

So my general question is what do my visitors think of the value of this thread. Has it reached its maximum value or because of new visitors, they have something to be gained by even glancing through perhaps one Volume? ..Maurice.

 
At Saturday, July 08, 2017 5:47:00 PM, Blogger Biker in Vermont said...

Dr. Bernstein, there is value still in that new readers are surely coming by even if only to read. You had been at this for many years before I found it a year or so ago. I learned a lot and am now a better advocate for myself. I still come here because I learn from the experiences of others and it serves to remind me that I am not alone in how I feel about these issues, and perhaps more importantly it is not me that has a problem. It is the medical system that sees men as second class patients.

I understand if it has lost its excitement for you after all this time, but it is still valuable to your readers.

 
At Saturday, July 08, 2017 7:18:00 PM, Blogger Maurice Bernstein, M.D. said...

Biker, what I wrote should not imply my interest in this thread is diminishing. It is clear from the volume of written responses, by a variety of commentators over the years that there is a widespread interest in this topic. My concern is why those who comment (as identified by their pseudonyms) stay for a while and then leave. (Please note that an example of one exception, the persistent, long participating and welcome commentator is PT) but the others stop or almost stop writing. Is this because of boredom with the topic? I doubt it. Maybe because they feel that they have contributed and now it is time for others to do so. Or maybe it is because beyond a certain point the "movement" is going nowhere and there is nothing more to contribute.

Yes, I am interested that this blog thread is helping to "spread the word(s)" but if I know why (and you can skim through all the fairly ancient Volumes) these contributors have left us or just are not writing again then maybe there is some editorial improvement that could be made.

Biker, do you think based on your experience here that all has been "said that needs to be said" or what?

Again, my posting now is not to demonstrate personal disinterest in the topic but to discover here at Volume 80 what could be made better both for my "old" contributors and the "new" visitors and, of course, the solution of the problem in medical care that this blog tread is all about. ..Maurice.

 
At Saturday, July 08, 2017 7:42:00 PM, Blogger Biker in Vermont said...

Dr. Bernstein, perhaps it has all been said, but some things need to be said over and over if the problem is still happening.

There have been a couple times that I asked if people see a difference now vs years ago. It does not generate much response. Personally I think medical protocols and societal norms for male exposure have come a long way from the way things were done back in the 50's/60's/70's. Guys growing up today would be shocked if they were suddenly treated in the manner we were back then.

At the same time we have gone backwards by virtue of the medical world adopting the "medicine is gender neutral" mantra. Gone are the male orderlies to do male catheters for example and in have come female doctors bringing female chaperones into the equation. Women now having equal access to medical school was a good thing for women's rights, but it came at a cost for their male patients who have been treated so disrespectfully with the chaperone issue.

So we've gotten better and we've gotten worse and maybe that's why the dialog here needs to continue.

 
At Saturday, July 08, 2017 8:21:00 PM, Anonymous Anonymous said...

Blog is useful but perhaps in a rut wrt prescriptions (lawsuit or individual patients speaking up). Might be time for the moderstor to allow some slack in the reins to stimulate new ideas; just a thought. REL

 
At Sunday, July 09, 2017 7:43:00 AM, Anonymous Anonymous said...

Maurice -- Thank you for your response. Having come to this blog less than a year ago, I can assure you that it is immediately relevant to anyone just encountering the problems described and discussed here. Like Biker, I learned a great deal from posts I read before contributing my own experience, and I continue to learn from posts made after mine. I'm certain that most of us would say the same -- and that's not counting the individuals who participate only by reading, who have not (and may never) contribute their own experiences, but derive the same benefits of learning and validation from reading about ours. The value of this blog as a public service shouldn't be under-estimated.

Regarding the issue of providers' "modesty awareness" eroding over the years of actual practice, I see your point from the provider's perspective: the need to take time to discuss the issue with patient after patient might start to feel redundant, particularly with the time pressure to see as many patients as possible.

But from the patients' perspective, the issues of privacy and modesty are not old hat; in the case of Biker and myself, the lack of advance warning led to traumatic encounters for which we are still, to one degree or another, feeling the effects. If we, as patients, don't know what could happen in procedures we haven't experienced before, how can we speak up before something happens that we didn't want to happen?

I don't know what the fix is -- how to encourage providers to follow through on their medical school training about modesty -- but I think that should be happening.

 
At Sunday, July 09, 2017 9:58:00 AM, Blogger Maurice Bernstein, M.D. said...

Thanks to Biker and for the 7:43 am writer with the missing pseudonym identification.

This "Patient Modesty" is the longest running thread on this blog with almost daily input compared to all the other 900 ethics topics that one can find here. It is on the basis of this activity that has motivated me here now at Volume 80 and 12 years after beginning the thread topic to wonder whether what has been transpiring here at this point is of the best value to a goal of providing gender equal attention by the medical profession regarding the issues of dignity and modesty.

Look, as I wrote above, I fully agree with REL's last post that the perhaps to the approaches to a solution as presented here may be currently in a "rut" but I am certainly not attempting to discourage the discussion of alternate approaches. That is why I called,at this time, for the consideration of why over the years there has been a "dropping out" to various degrees of previous "energetic" identified writer visitations to this blog thread (hopefully not related to their own ill health).

Yes, there could well be more than "speaking up" to the individual healthcare providers. It may require political or legal mechanisms or perhaps creation of a more energetic system of encouraging acceptance, entry and teaching nurses, techs and office workers with financial and management equality for both genders just as over the decades such equality has been accomplished gender-wise regarding physicians themselves.

So, let's go to it here to encourage active participation in this thread by more visitors and presentation of wider views and approaches if change is warranted and should occur.
To get more visitors, maybe each current visitor should through various approaches inform and encourage others about this blog thread and promote interest in their active participation.

This blog is non-profit with no attempt to "sell" anything except to discuss and promote ethical understanding and behavior. ..Maurice.

 
At Sunday, July 09, 2017 11:21:00 AM, Anonymous Anonymous said...

My apologies. The 7:43 AM poster was me.

RG

 
At Sunday, July 09, 2017 12:10:00 PM, Blogger Maurice Bernstein, M.D. said...

RG, your apology is, of course, readily accepted. But it is a worthwhile reminder to all writer-contributors to this or other threads how important a consistent use of a terminal pseudonym (if not formally signed in with some name in blogger.com. It's all about "continuity" of message.
Again, RG, thanks for your responses. ..Maurice.

 
At Sunday, July 09, 2017 7:41:00 PM, Blogger Dany said...

Hello Dr Bernstein,
(and, of course, other readers)

I'm still reading this blog, although I haven't posted since my initial contributions (when was that, volume 76 or 77?). I've been tempted to comment a few times since then but wasn't sure if I should.

Since you called out, here I am.

Dany

 
At Sunday, July 09, 2017 9:42:00 PM, Blogger Maurice Bernstein, M.D. said...

Dany, thanks for responding. As one who wrote here in the past but not recently until today, maybe you could explain why though "tempted to comment a few times" you were "unsure" to do so. Since continuity and progressive development of conversation here is important for the education of other visitors but also for the development of solutions to achieve goals of remedy to the problems being discussed, I would say that followup comments by visitors here are always welcome and is part of "discussion" which is in the title of this blog.

We can always learn from each other-- and over the years of this thread I can state (as I have in the past) that I have "learned" about the full meaning and expression of "patient modesty" as expressed not in a medical school setting but on an open blog thread. It does make a difference. ..Maurice.

 
At Monday, July 10, 2017 11:33:00 PM, Anonymous kiko1024 said...

I find all these comments interesting as to how individuals deal with issue of personal personhood/modesty Being a survivor of brutal sexual attack when a minor by 2 female medical staff to teach me a lesson as to who was in charge and thousands in counseling, I learned that I had to set limits- no female care, female doctor nor any intimate contact by female staff period. I have been verbally and psychologically abused by doctors as it "Suck it up!" Currently I had this discussion with my doctor who has moved mountains to work with me. A few years ago I was rushed to the ER after hours of a duodenal ulcer bleeding. Between passing out and flat lining numerous times I got my story to the doctors who arranged/moved a male nurse to ICU and made sore a male nurse was on duty the week I was there. Now, bear in mind that by Federal law you do not have to discuss or have present anyone you do not wish. As a survivor and is true of many survivors we wold and most likely refuse any care from opposite gender rather than reliving the trauma and nightmare. For men needing a scrotal sonogram if a male tech is not on staff request a male Dr. of radiology. I will go over anyone who steps in my way preventing what I need and how it must be handled. I will not accept the demeaning or insulting response that "we are professionals or we have seen it all". I certainly taken a few female medical staff aback saying that for their next breast exam they have a 23 year old male tech! Don't wait to be asked and insist on what you want. I asked a male radiology Dr. why don't they inform men that they can ask for a male radiologist. His response no one has asked-but never thought to offer when an appointment is made as the booking staff already know what the appointment is to be for. So hospital staff and doctors are also responsible, but the client bears the burden for looking after his best interests.

 
At Tuesday, July 11, 2017 7:14:00 AM, Blogger Dany said...

Dr Bernstein,

One reason that held me back from making comments was that I wasn't sure if they would be meaningful and/or relevant. One of the common theme that seems to bind many - and I would suggest perhaps all - of the posters is that at some point in their life, in some form or other, their modesty in a medical setting was compromised (in either a very unpleasant way, or simply too casually).

However I do recall you asking posters to move on from simply retelling their experiences to how to change things, how to improve the situation. Finding the right balance seems to be what is holding me back.

I have learned a lot from reading other posters' comments (Biker in Vermont easily comes to mind, having recently dealt with a similar situation). And maybe I will share some of my experiences with this.

Lastly, to the poster named kiko1024, I hear you. You will find you're not the only one here in a similar situation. Wish it wasn't so but, there you have it.

Dany

 
At Tuesday, July 11, 2017 8:48:00 AM, Blogger Maurice Bernstein, M.D. said...

Dany, I have been encouraging my visitors for years to move on from their presentation here mainly of their "true-life" descriptions of their psycho-traumatic modesty experiences within the medical system whether as a student or as a patient and switch to presenting here approaches to rectify the system. And I have repeatedly used the request to "speak up".

Just to give my readers an idea of when, perhaps, I first used the expression, I did a word search through all the Volumes and found my first "speak up" in Volume 36, November 2010 where I wrote in the introduction to the Volume: "And the patient modesty issue continues with concerns about which gender is more at risk for modesty abuse and which healthcare provider and provider gender is doing or not doing what.
One solution to the concerns continues now to appear and that is the importance of any patient with modesty concerns to SPEAK UP to the providers and to the system. I can't believe that any patient should find it necessary to avoid a necessary medical workup and treatment because of concerns that their modesty issues will not be attended by the provider. If it ever should come to that, and according to some writing here it has, there is something drastically wrong with the system or perhaps the initiative of the patient to make their wishes known."

So, though I admit that for my visitors to express their own personal experiences may be therapeutic for them and supportive of the experiences of other visitors here, I think we all agree that there is a giant medical problem for many who visit here and now the goal of this blog thread should be methods and mechanism of resolution of the problem. And the emphasis should be on advice and the results of attempts by my visitors to independently act upon their dilemma.

In other words, by now, our Volumes have been well documented with the "moaning and groaning" and it's time now to emphasize how to resolve this over all the Volumes, this "well-documented" problem.

So Dany, maybe you can resume posting and tell us what you did to make the system work for you. ..Maurice.

 
At Tuesday, July 11, 2017 10:43:00 AM, Anonymous Anonymous said...

Would a website with amazon-type product reviews of medical offices, clinics, and hospitals (focused on patient modesty aspects; sorted by geography and medical specialty) do any good?
REL

 
At Thursday, July 13, 2017 12:53:00 PM, Blogger Biker in Vermont said...

As noted previously I have had a couple dialogs with the local hospital about their policies concerning high school student shadows. This was after I learned that students as young as 9th grade are allowed in the OR as observers. I have not been able to get any policy statements other than students wear name badges that say Student (but not what kind of student they are), that students are well supervised, and that patients can refuse to have students present.

My specific queries as to whether there are any age-based limitations on student presence when patients are intimately exposed, whether students are allowed to observe when patients haven't had an opportunity to specifically say yes or no (emergency surgery, certain ER scenarios etc.) or whether patients are specifically told students are in high school (vs allowing patients to assume the students are adults in nursing or medical school). No answers to any of those questions.

I thought to do a "student doctor" search to see if anything has been written on this topic and in doing so I came across a large forum Student Doctor Network. There are numerous subforums, including for high school student shadows. I could not find any discussion about patient intimate exposure to high school kids and thus posed a question myself. I should note that in threads I did read that the focus of the students is far more on what the students need that it is on how the patient feels.

A key discovery is that hospitals appear to allow each doctor to decide what students can observe. A couple doctors responded to my query and didn't seem to understand why I would be concerned about young high school girls observing me being catheterized for example. Though the high school kids can't participate in patient care, as observers doctors are OK giving high school kids the same access as licensed medical professionals.

There is also a prevalent sense that because the word "student" is buried in the consent forms that the presumption is that patients have specifically agreed to any and all student presence, including that of high school kids. I did not see anywhere any perceived obligation to differentiate for patients a 9th grader from a 3rd year medical student. The onus to be properly informed is entirely on the patient.

Bottom line is for anyone who might object to 14 year old girls observing your surgery, including the prep, the onus is on you to surface their status because it is assumed you agreed to their presence when you signed the consent forms.

Dr. Bernstein, if the opportunity arises you might ask your students about their high school shadowing experiences. Some of them may have already learned it is OK to deceive patients if it benefits the medical staff. I read some comments where high school kids were referred to as colleagues so as to garner patient agreement to their presence.

 
At Thursday, July 13, 2017 2:59:00 PM, Blogger NTT said...

Hi Biker:

To negate the facility to in their mind legally allow anyone the doctor wishes to watch what they do, the patient would need to write something along these lines on any and all consent forms they sign.

"I hereby do NOT consent to any observers of any age or sex observing any preparations, testing, and/or treatment(s) done on my person at any time while I am a patient at this facility."

It's getting to be you have to take a lawyer along with you if you want to protect your wishes. Sad.

I've also been speaking to local urologists & a few urology depts.

To a person not one of the doctors and staff I spoke with ever gave it a thought that just maybe a man would feel more comfortable with male nurses and technicians attending them when intimate procedures are being performed instead of females.

One doctor commented that maybe that was why some of his male patients never came back after their initial consult.

I bluntly told him that many men would rather walk away now after the way they've been treated rather than hand their dignity over at the door.

We had a good back and forth conversation.

I usually start out with statements like "With all due respect to the qualifications, professionalism, and the high level of care your female nurses are providing your male patients." then go from there but be diplomatic. It usually opens then up to talking.

Urology is a key area for all men. We need to get more male personnel active in all facets of the field. Urology has to be told in no uncertain terms, that not all men want women being involved in their intimate treatment.

To many men are suffering in silence because they think female nurses are the way it's going to be and that's the way it is. They're afraid to speak up for fear of retaliation from the nurses and being labeled as weak. Sad.

That's all I have for now.

Regards to all,
NTT

 
At Thursday, July 13, 2017 5:18:00 PM, Blogger Maurice Bernstein, M.D. said...

Biker, I am not happy with college or high school or earlier student "shadowing" to whatever degree and for whatever the formal "purpose" is said to be. Not only is the patient's medical history at unnecessary risk for "distribution" and the patient's control of their "physical body" is open to "non-therapeutic inspection" which I don't think is ethical when the primary goal is the best professional diagnosis and treatment. Also, importantly, is the physician's responsibility and devotion of interest at the time of the patient=doctor relationship and activity is purely to the patient and not to some other individual or the physician's own personal life. None of these concerns, however, apply to a student who has already become a student in a school of medicine, however the patient should always be made aware that such a student is present with the informed consent of the patient and is a "medical student" and not a "student doctor" or even "doctor".

What I want to remind or inform my visitors to this "Patient Modesty" thread is that in 2014 I began a thread titled "Shadowing a Doctor: A Benefit or Harm"

http://bioethicsdiscussion.blogspot.com/2014/01/shadowing-doctor-benefit-or-harm.html



with contributions by visitors who have written to our "Patient Modesty" thread.

Of interest for me was another point against "shadowing" prior to medical school education and that was the introduction to those "to be medical students" an inappropriate education by those outside of a medical school environment regarding the ways and means of the sub-culture called the "tribe of medicine". That is the stuff of medical practice but indoctrinated to the "possible to be med student" from a different era and not the approach or technique of patient attention, diagnosis or care which they will be taught in current medical education.

So go to that thread and see if the comments there add something to your view of "shadowing". By the way, you can contribute to that thread since it is still open for Comments. ..Maurice.

 
At Thursday, July 13, 2017 9:12:00 PM, Anonymous Anonymous said...

A few points based on my 35 yrs in medicine. First, not all institutions cover the possibility of the presence of young (non healthcare program enrolled) observers in surgeries, exams, etc. in their informed consent documents. I’ve seen some that are overly broad and do slip it in. At my institution, up until my departure we did not allow any “student” observers unless they were formally enrolled in one of our documented healthcare training programs. If not, each patient had to explicitly consent in writing for the presence of the “outside” observer. This is the higher standard way to comply with HIPAA and patient personal privacy, but not all institutions take the high road.

My experience was that EVERY student vacation time period (Spring Break, Summer, Xmas break) there were medical center physicians wanting to have young adults of high school/college age shadow them. These young adults were children of friends, their own children, children of colleagues, etc. They did not see anything wrong up front with this shadowing, certainly not with reference to the patient’s feelings or preferences. I told them its possible, but you must get written consent from each patient and we would need a copy of that written consent. Or they could formally establish a shadowing program for the institution with admission criteria, screening, etc. That ended the matter always. My point being from my extensive experience physicians in this matter physicians just didn’t think about the patient’s perspective - but after years under HIPAA they did have a sense thankfully to check whether it is ok.

As a patient you need to be aware that if you are having a surgery or procedure during student Spring Break, Summer Breaks or Xmas break you have an increased chance of the physician having a young shadow. You always have the right to decline the presence of observers. You need to read the informed consents given to you (in the physician’s office and/or at the hospital). Decline to agree to the presence of observers. Under HIPAA your care CANNOT be conditioned on the presence of such observers. Unfortunately some of these forms are given to patients at the wrong time, when they are nervous, stressed about the upcoming procedure/surgery and really not able to carefully read the whole document and feel brave enough to question the content.

Finally, in small private outpatient offices physicians often bring in the young adults noted above (at the time periods noted). Even though you won’t sign a form for an intimate exam and some intimate procedures you have the right to refuse the presence of non healthcare operations observers. Its not a matter of being rude, manly, a bitch, or whatever, it is your right - so speak up. — AB

 
At Friday, July 14, 2017 5:24:00 AM, Blogger Dany said...

Dr Bernstein,

Thinking about an earlier post you made regarding the “I hate doctors” thread, I too do not think I “hate” them. To me, what it comes down to is trust. And I have yet to come across any physicians whom I could say I fully trust. I am always wary, cautious and definitely on high alert (expecting and dreading the worse) when I'm with one, due to some unfortunate experiences in my past. And I do not mean to single out doctors; I feel pretty much the same with any PA, NP, RN or other health professionals.

