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Patient Modesty: Volume 81
To make the necessary changes in the medical system's duty to provide gender equality to the personal and intimate concerns of all patients, perhaps what is needed is that both genders stand together to achieve that goal. ..Maurice.
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AS OF OCTOBER 20 2017, PATIENT MODESTY VOLUME 81 IS CLOSED TO FURTHER COMMENTS. COMMENTS NOW SHOULD BE WRITTEN TO
VOLUME 82.
180 Comments:
I strongly feel that for all patients to be provided by the medical system the gender of their caregiver, it is essential that both genders work together to get this goal accomplished. Do my visitors think that the female gender has achieved the goal and have no interest in the concerns of some of the male patient population? ..Maurice.
But men weren't for the women's movement? Seriously. Maybe from a politics stand point you might achieve a unified liberL effort to make a change like this in the healthcare system, but in doing so you will change it to a healthcare that is not based on merit but equality. So what I'm saying is that I don't hear women or other men complaining of these things in general. The younger generation is going to care less until it effects them and the older generations will have to have a passion an unified force for a change like this. There are all female clinics because they were in demand. Is there a law that requires them? If there is I'm not aware of it. I say that's an achievement but I didn't battle for it or demand it. Probably feminist Women did. But they don't even have to have been feminists. This is an intimate issue and I think woman are better equipped to be intimate with one another than men are to be intimate with one another.
Renee
Dr. Bernstein, generally speaking I don't think the majority of women care that men face a sea of women at every turn when it comes to intimate care. To change it might erode some of the advantages women have currently, and that is antithetical to feminism in its current form.
Women are suspect of any man that wants to be an L&D nurse but don't see anything odd about women that want to be urology nurses. This should speak volumes. They really do think men have no modesty and that men should not have any expectation of privacy in this regard. They don't see that there is a problem to solve.
My daughter-in-law's niece is in nursing school as is her nephew's girlfriend. Both aspire to work in pediatrics. It really begs the question as to what drives female CNA's, Medical Assts, RN's, NP's, and PA's to specialize in male urology. If lots of women weren't looking to work in urology, the industry would be seeking out men for those roles, but they can fill 100% of the need with women. Women are not going to want to change a system that would deny them apparently coveted careers.
At the end of the day however, Renee is right. Women band together and demand changes that they want. Men are more solitary creatures, and in this case the cultural expectation of no modesty, suffer silently etc is deeply ingrained from a young age. Not having their privacy respected is also deeply ingrained from a young age.
I was at a cookout this afternoon. I have known most of the guys that were there for 30 - 40 years socially and in work and civic settings. I've been naked in locker rooms with some of them. They've all been patients and so a discussion on this topic wouldn't be theoretical, yet it would be incredibly difficult to get a discussion going given the risk of ridicule of whoever starts the conversation. Even worse is the risk that one or more of the women would chime in embarrassing the guy that spoke up. Societal norms are hard to breech.
Renee
Female patients never ever banded together as you say to ensure that they were provided privacy in many intimate settings such as mammo, L&D, women's health centers etc. Team Vagina is responsible for that! Who is Team Vagina you ask? Team Vagina encompasses all the female nursing directors of all L&D suites, female directors of medical imaging, countless nursing directors of hospitals, outpatient surgery directors. It's been discrimination from the gitgo for the last 5 decades. With their phoney propaganda core measures which no one even knows what it represents or where it's posted. Pathetic!
In the 1950's when mammography first entered as a viable imaging modality and hospitals first purchased mammography equipment are you suggesting women marched with big signs to hospitals proclaiming on female mammographers must be hired. Were hospitals torched, businesses burned and rioting. Really!!! Of course not. Most radiographers were women as were the directors and thus only female techs were trained to perform mammography. It's the same to this day, not one male mammographer works, it is the only occupation in the United States that employs only females.
Now, Team Vagina has worked very very hard to push out all male orderlies in the past and replace them with something called a cna and medical assistants. Have you looked at the cna forums where male cna's and medical assistants don't get hired anywhere. Common sense might suggest that some of these people might get hired at urology clinic. Visit any urology clinic on the prostate side and look at the gender of the staff, exclusively female medical assistants. These people are soo highly trained, they can't even perform a correct blood pressure.
What is the point of having your blood pressure performed at you physician's office if they don't perform it correctly. That's about as Stupid as calling your physician's office to make an appointment when hearing that Stupid recording that says" if you are having a medical emergency, hang up and call 911". No, really. Now you expect the patients to be as dumb as the medical assistants they hire!
PT
Am I correct in what I have been reading above that there is no logical nor experiential rationale for the consideration, leading off this Volume, regarding both genders working together to promote changes in the medical system with regard to the discordance (if that is the right word) between how each gender is treated? Is my hope at the top of this Volume truly hopeless? Does each gender have to pull in opposite directions when a "common good" (patient gender selection) in the medical system is being attempted to be established? Or is it because, what has been discussed here all these years is some anomaly in terms of the real interest of most all patients, their concern being only one thing: "get well"? ..Maurice.
Maurice
Do you like ice cream? Do you ever take your family to an ice cream parlor on a hot summer day? You expect to get good ice cream since you are paying for it am I right. You wouldn't expect to get diet ice cream as that is crappy ice cream, bulimics love that kind. What if every ice cream parlor you went to discriminated against you because you are Jewish. Now discrimination is discrimination wether you are male, female, white, black, Eskimo or whatever. Ice cream is not free, it costs money and you are paying for it. But would you like the ice cream each and every time despite the discrimination you received.
In regards to your response, how do you define " get well" Getting well involves many components, mind, body and the notion that you were advocated for and that you were treated the same as everyone else, that you were not looked upon differently, treated differently or given any special differential treatment because of your race, ethnicity or gender. Why should the gender of those rendering medical care be be altered based on the notion that one half of the human population are all considered perverts by the other gender thus altering almost the entire medical industry makeup? Are all male patients automatically discriminated against based on perceptions that half the human race can't be trusted?
PT
What I'm saying Dr. Bernstein is that both women and men recognize female modesty, women don't recognize male modesty, and modest men are too embarrassed to say they are modest for fear of ridicule.
Throw in women controlling the majority of healthcare hiring and we have the system we do. It makes sense from their perspective given the open recognition of female modesty and their underlying assumption that men aren't modest.
There are degrees of modesty of course ranging from men whose modesty limits the extent to which they will go to the doctor to men who have no modesty. I posit that most men are somewhere in-between the two extremes. These are men that are somewhere between uncomfortable and embarrassed but endure it in silence because that is what society expects.
The missing element is society acknowledging that most men have some degree of modesty. If that could be acknowledged I suspect women would be receptive to making change in support of their fathers, brothers, sons, husbands, boyfriends etc. The question then is how do we get that acknowledgement.
The Men's Health Network now has it's first ever (as best I have been able to determine) guest article about male modesty. http://www.talkingaboutmenshealth.com/ The allowable word count was very limited and so what got said is limited but hopefully the message can be reinforced with some comments. You have to be logged in to comment, and as yet I have not found where I can register so as to comment. If someone figures that out, I'd appreciate hearing it. I would add that the search feature they have does not seem very robust either.
Even if articles can't say everything that you would like to say or can't say it forcefully enough, the more articles that get out there the more awareness and acceptance there will be. Each small addition helps.
When commenters on this blog use the word modesty it presents the issues as benign, it's far from that. Read any nursing text, all patients are to be treated the same wether male or female regarding any procedure that involves intimate care, draping and privacy are expected. But that's not the outcome. Female patients are given more privacy, proper draping etc. An example of this are the manner in which trauma level 1 male patients are treated vs female level 1 trauma patients. Female trauma patients are covered up quickly vs male trauma patients theft exposed long after the trauma has been called.
I don't write the rules, state boards of nursing wrote the rules and the rule says any nurse that does not use appropriate draping, leaving the patient unnecessarily exposed is guilty of sexual misconduct and is considered to be unprofessional and can be subject to license revocation. Yet the contention is that female staff assume men have no modesty and thus are treated unprofessionally. This is the contention, that the thought process is that female nurses step out of bounds in their nursing care and treat all men the same because all men do not care about their privacy.
If this is the case and I believe it is the case because it's true and I've be seeing this for decades then any female nurse who cares for male patients is unprofessional and guilty of sexual misconduct. I rest my case.
PT
Biker -- your article is first-rate. Captures every major issue clearly and concisely and reasonably. Thank you!
RG
Good Afternoon:
Congratulations Biker on another well written article. I’ve been going back & forth with the website owner as to how to login to make comments. If I get something that works, I’ll pass it along here.
Gender equality to the personal and intimate concerns of all patients will not happen unless and until men drop the preconceived notion that you have to have female nurses for caregivers in all aspects of medical care.
We cannot move forward until men start thinking the correct way and that way is WE HAVE A CHOICE.
Dr. Bernstein you said it was essential that both genders work together to get this goal accomplished. Yes there has to be cooperation from both sides but I see two major road blocks to getting on the road that will balance the scales.
First one in men themselves. Too many men won’t speak up for themselves and tell the healthcare industry enough is enough give us a choice. They’ve been brow beaten for so long by the system, they’re brainwashed on the idea they will be completely exposed and humiliated and that’s the way it is. The other group of guys are the ones that haven’t had to use the system yet. They naively believe the healthcare system is going to protect their privacy and respect their dignity. Then they go in for an exam or test & come out of the encounter shell shocked when they see what we were saying is how it is.
The other road block is that most facilities have women in positions to do the hiring As long as that’s the case, an equally qualified male will rarely get hired. The only real ways to stop this illegal practice is with a court challenge or legislation out of Washington. I’ve written many a letter to Washington about our plight only to be completely ignored to this point.
As far as all patients are to be treated the same whether male or female regarding any procedure that involves intimate care, draping and privacy are expected. You’re right PT it’s not the outcome. The reason the outcome is the way it is, is because the female nurses know they can get away with exposing their male patients because they know men are not going to speak up about it & stop it. Put up, shut up, and just get it over with is the current way most men think about medical interactions.
We are our own worst enemies.
As far as getting help breaking out of this quagmire men are in, I see little to no help coming from the medical community. They like things just the way they are thank you.
The immediate family can be there for moral support but that’s about it.
I agree with Biker in that I really don’t think women care one way or another if males are exposed intimately in front of female nurses and techs as long as their privacy and dignity are protected and respected.
If guys want change, it’s up to us to get off those couches & spread the word as to what’s happening and demand the system change.
Women are up at arms right now about possible changes to their healthcare under the proposed new healthcare legislation coming out of Washington. They’re banding together & standing up for themselves.
Take notice guys. This is what WE should be doing also.
Until we can prove to the powers that be in Washington and the medical community that we want equality, they have no reason to take us serious.
Get busy guys.
Regards,
NTT
Responding to Biker from last week on the previous volume (sorry, I was offline for a bit). First, you mentioned all your cystoscopies where handled by an NP. Not sure what that completely meant. In most urology practices now the patient is prepped by the MA. And, (if the state allows this, most do, some do not) the MA injects the anesthetic into the urethra. Then the physician or NP comes in a few minutes later and does the exam, with the MA present assisting. Sometimes if one is particularly “fortunate/unfortunate” there may be two additional women present in addition to the MD/NP depending on how the practice is organized. For women I’ll bet the MA’s drape/cover the women will she waits for the anesthetic agent to take effect in the urethra. For men that doesn’t seem to be the case and its especially annoying since the room door is opened and closed multiple times.