I've learn to compartmentalize things in my head to make it easier on me. I'm usually okay with anything not requiring me to take all my clothes off, but anything else gets a lot more nerve racking for me. I have mentioned in previous posts that I do not enjoy physical examinations (and that's putting it mildly). One consequence of this is that I always have to explain that I'm pretty nervous around doctors and that it will affect any vital readings they do or revue. To this day I still have (new) providers concerned over my BP readings and I have to explain to them that, no, it is not hypertension, I just suffer from “I-don't-like-doctors-itis” (call it white coat syndrome) and if they give me a few minutes to “settle down” the readings will go back to normal (and they do).

I can convince myself to accept of physical, only because I know I can (and almost always do) put a stop to it when it gets to the genital or rectal examination. This is where I draw the line, regardless of who the provider is. I have had to be quite vocal on a few occasions (it is still surprising to see how many military doctors / PAs will not take 'no' for an answer, or will do their level best to pressure/argue with you to get you to comply). I have noticed a similar trend (although perhaps less intense) with “civilian” professionals as well. While things won't get to an all out shouting match (usually), they'll try to convince you, to get you to change your mind (and, for all I know, maybe they believe they are doing the right thing there, for the patient's own good). It's unfortunate that, as a patient, I have to be firm and sometimes angry just so the person I am dealing with will back down and respect my choice. This might be a biased opinion on my part, but it seems to happen more often when the care is offered by a woman. Perhaps it is perceived as a personal insult by them.

But to me, the primary reason I don't easily trust providers is because I feel I am often being manipulated by them. I won't say outright being lied to, but... You know, a little missinformation here and there, things not said but implied instead, the witholding of imformation that might impact a patient's decision, that sort of things. Let's call them “little white lies” sprinkled here and there just so the patient can be nudged (or persuaded) to agree to the care. All of this, of course, being for patient's best interest (if it wasn't readily apparent, I am being being sarcastic here).

A classic example would be someone rushed to the ER (for whatever reason), and being told that “something has to be done” (whatever the procedure). Patient asks if it will hurt, and is told that no, it won't (or “just a little bit”). Turns out it did hurt (or more than a little bit). Quite upset, patient asks why he wasn't told and the answer given is “would you have agreed if you knew it would hurt?” as if it is justified to lie to the patient if the end result is to get him to agree (consent) to the procedure.

Perhaps it is only me, but I find myself more and more on the look out for these things, almost as if I expect that sort of behaviour from the health professionals I go see. I often pay more attention to what isn't said, wondering how and when am I being deceived by them. My past experiences have taught me that, no, “doctors” cannot be trusted (not implicitely anyway). That for me, to earn my trust, is a long and slow process.

Dany

 
At Friday, July 14, 2017 10:47:00 AM, Anonymous Anonymous said...

As retired 30 year high school teacher, I believe I can write with some authority that the vast majority of adolescence under 18 do not have the mental and emotional maturity to shadow a practitioner at any time during which sensitive patient information is discussed or any intimate exposure takes place.
To avoid this happening at hospitals and some offices be certain to read carefully any “consent to treat forms”. My wife has had several emergency room visits and one hospitalization and each time we were asked to sign such a form. The receptionists were in each case somewhat irritated when they realized that we were going to take the time to read the entire full page form instead of simply signing it. Obviously, most patient simply sign and hand back the form.
All three forms had one paragraph granting blanket permission for any number of observers to be present and another allowing for videotaping or the taking of pictures. The Massachusetts Patient Bill of Rights guarantees the right to refuse both observers and pictures and I find it extremely dishonest for the medical profession to use a tactic like this in an attempt to circumvent state law.
Each time, we crossed out and initialed these two paragraphs. On receptionist told us we couldn’t do this but I informed here that the document involved informed, not coerced consent, and I would gladly talk to her supervisors(s) if necessary. At that point she relented and accepted the form. In all three cases the receptions gave me a copy of the form giving permission to bill my insurance but they had no intention of giving me a copy of the consent form until I demanded one.
Even after this, at one ER visit, after my wife had seen a doctor, a young women walked in and without saying who she was asked to examine my wife. After I inquired and found out she was studying to be a nurse practitioner, I informed her that her learning for that day should involve reading consent forms so she would know which patients she was allowed to see. At that point, she gave me a hostile look and without a word stormed out of the exam room.
In summary, in dealing with the medical profession you must be continually vigilant if you care about you your bodily privacy and the privacy of your medical information because they so frequently place their concerns over those of the patient
MG

 
At Friday, July 14, 2017 1:58:00 PM, Blogger Maurice Bernstein, M.D. said...

Thanks to AB,Dany,MGG and the "regulars" for their participation in the discussion regarding "physician shadowing". Yes, in my opinion, there is a host of ethical issues the examples of which have been already noted here by my visitors. And the topic is important since it does appear that medical schools are encouraging or requiring some "shadowing" to be part of the admission evaluation for applying students.
My main ethics concern about such "shadowing" is a true ethical benefit for which party.
In all physician-patient relationships when the ethical principle of "beneficence" is carried out: who should be one primarily receiving the "good"? It has always been my understanding of the history of medicine that it should be the patient. The benefit for the physician or the shadowing adolescent should be secondary. interaction between the medical system and the patient should be based on the principle of patient autonomy. And that is why all decisions involved in non-life-threatening, non- emergency situations should be based on the principle of patient autonomy--the patient makes or has made the decision. The patient consents to the participants in the patient's care and consents to the tests and to the treatments.

Of ethical concern, however, is what is the role of the health of society with regard to individual patient autonomy and beneficence particularly with respect to societal benefits said to be gained through "physician shadowing"? If the "shadowing" promotes entry into the medical system of needed students to become doctors, nurses or med-surgical technicians for maintaining a healthy society should that trump concern about"shadowing" and the individually affected patient? Do we know, based on valid studies, whether this behavior actually, in the long-term, increases the population of healthcare providers who will be satisfied with their professional occupation and be a value toward the health of society through their presence or behavior.(Does anyone have statistics on this point?) This is important since the primary motivation for "shadowing" is student education about a possible occupation.And this is where the principle of ethical justice is considered. Is the value of "shadowing" to society sufficiently great enough to override any apparent losses of autonomy by the individual patient involved in the "shadowing"? Are those potential losses considered just when considering the potential benefit to society as a whole? Any answers? ..Maurice.


 
At Friday, July 14, 2017 2:33:00 PM, Blogger Biker in Vermont said...

Dr. Bernstein, medical or nursing students shadowing physicians and nurses can be a valid part of their education and in ensuring that there is a steady stream of qualified medical professionals joining the workforce. There is something in it for society. I accept that.

High school and college kids who are merely wanting to see if it is something they might like holds no societal benefit. I'm not so sure that there is anything so special about the medical field that kids in high school need to get a test drive before pursing education.

While I would not knowingly agree to a 14 year old girl observing me in the OR, some people would. At issue is each of us giving informed consent. There are very clear terms that if used would not confuse the general public. This includes medical student, pre-med student, college student, and high school student. Yet the standard term used for all of them is student doctor, and sometimes no term is used at all but rather "Mary is part of my team", "John is assisting me today", or "my colleague Sally". Each of those non-descriptors is a purposeful misleading of the patient for the benefit of the student. Until I learned better I didn't realize anyone other than a medical or nursing student was allowed to observe or otherwise interact with patients. My guess is few people know that student doctor that just observed their physical might have been in high school.

Great improvement would be seen as concerns informed consent if the medical world was simply required to make everyone wear name badges that clearly identified their status.

 
At Friday, July 14, 2017 5:25:00 PM, Blogger Dany said...

I agree there are benefits for future health professionals to shadow someone else for a while (it might even be part of their clinical rotation) but that benefit, in no way, overrule or supersede the patients' concerns or objections regarding said shadowing.

No patient has an obligation, be it civic, legal or moral, to accept to be a training dummy for anyone else. And this is something that might creep up on anyone unnoticed, because some facilities will not go out of their way to let you know training is taking place and you've been roped in, want it or not.

I know there are still places who, for fear of being told 'no' by the patients (or because it has happens and they aren't happy about it), will adopt a don't ask, don't tell policy where patients aren't informed. This is extremely insidious and misleading. These professionals are playing on their patient's naivety and ignorance, betting they won't be able to tell some extra staff have been added to the roster.

(this issue happened to me last year and I'm still kind of pissed off about it.)

In my opinion, if you aren't there in direct support of the patient's care, you don't belong in the room. Period. And if a provider, or institution, is going to bring in a student or observer, have the decency and respect to ask the patient if it's okay first.

Dany

 
At Friday, July 14, 2017 7:38:00 PM, Blogger Maurice Bernstein, M.D. said...

Continuing a bit more on the matter of physician shadowing by adolescents and beyond, I recommend you read the opinion of a physician written in the Albert Einstein College of Medicine "The Doctor's Tablet" website http://blogs.einstein.yu.edu/is-physician-shadowing-a-shady-practice/comment-page-1/#comments
but most interestingly the volume and variation of Comments the opinion received. The unifying part of this whole discussion with conflicting opinions is that though we are not all physicians or nurses, we are all potential patients. ..Maurice.

 
At Saturday, July 15, 2017 6:10:00 AM, Blogger Biker in Vermont said...

It should be noted that it is not just doctors that are being shadowed. High school kids are shadowing nurses too, and given nurses provide the majority of intimate care, it behooves patients to clarify exactly what that young girl tagging along with your nurse is. The "student nurse" may in fact not be enrolled in nursing school but rather high school. That said, in States like Vermont and New Hampshire where 16 year old high school drop outs can be licensed as LNA's, those girls do their clinicals with real patients and are not shadows, so it can be tough to avoid minors providing intimate care.

 
At Saturday, July 15, 2017 7:52:00 AM, Anonymous Anonymous said...

To the extent that "shadowing" is an expected prior experience for medical school admission, I think it probably shouldn't be resisted. However, I agree with those who believe the line should be drawn at age 18 as a minimum -- HS students really aren't mature enough, on the whole, to handle the possibility of intimate exposure (either physical or verbal; i.e. description/discussion of symptoms and patients' emotional responses).

From my own perspective as a patient, true informed consent would have to include full disclosure of the student's name, current educational status (undergrad pre-med, med-school) and the name of the school. "Student doctor" may be a standard term academically, but patients aren't going to understand it in the intended sense.


RG

 
At Monday, July 17, 2017 9:12:00 AM, Blogger NTT said...

Good Afternoon:

If the medical community wants patient’s to allow doctors and nurses to bring along observers on their rounds, then the medical community has an obligation to the patient’s to be up front and honest with the patient’s as to the identity, education level, and the age of the observers.

The healthcare industry cannot assume by signing an intake piece of paper that the patient automatically agrees to allow observers.

The patient alone has the right to say who will and who won’t participate in their care.

There are many people who do not mind allowing observers on their case.

At the same time, there are people who don’t want to discuss their case in front of anyone but their physician.

The medical community must respect these people’s right to say NO.

People that don’t want observers should try to stay away from teaching hospitals as you are more likely to be exposed to more people in one of them.

The more sneaky the industry is at trying to push observers on patient’s by calling them doctors or nurses when they are still in high school or haven’t had any medical training, will just serve to create more mistrust between the healthcare industry and the public they serve. Something nobody needs right now.

Regards to all,
NTT

 
At Wednesday, July 19, 2017 1:03:00 PM, Blogger A. Banterings said...

Maurice,

I am still here. I had to take a break from your blog. Reading on the topic brings back bad feelings and anxiety.

I have also seen some of the unique phrases that I use beginning to appear in policy. Being vocal makes a difference. The other problem was that this was almost a full time job with the research that I was doing to back the assertions that I have made.

The discussions that we all had got into some really deep psychological concepts. Even with my background in counseling, this was a lot to process. But myself, Ray, Kevin, Charles, and others were able to defend our position and assertions.

Basically I am burned out, as I am sure that others are.

Then there is life; it happens. I have not forgotten about the issue. I am working on a project that will bring change.



--Banterings

 
At Wednesday, July 19, 2017 7:10:00 PM, Blogger Maurice Bernstein, M.D. said...

Banterings, I appreciate your return today to the thread to which you have certainly constructively contributed in the past.

What I have found particularly of need to express appreciation was certainly your support of your discussion with valid and appropriate references in the form of accessible links. I express the same appreciation to a number of others writing comments here to their reference links too. References are always of potential value in all discussions as a method of supporting or rejecting a viewpoint.

Hopefully, "burnout", including yours, is reversible by "rest".
Banterings, also hopefully we will hear more from you about your project. ..Maurice.



 
At Wednesday, July 19, 2017 9:13:00 PM, Anonymous Anonymous said...

Hello Dr. B, and thanks NTT for your encouraging posts.

I am a long time follower of this forum, and I had intended to post under volume 79, but that one has now closed. I wanted to share my own recent real life event and interaction with local hospital staff. Back in 2014 I had sustained a perforated diverticulum, from long standing diverticulitis. From my perspective, I thought that I was having a major diverticulitis attack..., but I was slowly slipping into renal failure. Anyhow, I was still able to drive myself to the hospital, and was perhaps starting to become distressed a bit, but did indicate to the attending physician (female), that I would not feel comfortable with a 'catheter' being inserted. The attending proceeded with having me sign the consent for procedure, with laparoscopic approach, which had to be reverted Hartman's. However, when I had awoke from my ordeal, a catheter had been inserted against my wishes, and as it turns out by a female nurse. Now I have to ask you, do you think that my wife would ever want any female inserting such a hideous device? Nope! And do you think that I would ever withstand any male inserting such in my wife? Hell no! My wife would not even ever electively go to see a male obgyn. I can't help but to be curious what the spouse of any nurse would think of such a thing. After all, I was coherent, and expressive, to which I now understand that the attending had an ethical obligation to engage my concerns. While I have physically bounced back from this event, it has left a deep emotional scar. In my case, the end doesn't always justify the means. I even additionally had to go through this same hurdle during the take down process, which my doctor was supposed to insert this supposed standard of care. I had even asked the anesthesiologist to remain awake until I hit the OR, which wasn't relayed to the anesthestist. I had even requested that the medical center require separate auths for catheters, which apparently their Compliance Dept was interested in pursuing, which is interesting considering that most med auths have verbiage regarding blood transfusions in 'bold' print to appease certain groups..., but not for all of us which have concerns. Additionally, their auths also have photos, videos, etc., which I also always mark through.

Thanks,
H.

 
At Thursday, July 20, 2017 5:31:00 AM, Anonymous Anonymous said...

I'd like to echo Banterings' comments about needing to take a break from the blog. I too have had the experience that "reading on the topic brings back bad feelings and anxiety." For me, in fact, too much contact with this and other modesty blogs can trigger obsessional thinking and web-surfing on the topic, which I then have difficulty getting back under control.

I do think this reaction is important to acknowledge as another harmful side effect of modesty violations. Thanks to Banterings for mentioning this.

RG

 
At Thursday, July 20, 2017 7:37:00 AM, Blogger Maurice Bernstein, M.D. said...

I fully agree with RG and Bantering. What we have here on this 12 year thread is 12 years of "moaning and groaning" about each participant's personal experience or knowledge of experiences of others "in the news". And while I do recommend "ventilation" to my patient's various emotional issues which they bring to my office, I think there has to be a more effective therapeutic approach beyond expressing to others ones emotional history. That therapeutic approach should be "active attempts to FIX the system" and bringing others together to help. I think that spreading the word to others about approaches to the "fix" and personally doing something to attain that "fix" of the system should be invigorating methods to attain both personal relief and relief for others with the same upsetting experiences.

So, as I have written about this here previously, let's move away from personal descriptions of
previously experienced emotional harm and more on to specific approaches, with intent to carry them out with help of others, that will make further distressing experiences less likely or virtually absent.

Yes, "speaking up" to the various healthcare providers, as we have repeatedly written is of value but it is important that system changes are made-- system changes which involve education of patients to "speak up" but also system managerial (including provider education changes) also with attempts to legal and political awareness and actions.

So, let's talk about specifics regarding what can be started, how can it be carried out to a final result which will prevent the emotional trauma repeatedly and consistently describe here one Volume after another.

Let's talk here about this. Otherwise, writing and reading about this "moaning and groaning" by others will only produce fatigue, not be therapeutic and will accomplish nothing. This, what I wrote above, is my professional prescription. ..Maurice.

 
At Thursday, July 20, 2017 8:21:00 AM, Blogger A. Banterings said...

RG,

You hit the nail on the head with "obsessional thinking and web-surfing."

Let me also add the sensations that the body "remembers." For those of you not familiar with this, it is physical tactile sensations that are the result of memories and not a current, present, physical stimulation.

Classic PTSD symptoms.

One of the changes that the contributors have made is that these "side effects" of encounters with the healthcare system have been validated on this blog. Our assertions are no longer questioned on this blog for the validity of our claims. We are no longer considered outliers. Indeed the tone has changed. For that, I commend Maurice.

Slowly, the profession is also SSSSLLLLOOOOWWWWLLLLYYYY changing their view on this as well.

I have also kept an eye on the blog, mostly skimming the topics (as I am sure that many others do as well). I felt that it was important to chime in and let people know we are still here.

Maurice, thank you for the recognition of the contributions that I and others have made, and you are very welcome.



--Banterings



 
At Thursday, July 20, 2017 9:43:00 AM, Anonymous Anonymous said...

Hello H.,

Your experience sounds horrible. As others on this site have done, please try to affect change by speaking to the hospital personnel (nursing staff, doctors, admin.) If this is too draining for you, maybe your wife could do this. Everyone concerned must be notified that your requests were completely ignored. Please be adamant. The industry will not change until it is confronted with a need for change. Without your follow-up, business will continue as usual; and, many others will face the same indignities. Express your views in writing and in person. Write negative reviews. Notify appropriate agencies. This will take time and effort; but, change can happen, if enough people are willing to expend the effort.
Reginald

 
At Thursday, July 20, 2017 1:57:00 PM, Blogger Biker in Vermont said...

I have noted these things over time in different posts, but here are things I have done. None are profound, and for the most part don't do anything but plant a seed that increases awareness in a small way, but any input the medical world receives is cumulative.

I contacted the local tech high school LNA program and an area college RN program to pose the question as to whether their programs include male students, and if not do they have any outreach to attract male students. I pointed out that their websites only feature female students and that by doing so they are sending prospective male students a message that only females are welcome. Both responded with a "good idea, we never thought of that" type response.

I contacted the local hospital twice asking questions about their policies. The first time was about the high school LNA students doing clinicals at the hospital, including working in the OR. The second time was specific to high school student shadows. In both cases I was looking for policy statements as concerns their identification, patient informed consent, and access to patients that are intimately exposed. I did not get full answers but I know I caused a conversation to be had at the hospital.

I wrote an article for the Dr.Linda blog. She tells me it has been one of her most popular articles and in my discussions with her she admitted to not having been aware of the issue, and that she agreed with me on everything I said. I expect she now approaches her own patients differently.

I have spoken up. When I changed hospitals for my annual cystoscopy, I first posed certain questions about male nurse availability for the prep, and when I went for my first one I was not shy about saying I wanted a male nurse, which is what they gave me.