Many of the other in-office Urology tests, like urodynamics, bladder volume scans, etc. are done by the minimally trained/qualified MA too. Nurses and above must be used when medical discussions, test interpretations, diagnoses, etc. are needed because MA’s are not licensed medical providers. So practices reserve them for such activities (not cost effective for the grunt work anymore & they are needed to generate income not prep penises).
I also read your article - great job Biker. I applaud you for pursuing opportunities to publish articles that force some thinking about the double standard/discrimination pervasive in medicine. - AB
NTT, I would note that The Men's Health Network which appears to be well connected and well funded has not done anything in this regard. They encourage men to go to the doctor and they advocate for funding for things like prostate and testicular cancer, but my small article is apparently the very first mention of this issue in their history.
It has not even been on their radar, or if it has, they've not been willing to take a stand bucking the female-centric status quo, or perhaps the women who hold key roles in the organization. This is why I hoped that there would be some good dialog in comments. Very few of their articles get any comments. Maybe they're not really interested in having a dialog with men. Or maybe the key men there haven't had the full intimate care experience and are clueless.
Thanks AB. I appreciate learning about the use of MA's in urology. It is not good news. If I am going to be exposed to a woman I at least want it to be someone who has a license at risk if she misbehaves.
Prior to this year all of my bladder related matters were at one large practice at one of the major hospitals in Boston. An NP did all of my BCG/Interferon treatments. My couple dozen cystoscopies were all handled identically despite numerous individuals doing the prep. I had the same doctor throughout. It was always just me and one female for the prep and then only the doctor joining us. Nobody ever entered the room once I was in it except for the doctor.
I always assumed the prep person was an RN but last year I asked her specifically if she was an RN and she said she was an NP and that the practice was in process of converting to all NP's. It could be she meant only NP's for bladder cancer matters, though I'm not sure why cystocopy prep would require someone at that level. They don't wear name tags that make their licensing level clear.
Never did I see a male there other than the physicians.
As I said, the prep was done in identical fashion no matter who did it, and it was done in a very respectful fashion that minimized my exposure to literally only the penis as I was otherwise kept fully covered. As soon as my gown was raised a cloth with an opening for only the penis was put down and then the rest of me was covered. I was always told what each step was before she did it and asked if it was OK to proceed. If the doctor was delayed, she either maintained eye contact with me or otherwise was not staring at my penis while we waited. Clearly they were very well trained. I was always very self conscious but none of them ever did anything that specifically embarrassed me.
This year I switched to a large teaching hospital in NH which is far closer than Boston and for the 1st time had a male nurse (RN... they wear clear name tags there). It was only he and I for the prep and then only the doctor coming in. Going forward there may be a Resident with him but that is my choice. Urology takes two Residents a year, one female and one male. I will allow male Residents to participate but not female. I just have to tell them when I schedule my appt. Truth be told the RN's prep process left me a bit more exposed than I was used to but I didn't care because I at long last had a male nurse and was totally relaxed. I will ask for a male nurse when I schedule my next cysto and will then ask again when I arrive for the appt.
Thanks again for the warning about MA's. That's something I didn't know.
A Twitter tweet led me to read an article “Laughing with Cancer: How Did I get here?”. The author ultimately was diagnosed with prostate cancer. As with all articles I’ve read by prostate cancer survivors (a couple in newspapers like the NY Times, several on the web), this author also noted “Checking my dignity at the door became a rite of passage…”. That is, I’ve noticed time and again writers that describe their feelings during their prostate cancer journey comment on how one’s dignity goes out the door with a prostate cancer work up and treatment.
My question is, if as the medical profession asserts, most males have no modesty, why do so many writers of their prostate cancer journey later comment on “losing their dignity”. And, why do male patients getting worked up in a urology office for prostate cancer feel they have no dignity later? And why can’t male cancer patients be treated with dignity?
I think in fact this is another confirmation that the medical system is not addressing male dignity, is not correct in assuming males have no modesty/dignity concerns and in fact the medical profession is treating males in such a manner that it induces realization of a LOSS of dignity (even if the male patient had no modesty issues or adverse experiences in medicine before).
More specifically, the medical profession doesn’t provide robes, gowns & drapes for male patients like they usually do for the female patients. They don’t provide same gender assistants, scribes, observers, techs, etc. like they do for the female patients. The medical profession is intentionally lazy with respect to draping and covering male patients (an example of this is my experience waiting naked from the waist down in a urology procedure room for 1.25 hours for the doctor to arrive). Overall the medical profession just tends to ignore dignity/bodily privacy for male patients and they rarely if never ignore this for the female patient.
So again I ask the medical profession, an evidence based discipline, to show me the data that it is okay to treat male patients this way. Where is the data that males have no modesty and can have their bodily privacy ignored? Has anyone surveyed prostate cancer survivors to see if they felt their dignity was preserved throughout the whole ordeal? Does ignoring male privacy help or hinder the male patient and the health of the male population. Does ignoring male bodily privacy increase prostate cancer survival or hinder it? Where is the data to support how male patients are treated? - AB
AB, certainly I understand the point you are making. I know I have written this before but where has our teaching of first and second year medical students "evaporated" regarding attention to modesty issues in both genders?
I guess the business men or business women in the medical system have never been taught as medical students! ..Maurice.
AB said
" The medical profession is intentionally lazy with respect to draping." You could call it that but sexual misconduct is more the appropriate term and I'll mention that if you have a tray, body part etc that is sterile and you want to maintain sterility you should drape it with a sterile towel. I'm referring to a prepped body part or sterile tray such as used in paracentesis, lumbar puncture, central cath ( triple lumen), Stryker hip prosthesis, laparoscopy etc. Body parts that have been prepped with betadine for a procedure should be draped, covered with a sterile towel particularly if the patient is not in any kind of sterile environment whereby laminar air flow is not used. It's just downright stupidity!
Any patient that is prepped for a medical procedure and left in that manner for 1.25 hours without a sterile drape to maintain sterility is just unprofessional. Wether that body part is prepped for sterility or not no one should be left exposed for 1.25 hours. I have been involved in thousands and thousands of surgeries and never have I ever seen any patient prepped and have to wait 1.25 hours for the procedure to begin. I'll mention that if that were the case it would be documented should the patient return for post-op, procedure infection and there would be some explaining. I assure you risk would be notified on that one and certainly anesthesia is never given until the surgery is ready to begin.
PT
AB
Prior to my college attendance I volunteered at an animal rescue shelter as I helped veterinarians perform procedures on dogs and cats. I'll tell you that animals were treated better than you were treated. Most minor office procedures can be prepped and draped in 30 seconds. In the surgery department having your gallbladder removed. a Cholecystectomy can be prepped and draped in under 5 minutes. There is no surgical procedure performed on female patients whereby the patient is prepped and left exposed for any period of time let alone 1.25 hours.
I believe you as I have heard of male patients in urology clinics for a vasectomy that were prepped and left exposed for nearly an hour while three female medical assistants stood in the room waiting for the urologist. In conclusion, I believe any facility that treats patients like this is acting unethically and unprofessionally. Therefore, any physician, tech, nurse, assistant whatever reading this and if you've treated your patients as such. Do the world a Hugh favor and exit the industry STAT! For you don't belong and I consider you all IDIOTS!
PT
Dr. B wrote “where has our teaching of first and second year medical students "evaporated" regarding attention to modesty issues in both genders?I guess the business men or business women in the medical system have never been taught as medical students!”
Are you suggesting it is the business men and women alone who are responsible for the disparity in how female and male patients are treated? There are plenty who are responsible, but in the interest of brevity let me address just the physician's complicity in this matter.
There are plenty of private medical practices (it probably is still true more physicians practice privately than are employed, although that is changing). Way greater than 95% of private physician practices hire only females. Why is that? Where did physicians learn that it is okay to design their OWN practice for the female patients and basically say to any male patients “take it or leave it” and “man up”. Where did these physicians learn is is okay for them to discriminate in the hiring process? Where did these physicians learn that in their own practices it is okay to discriminate against customers based on gender? Where did these physician learn it is okay to treat different people differently, it is okay to provide a different standard of service to one class of patient versus another? I really wonder if gender is the only category physicians discriminate on or whether race, ethnicity, etc. are also triggers but that is another matter. The point is from the start nearly every physician ENABLES and PARTICIPATES in discrimination in hiring and in services and treatment of their patients. In their OWN practices.
Now many of these private practice physicians also have privileges at and practice at hospitals and surgery centers too. There they continue to enable discrimination because they never advocate for their patients, they never call out the biased hiring of that facility (that surely they must recognize). Of course they can’t because it would make them look hypocritical and apparently that is more bothersome than simply discriminating against patients.
Most physicians practicing at hospitals argue any new implementation of anything by the Hospital until they see the *evidence* for such new practices. Want to add a time out in the OR - better prove it saves lives or surgeons won’t do it. Want to require specific documentation in the medical record - better prove why it is necessary & helps the patient and billing. Want to discriminate against half your patients - no problem - no evidence needed.
So physician play a huge roll in enabling and propagating discrimination against patients. I’m reminded of signs that existed when I was a small child that said when whites had doctors office hours and when blacks had doctors office hours (and they didn’t overlap). Health care is structured for women. Men are offered access to this system but only if they tacitly agree to the discrimination. It is not just the businessmen & women who created and propagated this system, an overwhelming majority of physicians contributed to this, and never advocated to correct it.
So again I ask - how does the medical profession, physicians in particular, justify this discrimination. Show me the evidence based medicine that this helps all the male patients. I don't think they can. - AB
The article on Student Shadows has been published on the Dr. Linda site.http://drlinda-md.com/2017/09/guest-post-student-shadowing-informed-consent/
I had an upper endoscopy today without sedation. It was easier to endure than the transesophageal echocardiogram I had w/o sedation despite the scope going down much deeper, I think perhaps because they did a good job of numbing my throat first.
There was a small surprise though despite my having read up on the procedure beforehand. The young medical asst that brought me from the waiting room takes my blood pressure, then hands me a gown and says "everything off". That startled me but I thought she must think I'm having a colonoscopy. I tell her I'm having an upper endoscopy why would I need to take more than my shirt off? She says because of the sedation. The RN comes by and agrees I only need to take off my shirt given no sedation. I had no idea that sedation meant an automatic totally nude scenario, though there clearly wouldn't be a reason for anyone to remove or otherwise lift my gown or remove the sheet that I'd of had over the gown while I was sedated.
Anyway I thought I'd pass that along as another benefit to not being sedated. The issue hadn't come up when I had the T.E.E. being the staff I dealt with all knew I wasn't being sedated. A suggestion to those who do have these kinds of procedures w/sedation is to leave your underwear on anyway. If afterwards anyone says something about it you'd know that they did lift or remove your gown which then begs the question as to why. The procedure is through your mouth so there is no need to be going anywhere else.
Hello Biker,
I read your recent post with amazement. Is it possible for you to determine the rationale for total nudity, if sedated? I'd really like to know what reasoning was involved for determining that all clothes should be removed for this type of endoscopy, sedated or otherwise. If you are able to get a response from the medical personnel, please post it.
Thanks.
Reginald
I guess it's fashionable here to express the opinion that the vast majority of female nurses ate dedicated professionals and perhaps that's true; howver, it seems those I run into in medical offices are more aptly described as trailer trash. That said, this report may represent a new low: http://ktla.com/2017/09/06/5-denver-health-nurses-suspended-after-opening-body-bag-to-view-mans-genitals/
I guess none were fired which says a lot about medicine's ability to police itself.
REL
To me REL's news story is a matter of humans being objects and not human subjects. And while we teach all patients are human subjects while alive in their hospital beds or in death in the dissecting room it appears that some nurses were never taught that or disregarded this philosophic ethical principle for their own sexual self-interest.
I also object to the nurse's medical institution that did not provide the news media with the names of the nurses. Why do I object? Another example of the institution allowing to present the nurses as objects and not as human subjects who violated ethical principles.
Anyway, that's how I look at this from an ethicist's point of view. ..Maurice.
Yet, they are presented year after year after year as the most trusted profession. It should be noted that this mans genitals were view while he was alive and after he died.
PT
Maurice
Would you expect the Colorado state board of nursing to look into this? Would you expect this subject to appear on Allnurses? Would you expect that medical facility to report the nurses names to anyone. This was investigated by the police department so I would say that a police report could be obtained and the names of the nurses would then be divulged but in the final analysis would it really matter. These faceless, nameless people who don't advocate for a human being in life let alone in death so why would it matter to anyone. This is the face of today's healthcare and male patients see these kinds of faces everyday.
I'll ask our viewers to find a YouTube video of this subject being relayed by a young gentleman who perfectly relays the point of their behavior, he's remarks what would happen if the roles were reversed. These five nurses were as I read suspended and I assure you it is with pay so no, it was just a vacation. I have seen this occur over and over and it's nothing new. I have stories I could mention on this blog but I don't because they are so bizarre that I don't because I don't think anyone would believe me. We can post comments on sites like DrLinda-Md and portray it soo nice, with icing and strawberries and be so nice and sweet about it. Do you think anyone pays attention to it. Do you think anyone cares about how male patients are treated. Then you read something like this that leaks to the press and BAM, you are brought back to reality cause folks this happens everyday at every facility all day long.
It's pathetic how it's relayed in the news and how it is so downplayed. It's even more pathetic when a few nurses will say " well I don't treat patients like this and blah blah blah" . Do you hear that " that's the voice of self- righteousness talking to you. That's the voice of one individual protecting an entire industry. It makes me sick!
PT
Reginald, I wish I had asked specifically about why no clothes when sedated but once the RN agreed I only had to take off my shirt I moved on to a couple other questions I had. Sometimes they call as a follow-up and if they do I will ask the question. My guess is it must be a precaution should there be an adverse reaction to the sedation. Clearly there isn't as much a concern with the procedure itself being I only had to remove my shirt for the endoscopy and the same earlier this summer for the T.E.E. too. If my guess is right and the sedation is riskier than the procedure, then all the more reason not to be sedated if you can tolerate a little discomfort.
Concerning the Denver nurses I am appalled that the hospital gave them a slap on the wrist is all. Can you imagine going to that hospital for a procedure and wondering if your OR nurse is one of them? Or your floor nurse that needs to tend you in some intimate matter?
The reaction of the hospital to not fire them on the spot tells me that such behavior is an accepted part of the culture. I read comments on a different forum that ranged from totally appalled and thinking they should have been fired to those who thought it wasn't such a big deal because the patient was a guy. Yes you heard me right.
Apparently much of our society is not yet ready to accept that men are entitled to dignified and respectful treatment as regards their intimate privacy.
I sent a message to Denver Health expressing my thoughts on their having effectively condoned what the nurses did. This is something that we can do.
Colorado board of nursing
1560 Broadway, suite 1350
Denver, Colo
80202
I'm asking our readers to write to this nursing board regarding the incident. In my state their actions are considered sexual misconduct. I'll mention that the director of the board of nursing answers to the governor of Colorado. After reading the article on numerous sites I have come to the conclusion that the floor this patient was either the emergency room or the intensive care. Denver health on their site says they have a non-discrimination policy and they do not discriminate on the basis of gender. For a hospital this size 5 nurses would essentially entail the majority of their staff be it the er or Icu. From what I've read their have a new CEO who is a female. From from I've read the incident occurred from late March till early April but was not reported till May.
Typically, when a patient expires in an intensive care unit the patient is transferred to the morgue in fairly short order so the room can be ready and prepared. A deceased person will never occupy an Icu bed for very long. Within the emergency room a deceased person will be moved to a room adjacent within the er for some time allowing next of kin for perhaps a number of hours prior to transferring the patient to the morgue. I believe this patient was in the Icu prior to his demise and it's very disturbing the culture that exists and as I mentioned the 5 nurses very well could have been the entire Icu staff for that day. A typical Icu nurse will be assigned no more than 2 patients at any one time.
PT
Hello,
I sent the following note to Karen Jackson at CMS and received an immediate reply (see below). Medicare is BIG business for the health care industry. When it speaks EVERYBODY listens. Possibly, suggesting same-gender care to one caring individual at CMS may propel our concerns mainstream. Incidentally, I applaud Ms Jackson for being the only member of CMS Leadership to post her CMS e-mail address. You don't have to be a Medicare participant to offer suggestions. You may wish to research another CMS official to spread the word.
Reginald
Sent: Friday, September 8, 2017 2:38 PM
To: Jackson, Karen E. (CMS/OA)
Subject: Need for Change
Denver Health nurses suspended after opening body bag to see man's genitals
Hello Ms Jackson,
As a handicapped Medicare participant and as a human being, I find this headline appalling. I'm wondering if this is how I'll be treated when I'm hospitalized. Will my Medicare payments be given for this? Please consider what Medicare can do to prevent this from happening to me when I'm hospitalized. Will my care and safety be jeopardized because medical staff are viewing my genitals instead of caring for my injury/ illness? Creating new rules which are not respected or enforced obviously does not work. Medicare must insist that same-gender care be provided to anyone upon request. The shortage of male nurses must be addressed by aggressive recruiting.
Medicare has done a great job with bundled payments. This has forced medical facilities to improve care and efficiency. This must also be done with same-gender care so that incidents like the above are "never events".
PS Below I have included the URL for the story and a few brief excerpts. These should appall anyone with a sense of human dignity.
http://www.thedenverchannel.com/news/local-news/denver-health-nurses-suspended-after-opening-body-bag-to-see-mans-genitals
Five nurses at Denver Health Medical Center were suspended for three weeks after they inappropriately viewed a deceased patient’s body and talked about it, a hospital spokesman confirmed to Denver7 Investigates Tuesday.
A tip to Denver7 said the nurses disciplined admired the size of the deceased patient’s genitals and at one point opened a body bag to view parts of the body. A hospital spokesman confirmed details of the incident.
“Multiple staff members viewed the victim while he was incapacitated, including after he was deceased,” a Denver Police report says. .”
The report says the incidents occurred between March 31 and April 3, 2017, but weren’t reported until May 8.
Rasmussen said although the nurses received discipline considered “serious,” four nurses ultimately returned to work.
From K. Jackson
– thank you for your note and for reaching out to me. And thank you for your positive feedback on the bundled payment programs that CMS has worked with many health care providers to implement in the Medicare program. We are working hard to improve health care outcomes with innovative programs like the one you refer to. I will share your note with agency staff who are more expert than I am in health services staffing and recruitment.
Best regards,
Karen Jackson
Deputy Chief Operating Officer
Centers for Medicare & Medicaid Services
Karen.jackson1@cms.hhs.gov
410-786-0079
Reginald
Reginald
Thank you for your advocacy as I've said that CMS holds the key in much of this discussion. Based on her response I don't see much success as its business as usual. Some states have laws regarding necrophilia and Colorado is one of them and if I interpret the laws correctly it is a class 2 misdemeanor at least it should have been for the 5 nurses. I do not understand why they were not terminated or in the very least reprimanded by the board of nursing. It just may be the nursing board may or may not know of the situation and I encourage everyone to write them. Don't expect respectful care when you are alive and don't expect it after you die.
PT
Reginald
I want to mention that those 5 nurses were actually rewarded, not punished. They were put on administrative leave with the pending investigation. The hospital spokesperson said the punishment was serious, how do you call being three weeks of free vacation serious and he goes on to say a letter was put in their personnel file. Do you know how worthless that comment is? I have much experience in human resources and those letters mean nothing. Those letters grow legs and disappear after several months. The fifth nurse probably got another job and couldn't care less.
Administrative leave is always with full pay, They were rewarded after violating the nurse practice act, violating the core values of the hospital, violating the patients trust both when he was alive and after he died and violating rules set forth by the Colorado state board of nursing. Probably violating laws enacted by the state of Colorado regarding necrophilia and after all was said and done they got three weeks of vacation and returned to their job.
What would happen to you if you committed the same act and create any scenario you want and after all was said and done would you like to be rewarded with 3 weeks of paid vacation and then return to your job? They were rewarded because they are female and the hospital CEO, Risk, CNO and their nursing director is female. Three weeks of paid vacation?
PT
Good Morning.
What a sad state of affairs we are in.
What I find most disgusting and distressing about the "Denver 5" episode is most people view it as being funny.
What should have been a wake up call to the public is just a joke.
Sad.
I understand the next of kin was notified of the episode. I hope they sue the pants of the hospital & the 5 degenerates.
Regards,
NTT
Hello again,
In my original note to Ms Jackson, I yellow highlighted the "3 weeks" and "return to work". Unfortunately, this site doesn't seem to support highlighting; thus, it did not appear in my original post. I presumed that, as an intelligent individual, she didn't need to have me explicate. Yes, it may still be business as usual at CMS. However, maybe once, just once, the seed will fall on fertile ground and produce one hundred fold. We live for hope and spreading the word can't hurt.
Reginald
I'm going to step outside of my bounds here regarding people who view what the Denver 5 did was funny. I personally know of perhaps between 20 and 30 patients who died of medical malpractice and the family was never told the truth. Same kind of story, same channel but different day so to speak. Patient on a ventilator ( breathing machine), nurse and anesthiologist leave the vented patient unattended and go to the cafeteria for coffee and donuts. They return 15 minutes to find the ventilator had malfunctioned and patient had expired. Not necessarily the anesthiologists fault, rather the nurses fault, No one around to hear the alarm going off on the ventilator. Family told their loved one died of natural causes, not told the truth.
The above is an example of a lack of advocacy and those who might see the Denver 5 behavior as funny do not see this is advocacy gone bad and it comes in many flavors and many scenarios. As I always say bad Karma is a bit$h and it goes around, particularly if it's funny in that they don't see the true meaning of the implications. I'm sure at one time or another they or their loved ones will experience it. There is a good probability that one of them took a cell phone pic of this patient in the body bag. Once a patient goes to the morgue only security has access to this locked unit and I'm sure only the hospital knows the truth as to how these nurses gained entry.