I have insisted on not being sedated for 3 procedures (two being colonoscopies) and will not be sedated in Sept. for another procedure. For this upcoming one it included voting with my feet and going to a different hospital when they would not do it my way. For one of the other procedures they initially said no but quickly relented when I said I would go elsewhere. Along the way I learned that sedating patients is a lucrative billing opportunity. They had billed as if I were sedated and tried their darndest to say it was for something else when I contested the bill despite the bill being very clear. As an aside, a colonoscopy without sedation is not a big deal. It was a non-event comfort-wise, and I retained control of my body and exposure.

Again, nothing profound here but it all helps.

 
At Thursday, July 20, 2017 11:04:00 PM, Blogger Dany said...

I think, for the most part, men aren't aware of the modesty issue, or how it might relate to them, until it stares them in the face (so to speak). And by the time that happens, it's usually too late. Shock, surprise, fear of ridicule or reprisal often keep us quiet.

I recently (as of last year) had to deal with some urology issue. All in all, it was relatively minor (hematuria, which turns out to be fine) but I did have to go see a urologist. Among the tests he recommended was a cystoscopy and ultrasounds.

I had next to no knowledge about this beforehand (other than what I had researched myself, which wasn't that much useful for me). Thanks to some of bloggers here I had some information to go by.

The urologist took it as a matter of course that I would be under sedation for my cystoscopy. I nearly missed that fact, only cluing in when he added that I might feel confused after the procedure. After finding out he was planning on using Versed (which I wanted nothing to do with), I told him I did not want to be sedated for this. He did not agree.

I eventually managed to get my way but it wasn't easy. He was really insistent and didn't back down until I got angry with him (in fact, I'm pretty sure my sudden outburst scared him a little).

The procedure itself went well (not pleasant, by any stretch of mind, but not as terrible as I had anticipated), other than being greeted in the room by not just one nurse, but two and both were women. As it turns out, one of them was under formation and the other was "supervising" her. No one told me that was going to happen. No one asked me if I wanted to be used as a training aid either. The forms I signed prior to the procedure didn't mention that detail.

I didn't think of saying anything at the time (for one thing, I didn't know how many staff were required, and for another, I was too frazzled and concerned about the procedure to focus on this). Now, after realizing I was played for a fool, I'm kind of kicking myself for not speaking up right then and there (I had a nagging feeling "something" wasn't right).

The ultrasounds had me concerned as well (I didn't want any more "surprises"). So I had the doctor list for me all the organs he wanted to see. Much to my relief, it was only going to be kidneys, ureters and bladder (KUB). I will only add that, as I suspected, the image tech was a woman. I'm glad I knew ahead of time what the ultrasounds were about (and that I wouldn't have to remove any piece of clothing). I honestly don't think I would have agreed to do it otherwise.

Now that I have gone trough this once already, I am better prepared for an eventual next time (there shouldn't be one, or so I have been told, but...). I would even go see the same urologist (if he will take me on). Only next time, we're gonna have a little chat about staffing before I agree to do this again.

There is more I could say, but I do not believe it would add anything meaningful so I will simply conclude by saying don't be scared to put your foot down if you have to. It worked for me (although I had to get in a doctor's face to get my point across, which is unfortunate).

Dany

 
At Friday, July 21, 2017 8:16:00 AM, Blogger Biker in Vermont said...

Dany, you are correct that often times men (and women too) don't realize what they are about to experience until they are in the midst of it, and then are too embarrassed to say anything. My guess is most don't realize that they can get a pretty good idea by going online beforehand.

Guys, look it up beforehand, even before you go to the doctor if you suspect where your situation might be leading.

Having had a couple dozen cystoscopies at this point I can tell you there is no reason to be sedated. A little numbing gel a few minutes ahead of time is all that is needed. I am referring to a flexible cystoscope here, not the rigid kind used for surgeries. I also had at least a dozen treatments administered the same way. No sedation is needed. Neither of my urologists even offer sedation.

The time for a chat is not when you are approaching another procedure. It is the rare urologist that hires male nurses or techs. Best to inquire ahead of time. When I was switching to a different hospital/practice, I called, told them I was considering switching and posed a couple related questions to what we talk about here. At the time they had one male RN in what is a large practice. I told them that was one more than most had and that it was a good start. She said they are trying to find more males. I approached the conversation in an upbeat manner while being clear many men are uncomfortable having females prep them. In doing my homework prior to calling I knew that they take on two new Urology Residents each year, one male and one female, and so I asked about whether I could only have a male doctor and male resident if the doctor is including residents when I am there. She said just say so ahead of time and it won't be a problem. Again, I kept the conversation positive, but clear on my concerns.

 
At Friday, July 21, 2017 8:57:00 AM, Anonymous Anonymous said...

Thank you so much Reginald for your encouraging comments. I have taken some constructive steps to express my frustrations with this facility, and also for the 2nd surgery I had needed.

On the issue of constructive thinking, I have seemed to notice a huge double standard amongst society standards. For example, I was glancing at some TSA videos, where they have same gender pat-downs. And when law enf does checks, same thing. But wait, when it comes to medical..., oh wait that's apparently different. All of a sudden, the medical world is apparently magically immune from all of this. Each of these can be argued that they're skilled fields. So, what makes the medical world any different from this standard? Here within I believe is part of the dilemma.

Thanks,
H.

 
At Friday, July 21, 2017 7:41:00 PM, Blogger Biker in Vermont said...

Good points H about the differences between TSA & Police same gender pat downs vs medical care. Why is one group considered gender neutral but not the others? TSA and Police certainly receive more training than do CNA's and Medical Assistants.

 
At Friday, July 21, 2017 8:00:00 PM, Blogger Biker in Vermont said...

"We have no modesty here" can be added to the list of passive aggressive bullying techniques used to engender compliance of male patients.

I am just back from visiting a good friend at a rehab facility in NH. He is recovering from Guillaume Barre Syndrome and on his first day there they send in a young woman to assess his capabilities. She required him to completely undress, dress, use the bathroom and shower for her. He apparently must have hesitated or otherwise showed his embarrassment so she tells him "We have no modesty here", and so he complies rather than add to his embarrassment.

In telling us the story he tried doing the usual male bravado "this didn't bother me" kind of thing that I myself used to do, and certainly others here have done too. Having been best friends with him since we were college freshmen 46 years ago, I saw through it and could tell he was very embarrassed. I know him all too well. Regretfully a female co-worker of his was there as was my wife, both of whom saw great humor in his embarrassment in the way women tend to do. Their modesty is to be taken seriously but not that of men. Perhaps they really believed it didn't bother him but they enjoyed it nonetheless.

For me to have pursued the issue with him with the two women there would have only added to his embarrassment so I let it drop. Before doing so however I did make one comment that most likely that young woman would never have allowed for the reverse had she been the patient and a young male came in to assess her in that manner. Neither his co-worker of my wife got it. Had I been alone with him I would have told him it is OK to advocate for himself and demand to be treated with dignity. At some point down the road I will when we are alone.

Guys, this is something else we can do. We can tell our buddies that it is OK to speak up. I can tell that it has not occurred to my friend that he can do so.

 
At Sunday, July 23, 2017 3:30:00 PM, Anonymous Medical Patient Modesty said...

It has been a while since I’ve posted here. I wanted to share a very encouraging testimonial from Really prefer to keep that private (Female Patient) From Minnesota submitted on 7/21/2017 who fought for her rights to have an all-female team and her husband present for her hysterectomy at http://www.patientmodesty.org/testimonials.aspx. I am glad they found Medical Patient Modesty's web site and it encouraged them. Many hospitals will not allow you to have your spouse or personal advocate not employed by the hospital and I am so glad she successfully fought for that. I really appreciate this lady's courage and how she looked for another doctor who would accommodate her wishes after the 1st doctor rejected her requests. This case confirms how important it is for patients to not give in and fight until they find the right hospital and medical team willing to honor their wishes. The female gynecologist who operated on this lady is very compassionate and caring.

Misty

 
At Monday, July 24, 2017 4:07:00 PM, Blogger NTT said...

Hi Biker:

I'd just told the young woman at the rehab facility in NH I am a functioning adult male if I need assistance I will ask and let it go at that. What she did to him was a bunch of BS.

Oh and by the way young lady, modesty concerns will be adhered to.

Regards,
NTT

 
At Monday, July 24, 2017 5:41:00 PM, Blogger Biker in Vermont said...

NTT, just coming out of the hospital with GBS, he needs to learn to walk again at age 63 and is suffering from other muscle weakness. The assessment was necessary so that the physical therapists can mold his therapy to his specific capabilities & limitations.

One issue is that nobody told him that he would be assessed in that manner so for all intents and purposes it was an ambush. The other issue is that the rehab facility treated him in such a dehumanizing and demeaning manner by sending in a young woman to observe him undress, use the bathroom and shower, made worse by her "We have no modesty here" bullying tactic.

That facility will perhaps do a great job helping his physical recovery, but they will have killed a piece of his soul in doing it. Why doesn't the medical community recognize this rather obvious dynamic? That female staff in medical settings can successfully bully most men does not make it right.

This morning I told a young woman I work with about this to get her reaction. She told me that a few years back when she was 1st married her husband in his 20's developed a leukemia. At one point in the process he needed to get a sample taken from his hip bone I think it was. She was present for the process when the young female doing the procedure told him to drop his drawers. There were several additional young females there observing the process. My co-worker said it didn't even occur to her that he should have been afforded more privacy until afterwards when he told her how embarrassing it was to have all those women there watching him with his drawers pulled down. That she herself didn't see anything wrong with it until he pointed it out to her afterwards says a lot.

It is too late this time to help my friend understand he can speak up but I can help him understand it for the next time he goes into the medical system. This is something we perhaps all can do selectively. Last year I spoke with my son telling him that he can advocate for himself in this regard because the medical world will not treat him as the equal of female patients.

 
At Monday, July 24, 2017 10:13:00 PM, Blogger Maurice Bernstein, M.D. said...

Anyone want to respond to the following "bump in the road" to accomplish the goal of nursing provider selection by the patient?
Read the following and then return and respond, if desired.

Here is the link to the article:
https://www.ahcmedia.com/articles/136172-providers-must-tread-carefully-if-patient-objects-to-caregiver

..Maurice.

 
At Tuesday, July 25, 2017 3:49:00 AM, Blogger Biker in Vermont said...

Dr. Bernstein, I read the article and was disappointed that it lumped race, gender, religion, and sexual orientation all together as if they are comparable. To the extent they differentiated gender it was only in a very minor way and even then only directed at women's privacy.

Another disappointing aspect of this is that they only see patients as discriminating by having a preference. That hospitals only hire female mammographers, sonographers, and L&D staff for the comfort of their patients but do nothing in that regard for the comfort of male patients gets no mention at all. I posit that it is the medical world that routinely and rampantly discriminates based on gender in their hiring practices.

 
At Tuesday, July 25, 2017 5:02:00 AM, Anonymous Anonymous said...

Re: the article "Providers Must Tread Carefully...."

The first thing I noticed was how far down in the mix the issue of modesty was. "Gender" of provider as a preference was usually in the middle of lists of preferences ("race, gender, or religion"), and the issue of male modesty in particular wasn't even mentioned. The example given was a female patient requesting a female provider.

RG

 
At Tuesday, July 25, 2017 11:02:00 AM, Blogger Maurice Bernstein, M.D. said...

With regard to patient physical privacy concerns and the United States 1964 Civil Rights Act, it would appear that gender selection by the patient would trump and be accepted in contrast to the other factors such as race, national origin, disability or age with regard to requests by the patient in any argument regarding employee discrimination.
Another point supporting a patient's request to their physician rather than an institution for care by a specific gender is the following. As noted in the referenced article: Accommodating the request can be seen as the "physicians deciding among themselves how best to meet each patient’s needs, courts generally give physicians wide latitude in that regard." Physicians’ willingness to accommodate is “likely due to the unique nature of the physician–patient relationship."
So, my conclusion from reading the article is that you will not be requesting an illegal act by speaking up to your physician regarding your interest in obtaining nursing by a specific gender. ..Maurice.

 
At Tuesday, July 25, 2017 11:18:00 AM, Anonymous Anonymous said...

Hello Biker,
"We have no modesty here." - Should this be placed on every hospital window in the country? How would the general public react to this? Had your friend been a woman, would she have been told, "We have no modesty here?" This is absurd! Is there a need, in the education of medical personnel, for lessons in Respect For The Individual (whether male or female) - Body, Mind and Spirit? This sounds like the Middle Ages. When did an individual become solely a body? Whatever happened to "holistic" medicine? Is there any other profession which would utter, "We have no modesty (i.e. respect for your dignity as a unique human being) here?" Shouldn't simple common courtesy have been applied? Maybe common courtesy has become anachronistic? One can only hope that this is an isolated instance and that higher standards still shape the practice of medicine.
Reginald

 
At Tuesday, July 25, 2017 1:24:00 PM, Blogger NTT said...

Good Afternoon:

Or hand your dignity over at the door as you will not have any once you're checked in.

I don't know if they already do this but what about some sort of character assessment test taken before people enter med or nursing school to try and weed out the undesirables or on the job diversity training on a permanent schedule while you are under their employment.

Biker I agree, every male who has suffered through the healthcare system nightmare has an obligation to spread the word as far and wide as he can to warn every man he knows about the nightmare they will face if they need healthcare services and are not prepared for the onslaught they will face.

I warn anybody who will listen to me every chance I get.

It is funny on how very little is ever written up on male modesty yet they'll always talk about women's modesty

I can only hope something rocks the healthcare industry to the core and forces a change in attitude towards male patients before the next generation starts really needing care.

They way they treat male patient's, I don't wish this crap on any guy.

Regards to everyone,
NTT

 
At Tuesday, July 25, 2017 7:12:00 PM, Anonymous Anonymous said...

The article “Providers must tread carefully…” is quite misleading. Interviewing Emergency Physicians is flawed because emergency care is a very special category where providing the care timely is of paramount importance. In addition generally the ED physicians aren’t hiring the staff that are present in the ED and/or do most of the intimate care.

The Hospital/Medical Center with the emergency department is hiring the staff. Many have commented here on this so I apologize for repeating but a Medical Center (an equal opportunity employer) can hire one gender preferentially for providing care under an appropriate BFOQ exception to discrimination laws. In almost every case US hospitals do (tacitly) assert they will use the BFOQ argument for same gender care because they only hire females techs, staff, nurses, etc. for departments serving females, like Mammography, U/S or Labor & Delivery. What that means is males have a right to same gender care also at these facilities - its just they rarely demand it or know they can demand it.

My experience has been most hospital Risk Managers, CFOs, HR directors, Nurse Executives and Regulatory people do not appreciate that by hiring exclusively female staff to “minimize risk”, “meet modestly concerns of the women” etc they are actually committing to doing the same for males. There also is a default belief the gender of the care giver it is not an issue for males, hence it is okay to preferentially hire females who can “cover” both genders. That misconception has no factual basis and the contrary has been expressed in court cases about the same gender BFOQ for urology staffing.

Now and then we did get requests from patients for same race providers or at least no providers of a specific race. We could NOT accommodate these requests because of discrimination laws. Generally we would inform the patient of this and offer to transfer them if our care was not going to meet their needs, etc.

Individual physician offices are different. There the physicians are hiring the staff into their own business. It is their prejudices that determine who is hired and how patients are serviced. I think such physicians are influenced by their training at larger medical centers, where women are preferential hired and they tend to propagate this behavior. Here the patient doesn’t have much leverage other than commenting on evaluations, the internet and voting with her/his feet. For this reason, as I’ve said before, I tend to utilize providers at large medical centers that have arranged their (female) service lines to provide same gender care. They then have committed to arguing in favor of a same gender privacy BFOQ and thus male patients are entitled to that if they demand it (or in extreme cases sue for it). — AB

 
At Wednesday, July 26, 2017 8:45:00 AM, Blogger Maurice Bernstein, M.D. said...

AB thanks for your contribution to the discussion on this thread. I assumed from your comments that you are a physician. A physician, beyond myself, writing to this thread is, unfortunately, a rarity. I wonder if you could describe a bit about your professional activities and affiliations, remaining anonymous and without identifying institutions names or locations. All this would help put a personal professional perspective to your comments.
Again, thanks for your participation here. ..Maurice.

 
At Wednesday, July 26, 2017 8:41:00 PM, Anonymous Anonymous said...

Dr. B,

Sorry, not an MD I’m just a PhD who worked at three large urban medical centers, one very well known on the East Coast, one very well known in the NW, and one very well known in the SW. Originally entered medicine as an imaging scientist and supported Radiology and Nuc Med departments during my 35 year career in Medicine. But about 20 years ago I became in charge of everything regulatory, including Compliance, Risk Management, Safety, Accreditation, Licensing, etc. I was at my final medical center for the past 20+ years until I decided to retire early this past year.

Generally any real time patient complaint or unusual request would involved Risk or Compliance so I had *excessive* experience with any and all things unusual or dealing with patient rights, safety, etc. that happen in a very large medical center. I’ve dealt with every State and Federal regulatory agency there is in medicine, the Joint Commission surveyors many times, and of course many thousands or nurses and physicians and patients over the years. Also I’ve dealt with dozens of CFOs, Nurse Executives, CEOs, hundreds of clinical Managers, etc. And I’ve inspected hundreds of clinics and physician offices, licensed them as well as licensing Hospitals. So when I contribute it tends to be from this frame from reference (and my own experience as a patient too). FYI. — AB

 
At Wednesday, July 26, 2017 9:16:00 PM, Blogger Maurice Bernstein, M.D. said...

AB, there is nothing wrong with a PhD and your medical administrative institutional background is just what has been apparently missing in those contributing to this blog thread. (PT, I don't want to ignore you. I assumed you have had an institutional background too but"ground looking up"-- obviously different than AB.)
AB, I hope you stick around a bit (such as PT has done) and continue to present your experience and knowledge despite preserving your necessary anonymity to the concerns of my visitors here. ..Maurice.

 
At Thursday, July 27, 2017 5:13:00 AM, Blogger Biker in Vermont said...

AB, based on your experienced/knowledge, what do you see as the best way to make modesty based requests? I personally am a polite and courteous person by nature and pose any questions or requests in a calm manner (while my stomach is doing flip flops on account of fearing a bullying or dismissive response), but is there a best way to say it? Thanks

 
At Thursday, July 27, 2017 10:13:00 AM, Anonymous Anonymous said...

Biker in Vermont,

Let me first preface my comments with saying that when I was working I always wanted to hear about issues directly, rather than having them become complaints to the Joint Commission or CMS or the State licensing agency. It is much easier and *cheaper* for an organization to deal with complaints directly than let them escalate to where an oversight agency comes unannounced to investigate. That said, the institution has to be committed to rectifying the nature of the complaint, not just doing a one off appeasement of a single patient. Sadly many centers just do the one off appeasement and don’t address the larger issue. Because I dealt with so many complaints in my career I tend to give a medical center that I’m a patient at one chance to correct the deficiency directly rather than complaining about them to the licensing agency, Joint Commission, etc. I’ve had good luck with this (dealing directly with Administration first), but of course I can point out how they have violated various standards and laws because of my experience and perhaps threaten them a bit more realistically.

For the general patient my experience was they got effective change in the organizations I worked at by one of three ways:
1)lawsuit, usually class action about something discriminatory
2)complaints to State Attorney General, or the Joint Commission or CMS or the State Licensing Agency (as applicable and appropriate)
3)Complaining to their physicians, who as members of the medical staff, hold tremendous influence in the medical center. A one off complaint here probably doesn’t accomplish much, but complaints from multiple patients were often brought up by physicians to leadership. They want a smooth running clinical service and satisfied patients - so chronic issues get brought to Leadership.