PT
Three brief observations on the Denver 5 case:
(1) Science uses abstraction when it's helpful. But, like Hollywood's depiction of a shooting (bang, the victim falls dead), abstraction can obscure events rather than help. I fail to see the utility of a subject/object abstraction in the Denver 5 case.
(2) I have absolutely no desire to see a dead woman's genitals regardless of how she looked in life. This probably makes it very hard for me to relate in any way to the body bag opening at Denver Health. I can only view it as perverted behavior.
(3) Humiliation of men in medical settings by females who hate men probably occurs every single day. Medicine gives them the opportunity and they seize it. What strikes me as different about the Denver 5 case is the group aspect. I believe the counterculture facilitated the descent of the Manson family girls into extraordinary depravity. Makes me wonder about the culture at Denver Health and how conducive it may be to development of similar group behavior. Also makes me fearful of who else may be on medicine's payroll with apparently so very little to do.
REL
PT was right. No discussion of the Denver 5 on AllNurses. My guess is any thread started is quickly deleted.
Biker
Or maybe it was never placed there because this is a subject female nurses don't want to see discussed. This incident blows the gender neutral theory all to hell.
PT
Although what follows is my recent posting to ethicists on a ethics listserv and though not dealing strickly with physical modesty, it does deal with the issue of a form of "verbal modesty" between a physician and the patient.
I wrote:
A simple question: Should physicians feel comfortable if their patients consistently call their physicians by the physician's first name? That includes dropping the title "doctor" which is allowing this communication. to go from "Doctor Smith" to "Don" (the physician's first name). Is this really unprofessional communication and the physician should somehow correct the patient? Is the allowance that the physician may call the patient by their first name a valid argument for patient permission to do the same toward naming their physician? Or is the current seemingly unequal behavior in communication between patient and their physician an ethical "good" which should be preserved?
So to my blog thread readers: Is there some inequality here on the part of the medical providers? When first names are used to identify either party is this a form of verbal "undress"? How do you as patients "name" your doctor or nurse and how do you want or insist to be named by your doctor or nurse when they speak to you? ..Maurice.
Dr. Bernstein, having been raised to be polite and respectful I always refer to and speak to physicians as "Dr. so-and-so". It has never occurred to me to do otherwise, nor do I have any expectations or desire that this should change. In turn in the absence of being asked what I would like to be called I prefer to be called "Mr. so-and-so" by them. If they ask me how would I like to be addressed I'll tell them my nickname. The difference is being asked by them. I would never say anything if a physician called me by my first name or by the standard nickname that goes with it without 1st asking me but it would strike me as the taking of a liberty I didn't grant them. Nothing that rises to the level of complaining about however.
My thinking here is similar to the modesty issue. I want to be asked if it is OK to lift the gown for example rather than someone just lifting it as their right. There I might complain though.
I as well expect any other medical staff including the receptionist to call me "Mr. so-and-so" unless I have told them it is OK to do otherwise. Of course for privacy reasons when being called from a waiting area they use 1st names only which makes sense and is OK with me. I do expect them to shift to Mr. so-and-so once we leave the waiting area however.
Where I don't know what to do is what to call a PA or NP. Using their 1st name seems a bit disrespectful. Calling them Mr. or Ms. so-and-so doesn't seem right either but is better than using their 1st name, yet saying Physician Assistant or Nurse Practitioner so-and-so strikes me as odd. That leaves me with using Mr. or Ms. so-and-so until someone tells me better. Is there a right answer?
With RN's or below, I will defer to Mr. or Ms. so-and-so if their last name is displayed where I can read it, unless they first tell me to use their 1st name. If all I have is the 1st name that is what I use. If they don't have a name tag or the tag is turned around as often is the case I just go with Sir or Mam.
Just an observation which may not hold elsewhere in the country but in this region at least there seems to be a feminization of primary care underway.
After more than a year of a couple symptoms going undiagnosed and my primary care physician not doing anything more than having given me a couple referrals I decided it is in my interest to find a new primary care doctor, much as I like him on a personal level.
I looked locally (hospital and non-hospital), at a regional hospital an hour from here in VT, and at the large teaching hospital in NH that I been to for urology and gastroenterology matters. What I have seen is that there are more female internists and family physicians than male and that practices have more NP's, APRN's, and PA's than they do MD's. The ranks of the NP's and APRN's are almost exclusively female. Things are a bit more balanced with PA's, though there are more females than males there too. What is telling about the future is that on average the male MD's who are already fewer in number than the females, are also older on average. I extrapolate that to mean that at some point in the future male internists and family practice physicians will be few and far between. Primary care will have become the domain of women except for a few male PA's, though the question can be posed as to whether those female MD's will continue to hire male PA's once they have more fully taken over the system.
I also saw that some internists, NP's, and APRN's specialize in women's health. None specialize in men's health.
The other observation is that demand has outstripped supply. I could not find a single internist, male or female, that is accepting new patients locally or at either hospital. Even most of the NP's and APRN's are not accepting new patients. Note that there is no population growth in the region served by any of these hospitals over the last decade but rather a small decrease, yet there are no internists taking patients.
I decided my best bet was going with anybody I could find over in NH that was taking new patients so as to then have my primary care within their system. I plan to switch my cardiology over to there too and at that point 100% of my medical care will be within their system where hopefully coordination and oversight (by the primary care) will work better. Over in NH I found 2 male PA's who just started last year and who are still accepting new patients, and I've made an initial appt. with one of them. Having found an entrance point into in their internist system perhaps I'll be able to get an MD at some point as my primary care.
Most of what I learned here came as a surprise. A week ago I'd of told you no way would I go to a PA or NP for primary care. At least I found a male PA.
How about a lesbian physician or other lesbian healthcare provider for you heterosexual males with worries about modesty issues written to this thread? Did you know I have an active thread on this blog titled "Would You Accept a Gay or Lesbian Physician as Your Doctor?" You might go to
http://bioethicsdiscussion.blogspot.com/2010/08/would-you-accept-gay-or-lesbian.html
check it out and then return and respond here or respond there since you will see a Comment by Dr V from Canada referring to our Patient Modesty thread here.
I don't recall whether we have discussed here the sexuality of the males writing here who are complaining about the female healthcare providers which I assumed in the first paragraph "heterosexual".
Or do you all agree with some writers to that other thread who state they really don't care about the sexual direction held by their physicians? ..Maurice.
I have never thought about the sexuality of any medical staff I interact with nor do I care. As has been discussed I grew up in the age of mandatory showers in school, nude swim class for guys, and generally having to grow accustomed to same gender nudity. For most of my adult life I have been in locker rooms where guys shower together. Surely some of those guys have been gay, and to that I say who cares. Doesn't bother me in the least as for me there is no sexual context to locker room settings or interactions.
I had been in mixed gender nude beach or swimming hole settings a few times in my younger adult years and quickly became comfortable with it being we were all exposed and thus on equal ground. Being naked with women who are fully clothed in a medical setting is something entirely different. That is not equal ground. Even knowing that it is most likely not perceived in a sexual way by the doctor or nurse, the best I can hope for is that I merely feel self-conscious. I am in a position of weakness relative to them and it is not comfortable. Knowing that there will be times that the caregiver may have a prurient interest just adds to the discomfort.
Dr Bernstein,
When meeting a physician for the first time, I'll always give him or her their title. They worked pretty darn hard for it, so it's only respectful to use it. At least until the relationship is well established. That being said, if a doctor starts to use my first name, this implies he or she is okay with me doing the same. Any issue with this and we'll go back to "Mr " in a hurry.
In my neck of the woods, there aren't many PAs (not all provinces in Canada recognizes them) but the few I come across through the military seem to be fine with first name basis. I have noticed a more prevalent familiarity ("chummyness"?) coming from PAs and NPs than from doctors. This could be explained by a cultural difference.
At the regular clinic I go to, there's a family doctor (woman) as well as a PA (man). The doc is oh so prime and proper (formal) nearly all the time but that PA... Man is he is casual. Not that I mind, but the contrast is very apparent. I prefer dealing with the PA myself but, sometimes can't avoid having the doc "crowding in" (typically it will be for some confirmation or consult-type situation).
As far as sexual orientation goes, finding out (or realizing/discovering) that my physician is homosexual (or even transgendered) wouldn't bother me at all. It's not something that comes up casually in medical appointments so, it most likely would have very little impact on my interactions.
Dany
Hi Dr. Bernstein:
As far as the doctor goes, I don't think sexual preference plays as much a role in choosing the MD as much as their professional ethics.
I think what upsets both male and female patients is the way the MD not thinking a minute all the sudden ambushes their patient in certain situations.
That causes the patient to only want to seek out same gender care.
If in their first meeting the doctor and patient took the time to explain themselves to each out so both knew what to expect from the other, I don't think sexual preference as far as the MD goes would be an issue.
If female MD's want to have male patients, they will have to think about male related scenarios and how they would handle them before they start seeing male patients. One can't start a male physical then at the intimate part step out for a second & bring a female chaperone in announced.
I guarantee you'll never see that male patient again if he has modesty issues. And he will spread the word to others as to how you handled the situation which may in turn further erode your patient base.
Just my take.
Regards to all,
NTT
As a follow-up to the discussion about how do you address a doctor, I had a 1st visit today with the PA who will serve as my new primary care provider. As noted before there is not a single internist within 1.5+ hours of here that is accepting new patients, nor are most of the NP's and PA's. This guy has only been practicing since last year which is probably why he hasn't been fully booked yet.
The Medical Asst bringing me from the waiting area referred to him as "Dr. so and so". However when he came into the room he introduced himself simply by his 1st and last name and referred to me as "Mr so-and-so". My wife says where she goes the PA's are referred to as Mr. or Ms so-and-so.
I did learn that if he needed to bump me up to the MD, he is paired with one of the female MD's. That's fine with me being he's the one that'll do basic physicals.
Lastly on an unrelated note to what we discuss here, this was my 1st real encounter with a PA and I was totally blown away. Never have I had a PCP or a specialist for that matter who explained things as well as he did or was as thorough as he was in asking questions. He was also able to preliminarily diagnose and then test to confirm a recurring problem I have dealt with and been pursuing a diagnosis on for over a year. I went into this skeptical about seeing a young PA but my doubts proved unfounded.
Good Afternoon Everyone:
Came across an article that told the Denver 5 story but also included another incident that happened to a gentleman last December at the University of Pittsburgh Medical Center in Pittsburgh. Here's a link to the article.
http://www.nbcmontana.com/news/health/workers-at-2-hospitals-disciplined-for-violations-involving-patients-genitals/621418563
A "crowd" of UPMC Bedford nurses and doctors "lined up at the door" of the operating room to take photos and videos of the man's genitals while he was under anesthesia, according to the report.
The material taken on personal cell phones "had no clinical justification," and staffers "shared those videos and photographs to others uninvolved with the patient's care," the report says.
It's open season on male patients.
As per the Denver 5, nobody in Pittsburgh lost their jobs either.
There has to someone with the power to stop these animals that we can contact.
If these animals were lined up to take pics of a female patient, EVERY LAST ONE OF THEM would have been fired.
This can't be allowed to continue.