And in the past few years, because $ was tied to it, the patient surveys became a focus of medical centers and the reasons patients were dissatisfied starting being tracked carefully. So until the CMS reimbursement scheme changes again, it does pay to complete patient surveys, provide comments and let your providers know (as much as you can) why you are dissatisfied.

All that said, there is no magic way to *quickly* change the health care system. There must be consistent demands to provide equitable service to all patients and consistent complaints, comments, about inequitable services.

Finally, from my experience very few in health care (e.g., in HR, CFOs, Nurse Managers, etc.) actually intellectually recognized there might be a problem hiring only female nurses, techs, CNAs, etc. They somehow know it must be ok because that is how hospital and medical centers have been staffed but they can’t articulate the BFOQ exception for patient privacy. They don’t appreciate if they defend hiring exclusively females for female patient privacy they have set up a legal complication if they don’t provide the same opportunity for males. And since they use Patient Rights words indicating that ALL patients are entitled to patient centered care where their values & privacy are respected they really have created a problem for their organization only focusing on females & “assuming” it doesn’t matter for males. One needs to point this out to them. FYI. -AB

 
At Thursday, July 27, 2017 5:32:00 PM, Anonymous Anonymous said...

AB. -- I believe Biker is asking whether a courteous complaint is preferred to some slternative. There is nothing courteous anout an ambush so asking about the best tone for speaking up seems like a good question. My guess is that causing a scene (nothing illegal of course) that gets noticed by other patients and staff at a facility can change a business model. I once witnessed a scene caused by a customer at an auto dealer service center that did exactly that. Your opinion would be especially valuable on this issue. REL

 
At Friday, July 28, 2017 9:31:00 AM, Anonymous Anonymous said...

REL, Biker in Vermont,

On the question of whether to make a scene I can tell you how such patients were dealt with at large medical centers & affiliated physician clinics (my frame of reference). Front line staff & their Supervisor or Manager are expected to handle the complaint first. If it can’t be resolved than others are called. I frequently had to intervene with difficult customers who wanted/expected certain services or things that were or were not within the capacity of the hospital/clinic to appropriately provide. I frequently had to explain what we were required to do, what we can do, and what legally we were prohibited from doing. However, it is true the squeaky wheel often gets the attention first. Does this affect long term change at the institution? It would depend on the situation.

Making a scene in a clinic that currently is staffed with only one gender, say women, is not going to resolve the matter that day. It is appropriate to render a complaint but you shouldn’t leave it at the clinic or department level. After all, they hired the all female staff, they already are biased in thinking that this is an acceptable arrangement. One loud complaint may not persuade them to change. You will involve more in the organization and get more thinking about the issue if you also file a formal written grievance with the Medical Center and also write to Administration about your discrimination. You also force them to address the issue with the Joint Commission if you file a complaint with the Joint claiming your Privacy Rights were violated.

But in the end use what you feel most comfortable doing. After all, not many men are advocating right now for equitable health services. You likely are going to be one of a few that are working to bring change to the institutions and clinics you attend for healthcare.

One final point - don’t forget the importance of the health care services. Arguing so that you end up leaving with no health care can be harmful to your health. One has to balance risk - benefit. So it is a personal decision. - AB

 
At Friday, July 28, 2017 1:38:00 PM, Blogger Maurice Bernstein, M.D. said...


AB, we thank you for your recent postings, coming from (excuse the expression) the "horses mouth", which provides the concerned visitors here with the "pathophysiology" of the "disorder" within the medical system many are facing since it is important for them to know if they are attempting to find a "cure". And, of course, continuing with the medical analogy, as we physicians must consider when deciding on a "treatment", we always must "balance risk-benefit". Again, thank you. ..Maurice.

 
At Saturday, July 29, 2017 6:11:00 AM, Anonymous Anonymous said...

I've been thinking about NTT's comment from a week or so ago, that "very little is ever written about male modesty." How would one go about requesting or suggesting (or even commissioning) a scholarly study of men's attitudes toward modesty? And would such a study, if published in a sufficiently high-profile venue, be likely to have an impact on policies and practices?

RG

 
At Monday, July 31, 2017 6:28:00 AM, Blogger NTT said...

Good morning Ladies and Gentlemen:

AB if I may, I’d like to tap into that vast amount of knowledge you hold in that head of yours.

If I’m wrong in any my statements please correct me anywhere along the way.

For us lay people what’s been said is that our US healthcare system has systematically for years been speaking out of both sides of their mouth.

A two-faced medical system. Shocking! Absolutely shocking! :)

Out of one side of their mouth, they are telling the public they are supposed to be serving that they are an “equal opportunity employer”.

While at the same time out of the other side of their mouth they are telling their industry peers and regulators that they will use a BFOQ exception if needed and hire only female staff as they feel men have no modesty concerns but women do so by hiring just female works we can staff areas important to the privacy of women and at the same time take care of the medical needs of both sexes.

Now. If these statements are true, why hasn’t anybody called the system on the carpet to this point as their exception, cannot possibly past the exception test?

Since men don’t have privacy to begin with, take away a woman’s privacy then, take an equally qualified male nurse and place them in the labor & delivery area and they can do just as good a job as any female nurse. Likewise for an equally qualified male tech.

Their exception DOESN’T STAND UP to the test therefore it shouldn’t be allowed.

If they want to play the privacy card, they have to acknowledge that both sexes not just females have modesty concerns and as such both sexes should have their privacy protected.

You also have the Patient’s Bill of Rights that most hospital post in their lobby.

Two lines of the Patient’s Bill of Rights here at a nearby hospital state that;

Every person has the right to Personal privacy and the confidentiality of your medical record.

Every person has the right to be treated with dignity.

Very few men are treated with dignity.

So if their exception can’t pass inspection how do we as paying customers put an end to their charade other than class action lawsuits? Lawsuits would be hard unless there were say male nurses and techs that were trying to make inroads into female dominated areas.

Our country is in the process of trying to craft a new healthcare bill for all. Now while the coals are hot is the time to strike and make a difference for all men.

Who at JC or any other government regulator do we call and /or write to in order to put a stop to this?

Also, other than walking into a facility & seeing it’s filled with just female workers, is there a way to tell if a facility is or isn’t using the exception?

Thanks for your time AB.

Regards to all,
NTT

 
At Monday, July 31, 2017 2:52:00 PM, Blogger Maurice Bernstein, M.D. said...

NTT, a very appropriate question and comment.

Notice the fact:
The United States Supreme Court held that gender selection in marriage is Constitutional in the United States.

What about gender selection in medical care? And I emphasize "medical care to all genders" and not some other occupation. What evidence is there that would find that selection unconstitutional or argued as BFOQ to defy the humanitarian value of United States Civil Rights Act of 1964?

I have never taught my students that medical care providers are or should be looked upon as "genderless" and that patients should make that identification.

AB, do you think that this not rare discrimination of male patients within the medical care system is worthy of a legal fight, within the United States and to be taken to the Supreme Court as gender selection in marriage? ..Maurice.

 
At Tuesday, August 01, 2017 1:17:00 PM, Anonymous Anonymous said...

Why are male patients undergoing a testicular ultrasound not afforded the same privacy as female patients who undergo transvag exam?

In fact, there are two ultrasound exams that male patients may require, testicular ultrasound for epididymitis or a penile shaft for fracture.

During a transvaginal ultrasound the female patient is completely covered with a sheet. The female patient is then asked to insert the transvag probe herself. The probe is then manipulated by the Ultrasound technologist Outside the sheet. Why could the Ultrasound technologist not do the same for male patients. Truth of the matter is they could if they wanted to without comprimising the exam. You see that would mean breaking protocol because any male exams must require exposure, prolonged and unnecessary.

Once a young male patient as I recall he was perhaps 15 yo presenting to the ER with a possible penile shaft fracture from rough sex with his girlfriend. I overheard the female ultrasound technologist make a comment " he broke his little dick during sex"
I will make it known that I am not an ultrasound technologist, however, I have used the ultrasound machine as a tool to locate deep vascular structures, veins etc. Thus in many regards I can see that a testicular ultrasound could be performed while affording the patient full privacy. I have asked a few male ultrasound technologists this very question and they agreed.

The licensing agency is called ARDMS. ORG, I suggest you visit their website. Once there you will see virtually nothing as far as what you the patient can expect during any ultrasound.

ARDMS
1401 Rockville Pike
Suite 600
Rockville MD 20852-1402

I would like our readers to write to this agency, invite them to this blog and ask them why are there different protocols between the genders, why do they offer no patient instruction as to what exactly will happen during these intimate ultrasound exams on their website which already in stills little or no trust. Please be sure to comment what I have wrote.

Thank you

PT











 
At Tuesday, August 01, 2017 2:52:00 PM, Anonymous Anonymous said...

NTT,
You stated: “For us lay people what’s been said is that our US healthcare system has systematically for years been speaking out of both sides of their mouth.”

There is truth to that. The reasons are many and complex and too numerous to cover all of them in a blog format. I will highlight *one* reason for the heavily unbalanced gender of staff in medical centers (AND in private physician offices), as it plays out everywhere. And that is, there is a “unstated” belief that it is less troublesome, less costly, to hire all female staff for intimate care activities than males.

What do I mean by this? First example is Mammography. A significant fraction of women object to male techs performing/being present for their mammograms. Women are good about complaining vehemently about things like this - I speak from experience dealing with MANY complaints. I give women lots of credit - by complaining they change the system. By complaining we now have many thousands of Women’s Imaging Centers in the US, all staffed by women and designed to be women friendly. There are zero Men’s imaging centers…

Another example - Ultrasound of the Genitals. Women file complaints about male techs. Mostly because they don’t understand the nature of a transvaginal U/S exam. But the result is the organization has to evaluate whether something inappropriate occurred and then has to consider whether the male U/S techs need chaperones for female patients. This seemingly adds a “tax” or “expense” to having the male U/S techs. Whereas men do not speak up enough about their experiences with female U/S techs. There is no “tax” or extra “expense” seemingly with having female U/S techs scan males. This reinforces the belief it is better to have female U/S techs than a mixture of male and female techs. *And unless males start complaining, start requesting, or other action is taken (as I’ve mentioned before) little will change*.

One can go on down the line. Ultimately one sees experienced Risk Managers and experienced clinical Managers favoring hiring females for certain positions involving intimate care. Unless there is someone there who appreciates the broader legal ramifications the medical center or physician office will tend towards the biased hiring. At my former medical center we could not defend being an equal opportunity employer and providing equitable patient rights if a department only hired female staff for patients of both genders. But we seemed to be the exception I can tell you from my own personal experience.

Since any large medical center does Mammography & they have hired exclusively female staff to do the routine mammography (even though 1/3 or more of the Rad Techs qualified are Male) it means they by default are arguing the BFOQ of bodily privacy (the alternative being blatantly discriminating in hiring). So males need to start requesting the same accommodations as females and complaining about their inappropriate experiences, their inappropriate accommodations & their violated patient rights.

NTT, you asked how can a patient tell staffing at a facility. You really can’t unless they post info on their web site (some clinics/departments now post group photos of the clinic staff). It is safe to assume most places will be staffed with predominantly females, if not exclusively. You need to ask when booking an appointment. If you live in an urban area I’m pretty sure you can find a medical center that has males employed for just about any test you many need. Rural is much tougher. In a later post I’ll give info on how to complain to the Joint Commission, etc. — AB

 
At Tuesday, August 01, 2017 4:04:00 PM, Blogger Maurice Bernstein, M.D. said...

Again, thank you AB for your detailing the mechanism underlying the disproportional access to male techs and nursing staff.

As a physician, I am always directed to look at possible etiologies of symptoms which should be ruled in or ruled out.

One element of the differential in considering the physical modesty issue in men is the concept of "gynophobia", an abnormal fear of women. Do those who write here find fear of women in any other situation beyond the medical environments which have been repeatedly described here? From what is written here I would think not. If my assumption is correct, then what alternative psycho-physiologic mechanisms could be the basis for the expressed concerns? Could it be a fear of expressing to those women attendants (and even men present) a personally unwanted sign of sexual interest such as inappropriate penile erection or even unwanted ejaculation?

As some of my visitors may recall, I have previously described on this thread that penile erection while the doctor is performing a genital exam is not rare nor pathological. And I have previously written that we specifically teach our medical students to be aware of this possible reaction by their patients and to promptly express to them the "normality" of this reaction occurring including then that the reaction is valid evidence of normal neurological and vascular function.

Perhaps some visitors will consider understanding of the psychological, social or physiologic personal basis for the concerns they express here as not pertinent and that the unequal attention by the medical system to the requests of each patient is the pathology that needs to be studied and remedied. But we have to remember that the medical system is just half of the issue and we cannot ignore the distressed patient. ..Maurice.



 
At Tuesday, August 01, 2017 7:11:00 PM, Anonymous Anonymous said...

AB

I want to clarify some issues regarding your comments. FIRST, female patients never ever had complained about mammography technologists gender. They never had to, the choices were already implemented. You could NOT to this day hire a rad tech to perform mammography, WHY? Because no male rad techs have been trained, they don't train male rad techs in mammography, period.
The training into mammography has always been blocked first by medical imaging directors, hospital administrators etc. No female patient ever in this country has ever walked into a mammo suite and encountered a male tech.

It's very important that we keep these points in mind I have made throughout these discussions. Why? Because it demonstrates the discrimination MADE by the facilities, NOT by the demands of the female patients seeking a mammogram. The one occupation in the United States that is 100% dominated by one gender only is mammography. I do not believe you can find another occupation in this country whereby it is occupied exclusive by one gender.

Just as a side note, The Medal of Honor has been given out since 1861 to thousands of soldiers. There is one woman who was awarded the medal. So, there are few exclusivities you will find and it only furthers my point. You don't have to look far to find discrimination in medical facilities and the discriminations implemented are not always done based on patient demands, rather implemented by the very female staff themselves.

PT



 
At Tuesday, August 01, 2017 7:23:00 PM, Anonymous Anonymous said...

Dr Bernstein, really? You're not asking women why they prefer same gender for their exams; why ask male patients?

And at the end of the day, what difference does it make? Medical care in the USA discriminates against male patients in this regard and that's the only thing that matters!

Frankly, I'm offended by your post!

Ed

 
At Tuesday, August 01, 2017 7:42:00 PM, Anonymous Anonymous said...

Maurice

I am in no way challenging you thought process into the realm of modesty issues here. I'm offering no insight to these psychophysiologic mechanisms. What I've suggested all along at least as I have seen it, the driving force, is discrimination. As I've said all along the term modesty is not appropriately applied. There is tremendous discrimination directed towards male patients in the medical arena, so much so that many male patients simply choose not to seek care. That in and of itself should be a Hugh wake up call for the medical community.

They tend to ignore it and brush it aside. Their comments on some forums is " we will minimize your exposure" . First of all, no they do not and secondly that is an expectation to drape appropriately and keep exposure to a minimum, that's not the case and for them, female staff when they are patients I can assure you. I continue to believe all facilities do nothing but practice discrimination first, practice medicine second, no disrespect to you. One of the keys I believe is legal intervention and as you know Medicare continually makes new rules in order to receive reimbursement. It is through these rules that Medicare requires might be the key, that all medical facilities must have a specific percentage of male staff to insure male patients are offered the same privacy considerations. I certainly can see this as a reasonable requirement in order to be reimbursed by Medicare, what do you think? Certainly would hit the pocketbook of Urologists if they don't comply.

PT

 
At Tuesday, August 01, 2017 9:23:00 PM, Blogger Maurice Bernstein, M.D. said...

Ed, I understand your concern about what I wrote but I want to add and clarify my previous words. First of all, it is my opinion that the ethical and most likely legal burden of this issue lies with the behavior of the medical system itself. It is NOT the patients or their views or feelings which are at fault.

My view has been from the beginning of this thread that those writing here, both male and female (and in most recent years primarily male), expressing their dissatisfaction with the system with regard to the gender of those who attend to their medical needs are possible statistical outliers. That assumption was based simply on my years of attending to patients as internal medicine physician. I had never heard from any patient about gender selection or upsetting experience related to gender. My view when faced with the writings to this thread was an assumption and I await statistical study to show that my assumption was in error.

But, my assumption of statistics is not setting my view of those patients who write here or others who have a problem with gender selection and haven't written. All patients, regardless of outliers or not, ethically and legally deserve attention by the medical system to their gender preferences. The medical system should see that all patients receive care by the gender with whom the patient feels more comfortable and should prevent emotional distress by not attending to this issue.

My last posting was simply attempting to understand the mechanism of distress by male patients who write here and not about ignoring the necessity of medical system change for the benefit of all patients (including "statistical outliers" with gender concerns if such a group even exists).

Ed or anyone else please let me know if my view needs to be better and more fully described.

..Maurice.

 
At Tuesday, August 01, 2017 10:40:00 PM, Anonymous Anonymous said...

Maurice

You have brought up a concern men may have of an unwarranted erection during examination by female staff. That you have taught your medical students to be aware of these situations. This subject was thoroughly covered about 3 years ago on this blog. We visited the website whereby female nursing students were told to carry a steel spoon and strike an erect penis of male patients that were disrespectful.
That one poster stated that because of this practice was rendered sterile. I don't think this is one of those psychophysiologic mechanisms you are looking for. We all know know that a simple physiologic action can get us assaulted by a psycho female nurse with a spoon.

PT

 
At Wednesday, August 02, 2017 12:31:00 AM, Blogger Dany said...

Dr Bernstein,

I am not convinced that the people contributing to this blog are, as you say, "statistical outliers." I would be inclined to believe that they represent the more extreme end result of having suffered inappropriate/upsetting behaviours from the health care system. I believe a vast majority of people are concerned about gender care but aren't saying anything. They accept it (sometimes grudgingly), having been constantly reminded that it doesn't matter, because this is what the system wants (it is more effective, less costly). And in situations when access to health care is precarious or difficult, any providers will do.

I want to relate an interesting experience that happened to me about 10 years ago. Most people are familiar with the "movember" campaign designed to bring awareness of men's health (either psychological or physical, but specifically prostate health and other urology related issues).

Now, someone in the health department where I lived at the time, thought up this idea of furbishing a bus and converting it into a "clinic on wheel." The idea was to drive the bus around, park it somewhere and do free information/consultation right then and there. The initiative involved heavy media attention so people would know when the "bus" would be in their area. At face value, this was a excellent idea.

When I learned the "bus" was going to be in my town, I thought I should check it out (not that I had any medical concern at the time but what the heck, I wanted to see for myself). So I went and waited to get in.

I was greeted by a woman (a nurse I believe), who was ready to do a mini triage to see how to best help me (did I need information about "men's health" or did I wanted to talk to a care provider. The inside had semi-private booths where people could talk to a provider if desired. There was also I believe two small examination areas in the back, where people were shuffled to if needed. And they had referral to local clinics or hospitals ready to hand out if required.

Now here's the thing that baffled me the most. This clinic on wheel, who was stood up for the specific purpose of promoting men's health (with an eye toward urological issues such as prostate health) was entirely manned by women. There was not a single male provider available.

After asking a few questions, and verifying that there weren't any male providers (that was a fun talk, getting stink eyes from three of them - obviously my concerns were not welcomed there), I left. There was no way I would agree to do any kind of assessment at this place.

Somewhat curious about how popular this clinic would be (and really wanting to find out if I was the one with the screwed up way of thinking), I stuck around. I sat at a nearby park bench and casually observed who went in, and roughly how long they stayed. This was not a rigorous study, merely my own observations. I must have stayed about an hour (maybe a bit longer) and saw roughly about 40 or so people go in. Obviously men, sometimes couples, mostly middle-aged to seniors but a few young men as well.

My assumption was that if they stayed only a few minutes, they were getting information only, and if they stayed longer, they were in consultation with one of the provider. My gut feeling was that most would back out of there in a hurry as soon as they found out there was no male provider. Turns out I was right on the money.

I would say that, of all the people I saw going in, 80 to 85% of them walked right out mere minutes after they got in. And it doesn't take a PhD to realise why that is. To me anyway.

The campaign was deemed a success (or at least this is what was reported to the media) but I have a funny feeling that it fell quite short of their expectations. I am hoping someone, somewhere, dared to mention the elephant in the room and suggest that not having any male provider was an unfortunate deterrent to providing the care they were aiming to do.

Dany

 
At Wednesday, August 02, 2017 1:01:00 AM, Blogger Dany said...

As an addendum to my previous comment, I should add that this "bus" toured the various towns nearby (staying 2 to 3 days at the time) and was active for the entire month. I have no way to know precisely how many people were drawn to the clinic or what formula they used to measure success afterward. I would guess that overall, lots of people went in to talk, with a small fraction actually getting consultations done. Or, like me, went in somewhat open-minded and willing to check it out but, backed out after realising they would not be seen by a male care provider.

And for any lurkers reading my comments, I do want to say (because I think it is important) that I have no issue with women providers as such. I have no reasons to believe that nurses, doctors or PAs are any less qualified, skilled, trained or have less experience by virtue of being women. This is not the issue at all. For me, I am simply not comfortable with the idea of having an intimate assessment done by a women.

Another example I have is with my own father, who is currently suffering from some urological issues and flat out refuses to seek care. My mom calls him a thick headed fool for it but, I am convinced he knows he will have to deal with female personnel about this and will not put up with it. It's pretty sad, when you think about it but this is the reality of the health care system.

As the saying goes, "you don't attract bees with vinegar." The system has to change in order to appeal to men (to make it more comfortable), otherwise, men will simply not seek care, or avoid it as long as possible.

Dany

 
At Wednesday, August 02, 2017 4:31:00 AM, Anonymous Anonymous said...

Dr. Bernstein -- In response to your question above, I as a male patient personally have tended to prefer female physicians. My response to an unannounced and unwanted "chaperone" was first of all the unpleasant surprise of an ambush, being exposed to a non-participating witness without my consent. Several weeks of depression and anxiety ensued, during which I began to recall some repressed memories of abusive situations in medical offices which unpleasantly echoed the witnessing scenario. For me, the issue is that third-party, non-participating witness -- the idea of being on show to someone who is NOT in the room to examine or treat me. My preference is still for female physicians, but due to the greater likelihood that female providers will impose "chaperones" for intimate male care, I am training myself to see male physicians instead.

Earlier, I had asked about the possibility of commissioning a scholarly study of male patients' views on the matter of provider gender, "chaperoning," etc. As has been noted here, very little on this exists in the literature, and you yourself stated in your latest post that "I had never heard from any patient about gender selection or upsetting experience related to gender." Do you think such a study could help gain some recognition for male patients' preferences?

RG

 
At Wednesday, August 02, 2017 7:23:00 AM, Anonymous Anonymous said...

You've been very forthcoming on your views and we may very well be statistical outliers; I don't care. My employer provided health care is reported to the IRS as imputed income; nearly $25 grand. I'm going to get "it" delivered in a manner I'm comfortable with.

I'm relatively confident the mechanism of distress is varied for male and female patients alike. Do you understand it for female patients; why the focus on the guys?

I've been following this blog since 2007 when I had my first bad experience with civilian healthcare and regret not walking out of the damn OR with the sheet wrapped around me. You seem to raise this issue on a regular basis and I don't get the value added in knowing the various reasons why just the guys are uncomfortable with opposite gender care.

Ed

 
At Wednesday, August 02, 2017 8:31:00 AM, Anonymous Anonymous said...

And it looks like it may even be worthwhile to try to balance putting up with the "stink eyes" and other medical assistant behavior that Dany refers to against the expected benefits of going in for that urologic exam: NEJM July 13, 2017

http://www.nejm.org/doi/pdf/10.1056/NEJMoa1615869

REL

 
At Wednesday, August 02, 2017 9:33:00 AM, Blogger Biker in Vermont said...

It has been a good discussion going here of late.

Dr. Bernstein, the mere fact of discussing men's modesty speaks volume when women's modesty is just assumed as normal and natural without any discussion needed. Why are men modest? Lots of reasons I suppose but fear of women is probably not one of them.

As has been discussed in the past, older men were raised to not expect any intimate privacy except when their exposure might offend females. During mandatory nude swimming lessons in public middle & high schools, in some jurisdictions female staff members could wander in to ask the gym teacher a question so long as she wasn't offended by all the nude boys. Whether the boys were offended or embarrassed was irrelevant. More or less the same scenario occurred during school and sports physicals for the boys. Women could observe so long as they weren't offended. This is why few older men will ever speak up even if embarrassed. Making believe it doesn't bother you is just too ingrained. That in turn has fed the medical world the ammunition they needed to justify their discriminatory hiring practices and disparate treatment of male patients. They took it as proof that men have no modesty.

The converse of that was females were raised that it was OK to see their brothers but not for their brothers to see them. I'm the 2nd oldest of 7 spread across 18 years, 6 boys and 1 girl. I don't recall ever seeing my mother change my sister's diapers, dress her, or bath her, but my sister certainly saw all those things with our youngest brothers. Women going into medical careers and subsequently into hiring authority positions just carried those mindsets with them. Their brothers could run around naked in the sprinklers but they had to wear a bathing suit.

The issue is cultural more than it is purposeful discrimination. Those making hiring decisions in hospitals aren't saying I'm only going to hire only women in hopes of embarrassing the male patients. Most of them instead just think that the men don't care. They know that women care and so defer to hiring women. At the same time, they have certainly gotten enough feedback to know that at least some men care, but I suspect it is just too convenient to chalk them off as being a little off. The medical world has also taken the stance that being polite is the same as being respectful. Again, a convenient and self serving stance.

The bottom line is that short of large numbers of men speaking up, only class action lawsuits or legislation is going to cause real change.

 
At Wednesday, August 02, 2017 11:25:00 AM, Blogger Maurice Bernstein, M.D. said...

Biker, I agree and while I agree that public "moaning and groaning" can be personally therapeutic, constructive discussion of the issues leading to conditions preventing such distress is far more valuable to mitigate the need for such emotional display.

AB, maintaining anonymity, unless I missed it your previous writings, how aware and impressed were your previous medical center employers regarding the concerns of this blog thread group of male patients who have been expressing their realistic discontent? You apparently see the ethics and/or laws which should affect business decision-making. If invited by you, do you think any of your prior employers would be interested to participate, anonymously, in what I think is a valuable and constructive discussion here?

AB on a very personal question: again maintaining your personal anonymity Do you see yourself as a part of the class of patients writing here whom I personally have classified as "statistical outliers" or one who on weighing physical modesty vs medical need or appropriateness is satisfied with accepting attention and care by one of an opposite gender?

And finally, though I personally assumed that your were of male gender, I would be still very encouraged based on your commentaries if you turned out to be of female gender.

Again,it is clear that those currently writing here are pleased with your presence. ..Maurice.

 
At Wednesday, August 02, 2017 1:39:00 PM, Anonymous Anonymous said...

Good questions Dr. Bernstein. First, I personally had only female physicians the first 30 years of my life (at a time when there were few female physicians). One would be hard pressed to consider me an “outlier” on the modesty spectrum. I also grew up in the era Biker did and had experiences that really would be considered inappropriate today. Today I prefer male physicians because it 1) eliminates the need for a chaperone which I do not feel comfortable with, and 2) I no longer feel I have to support women physicians who at one time were woefully underrepresented in medicine and 3) there are some things I feel more comfortable discussing with a male physician.

For me personally the big issue is having equitable treatment, having equal rights, including privacy rights. How males are discriminated against in medicine came to my attention in the 90’s when medicine (broadly, in the US) moved towards creating female friendly clinics and imaging centers, staffed only with females (for intimate care activities of females). It also became blatantly obvious medical centers and physician clinics did NOT have the same concern for the male patient (still no men’s imaging centers 20+ years later, and only a handful of true Men’s Clinics in the US, compared to 10,000+ Women’s clinics).

So you ask how aware were/are medical center leadership, etc. about male modesty and privacy? I approached this matter (given my position in the medical center) on a case by case basis. So for example dealing with HR on what constitutes an Equal Opportunity Employer and how we can’t just hire females we positively modified hiring practices. With individual clinic leaders on how they will accommodate the male patient the way they do the female patients affected hiring of medical assistants, etc. I can tell you 10 years ago when I started working to improve our organization most clinical leaders were clueless about this topic, why they could seemingly hire only females, whether males have any privacy needs, whether males have any rights, etc. It was pretty eye opening but really it just confirmed what we and other organizations had done - design medical practices to cater to the female patient and force the male patient to accept that standard. (Frankly it was a pretty good business strategy because males don't complain enough about their rights.)

Sorry but I did not direct them to your blog (wasn’t aware of it initially anyway).

A final comment about research studies on modesty. The few that exist tend to be paper surveys, usually done on an ensemble of patients visiting a clinic. Many of these patients (male or female) may not have been placed in a situation where they might feel modesty issues and many do not have any idea of what some medical tests truly involve and who may be present. Females nowadays can get their OB/GYN care at an all female clinic if they want and always get their mammograms done by females. They may not experience opposite gender intimate care. Conversely, some male survey participants may not have had a “work up” at a modern Urology clinic and what is involved in a Cystoscopy, etc. So, I’m still looking for a good study where survey participants have had one or more recent medical tests/procedures involving intimate care so they can validly assess themselves for degree of modesty. Until then I think modesty numbers may be underestimated. Regardless if they are underestimated or not, each patient is entitled to equitable care. If female patients have a right to care that preserves their modesty, male patients have that same right, and they should advocate for it. Clinics and health systems should NOT be designed to assume males can have reduced personal privacy rights. -AB

 
At Wednesday, August 02, 2017 9:40:00 PM, Blogger Maurice Bernstein, M.D. said...

Ed, if you are the same Ed posting on a different topic (drug testing airline pilots vs physicians), the writer identified himself as a commercial airline pilot. If you are the same Ed and perhaps "off topic" of this thread, but I wondered about the airline rationale for the apparent gender bias of employees interacting with passengers in the cabin. Is there a significant female gender bias and one which is thoroughly accepted by the passengers? ..Maurice.

 
At Friday, August 04, 2017 11:42:00 AM, Anonymous Anonymous said...

AB --

Your comments on survey parameters make a great deal of sense. If I'd contributed to a survey before my unacceptable (and eye-opening) experience, I would not have have had an accurate understanding of the issue at all, and my answers would have been meaningless.

RG

 
At Friday, August 04, 2017 10:11:00 PM, Anonymous Anonymous said...

Ha! I was hoping to see Reginald and looks like you may be the last poster. I know it's been a little while (since April) but I suppose I question the relavence of my topic to the discussion. But I did have many uncomfortable interactions with my "best neuro in town" doctor. He's really hard to get along with and I'm encouraged by my other docs to stay with him. My brain MRIs came back in May "highly suggestive of demyelinating disease". You once asked why my doctors don't speak to me in plain english, but it's me in my search to understand who finds the terminology you hear. I don't think they like that, but in being vigilant I have found errors like missing MRI images on comparison. I feel I can't miss a beat because getting answers is like pulling teeth. I have been told I have low self esteem, that I am ambivalent and have mood swings. There's all this psychoanalysis by my neuro when I really just want to know about the lesions on my MRI. I take Valtrex for oral cold sores so he asked do you have herpes and as I went to explain he cut me short and said thats the same thing. Seriously, he's like a little monster. The only doc telling me to find someone else is my pain management doc. All his reviews say ignore his bedside manner and dry humor (sarcasm in my opinion) because he's great at diagnosing. The problem is that I don't meet the McDonald criteria and he says a spinal tap won't change his treatment plan and that if he found a lesion on a thoracic MRI (the only one I haven't had) then he would just have to do a follow up MRI on that in November too. This sounds a lot like population health to me and I'm sorry but now I'm not worried about the population.. just me. I wonder if I should be pushing for these things? A spinal tap or thoracic MRI which is still missing. I have repeat brain MRI in November. I have no abdominal reflexes which I looked up to see why he was testing them and my symptoms he attributes to dysautonomia. The thought of my follow up appointment with this man turns my stomach. Thanks for listening I know I said I'd keep you posted so sorry such a long time has passed. K, hope everyone is well!

Renee

 
At Saturday, August 05, 2017 8:31:00 AM, Blogger Maurice Bernstein, M.D. said...

Renee, I appreciate your intellectual responses and challenges with your physicians but despite all that, which obviously is concerning for you, however, more pertinent to this thread topic, how do you feel with regard to their "laying on of hands or laying on of eyes" as you are being physically examined. Are you comfortable in this aspect of their behavior as your physicians? Do you look toward a woman physician as more comfortable both from a communicative and action point of view but also more comfortable with the way a woman physician would perform your necessary physical examination? Or are you satisfied in this respect with their behavior and your emotions during this activity? ..Maurice.

 
At Saturday, August 05, 2017 11:42:00 AM, Anonymous Anonymous said...

Hello Renee,

We're happy to hear from you; albeit, I'm sure that we were all hoping that your situation would have improved. Although many of us here are concerned with same-gender intimate care, our greatest thrust seems to be to "speak up" regarding our health concerns. You seem to be doing this, even though you've been told that you lack self-esteem, etc. Please continue your persistence and "aggressiveness" regarding your care. Yes! It is GOOD to be worried about "just me" (as you say). Sometimes doctors are circumspect because they're unsure, MRI's lack definitiveness, many possibilities, etc. If you can't find another qualified doctor with expertise in you area of need, I'd like to suggest the following: 1. Express to the doctor that he/ she needs to LISTEN to your concerns (Be forceful but, not belligerent.) 2. Ask about the "end game" - where are the tests, MRI's, etc. going? 3. If the explanations are vague to you, ask the doctor to draw a decision tree for you regarding your situation. (i.e. if this test is positive then, ... If it's negative then, ....) Sometimes the pictorial form of this diagram will help both you and the dr. to visualize "where you're going". (See Wikipedia, decision tree, if you're unfamiliar with these.) 4. Finally, take a deep breath during your visit and tell yourself that the most important person in the room is YOU. SLOW the doctor down and express your feelings, questions and concerns. It's completely acceptable to say, "Doctor, I really need you to tell me ...."
We wish you the best at your next appointment. Please keep us informed and make us happy when you tell us that you took charge of your medical care and that you adamantly SPOKE UP. I pray for your improvement.
Reginald

 
At Saturday, August 05, 2017 2:33:00 PM, Anonymous Anonymous said...

Thank you both for the warm welcome! I'll respond in order
Hi Doc. B,
Thanks for letting me post. I have some things going on but still enjoy the topic. Sometimes I'm afraid you guys aren't going 2 like my opinion. So I'll just be honest. I saw you talking about statistical outliers & I agree. I've never heard men complaining of these things. I never thought a guy would complain about a female in an intimate setting. I think that many straight guys would be homophobic & wouldn't move to be examined by the same sex. I guess a gay man would choose a male physician for these things, but I couldn’t say for sure. Maybe I know too many alpha males. Maybe because I never had a man discuss his colonoscopy w/me. My nephew loves 2 see our female NP because he thinks she's cute. I know he has had tests that require intimate contact. I think we have to acknowledge that on some level whether the examiner is male/female these types of exams are going to be uncomfortable.
Regarding my preferences & experiences w/these exams, because of the neurological problems coming up now, I get a physical exam at each neuro visit. Without having discussed the physical exams I've told you that I really don't like this doctor. He's very paternal & acts more like he has the right to examine me than he has permission to. To tell you the truth, it kind of turned me on. It is absolutely the one positive feeling I've had toward the man. Still at the wrong moment on the wrong day it might really piss me off.
I was in the exam room searching for the history of symptoms on my telephone because that's where I log them otherwise I'll forget. I was trying to answer his questions. He said what are you doing & he took the phone from my hand & set it in the chair next to me. I had a couple of things in my lap too. He grabbed my purse next & put it in the seat next to me. Then he grabbed my sweater, also in my lap, & put it in the chair next to me. Then he immediately began to do his neurological exam. At first I was really mad but later I looked back on it & I thought actually that was kind of sexy. I don't know if this is the answer you're looking for but at least it's honest.
You ask if I prefer a woman for intimate care. I do not. My primary care is an ARNP. She is female. She is younger than me which makes me more comfortable w/her. It takes away from her authority & I give it to her anyway. I empower her instead of her having power over me. I don't think I would much care for an authoritative female physician doing anything for me. My annual exam is done by the same GYN for 10 years. He has also allowed me to control much of the interaction. Also I just don't want a woman looking up my Hoohoo!
Back to men again, I've never heard my father, grandfather, uncle, brother, or my nephews complain about being treated by a femal or having a chaperone in the room, but that doesn't mean I think any of you here are wrong for that. I would doubt it is the norm obviously but the story of the spoon on the penis in one of the post above tells me there's probably a lot I don't know.
I do think it's not a competition between men & women as far as resolving an inequality of treatment from medical personnel. Yes the care may be centered on me at the GYN, but everywhere else women are dismissed for our symptomatic complaints as “somatically preoccupied.” It really sucks & it sucks the older you get.
If I had not fought for the MRI of my brain it would have never happened. If I had not challenged the opinion of one doctor that the changes were age related on my MRI they may very well have not done the follow up MRI to discover that there were too many lesions for this to be an age related thing. I even told them that if my discs/films came w/ a different demographic that the neuroradiologist would've made a completely different call even if it was just a follow up w/ an MRI again in six months.
Renee

 
At Saturday, August 05, 2017 2:49:00 PM, Anonymous Anonymous said...

Hi Reginald,

Thanks for being so nice and thanks too for your prayers. I’ve never heard of the decision tree although in my searching things online I’ve seen algorithms. I will look for the tree, but sounds like a similar thing but more specific to my situation. I think this time I’m going to ask him to look at the MRI’s with me. He’s really never shown me what they are looking at it. Also, I’m going to ask him like you said, why no thoracic MRI, spinal tap, or evoked potential thing? If it’s important to diagnose MS early to prevent unnecessary lesions from developing, then why not get all the data you can? You know they say be careful what you ask for and I don’t want to push for a spinal tap if it isn’t a good thing. Well, this visit should be interesting. Since my last visit I forwarded a lot of information to him about previous accidents I’ve had, including getting rear-ended by an RV. I told him I fell twice in the last year which I didn’t tell him before because I didn’t think it was relevant. You know they ask you on every visit. And I will flat out ask if he is cutting corners to cut cost, because I am not about population health. It’s all me baby!! Lol :) Thanks for supporting my non-belligerent aggressiveness.