I am thoroughly ashamed of the United States healthcare system for it's total lack of any good judgement and their complete disrespect for their male patient's privacy and dignity.
These were sick people that only wanted their help. They didn't go there to be put on show.
Every one of those animals in Pittsburgh should have been fired.
Regards to all,
NTT
NTT
A story was relayed in discussion regarding the Denver 5 whereby an overhead code would be announced when a male patients genitals should be viewed by nursing staff. This occurred in a post surgical recovery unit which typically receives patients that are still under the effects of anesthesia. The article did not say where this occurred, however, I have read this happening before so I believe there is validity to the story. As I have said before and I'll reiterate it again, these behaviors happen every day at every medical facility. Once in a while the events make it to the news and you read about it.
PT
NTT: Thanks for posting the link. I agree with your "animals" characterization and don't see additional HIPAA training as beneficial. Surely most decent individuals from many walks of life would have recognized the behavior as inappropriate -- HIPAA or not. Unfortunately, it appears probable that medicine is attracting more "animals" than other industries and appears to not really care. Notice how the administrators were so elated to be bragging about how they'd taken action. If medicine is unwilling to curb such behavior through consequences, then it will be difficult and time-consuming to change it from the outside. A strategy is desperately needed along with conviction for the long haul. REL
PT.
If this behavior happens everyday then the facility mgmt. should be held responsible for the behavior of their employees and as such should be prosecuted and sent to prison along with animals.
There has to be a federal agency that men can complain to.
Regulators must be take the camera phones away from all healthcare employees during working hours. Get caught with one, mandatory termination. Caught with patient pics on it, automatic loss of license and your turned over to the cops for prosecution.
All decent people have to take a stand on this & put these animals where they belong. In cages.
Regards,
NTT
NTT
Genitals photographed, shared by hospital employees, a common violation in the healthcare industry. This is the headline in an article written on Penn. state news. I agree with it because I know of it happening at " Every " hospital I've ever worked at. The cell phone issue I agree should be banned in patient areas but they are not. Hipaa laws in my opinion don't have enough teeth, fines should be heavy yet not enforced. More and more people enter the healthcare industry only for a paying job.
There should be extensive training in medical schools and nursing programs regarding patient privacy but there is not. Hipaa laws are only mentioned once staff begin working at medical facilities and the implications are poor in the presentation. Nothing is going to change, it's just business as usual. Millennials cannot be separated from their cellphone these days for more then 5 minutes, it's a must have as its a tool for those lacking any self esteem and personality. Every operating room staff have their cell phones on them and are playing on them as well during cases. No one enforces the policy and there are no policies regarding cell phone use anywhere in patient care areas.
Is it a modesty issue when an unauthorized cellphone pic of a patient's genitals are taken and shared? In the Denver 5 case the family was notified of the incident. I can't but wonder what those people must have thought. " What, they opened his body bag to gawk at his genitals, " It's a crime if you take a cellphone pic of your patients genitals according to laws, however, is it still a crime to bring in an observer to view your patients genitals when that person is not involved in your patients care. It should be a crime in that you could have shown that person the cellphone pic but rather just bring them in and have them take a peek in real time.
The case in the Pen. hospital actually touched on this when state regulators investigated the incident. The description was that the onlookers were described as a pyramid of cheerleaders gawking in the or case at the patients genitals with most of them taking cell phone pics. The regulators determined that staff should not have allowed people not involved in the patients care into the operating room.
Now, this is the first time I have actually read where this issue was addressed. I have to say I'm actually surprised in that I've never ever seen this enforced in any surgical suite.
PT
The culture and ethics of any organization starts at the top. If the top mgt at a hospital truly disapproved of the Denver 5 type behavior that behavior would stop. They wouldn't have to fire very many nurses or doctors before the message sank in. Fire a manager or two and managers as a group will get the message and they will make sure the rank and file know the rules.
It wasn't a healthcare setting but where I worked being dishonest or unethical would get you fired very quickly, far more quickly than if you were just bad at your job. I was the Chief Operating officer and then the Chief Financial Officer and can assure you that any Payroll Clerk that divulged someone's salary would be fired pronto. Same for anyone in Human Resources that divulged that which they shouldn't divulge. The CEO fired his Executive Secretary for talking out of school so to speak. I fired the IT Director for getting a freebie laptop for himself buried in a very large technology order. I fired a production manager for including a case of oil for himself in a large parts purchase. People knew we would not tolerate inappropriate or unethical behavior and guess what? It rarely ever happened and it helped attract quality long term people who wanted to work for a company with a high ethical base.
Hospitals could do the same if they chose to.
Here is an article from Men's Health that more or less says it is OK for medical staff to look at and discuss amongst themselves patient "unusual" genitalia. This is partly why it is tolerated. Many people just don't see a problem with it. They do agree that doing it to a dead person such as the Denver 5 did is going too far.
http://www.menshealth.com/health/colorado-nurses-suspended-for-mocking-dead-patients-penis
Biker
If you read in particular rules set forth by state boards of nursing, it is not ok to discuss patients genitalia with anyone not involved in their care and it has to be for a reason, as always the np basically covers for them by making excuses.
PT
Biker
Now if male nurses discussed between each other large female breasts than I'm sure that np would be having a cow right now and would want those male nurses fired.
PT
Hello,
On a more positive note, please read the comments below from Jeremy Zoch, CEO of St. Joseph Hospital, Orange, CA. "Some patients request male nurses specifically, particularly in a hospital like St. Joseph that serves a wide diverse population. To be the trusted source of care in our community, we have to meet the cultural demands of our patients." At St. Joseph Hospital about 13 percent of the nursing staff is male. Zoch says men can be compassionate, empathetic and caring at a patient's bedside. He began his career in healthcare as a bedside nurse assistant. Below I've attached the general e-mail and the address of St. Joseph Hospital, Orange, CA. Sending a complimentary e-mail or note to Mr. Zoch might further motivate him; and, he might encourage his fellow hospital CEO's to hire more male nurses to fill a, heretofore, unnoticed need.
SJO-Feedback@stjoe.org
St. Joseph Hospital
Orange County Hospital 1100 West Stewart Dr, Orange, CA 92868 (714) 633-9111
Reginald
It has nothing to do with male or female, it has to be changed by making the patient the consumer. The patient pays for the service (one way or another) and has a right to make demands of the service. That is how change will occur.
We hear all the backlash from providers that patients are not the same as the person ordering a burger. The ACA has moved us closer to this paradigm. This is what all patients need to get behind, "have it YOUR way." Only then will we achieve the dignity that we demand.
Providers reject his concept because they know that they will no longer be able to say, I am a professional and this is how we have always done it.
The universe is governed by certain universal laws. One is that systems seek equilibrium. When we physicians were not meeting patient needs, patients sued them for legitimate lapses in care. These incidents would have been overlooked (in many instances) if the physician had treated the patient with more dignity.
This in turn drove up malpractice costs to the point many physicians could no longer practice on their own. They became employees of large healthcare systems that have the customer service model, just like retail and fast food.
The large healthcare systems are not at the point yet that patients demand. It is not until they have financial consequences of poor service that patients will finally receive the treatment they deserve.
--Banterings
Good Afternoon:
If mistreating men wasn't bad enough, checkout this story out of Florida as to what the so-called "Lady nurses" are doing.
https://nypost.com/2017/09/19/naval-nurses-booted-over-disturbing-pics-posts-of-mini-satan-newborns/
These people & the industry need to be STOPPED.
We need better regulations with sharper teeth.
Regards,
NTT
After reading NTT's link about the Pittsburg/Denver incidents, I saw healthcare's "get out of jail free card:"
The hospital system has a strict policy against photography not intended for educational purposes or for the benefit of the patient, public relations senior manager Rick Pietzak said in a statement. Source: Workers at 2 hospitals disciplined for violations involving patients' genitals
I propose in the interest of furthering patient education, that anyone who has the ability to take pics of medical providers' exposed bodies do so and publish them to educate patients that medical providers are people just like us and there is nothing sexual about images used for educational purposes. This reenforces that assertion.
There is additional educative value if there is an anomaly with the person's body, especially the genitalia.
Before one would find any fault with my proposal, why would anyone participate let alone allow the Pittsburg and Denver incidents happen?
I think that this would solve that problem.
--Banterings
Hi AB:
They continue to do this crap because it's fun, they like to look, and most importantly they know the worst punishment the system will hand out is a suspension. More times than not with pay.
The system has no incentive to stop these animals because nobody will come down on the healthcare system and say no more. They all look at it as a joke and it will pass and things will be back to status quo.
If decent people don't take a stand here and now and demand this system be changed then we deserve what we get.
Regards,
NTT
By the mid to late 60's mammography began to be used as a diagnostic tool and by the mid 70's was a modality at many hospitals. As I have said a number of times and I'll say it again the selection of gender staffing was strictly female determined by the hospital. Over the years there have been a few complaints by patients, " the mammo tech was rough with my breasts and she was rude. She will never do my mammogram again." These are type of complaints female patients have about 99% of the time if they do have a complaint.
There have never been complaints such as anyone taking a cell phone pic of their breasts, never. There have never been any complaints by mammo patients such as " I was ambushed, it was a male mammo tech" . That certainly has never happened. Neither were there ever nude pics of playboy magazine of full nude foldouts of women displaying their breasts at any mammo suite. Finally, there has never been a death after a female patients mammogram whereby she had her breasts displayed after being placed in a body bag and certainly not while she was alive while receiving said mammogram.
Now with male patients it's a different story, you can expect any of the above to happen and with frequency. The female healthcare instituted respectful care to their female patients chest anatomy but cannot institute and carry out respectful care with male patient's genital anatomy. Remember, you are a patient but it appears not in the same general capacity as a female mammogram patient as far as patient rights go. Remember all the negatives that happen to male patients everyday, never ever happens to female nurses, female cna's etc. when they receive their mammogram.
PT
I want to offer some HOPE to all who are disgusted about the goings on in Pittsburg...
It is not the end of the story. There is much more to come. I can't say any more because of ongoing things. As soon as I can, I will post a follow up to this.
--Banterings
In the past whenever I have had to endure an abusive doctor or nursing staff I have stated my wish to speak to either the chief of staff, in relation to doctors, or to the head of nursing services. I guarantee you that I received immediate results and direct access with profound apology hoping to avoid possible litigation. When ever this was necessary, I did it at once while in the hospital bed not after being discharged. The next step up is the CEO and you would be amazed how willing many of them are to speak with dissatisfied clients especially when a legal process could happen.
Hello,
CMS (Medicare, Medicaid) has a questionnaire re care innovations (https://survey.max.gov/429625). This may be a great place to spread the word that same-gender male care is a concept whose time has come. The questionnaire is extremely long; but, there are opportunities to elucidate the pressing concepts appearing in this blog. Again, you do not need to be a Medicare beneficiary to complete the form. No personal data is required. You can skip any part that you wish. What better way to stop cursing the darkness? As I've stated before, when CMS talks, health care jumps. (CMS proposed 2018 budget is 737,854 Million dollars. Is there any wonder that when CMS embraces bundled care, bundled care it is?) Admittedly, CMS is a huge, seemingly impersonal bureaucracy; nevertheless, what loss is there in an attempt to sway current health care practice? A few completed questionnaires, stressing the need for same-gender male health care and encouraging males to enter nursing, may indicate to CMS that this is an avenue worth pursuing. Just pasting some of the comments made in this blog could elucidate our concerns. This is not the military. We don't have to follow the chain of command. Here's a chance to contact the mover-and-shaker of health care. Are you in?