~Renee

 
At Saturday, August 05, 2017 5:39:00 PM, Blogger Maurice Bernstein, M.D. said...

Renee, thank you for your most interesting comments to my questions and Reginald's responses. As with every posting by a fully anonymous writer on this or any other blog, as Moderator I have no way of proving that any comments on this particular thread or on any of the over 900 threads here (except my own and a very rare individual known personally to me) is really the true history and even the true emotional feelings of the writer.) Nevertheless, I and "we" must go on the assumption that the experiences and verbal conclusions written here are valid and as much as possible expresses truthfully what that writer has experienced and what is their understanding and philosophy of what they write.
Renee, all this disclaimer written above should in no way diminish the value to us all about what you wrote to this blog thread..and I thank you.

I also find your support of my "statistical outlier" ASSUMPTION comforting since though you are only one responder, your consensus and personal experience is consistent with what I have concluded after years of my personal experience as a internal medicine physician. But I understand without valid statistical facts our conclusion is not proven. Also our conclusion should NOT diminish our proper and ethical hope that ALL patients regardless of physical sex or personal sexuality are provided the opportunity to obtain healthcare provider gender of each patient's desire and request. That has always been my view from the start of this thread. However, in current social practice,I have also said that the patient who is ill and needs medical or nursing attention should weigh their decisions regarding provider gender as it may affect their health and life.

Again.. and I am sure I "speak" for the others participating here, Renee, thank you. ..Maurice.

 
At Saturday, August 05, 2017 6:26:00 PM, Blogger Biker in Vermont said...

Renee, thanks for joining the discussion again.

In response to your comments, unless you are a physician, nurse, or med tech that deals with male intimate matters, I'd of been very surprised if you said you had heard men talk about their modesty concerns. It is not something many men would ever discuss with a woman on account men know that society expects them to not be modest. To complain to a woman would be a sign of weakness, especially for alpha male types. Even if you asked directly, few men would tell you the truth. Instead they'd joke about it so as to convince you it didn't bother them, even when it really did.

 
At Saturday, August 05, 2017 7:12:00 PM, Anonymous Anonymous said...

Biker,

That makes sense and I was about to tell Doc. B. that had I been able to include more than 4096 characters to my post I would have asked that you guys don't crucify me for what I said. (also thank you for not doing that:) It's true that this line of thought in my post leads directly to what you have said, and it was not my intention to suggest weakness or femininity of any man who voiced modestly complaints. But what a great place to land because it is illogical to suggest that any man who is modest must be weak or gay. This confirms there is a group of men like yourselves of which no one likely knows the number that are struggling with this issue. It also makes sense that men who are modest would be reluctant to speak up, especially to a woman. But just like in any group of people there is likely a mix. I don't doubt that there are many with legitimate modestly complaints, but I can also see that perhaps some of this population of men could be men who are angry at women for past experiences or they could be men who do not want to see women in professional and authoritative roles. There are probably many dynamics to consider. I'm not suggesting that of anyone on this board, but just from a logical perspective, there has to be multiple reasons and that's to name a few. I mean look at my post... I OBVIOUSLY have a problem with authority figures in general. That's how I ended up in this group!

Renee

 
At Saturday, August 05, 2017 7:25:00 PM, Anonymous Anonymous said...

Doc B. I agree that whenever possible all patients should indiscriminately be able to request a physician or other medical provider with the gender of their choice. Your blog's purpose is becoming clearer to me as we discuss this because my thoughts are that this choice may not be available to many because the field is full of females, thus the "speak up" motto among you to effect change on the system. That's the only way you'll see better gender diversity in the medical field... is for those of you who are unhappy with the current situation to speak up. I don't know though... I may just ask the men in my family more forcefully about their experience.

Thank you!
Renee

 
At Saturday, August 05, 2017 9:06:00 PM, Anonymous Anonymous said...

I apologize for this delayed response to Biker’s in VT’s story about his friend:
“He is recovering from Guillaume Barre Syndrome and on his first day there they send in a young woman to assess his capabilities. She required him to completely undress, dress, use the bathroom and shower for her. He apparently must have hesitated or otherwise showed his embarrassment so she tells him "We have no modesty here", and so he complies rather than add to his embarrassment.”

This is yet another example of medical processes, especially for males patients, that have NO medical justification other than perhaps degradation of the patient. Yes, the patient must be assessed for ability to perform daily activities - that is important. However, everyone knows that it is harder to put on/take off long pants than mens boxers or briefs. He should have been provided a pair of his pajamas, long sweat pants or long pants and told to put them on and button them/tie them. He could have done this UNDER his gown (to maintain privacy), if that was what he was wearing to start the eval. He then could have been asked to take them off. To require him to be naked in front of a room full of people is NOT providing personal/bodily privacy and has NO medical justification.

Similarly with using the bathroom. He doesn’t need an audience for this. One person would suffice and it can be done in a way that is respectful. Finally, taking a shower is the most difficult. He could have been provided a male CNA to assist/evaluate and his wife could have also helped evaluate. He didn’t need multiple women watching him.

Reverse the situations. Would they have multiple men in the room and ask a women to strip naked and demonstrate how she can put on her panties and bra? No. She doesn’t even need a bra for the first phase or rehab - she needs to be able to pull on a T-shirt or wear a shirt & put on pants/pajamas too. If she can pull on a T-shirt she can pull on a jog bra. Etc. (Sorry, we had a large NeuroRehab facility - had lots of experience dealing with issues there and this treatment of your friend is highly disrespectful).

Medicine itself needs to evaluate their processes to promote patient bodily privacy. As you described it sounds like they (the staff, this NeuroRehab facility, etc.) have no concept of privacy, at least for males. Such places should be criticized. The Medical Director should explain to this patient why this needless exposure was necessary and does it happen to females also. Seriously, the Medical Director is not doing his/her job. Sadly this is rampant everywhere. -AB

 
At Sunday, August 06, 2017 5:23:00 PM, Blogger Biker in Vermont said...

Renee, yes there are many dynamics at play. For some men the issue may be body image, for others a religious basis. Some may just be shy around women. Some have had bad experiences in which female medical staff behaved inappropriately. Some just resent the double standard. What most men do have in common is that they have been socialized to not speak up if a situation makes them uncomfortable or embarrassed. Real men just grin and bear it and all that. It was very hard for me to break out of that mode myself and start speaking up in medical settings. I regret not doing it years earlier.



 
At Sunday, August 06, 2017 6:53:00 PM, Blogger Dany said...

Biker in Vermont,

Yes! I think you accurately described the situation many men are confronted with in medical settings. Men are expected to be tough and to accept it; you can't complain or else you'll show weakness. And that's not manly. So we shut up and put up with it.

And this is such a prevalent cultural bias that it is even a "persuasion" technique quite a few medical personnel - ironically women - will use to berate or badger any reluctant or hesitant patient. I wish it wasn't so but I've heard too many stories along those lines to doubt them.

Dany

 
At Sunday, August 06, 2017 7:15:00 PM, Blogger Maurice Bernstein, M.D. said...

A bit of philosophical consideration:
How do you interpret how the doctor, the nurse, the tech and the medical system looks at you when you enter the system as a patient? Are they looking at you as an "object of intervention" or are they looking at you as a "subject of care". Can you tolerate one view and cannot accept the other? How do you defend your point of view or argue against the other? Can you accept one or accept the other depending upon the situation? If the latter, "depending on the situation" can you set the parameters of what represents that appropriate "situation"?
Conversely, how do you interpret how you look at the doctor, nurse, tech and medical system when you become a patient? Should they be "objects providing intervention for your illness" or should they be "subjects attending to your care"? Should the patient be required to make such a distinction?
Might it be that the current situation in society with regard to medicine, limits the ideal degree of patient "care" by the medical profession and the relationship between the profession and patient does tend to make both more "objective" rather than "subjective" in what relationship is attempted to be established? And the solution to reverse the situation will be...???. ...Maurice.


 
At Sunday, August 06, 2017 7:51:00 PM, Anonymous Anonymous said...

@Biker,

I get what you're saying but I don't think humiliating experiences are unique to men. I mean having an open gown in the hospital and being told there's no modesty here just tells me that they are saying don't worry.. we don't care because we've seen it all. I mean, I watched my older sister in the hospital for two surgeries in the last 5 years. Her rear end showed through the gown. She wasn't given special accommodations for that. Also, I recently had the amazing opportunity to see my younger sister give birth. If that's not the most humiliating and vulnerable place to be in medicine, I don't know what is. She said she felt like a farm animal. Legs spread wide open for all to see with an epidural and requiring help to lift up her legs while she pushed. and yes she went to a clinic with all female doctors but those types of clinics didn't always exist and even now if you want to see a female OBGYN good luck getting in any time soon. So I'm guessing that many women and up in this hiked up humiliating birthing position in front of male doctors all day long every day. But I get the feeling it's just understood that's part of having a baby and one has to endure this and go on.

~Renee

 
At Monday, August 07, 2017 4:07:00 AM, Blogger Biker in Vermont said...

Renee, it is a matter of degree rather than absolutes.

Sometimes women are intimately exposed to male physicians, nurses, and techs when they'd have preferred female staff. This is especially so in ER and OR scenarios. For men it isn't sometimes but rather most of the time.

By way of example, over a 12 year period I had about 3 dozen cystocopies and bladder cancer treatments. Except for the cystoscopy I had a couple months ago, all of the RN's and NP's doing the treatments and cystoscopy prep have been female, and these are literally hands on the penis treatments and procedures. How I got a male nurse this year is due to switching from one very large hospital based urology practice that doesn't hire male nursing staff to another very large practice at a different hospital in a different State that has one male RN amongst their many RN's.

It was a female tech that did my testicular ultrasound after a female RN did an exam, and on a different occasion a female that did a lower abdominal ultrasound which also exposed me. It was a female RN that prepped me for a vasectomy and who chose to not so much as cover me with a sheet so as to make me feel less exposed. Instead I sat in the birthing like chair spread eagle in just a polo shirt and socks. All four colonoscopies I have had only had female nurses in the room. When I had my 1st bladder cancer surgery, of the 5 medical students that ambushed me to announce they'd be observing the surgery (performed via the penis) 4 were female.

This is why I say it is a matter of degree. Women sometimes have opposite gender exposure in medical settings but men face a sea of women at every turn.

 
At Monday, August 07, 2017 4:46:00 AM, Blogger Biker in Vermont said...

Dr. Bernstein, I will admit I never thought about it in terms of object vs subject. This is hard to answer. In theory I'd generally prefer to be a subject rather than an object but I'm not sure that as a patient I can know most of the time how it is I am being viewed. If I had to guess I'd say that most of the time I am an object, and I accept that given they are just going from one patient to another all day long and they may or may not ever see me again.

In reverse, I will initially see any medical staff person as an object too, until such point as I have developed a relationship with them. Perhaps that is what triggers the patient becoming a subject, familiarity as a relationship develops.

I suspect that "patient as object" makes it a whole lot easier for female staff to not think about whether her male patient is uncomfortable or embarrassed. I also suspect that "patient as object" also serves as an emotional shield for staff that allows them to keep going amidst what they see everyday.

 
At Monday, August 07, 2017 8:22:00 AM, Anonymous Anonymous said...

@Biker,

More later on topic, but wow... you have been through a lot! I'm sorry to hear that. How could anyone be insensitive to this kind of scenario.

~Renee

 
At Monday, August 07, 2017 11:06:00 AM, Blogger NTT said...

Hello:

As there are very few Florence Nightingale's left in healthcare I agree with you Biker that most female staff will look upon their male patients as "objects".

By doing it in this way they remove the human element from the equation which in turn allows them to act without any conscience or feeling towards their male patients.

So a male patient was left exposed on a gurney in a hallway or on an exam table in a room for all to see. What's the big deal.

So there were three or four female chaperones with the female nurse when she went to catheterize a male patient. So what.

It's this insensitivity towards men that is running rampant through the healthcare system that's causing more and more men to just walk away.

If this is to stop, we must find someone who has clout behind them to speak on behalf of all men and women who want same gender caregivers.

Otherwise, this nightmare will never end.

Regards to all,
NTT

 
At Monday, August 07, 2017 11:51:00 AM, Anonymous Anonymous said...

Hello Dr. Bernstein,

The predicates “object” and “subject” are relational. Is there really a need to identify with which predicate I am being considered or, in which manner I view my care givers? Instead, should our concerns be that we are NOT viewed as a mere “injured” body? As unique, unrepeatable individuals we are a nexus of body, mind, spirit, emotions, soul, experiences, backgrounds, cultures, etc. Is it possible for me to be viewed as a unique individual seeking medical assistance from an equally unique medical individual? Would this obviate the need for the relational bifurcation of “subject” and “object”?

Reginald

 
At Monday, August 07, 2017 1:02:00 PM, Blogger A. Banterings said...

In regards to SUBJECT or OBJECT, I am a human being and expect to be treated with dignity and respect . It is my body(which I must suffer the consequences of the medical encounter) AND I am the customer, I will be the one making all final decisions.

I expect that I be asked (in a polite and courteous manner) and NOT be TOLD to do something OR that something is NEEDED (...I need you to get completely undressed...).


--Banterings

 
At Monday, August 07, 2017 9:27:00 PM, Blogger Maurice Bernstein, M.D. said...

Reginald et al: It is my view and what I teach my medical students is that neither the patient nor the physician or other medical caregiver should be considered an "object". My classical example to teach of an "object" impression of the patient is when the medical resident tells the intern to "draw blood on the gall bladder in room 203" rather than identifying the patient as "Mrs. Jones who is scheduled for surgery in 1 hour." How much more time would it take to express the command in the latter manner? Yet, the difference establishing Mrs. Jones as a human patient with a problem who needs to be treated rather than a anatomic structure.

And patients should look at their healthcare provider in the same manner. They should be looked upon and treated as human beings with lives and personal issues which may be just as occasionally challenging as that of their patient. Neither patient nor physician should be "objectified". Each requires help by the other to solve a medical problem or obtain proper care.

That is why, though I have repeated the need to "speak up", a more proper expression of interaction between parties would be "speak to". Each, the patient and the caregiver, have responsibilities to understand each other.

Finally, all first and second year medical students (as I may have mentioned previously) are instructed to maintain equal eye level, if possible when communicating, to establish a needed sense of equality in all that is being discussed and considered. There should be no "objects" in communication nor in physical examination or treatment. In the sense of what has been discussed here, neither the patient nor the healthcare provider should consider their body parts, whichever, as objects. ..Maurice.



 
At Tuesday, August 08, 2017 4:33:00 AM, Blogger Biker in Vermont said...

Dr. Bernstein, I'm not sure that referring to the patient as Mrs. Jones rather than the gall bladder in 203 really means the patient is a subject rather than an object. It could just be giving the gall bladder a name. Or it could be they really are seeing the person Mrs. Jones as a subject.

I liken it to medical staff all too often thinking being polite is the same as being respectful. They are not the same.

I agree that interactions with medical staff are much nicer when they maintain equal eye level. That goes a long way towards making me feel like a subject rather than an object.

 
At Wednesday, August 09, 2017 9:13:00 AM, Blogger NTT said...

Good Afternoon:

Just a question.

We pay thousands upon thousands of dollars every year to the insurance company's for healthcare premiums.

As paying customers, could we use the insurance company's to help put added pressure on the medical community to force a change in their bad habits?

Just a thought.

Regards,
NTT

 
At Wednesday, August 09, 2017 9:21:00 AM, Blogger A. Banterings said...

Here is an observation; Whenever we talk about improving the patient experience (such as treating them as human beings), providers always have to remind us how rough their working conditions are, they should be treated better, etc.

I have never seen a conversation that providers were having about improving the conditions for them and any of them say "...and let's not forget that we need to improve the conditions/treatment of the patients too..."

Anyone else ever notice this too?

Personally I find it as marginalizing patient issues that they cannot have a discussion solely on their experiences.


--Banterings

 
At Wednesday, August 09, 2017 12:04:00 PM, Anonymous Anonymous said...

Although it may not be directly germane to the current subject/ object thread, the following article may be insightful. http://www.outpatientsurgery.net/outpatient-surgery-news-and-trends/humor-and-jokes/behind-closed-doors-who-are-we-to-judge-our-patients--05-17?utm-source=tod&utm-medium=email&utm-campaign=tips. The article is anecdotal and may improperly impute one individual’s penchant to all health care personnel. What’s interesting is the admission that prejudging of patients occurs. Possibly, this is the crux of our blog musings. Is it possible that what we want (both male and female) is NOT to be judged or pigeon-holed? Are we objecting to being just another illness or procedure? Are we just asking for an accommodation of our individual modesty, dignity or personal idiosyncrasies WITHOUT being judged as aberrant, freakish outlier problems for medical personnel? If this is the case, the question then becomes Can (or will) the mega medical system grant (or be “persuaded” to make) individual accommodations within its very structured protocols?
Reginald

 
At Thursday, August 10, 2017 10:30:00 AM, Anonymous Anonymous said...

Summary:

The following suggestions have been made to promote medical caregiver gender choice by patients in these volumes.

1. Speaking up in two versions. a. courteously. b. causing a scenr

2. Lawsuit

3. Somehow using insurance companies. (NTT's most recent post)

Have I missed somethibg?

REL

 
At Thursday, August 10, 2017 11:31:00 AM, Blogger NTT said...

Good Afternoon:

Seniors might want to inquire if AARP can throw their weight into the game & help out their paying members.

Regards,
NTT

 
At Thursday, August 10, 2017 4:39:00 PM, Anonymous Anonymous said...

To REL --

Another effective approach is to report (or simply threaten to report) a provider to governing/accrediting bodies, such as a state's medical board. I found that more attention began to be paid to my complaint the very minute I mentioned the possibility of contacting my state's board.

RG

 
At Thursday, August 10, 2017 11:41:00 PM, Anonymous Anonymous said...

Female nurses taking cell phone pics of their male patient's genitalia, frequency of occurrence.

How often do you think this occurs? Is this something that's age restricted. Does it happen to elderly male patients? Do you think it happens to young male patients only. On Allnurses there is a subject called " Don't risk your job over social media " This nurse talks about an incident whereby a female nurse takes a cell phone pic of her male patient's genitals so that she could capture his tattoo and " send it to her friends"

There were four other nurses in the group who stood by and said nothing. Only later did one nurse in the group report it to her manager and as a result the nurse who took the cell pic was terminated. I assure you the nurse who reported this incident did so not because of a duty to that patient, rather this most likely was an opportunity to get the nurse fired for other personal reasons. Nurses only get other nurses fired when it gains them something.

Furthermore, the article on Allnurses doesn't come out and say to the audience, hey this is wrong or unprofessional, but rather, don't get caught. Don't let social media get you fired! There are many incidences on the web whereby cell phone pics of elderly male patient's genitals were taken by female cna's at nursing homes and posted to the web or their Facebook account. The fact of the matter is age doesn't matter.

Female nurses don't want male mammo techs, they don't want male nurses in L&D and increasing females entering gyn residencies reflect preferences among the female population. Yet female healthcare employees will commit unprofessional acts toward their male patient population, acts that they themselves don't want committed towards them potentially by the male healthcare workers that female healthcare employees work so hard to discriminate and keep male employees out. Make sense?