Reginald
Reginald --
Thanks for the questionnaire link. I've just completed it.
RG
In 2 days I will be introducing my group of 6 first year medical students into the skills of performing a physical examination. The first session deals only with the category: General Appearance (which is the observations of various aspects of physical and behavioral aspects of the patient) and obtaining the Vital Signs (pulse, blood pressure, respiration, temperature and the patients estimation of pain). But, beyond these specific examinations, I will be discussing aspects of the physical examination, some of which has been the major topic of this blog.
Here is a portion of a document I created which I e-mailed to my students today in preparation of the upcoming session and which I will at the session detail further and answer the students' questions.
MODESTY AND PROPER DRAPING: Modesty varies with the patient, gender of the patient relative to your gender and the area of the body being examined. It is important to make the patient aware of what you are going to examine. Listen and watch for acknowledgment and consent. DRAPING is important for modesty issues but also to protect the patient from CHILLING which if it occurs can cause SHIVERING or unwanted increased muscular tone which may interfere with obtaining a valid physical exam. The DRAPING should be removed in SEGMENTS and only at the time that area of the body is about to be examined.
Yes, I will emphasize "communication with the patient" and that will include "listening" and "patient-oriented reaction".
Any suggestions for my teaching by my visitors here? ..Maurice.
From what I've read in these volumes:
Modesty varies with the patient, gender of the patient relative to your gender and the area of the body being examined.
->
Modesty varies with the patient, gender of the patient relative to your gender, the area of the body being examined, and the number and gender of underlings present at the exam.
REL
Regarding the incident that occurred at a hospital in penn. I decided to e-mail the ethics department for the American Nurses Association, I told them what had occurred, as well as the incident that transpired in Denver as well. Here is the e-mail that I got back.
PT
Thank you for contacting the ANA center for ethics and Human Rights ( CEHR). The ANA represents the interests of 3.6 million registered nurses and is the strongest voice for the nursing profession. Thank you for rich feedback on this issue that unfortunately paints nurses in a poor light.
ANA strongly believes that all nurses should exemplify ethical standards in all practice settings. Please check out our Code of ethics for nurses with interpretative statements. I encourage you to continue to have these discussions and encourage nurses to know and live the code of ethics every day.
Liz Stokes
AMerican nurses association
This has to be the most lame response I have ever received from anyone. I responded back to tell her, no that is your job. It is not my job to preach to nurses about ethics.
PT
Maurice -- This seems like excellent basic information, especially the crucial idea that "modesty varies with the patient" in all the ways you list.
In this course or this lesson, do you touch on the "chaperone" issue at all, and how to introduce that particular subject in a patient encounter?
RG
Dr. Bernstein,
Please amend your note to students to read " ASK FIRST, listen and watch for acknowledgment and consent. Any hesitation should be explored and discussed with the patient. Consent to examine private body parts SHOULD NOT be assumed."
Reginald
A mob of cna's were charged with felonies for posting humiliating pictures of nursing home residents on snapchat with their personal cellphones. This happened in Wisconsin and many are aware it is a growing problem as acknowledged by the Greg Crist, spokesperson representing the American healthcare Association. Who primarily is doing this according to the article, young females who are active on social media. I'm suggesting that includes about half the workforce in the entire medical industry. I rest my case.
PT
REL, I like your addition to Dr. Bernstein's statement "and the number and gender of underlings present at the exam." That is part of the issue. Too many in healthcare don't think it matter show many people are observing.
Reginald, a non-emergency physical examination is not performed until after the physician (or my case, the medical student) has taken a history and has developed a relationship with the patient during that process. Part of that relationship is to make the patient comfortable to "speak up" whether it is something in the history or in the relationship itself. When I sit with each student (twice in a year as part of an evaluation) I watch for the student encouraging such patient "freedom" in communication. This "freedom" should carry over to the physical exam. Again, first and second year students may spend 45 minutes to an hour first developing this relationship before examining the patient.
One thing to remember is that these first and second year students do not perform rectal or pelvic exams on patients,
In recent years, yea RG, I do go over chaperones bringing to them the concerns raised on this thread. The only "chaperones" the students may experience is that of the patient's family members accepted presence by the patient in the room. Most of the time the students do not take the initiative to ask them to leave and await that request to the patient.
I must say, this teaching experience all these 30 years beyond carrying out attention to my own patients has been a rewarding experience that all physicians should be encouraged to include in their professional life. Rewarding..also in the sense that we get reminded regarding the elementary ethical best of medicine in our participation in the early teaching of medical students. .. Maurice.
I find it most interesting that anyone would think a 20 minute meeting with a stranger would build any sense of "freedom" to discuss personal issues, especially with an individual who is between 20-50 years their junior. Sometimes medical people can be so ignorant about the human condition. Talk with a senior about what they tell a doctor and their answer is only what they want him to know- which means not everything or much of anything. Trust is a matter which is built up over a great period of time and experiences with a particular individual but never with a rotating staff one does not encounter on a regular basis. The big problem in medicine is that it is part of "the good ole boys" network and thinks and responds as males or "the good ole boys network". Society in recent years has seen the collapse of trust in the "good ole boys networks", such as financial networks, legal and judicial systems,and religious institutions,etc. which have long been bastions of the old boys networks because it has been discovered that they can't be trusted just as now we no longer trust the medical system to care about what is in our best interests as they function as a huge money making factory system of indifference. Sorry guys, but people in the medical industry should be talking to and seeking the opinions of your clients and not just teach young kids with no personal experience subject matter which will be thrown out with all other unnecessary information in the name of expediency. Feedback should be taken seriously because when treated with indifference people do make sure a large network of their social circle knows what has happened to them and in turn you are as the old expression states, "damned by faint praise" This is a situation brought on by the medical industry, because you are now an industry operating in large scale factory/assembly line models which you as the industry must correct yourselves internally before trust of any kind will be restored by clients. Now medical practice will dismiss any of this as not meeting their perceived criterion, however remember that a good part of your client base is as well educated as you and in many cases better educated than medical doctors and personnel. An , a lady I know that just turned 99 responded when I asked the silly question her philosophy of how to live a long life, she responded "stay the hell away from doctors and their staff"!
Hello again Dr. Bernstein,
I'm not sure why, even in an emergency situation, the patient isn't asked for permission to perform an exam (provided the patient is conscious and capable). Is it possible to spread the word re exam modesty and permission in your medical faculty meetings, convocations or discussions? Getting your colleagues on board exponentially increases the exposure of the topics. I understand that fellow professors may not welcome unsolicited recommendations re their curriculum content; nevertheless, a subtle statement that students seem to need advice re patient modesty, privacy and consent could plant the seed, even for those instructors of 3rd 4th & 5th yr students. I wish you well in the coming semester/ quarter.
Reginald
Good Afternoon:
The only way to curb these animals PT is to take away the urge to take pics and you do that by making it a federal offense for any healthcare worker caught on duty with a camera phone on their person.
Anyone caught gets fired and if inappropriate pics were taken the person is prosecuted & if found guilty gets a mandatory prison sentence.
Society needs to stop pussy footing around with this problem and address it so everyone is safe.
regards,
NTT
Dr. Bernstein, I have one suggested change. You said that the patient should be the one to ask family members to leave the room. A better way would be for the doctor to ask them to leave and then allow them to stay if the patient interjects saying it is OK for them to stay. That gives an out to the patient that doesn't really want family members there but is too embarrassed or intimidated to tell them. The doctor plays the bad cop rather than the patient. Sometimes family members are clueless and think they're entitled to a ringside seat.
Biker, your approach might be the "right" way for the patient's physician to handle to issue of family members in the room but I think that for first and second year students who are "using" the patient to complete their education, I think it is best to allow the patient to make the decision themselves rather than respond to "an order" by the student. Actually, family in the room are often helpful to the student in reminding especially an elderly or very infirm patient pertinent history missed by the patient. Another issue when family are in the room, the patient asks the student to return when the family leaves. This is not practical considering the limited time of the student group on the ward and we must find another patient for that student. Again, the student is NOT the patient's physician and does not have the "clout" of the physician (if that is the right term to use). But thanks for your thought. ..Maurice.
Maurice
I have no suggestions to offer in regards to your medical students. Why? It's just that I think it's pointless and I can predict with absolute certainty that after completing the program they will resort to the mindset that's been prevalent all along. I have given up on the entire medical community and appreciate that I've worked in the business for many decades. How are they going to be any different from say the 5th year resident who snapped a cell phone pic of his patient's penis and then shared it with other staff. How are they going to be any different from Dr Sparks, the female physician who groped her male patients for years. How are they going to be any different from the physicians who all crowded into an operating room to snap a pic of a patient undergoing genital surgery. I'm a critic because not only have I experienced unprofessional behavior as a patient, but I've seen it happen so many many times to patients to other patients. I believe it's getting worse and worse and there is no end in sight.
PT
Dr. Bernstein, I understand the difference as you describe it with medical students vs primary care physicians. It would still be good to tell the students that when they are physicians seeing their own patients that they should be aware that sometimes patients don't want their family present but the family dynamics are such that the patient can't tell them to leave. Just something for them to be aware of.
I do understand the situation with the very elderly. My wife took her parents to their appts.in their 80's and 90's and if she wasn't present, the doctors would never have gotten full answers to their questions. She'd have to remind her parents what they had been complaining about the day before. However she would not be in the room if her father had any intimate exposure.
In Pennsylvania a 27 year old female funeral director was arrested and charged with showing off cell phone pics she took of dead corpses as a means to gross out family and friends. Perhaps she wants a few weeks of free paid time off from her job or perhaps she read about the Denver 5 and the incident at a hospital in Pennsylvania. She is taking this exploitation to a whole new level and I'm sure many female nurses out there can learn a thing or two from this woman. This may just be the new rage, I guess live subjects have become rather boring which may be a good thing now for male patients that we get a reprieve from all these inappropriate cell phone pics.
I'm going to forward the article to the ethics department at the American nurses association so that they can disseminate this out to all other female nurses. As you see I'm doing everything I can to help male patients get the privacy they need. I'm sorry this is happening to the deceased but the medical community thinks that getting the body well is all that matters, they don't care about how we feel when we are discriminated against, they don't care about how men are exploited every day at medical facilities across the country. It's unfortunate that the dead can't complain about modesty issues or how they are exploited every day but I'm sure it's going to be happening more.
PT
Maurice,
In regards to draping, the BEST WAY is for the physician /student to tell the patient what they would to examine and why they want to examine it, then ask permission letting the patient know that they can alter or refuse any or all parts (without retaliation).
Then they can explain the procedure to examine (including draping) and ask if this is acceptable or do they have a better means to achieve the goal.
As per the legal requirement in ALL states, they need to let the patient know alternatives. For example, most physicians visually examine the genitals when a STI is suspected then follow up with blood and/or urine tests if not visually evident. They would need to let the patient know that if they refuse the physical exam, blood and/or urine tests are alternatives.
Finally, NEVER use words such as "I need to" or "I have to." Use "I want to." This implies that the patient and physician have NO choice in the matter as if some god-like entity ordered this. This has been one means of eliciting compliance from patients by providers historically. (Reference: "Behaviour in Private Places: Sustaining Definitions of Reality in Gynecological Examinations.")
--Banterings
Ah yes... "I need to..." The subtle and yet effective way to compel a patient to cooperate. I'm almost tempted to call this a (soft/softer?) form of coercion but I suspect some would disagree with me.
I've addressed this issue with my care providers on a few occasions. Mostly by challenging them on the use of the word "need." (something along the lines of "no, I don't think you need to; you might want to, you might even think it's a good idea, but you certainly don't need to"). Some providers will accept the rebuke gracefully, others... Not so much. The key is in the delivery. No need to be snarky.
I must have made a impression on some of them because it hardly comes up anymore (with my regulars, anyway). That or there's a notation on my file about this (and that wouldn't surprise me at all).
Thank you A. Banterings for the link to this article. Very interesting to read as it opens a window in the ways of thinking of medical personnel and how they endeavor to manipulate context, events and... Well, perceived reality (in other words, normalization).
Dany
Maurice --
I think REL, Biker, and I are pretty much saying the same thing about adding the "chaperone" issue to your discussions with students.
Over the past few months I've asked several female providers about this, and the universal response is that their med schools have recommended "chaperones" as a matter of course. Here's the publicly posted reply by "Dr. Linda" to my inquiry:
"We were trained since the time we were students to always have a chaperone with us when we are examining a member of the opposite sex. This purely for medicolegal reasons. I remember being told that you can never be sure who will try to make a complaint."
This is apparently the standard line. Anything you can do to challenge it would be very welcome. Thanks.
RG
Re the Denver 5 perverts: This sort of thing happens every day, numerous times, in hospitals and clinics across the U.S! It's just not reported, as nurses protect their own. It's a safe bet that the manager who simply slapped the wrists of these perverts was a former female floor nurse who enjoyed the same kind of voyeurism. Just reverse the sexes of everyone involved, and you'll see how ugly it is! Male nurses that committed voyeurism on a female client would not only be identified and fired, but would face serious charges via the BON and possibly criminal charges of sexual voyeurism, which is a felony - they might even do time in prison.
Yes, these female committed a serious crime; let’s look at Colorado’s statue which falls under sexual assault/rape: “The actor, while purporting to offer a medical service, engages in treatment or examination of a victim for other than a bona fide medical purpose or in a manner substantially inconsistent with reasonable medical practices.” And this: “The victim is physically helpless and the actor knows the victim is physically helpless and the victim has not consented.” This crime can be charged in Denver County, Colorado, or other Colorado counties as either a Class 2, 3 or 4 felony, and is often referred to as rape.
These criminals (and yes they are animals as another referred to them), should be publically identified so at least we know who they are and can reject them if they try to provide “care.”!
As said in this blog, it’s open season on male clients! No wonder males avoid the corrupt US sickcare industry!
E.O.
Hello Everyone . I came across a interesting article on male nurses in the military . ( Or should I say lack of ) . It may help explain why things are the way they are today . The mindset of the people in charge . Google history.amedd.army.mil/ancwebsite/articles/malenurese.html . Thanks again to our government for getting things wrong from the start. AL
A few weeks ago I sent a letter to the President of the local hospital pointing out that other than the one male doctor, 100% of their urology staffing is female, that 100% of their dermatology staffing is female, and that they only have female ultrasound techs. I pointed how that is unacceptable to me and also to other men that they will never hear from because they either avoid healthcare or they go elsewhere. I pointed out that I am getting most of my health care at their primary competitor due to their female-centric staffing model.
Today I got a response from the Patient Relations Dept apologizing for any bad experiences there and telling me that they do not hire based on gender but rather skill and experience. This next part I found very odd but she said they are not a BFOQ Employer and cannot hire someone based on their gender. The one good piece to the response was that they said they recently hired a male ultrasound tech.
While I am tempted to respond on the BFOQ item, I'm not going to bother. They heard my message and clearly are not interested in addressing the gender issue. No way would they hire a man as a mammographer so of course they hire based on gender.
Good Evening All:
Biker I find the statement "she said they are not a BFOQ Employer and cannot hire someone based on their gender" weird also.
That to me says they hire male mammographers & male nurses. Otherwise she doesn't know what she's saying or they are using the exception to hire females only in mammography and L&D & she's clueless. Every hospital is a BFOQ employer or women would be on the war path.
Regards,
NTT
Biker
You did good and I applaud you on this one as more and more hospitals need letters like this one. As I have mentioned many times any medical facility such as a hospital that employs only female mammographers and female nurses in L&D show a Hugh propensity for discrimination when male staff are not available. You see those medical facilities by hiring only female staff guarantee automatic privacy for their female patients yet not only can they not guarantee same gender care for their male patients, they cannot guarantee professional behavour as we have read incidents in the news.
Regarding the Denver 5 there is a YouTube of a talk show which I believe it's called Bob and something else with 2 males hosts and one female host on the talk show. The female host states that behavour as these 5 female nurses exhibited happens all the time. Not sure where she gets her info but I know it's an every day occurrence as I believe her, I've seen it. I'm rather sick and tired of the hospital spokesperson who say that the behavour that these 5 nurses exhibited in no way a reflection of the professionallism that our nursing staff provide as a whole. How would he know, they got caught cause someone told on them.
In upstate New York the female nurse who took a cell phone pic of her male patient's genitals, the hospital spokesperson said the exact same thing. Sad, these administrators have no idea what goes on in their own facilities. Finally I have one last question to ask.
Maurice
When you started this modesty blog I get the impression based on your comments that you viewed those who post here as outliers with modesty issues as some kind of an abnormality, in need of counseling with benign complaints. For 10 years now I have tried to help people see the big picture of what really goes on in health care. I've never posted the really bad stuff like malpractice deaths, cover ups, criminal behavour and issues that no one would think would happen in a hospital to their loved ones. For if I did the posts from me would be infinite. Maybe the incidence of Dr Sparks behavour, behavour of the Denver 5 or the female nurse in upstate New York should never be posted on your blog and maybe they don't apply in that they are criminal in nature, not applicable in the modesty sense. Nonetheless they are real events which as a whole sway our opinions about seeking opposite gender care, gender neutral, an elbow is an elbow, we've seen it all kind of bullcrap. Maybe what you seeing is the root cause or would it be that it's just behavour that is swept in to the medical ethics black hole, small and indiscriminate.
PT
Yes, PT, I have written that those posters to this blog thread may be statistical outliers but I have no statistics to say that they are. As I have explained in the past, I made that assumption simply based on my years of clinical experience and communication with colleagues. No patients have talked to me about concerns regarding any modesty issues. However, despite my experience, I have kept this thread going all these years because I don't think what is written here is "hogwash". I think the comments written here represent real experiences and concerns and upset.
I keep looking for some widespread action by those writing here but that may be just wishful thinking and it may be for the present the best that can be done is to "speak up" and not just to any common healthcare provider but to the institutional elite who hopefully have the power to make and encourage changes in the medical system to be fair and attentive to the concerns of patients of all genders ..Maurice.
In the wake of encouragement from PT, below is another summary of what might be developed into a "widespread" strategy. Most items are taken from suggestions that have appeared in these volumes.
1. Speaking up (courteously or aggressively)
2. Lawsuit
3. Complaining to insurance provider about care provided, particularly complaining to CMS
4. Using AARP (manner to be determined)
5. Reporting to a government agency
6. Forming an advocacy group (e.g., National Organization for Men's Health)
7. Linking with an existing advocacy group (e.g., A Voice for Men which has had some articles about men's treatment by the health industry https://www.avoiceformen.com/allnews/men-die-earlier-but-womens-health-gets-four-times-more-funding/ )
I hope someone will correct any errors and omissions that I have made in this summary.
REL
Good Afternoon Everyone:
Dr. Bernstein you're looking for some widespread action. Myself, I don't see that happening until and unless more men get past the stigma of being seen as weak if they open their mouths & just say NO.
I've been writing congressional representatives for months and gotten nowhere.
Our situation will only change after men do as women did and speak up in one loud clear voice.
The medical community has done a superb job of drilling it into men to hand over their dignity at the door then put up, shut up, and do as your told. Urology departments get an A+ for the snow job they've done to guys.
Until enough gentlemen are put thru their ringer then are willing to talk about it I just don't see any big movement on the part of the healthcare industry to fix this issue.
I personally don't know the contact info of any "healthcare elite" that I can call, write to or email and explain the situation to and ask for their help in correcting this wrong.
Maybe we need full page ad in a major newspaper to shine a light on their dirty little secret.
I'm open to suggestions as to how to get this issue out in the public forum.
Other than those of us that have been put through their ringer and know we can push back, I don't see anything happening until enough men see it for themselves & speak up.
Regards,
NTT
NTT, you know maybe starting out with a "full page ad in a major newspaper would be a worthy beginning. How much does that cost?
May I make a suggestion, I really believe that it is important that all who read this blog thread or write here should get together and form a group to design ad help finance a newspaper ad. I think that someone here should succumb and provide an e-mail address for the others to write. As Moderator here, it would not be fair for me to personally and directly take a stand on the issues presented here though I certainly understand the arguments presented here regarding the modesty and dignity issues. However, if one participant want's to lead this group with disclosing a contact e-mail address that would be appropriate, I have given out my e-mail address previously on the top of this blog for visitors to contact me and here it is again: doktormo@aol.com. I can forward e-mail addresses to the leader but it would be better to have someone other than me to be the recipient for this group project e-mail. ..Maurice..
Any comments on this? ..Maurice.
Here is an idea how to change the system: Write a "how to molest and get away with it" booklet aimed at people who are sexual predators. Illustrate how medical providers commit these assaults and get away with a slap on the wrist. Teach them to say that it was for educational purposes.
This would outrage the public to the point that real protections will be enacted...
--Banterings
Comment on newspaper ad: I certainly understand the desire to do something. However, I believe a reasoned strategy that can be sustained and modified depending on outcomes is better than a knee-jerk, one shot approach. Newspapers don’t have much circulation now and I suspect charge a lot to try to make up for their losses. Depending on the news of the day, an ad could have almost no impact relative to the effort and money put into it — too risky. Some thought needs to be put into this; I suspect that an organization or linkages to an organization with a web presence could gain momentum over time and would cost less. Just my initial thoughts on this proposal.
REL
Maurice
On a side note you said that " posters to this blog thread may be statistical outliers but I have no statistics to say that they are " We have to consider both sides of the fence. Consider all the female patients who in 2011 had a mammogram, 3 million. They too are statistical outliers
since they had a female perform their mammogram.
PT
I don't know if there is a precise meaning to "statistical outlier" that I'm not aware of, but every article/study I've read on the subject reports that male patients overwhelmingly prefer NOT to have third party witnesses during intimate examinations or procedures. The actual number run from 1% to 10% based on the study.
I haven't read studies specific to same-gender care preferences among male patients, but I don't think they would be hard to find if they exist.