PT


 
At Friday, August 11, 2017 12:14:00 AM, Anonymous Anonymous said...

State nursing boards DONT want the general population to know how many nurses were reprimanded for boundary violations. No not good for business, not good for the organization that says year after year after year that nursing is the most trusted profession. Boundary violations entail a number of violations of behavior but typically focus on having a sexual relationship with your patient.

Since 95 percent of all nurses are female the nursing experience for many is well it's just a meat market. After all they can pick and choose, they already have judged you based on the looks of your junk and they go out of their way to see your junk, any chance they get. Now if there were such a thing as male mammographers you certainly may have male mammographers who may think well, she has great breasts I'll choose to try and pursue her for a sexual relationship. Oh but wait a minute, wait a minute! We can't have males doing that to us females.

For that is our job, despite that fact that many of us are soo stupid, we don't realize that having a sexual relationship with your patient is a violation of the nurse practice act. But wait a minute, wait a minute, we are female nurses and we can do anything we want. We can get away with this unprofessional sh$t. We can do this but we have worked for many years to make sure the same doesn't happen to us.

PT

 
At Friday, August 11, 2017 3:39:00 AM, Anonymous Anonymous said...

So we have

1. Speaking up (with courtesy or aggressively)

2. Lawsuit

3. Somehow using insurance companies

4. Using AARP

5. Threatening a report to a government agency

Are there other suggestions?

REL

 
At Friday, August 11, 2017 11:16:00 AM, Blogger mitripopulos said...

Informing the insurance company does help, especially if when talking to them about the reason for the complaint also contest any payment to the offender. I once dealt with a very psychological and emotionally abusive urologist. When I returned home I called the insurance co. and filed a complaint and also contested payment. When the medical facility filed for the insurance reimbursement they received a surprise by the insurance co. They medical facility NEVER PURSUED PAYMENT.

 
At Friday, August 11, 2017 11:40:00 AM, Anonymous Anonymous said...

Hello,
In my previous post asking, Can (or will) the mega medical system grant (or be “persuaded” to make) individual accommodations within its very structured protocols?, my intent was changing the medical paradigm on a global (i.e. industry) basis. I agree with the speaking up, etc. approaches; however, why should each patient have to confront this individually and for every encounter with medical personnel? How can we affect a societal change? How about a National Organization for Men's Health which would address concerns of this nature?
Reginald

 
At Friday, August 11, 2017 3:57:00 PM, Anonymous Anonymous said...

Current Summary:

The following suggestions have been made to promote medical caregiver gender choice by patients in these volumes.

1. Speaking up (courteously or aggressively)

2. Lawsuit

3. Complaining to insurance provider about care provided

4. Using AARP (manner to be determined)

5. Threatening a report to a government agency

6. Forming an advocacy group (e.g., National Organization for Men's Health)

Hope this type of post is not regarded as a nuisance. It is intended to promote a focus on what has been achieved here after so many years and volumes.

REL

 
At Friday, August 11, 2017 11:07:00 PM, Anonymous Anonymous said...

There is much truth Mitripopulos mentions about your healthcare insurer. They will take and investigate complaints by patients regarding quality of care. I want to mention to our readers about Medicare and their rules regarding treating patients with dignity and respect and almost all hospitals fall under rules of Medicare.

The standards are increasing each year and if hospitals do not comply with Medicare rules they forfeit reimbursements up to 15 percent. It is just my opinion that if a hospital has core values that mention dignity and respect and violates those codes I would expect that a formal complaint to Medicare would apply even if you are not on Medicare.

PT

 
At Saturday, August 12, 2017 6:27:00 AM, Anonymous Anonymous said...

I'd join an organization promoting men's concerns regarding health care. I think that idea has some serious potential.

RG

 
At Saturday, August 12, 2017 8:43:00 AM, Anonymous Anonymous said...

RG

I just visited Menshealthnetwork.org, I think we can cross that one off the list.

PT

 
At Saturday, August 12, 2017 1:36:00 PM, Anonymous Anonymous said...

I am a male and I recently had kidney stone surgery and they placed a stent with the string out of my urethra. I was also put on Flomax. The Flomax had a side effect of giving me spontaneous erections and the string in my urethra irritated/stimulated my penis when it moved. On the day my stent was to come out, I was called into the examination room and told that a female LPN was going to do the removal. I had no problem with her being a female. But she asked me to go to the bathroom to empty my bladder which I did. However, while urinating, I got a full blown erection. I tried to get it to subside, but no luck. Upon returning to the exam room she said "OK, drop your pants, hop up on the table and we'll get this thing out of you." Now mind you, my wife accompanied me and was sitting in the corner. I didn't know what else to do, so as I dropped my pants, I mumbled something like, "sorry, but this thing has had a mind of its own lately." and laid back on the table fully erect and fully exposed. I was mortified. It wasn't that I was exposed, it was that I was in a state of unintentional arousal. The nurse grabbed hold of my penis and bent it toward her; it was obvious how hard it was because she had to apply some force to get it pointing toward her. She then said, "OK, you ready? On three; one, two three" and pulled out the stent. I was surprised it really didn't hurt much; I thought being hard it would hurt more than being soft. She then said, "OK, that wasn't so bad, right?" I said, "No, not the removal of the stent part anyway." I stood up, still erect and pulled up my pants as she gave me cautions about bleeding, pain, etc. It didn't seem to phase her a bit, but I was so uncomfortable, I couldn't look her in the eye and I missed half of the aftercare instructions. She never made mention of it at all, but I can imagine there was plenty of lunchtime conversation at my expense. Don't get me wrong, I'm not blaming her in any way, and in one way, I'd rather it happened with a female rather than a male nurse. But I just felt so weird during and afterward. So much so that I was actually shaking when I got into the car with my wife. She actually got a chuckle out of it saying "I bet she didn't expect that!" I still feel a bit weird about the experience and I hope I don't get the same nurse during my follow-up visit. I'm just not sure how to feel about the experience.

C.E.

 
At Saturday, August 12, 2017 2:35:00 PM, Anonymous Anonymous said...

PT --

Hadn't heard of this organization, so I went and looked at their site. You're probably right -- I didn't see any mention anywhere of male modesty or privacy issues. But I joined up anyway and left a post titled "patient modesty," just to see if anybody might be interested in taking it up.

RG

 
At Saturday, August 12, 2017 2:42:00 PM, Blogger Biker in Vermont said...

C.E., there was no way for that to not be embarrassing no matter who did the procedure, male or female. The only alternative would have been to have made them wait for it to subside. The LPN could have moved on to another patient and then come back.

Where I find criticism of the medical facility is that the LPN was trained to ignore it (which she apparently did very well) rather than to acknowledge it and ask you if you'd prefer she came back later. Clearly the training assumes that by ignoring it you'll think it didn't matter to her at all. Maybe some men would prefer it to be ignored but I'd rather it be acknowledged and made my choice as to whether to proceed. That conversation could have been had without you dropping trou.

My guess is that you were the proverbial deer caught in the headlights and acted on automatic following instructions. Don't feel bad. I think we've all been that deer one way or another. I know I have and while I felt bad about it in the immediate aftermath, I then resolved to never let it happen again.

The other thing I find wrong is the procedure. There is no reason to drop your pants and hop on a table. You could have gotten on the table fully dressed and then slid your pants down just enough for her to remove the stent. This casualness when it comes to male patients is one of the things that rankles me. I doubt she'd of told a female patient to drop trou and get on the table.

 
At Saturday, August 12, 2017 2:53:00 PM, Blogger Biker in Vermont said...

PT, ye of little faith. I went to that Menshealthnetwork.org site, poked around, did a search on modesty, found nothing, and so I sent them an email suggesting it as a topic they should cover. They got right back to me asking if I'd like to write an article for them.

 
At Saturday, August 12, 2017 3:31:00 PM, Anonymous Anonymous said...

CE --

If you don't want to see that nurse again, say so. If you don't know her name, get her name and then say you don't want to see her again. You don't even have to give a reason if you don't want to. You have the right to decide who treats you.

RG

 
At Saturday, August 12, 2017 5:39:00 PM, Blogger Maurice Bernstein, M.D. said...

CE, penile erection in your case would not be an unexpected possible reflex reaction. The failure of the LPN would have been to promptly acknowledge that she is aware of the erection and that it represents nothing further than a physiologic reflex reaction demonstrating normal vascular and neurologic functioning and proceed to complete the procedure but with reassurance to the patient (you). By remaining silent about the reaction and what surely must have been your noticeable concern the LPN failed her duty to look at you as a "subject", a living human patient with need for support and this moment and not an "object" with a stent, string and an erect penis.

Her behavior was a sign of being uneducated in the sensitive procedure she was responsible for carrying out. There is nothing I find in her behavior to warrant "lunchtime conversation" particularly if she had been properly educated in the procedure she had performed. ..Maurice.

 
At Saturday, August 12, 2017 6:09:00 PM, Anonymous Anonymous said...

I appreciate everyone's comments. The nurse was very nice, but she was a seasoned person with many years of practice (she was probably mid 40ish). She reminded me in both looks and demeanor of the nurse character Luverne on the 1980's comedy spinoff of the Golden Girls with Richard Mulligan. Matter of fact, all business, get the job done. When I was first called back she made a comment about me probably really looking forward to getting the stent out, and I agreed, as it was very uncomfortable and irritating. So that probably made her feel like she was doing me a favor getting it out ASAP regardless of my state. In hindsight, should have just said, "can we wait a few minutes until I'm ready?" and I could have avoided the whole situation. But as I have seen so many other posters say, they feel like any hesitation or protestation of a procedure or the way it is carried out will be met with ridicule. I felt that way exactly. Especially since she had such a matter of fact, down and dirty approach. I think she just assumed I had no qualms about anything and it was what it was. I think maybe why this upset me so much is that this is the first time I have truly understood the difference in treatment between how men are treated vs. how women are treated. Truth be told, I actually prefer women care providers to men because in my experience they seem to listen much better. Again, I really don't fault the nurse, I think she just subscribed to the old "men are tough and they don't worry about modesty" line. It's an institutional culture that needs to change as you have stated Dr. Bernstein.

 
At Saturday, August 12, 2017 6:12:00 PM, Anonymous Anonymous said...

C.E.

 
At Saturday, August 12, 2017 6:45:00 PM, Blogger Biker in Vermont said...

C.E., other men here have commented on how they were more comfortable with female medical staff and thought they had good relationships with their current provider only to have the female physician, PA, or NP embarrass him by bringing in a female chaperone, or do some other gross violation of a man's dignity.
There is nothing wrong with choosing female providers or just accepting those who are assigned to you such as this nurse, but guys need to be ready to speak up because no matter how nice they are, few women recognize male modesty as an issue. They think just being polite is enough.

 
At Saturday, August 12, 2017 8:41:00 PM, Anonymous Anonymous said...

C.E

You should consider yourself very lucky she didn't assault you by striking your penis with a spoon!

PT

 
At Saturday, August 12, 2017 9:25:00 PM, Anonymous Anonymous said...

Biker in Vermont

You are right, I have little faith, actually I have little trust. Did you take the time to view the staff for that site. The two top administrators are women, the rest are male M.D's

So, if you write an article and you present the subject in the view that it's mens hang ups regarding modesty issues, then you are doing this site a great disservice. Rather it should be presented as double standard, discrimination, unprofessionalism and everything else we have commented on here about the subject.

My other comment is why did they ask YOU to write the article. Are they that stupid on the subject, why can't they write it. After all they are the experts, they ( female administrators) know everything about men's health obviously. You telling me they are clueless about the subject or pretend it doesn't exist.

They claim it's a non profit organization, I wonder. Furthermore, it seems everyone wants to cash in on the prostate cancer awareness since the breast cancer money is pretty much played out. That cash cow has been milked for everything it had. Why all the attention for prostate awareness. You have radiologists who can't even read an MRI properly and make the determination what kind of a lesion it actually is. It's all a joke. Why can't those female administrators just read this blog and get it themselves. I actually have reported agencies to the IRS cause I saw it as a racket.

It irritates me tremendously that no one seems to get it even halfway right on this subject. Read the commentary left on DRLinda. Not even close. I'd like to know exactly and perhaps I will take a much, much closer look at this organization. I'd like to know exactly what they do for men. Maybe I'll write an article, I'd ask them if I can post website photos of female nurses who were arrested, with all the other
pathetic trash committed and how in the world does that industry gets voted year in and year out as the most trusted profession.

You will never get anywhere being nice on this subject. Your concerns will not be taken, you don't seem too concerned about it will be their response. This blog never ever should be called modesty, I've said that years ago. Is it still a modesty issue when staff are unprofessional, taking a cell phone pic of your genitals when you are unconscious and sending it to their friends. Some people take life for granted, some take it as precious. I'll tell you this, when you are vented, in a barbed coma, life at that point is very tenious, you are at the lowest point of your existence. When you don't have your health, you have nothing! When you have nothing the very people who are dedicated to help you hang on to what little existence you have by taking a cell phone pic of your genitals and sending it to their friends

What more needs to be said!

PT



 
At Saturday, August 12, 2017 10:07:00 PM, Anonymous Anonymous said...

As I mentioned previously just how many inappropriate cell phone pics of patients genitals are taken at medical facilities?

I'll ask everyone to visit Propublica.org, here you will see the cases of 65 incidents at nursing homes alone of inappropriate cell phone pics of patients. I have been researching this site for some time. These incidents were found since 2012 but I intend on writing them regarding the number. The actual number is over 300.

This is just the ones who were CAUGHT. This number does not include cell phone pics that were taken in hospitals, doctors offices or outpatient surgery centers.

PT

 
At Sunday, August 13, 2017 3:25:00 AM, Blogger Biker in Vermont said...

PT, yes my article will be polite because I want them to actually publish it and I want people to read it and think. If I give them a rant it'll never see the light of day and nothing will have been accomplished. You have to walk before you can run. Those female administrators may think they know all about men's health but the reality is they know little about men. They aren't capable of writing an article.

When I approached Dr.Linda, she herself had never thought about the issue but was receptive and asked me to write it. She tells me she learned a lot about this topic as a result and that it has been one of the most popular articles ever on her site. What the article accomplished was increasing awareness and giving it a little bit of publicity where there was none.

As bad as the egregious photos of penis type incidents are, there is far more to gain in addressing the everyday kinds of lack of respect and dignity men experience. The female penis photo staff are but a tiny fraction of medical staffing. It is the rare man that will ever experience that. Close to 100% of men will experience female medical staff being casual about their intimate privacy and acting as if it doesn't matter.

There is nobody out there supporting penis photos by female staff as being acceptable. We don't need to convince anyone that's wrong. Conversely, close to 100% of women in the medical world think just being polite to male patients is all that is needed, and the male medical staff and administrators are OK with that because it affords them a convenient staffing model. We do need to convince people this is wrong.

I will note that the Dr. Linda article has been read enough that when you google male medical modesty it is now near the top of the list that appears.


 
At Sunday, August 13, 2017 2:09:00 PM, Blogger NTT said...

Baby steps will lead to the springboard that catapults this issue into mainstream where it can no longer be ignored by anyone.

Regards,
NTT

 
At Sunday, August 13, 2017 4:08:00 PM, Anonymous Anonymous said...

Some random thoughts. First, in the past I have contacted my Senators and Member of Congress asking why males to not get the same representation for health care issues in the government as females? There is no Office for Men’s Health (like there is for Women) and attempts to get one approved have failed in Congress. In the NIH there is no Director for Men’s Health Research (like there is for Women). So starting with our government there is a general consensus still that men or males have sufficient health care representation. (No comment on how well the male members of Congress advocate for men’s health. See below as one example).

The NIH funds plenty of health research. You can see the category specific funding for many of the past years and estimated FY18 funding at

https://report.nih.gov/categorical_spending.aspx

Many research dollars benefit both sexes, but of the research directed at a particular sex, you’ll see that women get about 95% of that funding (the “Women’s Health” line item is huge, there is no “Men’s Health” line item). Indeed, breast cancer ALONE is funded more than twice as high as prostate cancer. The former has ~25% higher mortality, but a lower incidence than prostate cancer.. So again it seems the government places most value on women’s health care, despite the fact that the female life span in the US already is significantly longer than the male life span. One would think in an equitable society funds would be dispersed to achieve equity in life spans or equity in an other reasonable sex metric…

Finally with respect to treating the bodily privacy of males versus females. I always bring up in any discussion about this a request to show me the peer reviewed studies that show 100% of males have no modesty and are comfortable having their bodily privacy violated in medical settings. Medicine is now supposed to be evidence based. So where is the evidence that supports our current health care system design where women get all-women clinics for their intimate exams and men do not get any similar accommodation, if they want it? There must be compelling documented evidence that NO males or very few males feel they need bodily privacy in medicine for the system to be designed this way. What few studies I've seen seem to suggest just the opposite. Any article should mention the evidence supporting our medical system and its practice(s).

Medical professionals pleading ignorant or feigning ignorance about male bodily privacy rights are at best being disingenuous. Everything in medicine currently is evidence based. Something as fundamental as designing clinics and exam rooms and staffing models to only accommodate women is an intentional disregard for evidence based medicine and is tantamount to male discrimination. Show the data or stop the discrimination. -AB

 
At Sunday, August 13, 2017 8:47:00 PM, Anonymous Anonymous said...

Biker said " There is nobody out there supporting penis photos by female staff as being acceptable."

That's makes no sense, for if that were true it wouldn't happen. Did you ask the female nurse in New York who was recently arrested and what about the data I posted yesterday on Propublica.org which by the way is actually 293. Apparently they supported the act since they committed it. You can minimize bad behavior all you want, these are not just acts of bad behavior but felonies.

For every unprofessional cell phone pic committed by a healthcare worker that is caught, there are a 1000 who get away with it. When staff are terminated for cell phone pic violations very few are reported to the board. In fact very very few are even arrested.

I'm not at all surprised by Dr Linda's comments, they all plead the 5th. Ask her if she has ever had a mammogram and what are her thoughts regarding who performs it. Would she be ok if a male performed it and another male chaperoned the procedure. Now does that make her a hypocrite if she objects.

I know of many people during my healthcare career who were terminated for cell phone pic violations, Doctors, pa's , nurses, respiratory techs etc. Were they arrested, no. Were they reported to the board, no. Were they reported to an agency for statistical reasons, no.

PT

 
At Monday, August 14, 2017 4:14:00 AM, Blogger Biker in Vermont said...

PT, I am not trying to sweep the genitalia photos matter under the rug but rather just say that it is a very small subset of the general lack of respect for male privacy in the medical system. There will be consequences for the person who take genitalia photos of patients and gets caught. There are no consequences for routine privacy violations of male patients nor is there even acknowledgement that it is wrong. There are something like 7 or 8 million nurses, doctors, med techs etc. in the US. How many of them are you suggesting take cell phone pictures of patient genitalia or condone it being done by others? Compare than number to how many treat males as 2nd class patients as concerns their intimate privacy.

There are 125 million or so teenage and adult males in the US. Not everyone receives healthcare each year and not all encounters involve intimate exposure, but it is safe to say that multiple tens of millions of teenage and adult males are treated as 2nd class patients each year when it comes to their intimate exposure. For millions with chronic conditions those privacy violations occur multiple times per year.

Medical staff, male and female, know that women generally have modesty concerns and they act accordingly. I would not expect Dr. Linda to wonder why only female staff do mammograms. The answer is obvious, most women are modest and the medical world knows it.

When it comes to male patients however, modesty is not commonly recognized. It doesn't occur to most female staff that men care about their exposure and to the extent few men will ever acknowledge it let alone speak up, that stereotype continues to be accepted as valid. I'll re-use an example here that I noted a while back. It never occurred to a young woman I work with that there was anything wrong when her then 20 something cancer patient husband was told by a young female nurse or med tech to drop his drawers so that she could get access to his hip. My, friend and several young female students were there and watched the whole thing. It was only afterwards when her husband told her it was embarrassing that she realized maybe he wasn't treated well. He didn't complain to the staff afterwards and so as far as they're concerned the whole thing was just routine and acceptable. This is how people like Dr. Linda can come to never have thought about the matter. It is why awareness articles can be very valuable in getting people to think about it.

As an aside I have started another conversation with Dr. Linda about student observers. Maybe that'll lead to another guest article.

 
At Monday, August 14, 2017 10:42:00 AM, Anonymous María said...

I just can't believe that "shadowing" in not only
accepted by the medical profession, but an unwritten
requirement to get into medical school. Since when do
patient have to compromise their privacy by letting
know nothing prospective medical students into the
room??? And what if they decide not to pursue a ca-
reer in medicine anyway? Then patients have surren-
dered their privacy for nothing. Not to mention that
those people are not bound by HIPPA, any confidentia-
lity rules and may not be able to legally sign any
contracts at all!!! This abomination must end.
My faith in humanity wanes by the day. Many people
say that there's been some progress. Yet such things
as EMRs, cameras in the OR, chaperones (they have been
around for quite some time), cell pics of patients,
scribes, shadowing of doctors, not to mention the
root of all evils: the gender neutral culture are
being increasingly pushed on us without even asking.
Looks like we're faring worse by the year.

 
At Monday, August 14, 2017 11:23:00 AM, Blogger NTT said...

Good Afternoon:

Welcome Maria. You are correct. The healthcare industry is out of control. Their lobby dumps millions of dollars into pockets in Washington so they can have things their way.

If we the people want change then it's time for new blood in our nation's capital. If our elected representatives don't want to listen to us then it's time to vote them out of office.

Regards,
NTT

 
At Monday, August 14, 2017 12:33:00 PM, Anonymous Anonymous said...

Thanks to recent posters who are "hitting it out of the park". Keep up the "good work".
BJTNT

 
At Monday, August 14, 2017 3:10:00 PM, Blogger Maurice Bernstein, M.D. said...

For those who are interested, I had created a thread back in 2011, last comment 2013, that specifically discusses unidentified photographs of live patient body parts displayed by a poster on the internet. PT has posted there and there is also an AB but most not likely the AB who is currently posting here.

I think that the discussion on this Patient Modesty thread should now be directed to patient gender equality in the specific patient's access to the gender of their healthcare provider or any others in the patient's presence.

The important issue of posting unidentified body parts can be more specifically discussed on the thread "Should a Non-Identifiable Picture of a Patient's Body or Tissue be Posted on Social Media without Patient Permission" http://bioethicsdiscussion.blogspot.com/2011/02/should-non-identifiable-picture-of.html

I most appreciate the acceleration in the volume of postings here with an attempt to figure out how to change medical practice and culture by the very patients the system is present to serve. ..Maurice.

 
At Monday, August 14, 2017 4:01:00 PM, Anonymous Anonymous said...

Maria,

You may not know this but a patient does NOT have to consent to the presence of shadow students, observers, etc. You can decline the presence of a chaperone (in this instance the physician may decide s/he cannot perform the exam/procedure without the chaperone for fear of med/legal issues). As a patient you made an appointment with a specific provider and you implicitly (in an office setting) or explicitly (in a hospital) consented for care/treatment by the selected provider (physician, NP, etc., whoever you booked with). But that doesn’t mean you explicitly consented for others to be present, especially for intimate exams.

Even in teaching institutions you have a right to decline to allow students to examine you. Fortunately many patients do see value in having enrolled students learn how to examine them, but you can decline. Your care is NOT contingent on allowing observers to be present.

Dr. B:

As for photos taken of a patient, they must be relevant to the care/treatment/healthcare operations AND they become part of the designated record set (i.e., the patient’s medical record). Photos of patients taken by cell phones almost NEVER meet these criteria and thus become illegal. Photos that are part of the designated record set may be anonymized put cannot be published publicly (e.g., on social media) without explicit patient written consent. Healthcare workers cannot unilaterally decide it is okay to take, share and publish photos of patient body parts if the patient photos are “anonymous” - it isn’t okay, it is illegal unless all of the proper steps, including consent have been fulfilled.

Every organization has some bad apples (usually a very small percentage). The best defense against inappropriate photography is the culture of the medical center. It has to start at the very top with a clear understanding there is a zero tolerance policy. This message has to be conveyed to all of the healthcare workers, including physicians, nurses, CNAs, etc. It won’t stop inappropriate photography completely, but it will prevent some instances (when coworkers speak up) and it will lead to reporting of the offenders. If the organization is serious it will lead to termination of the offender, reporting to their board & hopefully loss of license or certification for the perpetrator. And if they are sued by the wronged patient the accused healthcare worker must pay for their own defense, the organization doesn’t have to provide their legal defense because the healthcare worker violated law. —AB

 
At Monday, August 14, 2017 4:30:00 PM, Blogger Dany said...

Hello Maria and welcome to this blog! I'm glad to see another woman here sharing our modesty concerns.

Much like NTT mentioned, it would seems the health care system is getting out of hands. I only count my blessings that, being from Canada, the whole chaperone nonsense hasn't made has much ingress here as it is in the USA.

(I can't imagine what it would be like to deal with a doctor, a chaperone AND a scribe all at once for a routine physical. "Gulp" is the only thing that comes to my mind.)

Biker, I'm looking forward to any new articles you plan on submitting. I was impressed with the article you wrote on DrLaura's blog. You might just have found the ideal venue to raise awareness at large.

On to the gender preferences... What happens when you're told straight up at a facility that they do not accommodate for gender care? Would that be ground for a formal complain? Should you first ask to talk to the DON (Director of Nursing - kind of like the foreman of all nurses in the facility, which is not the same as the charge nurse but perhaps an adequate first step)? The facility administrators? Or make a complain via the Human Resource department?

Dany

 
At Monday, August 14, 2017 5:46:00 PM, Blogger NTT said...

Good evening

Another defense against inappropriate photography is to take the cellphone cameras out of the hands and pockets of healthcare employees during working hours.

There should be a federal law against it & the first time you're caught you're terminated no questions asked & if you took inappropriate pics the authorities are notified & you face any legal consequences.

Courts are catching on that women are predators also. Look at all the recent female teacher cases in the news. They're starting to put them in prison where they belong.

Put a few more nurses in prison & the industry will take notice that they are on notice.

Our healthcare system is not proactive in these areas. They wait until they've been caught to react.

Regards to all,
NTT

 
At Wednesday, August 16, 2017 5:37:00 PM, Anonymous María said...

Wow, I wouldn't like to seek healtcare
in Canada. I've heard -correct me if I
am wrong- you can't choose the doctor
or nurse, let alone the gender...
Btw, I've posted several times and it
seems it didn't get through. I've must
have dome something wrong.

 
At Thursday, August 17, 2017 2:58:00 AM, Anonymous Anonymous said...

Hi All -- I promise not to post another one of these summaries. It seems to me that disrespectful actions by healthcare providers ranging from inappropriate use of cell phone cameras to ambushes to scribes/chaperones are all subsets of the same problem and may be opposed by the same strategy.

Updated Strategy List:

1. Speaking up (courteously or aggressively)

2. Lawsuit

3. Complaining to insurance provider about care provided

4. Using AARP (manner to be determined)

5. Threatening a report to a government agency

6. Forming an advocacy group (e.g., National Organization for Men's Health)

7. Online reviews of medical facilities vis a' vis patient modesty concerns.

(Have I missed something?)

I believe the civil rights movement accomplishments followed aggressive (often illegal) behavior and lawsuits. So 1. and 2. might seem to be proven techniques for change. However, that all occurred before the internet. Possibly a combination of 6. and 7. might work as well today.

REL

 
At Thursday, August 17, 2017 8:52:00 AM, Anonymous Anonymous said...

REL,

I would argue to strengthen your #5 “Threatening a report to a government agency”. It really should be “threaten and file complaints with the medical facility, and with applicable oversight regulatory bodies (e.g., Licensing, CMS, Joint Commission, etc.)

“Threatening” is fine in the moment but unless complaints are filed by patients it becomes a pseudo self justifying excuse by the organization - “We have never received any comments or complaints on this”.

Complaints, especially to regulatory bodies end up costing the medical facility time and money to defend. It forces them to review their processes, think about what is and isn’t appropriate and what is defensible or not. It can lead to changes. Never filing a complaint with the Administration means the threat at the local level gets swept under the rug and likely nothing changes.

The Joint Commission has the same view. Unless they see multiple complaints on a topic, it doesn’t get on their radar. File a complaint with them if they accredit the facility you are a patient at.

State licensing agencies vary around the country, some have patient rights regs, some do not. Depending the particular experience you may be able to trigger a licensing survey of the medical facility by carefully documenting your experience and relating it to patient rights, safety, discrimination, etc.

States usually have a particular gov’t agency that handles cases of discrimination. Most states require public facilities (e.g., Hospitals/Medical Centers) to not discriminate services and accommodations because of gender. It is worth filing such a complaint if you are aware one gender is receiving care and services that was not available to you.

States Attorney Generals often investigate allegations of discrimination in medical facilities. Usually these are cases brought by disabled or deaf patients but there is no prohibition on submitting factual complaints about other types of discrimination. (There is no down side to you the complainant, at worst you get a letter back the complaint was “unsubstantiated”)

CMS oversees the Joint Commission contract for surveys. Complaints to CMS means first they must investigate the complaint and secondly the Joint Commission is not doing an adequate survey job. These complaints help.

From my lengthy experience at a very large medical center written complaints (“Grievances) can be effective. Don’t just threaten - DO complain. —AB

 
At Thursday, August 17, 2017 10:42:00 AM, Blogger Maurice Bernstein, M.D. said...

I am so pleased reading all the constructive comments, including AB, a contributor with a pertinent professional background.

We are really moving along with Comments to Volume 80 since beginning July 3. With current 158 Comments, with this one, after another 15 or 20 more, we will have to move on to Volume 81 if we don't want Blogger.com to prevent accepting more to publish in this Volume, as it has done in the past..
This is not a complaint regarding the posting activity only a concern which has happened in the past with "excessive" postings. So keep up your constructive comments! ..Maurice.

 
At Thursday, August 17, 2017 5:26:00 PM, Anonymous Anonymous said...

AB -- Great info. In fact, one of my concerns sbout courteous speaking up has been that a single, quiet accommodation will occur, along with some snickering behind the patient's back, but nothing else will change. An actual complaint will tax bad behavior and encourage change. REL

 
At Friday, August 18, 2017 9:53:00 AM, Anonymous Anonymous said...

It is my estimation that there are about 300,000 inappropriate cell phone pics taken every year at medical facilities across the U.S and yes it is a real problem.

REL, I would like you to continue to post your online summaries, I'm going to do some research and make some suggestions for you to add. Thank you

PT

 
At Friday, August 18, 2017 11:07:00 AM, Blogger Maurice Bernstein, M.D. said...

PT, "300,000" is a huge number. Can you tell us how this number was "estimated" so we can understand its potential validity?
Is the number extrapolated from some actual data? Interesting. ..Maurice.

 
At Friday, August 18, 2017 1:58:00 PM, Anonymous Anonymous said...

Hello,

The following site might be useful for filing CMS (Medicare/ Medicaid) HIPAA complaints https://htct.hhs.gov/asett/public/home.act .

Reginald

 
At Friday, August 18, 2017 8:28:00 PM, Anonymous Anonymous said...

PT -- Please do let us know new suggestions. I suspect the group will let me fudge on my promise enough to incoporate your ideas and AB's remarks about actually filing complaints to generate one more summary. REL

 
At Friday, August 18, 2017 11:28:00 PM, Anonymous Anonymous said...

Maurice

Currently in the United States there are 5,564 hospitals, 5,310 outpatient surgery centers, 16,056 nursing homes and close to 155,000 physician offices. Additionally, there are about 10,000 urgent care centers as well. For a moment lets exclude physician offices and urgent care centers. Thus the number of facilities are 26,930 and that's excluding as I said physician's offices and urgent care centers. Do you think 300,000 inappropriate cell phone pics is a hugh number. Let's just for the sake of my argument assume there has never been any inappropriate cell phone pics ever at any of the 155,000 physicians offices nor the 10,000 urgent care centers. Now we know there has been but for the sake of my point exclude those. From published data nursing homes are notorious for inappropriate cell phone pics and appreciate the fact that only a very small number from any of the above mentioned facilities are ever caught. Personally, I know of 8 inappropriate cell phone pics occurring at one hospital alone in 1 year. For the 16,000 nursing homes and based on the reporting data from Propublica.org that number alone exceeds 300,000 and that's not even considering ANY of the other mentioned facilities. Every hospital has this kind of problem, bad bad for business if it's reported. Consider the 5th year resident at one of the most prestigious hospitals where this happened, he took a cell phone pic of a tattoo of a patient's penis during surgery. The hospital wanted to find out who reported to the news and terminate them as well, no facility is immune from it. Yes, 300,000 a year is probably on the very low end. Do you think hospitals know or care that nurses have their cell phones out and playing on them during surgery cases, Think again, I see it all the time.

PT









 
At Saturday, August 19, 2017 7:37:00 AM, Anonymous Anonymous said...

AB -- Your argument in favor of formal complaints makes sense, and in fact I heard much the same from the state board I contacted regarding my own incident. Establishing a record outside the provider's own practice, exposing patterns of bad practice, are valid benefits.

On the other hand, doesn't a complainant risk being branded a troublemaker or "difficult patient" by virtue of making so much trouble for a provider? I live in a small town, where there are only a couple of options for health care, and was worried about the potential of being refused care.

RG

 
At Saturday, August 19, 2017 3:12:00 PM, Anonymous Anonymous said...

RG,

Over my career there were many patients who complained to the licensing agency, State Attorney General, Joint Commission, etc. & who continued to come to our medical center for their care. We had patients who sued us and still came to us for their medical care (and there were plenty of choices in the city)!

No, medical centers do not withhold care because you filed a complaint. There are too many regulatory and legal restrictions for that to happen. Yes, patients sometimes are discharged from clinic practices but only if they are particularly egregious in actions or refuse to comply with all medically reasonable recommended care/treatment. For example, a patient that threatens physical violence against the medical staff/providers and acts totally inappropriate to staff may be discharged from a clinic (EDs can’t really do that because of the EMTALA law, and if the patient is admitted to the Hospital they can’t be discharged until it is a medically appropriate discharge or a medically appropriate transfer is arranged.) Patients that are totally noncompliant and simply seeking drugs, for example, may end up being discharged from a clinic (with referrals to facilities where they can get further care and treatment). But in general patients cannot be refused service or given a lessor service because they previously complained about the quality/safety/appropriateness of the service they received. I would recommend any complaint be factual, not rambling but coherent and express clearly the issues identified and why your safety or patient rights or medical care, etc. was unsatisfactory and/or in violation of their policies or state or federal regs, etc. It is human nature for those that review the complaints to perhaps discount tin foil hat sounding letters (ones that include all sorts of conspiracies, etc.) and conversely a factual well reasoned written complaint is very hard to dismiss as simply a misunderstanding.

One tip, not only file a written grievance with a relevant oversight regulatory agency but file a written grievance with the Administration of the medical center at issue. If the hospital/medical center were to get investigated the surveyors in some manner ask the medical center if they are aware of the general complaint and what they have done to address it, if anything. If they have done nothing (and it is an issue) it really undercuts their standing in the eyes of the surveyors. Plus, once you have a well written complaint, might as well submit to multiple places - doesn’t really cost much extra.

Finally, surveys you may get from hospitals/medical centers after a patient encounter are anonymous (your identity won’t be know to the hospital/medical center unless you willingly identify yourself). Patients should always complete those surveys and provide written feedback about unsatisfactory experiences and score the facility appropriately. $ rides on good scores, so the facility does review the written comments from the surveys to attempt to improve their scores. —AB

 
At Saturday, August 19, 2017 3:49:00 PM, Blogger Maurice Bernstein, M.D. said...

AB, I know that I "speak" for virtually all of my visitors (and contributors) to the narrative of this blog thread thanking you for participating here and providing us with an experienced view of the medical system "from the top" that, perhaps, none of us (including also myself) are fully aware or even have misconceptions.

Yes, complaints and suggestions of reactions as written here over the years have contributed to the theme of this thread but what we have virtually devoid of here are physicians or nurses or those with administrative duties within medical facilities. It is this latter area within the medical system in which we are not all clearly aware but AB with your contributions I feel we are all becoming more educated. Again, thank you and hopefully you will stick around here a bit longer. ..Maurice.

 
At Sunday, August 20, 2017 7:48:00 AM, Anonymous Anonymous said...

AB -- Thank you very much for your response. I'll echo Dr. B's appreciation for your contributions -- we really do need to hear from more medical professionals. It's good of you to share your time and expertise with us.

 
At Monday, August 21, 2017 11:20:00 AM, Anonymous Anonymous said...

Hello,

Below are e-mails sent to and received from CMS (Center for Medicare & Medicaid Services).


Sent: Friday, August 18, 2017 5:24 PM
To: CMS OMH
Subject: Office of Men's Health

Hello,

I was perusing the CMS website and could not locate an Office of Men’s Health. Can you direct me.

Thank you.

From: CMS OMH
Sent: Monday, August 21, 2017 6:03 AM
To:
Cc: CMS OMH; Young, Brian M. (CMS/OMH)
Subject: RE: Office of Men's Health

Good morning,

Unfortunately CMS does not have an Office of Men’s Health, but I will provide some resources for you.

http://www.menshealthnetwork.org/

https://medlineplus.gov/menshealth.html

https://foh.psc.gov/calendar/menshealth.html



Sent: Monday, August 21, 2017 10:38 AM
To: CMS OMH
Subject: Office of Men's Health

Hello,

I’d like to suggest that CMS consider initiating an Office of Men’s Health. This would seem to be an important service to men served by CMS.
Equity would seem to indicate that there is no justification for a Women’s Health section without a Men’s Health section.

CMS OMH
11:12 AM
RE: Office of Men's Health

Thank you. I will pass your email on to management.

End of e-mails to CMS.

Should we be shocked that CMS doesn't have an Office of Men's Health. Please check for a Men's Health section at Mayo Clinic. You'll certainly find the Office of Women's Health. Shouldn't such a large and respected medical center have a Men's Health Office? Yes. "Men's Health" is usually addressed in Urology but, isn't that rather self-limiting? Maybe health care personnel need to be educated that men's health care is more than just urology. Others here may wish to contact CMS, Mayo, etc. regarding their lack of concern for men's comprehensive health, including same-gender care.

Reginald

 

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