RG
RG
Who would collect the data, why would they collect the data. After you are ambushed, that would be data I doubt they would not want anyone to see. What good would the data do? Who would act on it? You have brought up a good point! To say there is no data simply says there is no problem. Obviously, an elbow is not just another elbow as we have seen with the Denver 5 and I hope no one gets sick of hearing it cause I wont. I'm planning on squeezing every little bit of mileage I can as I'm going to throw this incident over and over in their faces.
I think a lot of the problem is education. Many males are ambushed and they often will assume that is just the way it is. They may not appreciate the way their care was administered but I doubt they feel there is no one to talk to about it. You really get the big picture when as a patient you are treated unprofessionally a number of times and you work in health care for many years as in my case. That is when you realize just how f$&ked up the whole system is from top to bottom. The entire medical industry needs an enema and I don't mean for therapeutic reason I mean flushed down the drain.
PT
PT --
You make a good point about incentive for a study of male patients' experiences and preferences. The excellent article on gyn exams (link posted above) was actually based on a sociologist's study. Perhaps that would be a better, less biased perspective.
RG
Good Morning:
The medical community's response would be why do a study? Majority of men come in & do as they're told. Everything is fine.
Until more guys push back & demand same gender care they won't take the time to listen to us much less do a study that they'd consider a waste of time.
Regards,
NTT
Hello Dr. Bernstein,
Your comment re media exposure or formation of an appropriate organization sounds right. If regular posters would like to form an organization devoted to same-gender care, the organization could write to hospitals, medical organizations, CMS to advocate for such care. This may have more of an impact than singular letters from private individuals. Of course, your name (as well as other interested medical individuals) would be necessary for even the slightest acceptance from the medical industry. Media spot ads could follow organizational inception.
Reginald
I agree with REL about newspaper ads. In my experience, paid newspaper ads have not really brought much attention to events for Medical Patient Modesty. So many people resort to online subscriptions today. However, I think it is a good idea to approach editors of newspapers and ask them if they will write articles about patient modesty issues or even allow guest authors to write articles in the newspapers at no charge. We also could ask them to post the articles to their Facebook pages (since many people look at Facebook pages for newspapers today).
The Chicago Tribune article on patient modesty in 2015 (http://www.chicagotribune.com/lifestyles/health/sc-hlth-0513-patient-modesty-20150507-story.html) has brought a number of people to Medical Patient Modesty over the past few years. The writer for this article approached Dr. Sherman, some of the patients MPM helped, and me and shared she wanted to write an article about patient modesty. We need to see more similar articles.
Misty
Hello again,
I just sent the following e-mail to Public.Affairs@oig.hhs.gov (Public Affairs, Office of the Inspector General, Dept of Health & Human Services). I intend to continue to try to find an ear at CMS. You may also wish to send your comments.
Public.Affairs@oig.hhs.gov
Today I received my Medicare & You 2018 booklet. On page 103, titled Know Your Medicare Rights, the following is stated "All people with Medicare have the right to:
Be treated with dignity and respect at all times
Be protected from discrimination".
I'm concerned that I cannot be treated with dignity and protected from discrimination, if I do not have the correlate right to same gender care, if I request it.
If I find it undignified, for cultural, religious or personal reasons, to be treated by a member of the opposite gender, I, as a Medicare beneficiary, am not being treated with dignity and respect, if this option is not afforded to me.
If a woman can expect to have same-gender care for her mammography, I, as a male, should expect to receive same gender care for my male-specific care. If Medicare does not offer me this, I am being discriminated against because of my gender.
Please indicate how Medicare can accommodate my, and other males', need for same gender care, to the same extent that is afforded females obtaining health care via Medicare.
Thank you. [End of e-mail to OIG]
Reginald
Reginald, Clearly stated with the specific matter addressed. The approach as being cultural, personal and especially religious hits the nail on the head. The fact that intimate medical care from opposite gender based on religious view is something they can not push aside-that trumps any objection.
Hello,
I received the following from OIG. Please indicate the salient points you'd like me to make (as succinctly as possible). I don't think Mr. White is as familiar with the issue as we are. I believe that he is considering direct, blatant discrimination rather than indirect, subtle discrimination. Please post the comments you'd like me to relate to him so that I might give a "unified" response. Later, others may wish to contact him to show that the remarks aren't from just one individual. Thanks for your input.
From: White, Donald B (OIG/OMP) [Donald.White@oig.hhs.gov]
Tuesday, October 03, 2017 2:26 PM
I’m wondering under what scenario you may have been denied same gender care?
If you are enrolled in Medicare fee-for-service you can choose any doctor, male or female, who accepts Medicare. If you are enrolled in Medicare Advantage you can choose your doctor from a network (and I have never seen a network with all female doctors).
Thanks for explaining further! -- Don [End of e-mail response]
Reginald
Reginald, he is only looking at this from the perspective of the doctor's gender. It is as if he doesn't realize that virtually all of the intimate care is provided by female nurses, techs, medical assistants and CNA's, plus of course the presence of female chaperones. Perhaps he is young and healthy and has not yet experienced the medical system.
Hello Biker,
I agree. I've drafted an (unfortunately) rather long response that I'd like others to criticize before sending it to Mr. White. I'd like to be certain that I've stated our case properly. Can you assist?
Reginald
Reginald, yes I would be glad to assist.
Other folks are taking notice; follow the link:
http://www.wbur.org/commonhealth/2017/09/08/patient-doctor-female-male-bail
Ed
Definition of Clueless, having or providing no clue, completely or hopelessly bewildered, unaware, ignorant or foolish.
The spokesperson for the hospital where the Denver 5 were involved in unprofessional behavior as well as the hospital in upstate New York where a female nurse snapped a cell phone pic of her patient's genitals said " this behavour is not representative of the great care our staff delivers each day " . How would they know that? Its clear they don't have a clue what their staff do each day if this kind of crap goes on.
Reginald
I believe any discussion with CMS should include examples of unprofessionalism as evidenced by Denver 5, the Ent in New Mexico as well as the nurse in upstate New York. There are countless examples on the web, however, it should be made very clear that male patients apparently are frequently exploited as patients and clearly don't have the choices female patients have. Point out that mammography is a 100 % dominated by female staff as is L&D. Ask him if he has been to a urology clinic and better yet I plan on writing these clowns since I need to send them boxes and boxes of examples. You know in the real world there is no cure for stupidity.
PT
I want to offer up another piece of how we came to where we are as concerns societal norms being that males should have no modesty in healthcare settings. Some of the older guys here may relate to this. Up until roughly the early 70's in much of the country middle & high schools and colleges that had pools had mandatory swimming classes for boys - no bathing suits allowed. YMCA's had strict rules against boys and men wearing bathing suits. The norm in schools and at the Y was no women were allowed during those classes.
School swim teams often wore suits for meets if there was going to be a mixed gender audience. However, there were places that suits were not worn during meets despite girls and women in the audience. The same occurred for YMCA-based swim teams. Y's had viewing days when Mom's, sisters, sister's friend etc could come observe the boys, and the boys did not wear suits on those days. Apparently it was deemed OK for the boys (all ages) to be seen swimming in the nude on these viewing days and at those swim team meets where the boys did not wear suits.
Pre-pubescent boys taking lessons at Y's sometimes had female instructors. Older boys always had male instructors, but there were times a female would substitute for the male instructor, and there were places where there were female assistant trainers for swim teams.
At the same time Middle & High School boys almost universally had to take gang showers after gym on the basis that boys had no modesty. This is why older guys tend to be more comfortable around other men than are today's younger guys.
Thinking about the mindset behind this, it is easy to see how it carried over into the medical world assuming that it doesn't matter for guys. It didn't begin in healthcare but rather just continued after nude swimming in schools and at the Y ended. Society never did think males were entitled to privacy.
Lloyd wrote the following to my general comment blog thread and I reproduce it here for you experts to respond. I left a link to here for Lloyd. ..Maurice
---------------------------------
Who chaperones my wife when the doctor or PA is a lesbian, for all you know she has a lesbian nurse for her chaperone.
Dr. Bernstein, concerning Lloyd we recently had some discussion that touched on the gay/lesbian matter. For me it doesn't matter. My guess is that the PA I recently saw as my new PCP, and who I could not have been happier with, is gay. I was totally comfortable with him. Having grown up in an age when boys were socialized to be comfortable being nude with other boys, I'm OK with being exposed to male medical staff. Having spent as much time in locker rooms as I have, I'd be foolish to think I haven't been naked in the presence of gay men many times. Doesn't bother me.
Being nude in front of clothed women is an entirely different matter. That was not something I was raised to be comfortable with nor have I acquired a comfort level as an adult. That said, due to no-choice necessity I have been exposed far more than most ever will, and whether they were lesbians with no attraction at all to me or straight women who had no attraction at all to me matters not. They are women.
A big piece of this for me is a resentment of the double standard they represent. Female nurses & techs who expect male patients to be comfortable with them while they themselves would never allow a man to do their mammogram strike me as disingenuous when they say there is nothing sexual about healthcare. It certainly is to them when they are the patient. I don't like their sense of entitlement to see and/or touch me when exposed.
I think a lot of the problem is education. Many males are ambushed and they often will assume that is just the way it is. They may not appreciate the way their care was administered but I doubt they feel there is no one to talk to about it. You really get the big picture when as a patient you are treated unprofessionally a number of times and you work in health care for many years as in my case.
I just read the article by Carey Goldberg that Ed posted (Sunday, above). I noticed that comments are already closed, but I sent an email to the author with some further observations.
RG
Just a thought, but maybe we should recruit female MDs to our cause of extending respect and dignity [in general] and modesty [specifically] for males. Women seem more sensitive to modesty than men and female MDs might be willing to take on an advocacy leadership role for male modesty in the medical community. A selling point to female MDs would be that if they assume a leadership role, it could benefit them with increased wages.
According to Fortune magazine, Oct. 1, 2017 issue, page 15, regarding "new government data released in mid-Sept. offered some good news" regarding the "gender wage gap" for slightly overall improved wage percentage for females. The source is the Bureau of Labor statistics, 2016 data. However, female "physicians and surgeons" make 63% as much as male physicians and surgeons, next to the bottom of 35 industries/fields.
If female MDs evinced leadership, they might be in position to demand higher salaries. Then again, the health administrators, bean counter execs, and owners [MDs in CA If you believe the LA Times newspaper that all medical facilities in CA must be owned by MDs - of course, they only need to be the titular owners] only care about their customers who are the health insurance companies and the government who pay most of the bills. Again, these "bosses" couldn't care less about male modesty.
BJTNT
The health administrators couldn't care less about patients as people, but that doesn't mean they don't market to the contrary. Many TV commercials by health administrators promote variations on the theme that the medical community cares for patients - meaning care for patients as people and not care as in treatment. Several examples: "We don't just treat you, we care for you" and "...to feel safe, comfortable, and well cared". It's too bad they didn't take a course in the business administration college where they would have learned to evaluate marketing and also may have heard this story. Fifty years ago car dealers used to advertise that they were honest. They wouldn't think of doing that today because they realized that all they were doing was informing the public of their dishonesty. Had health administrators learned this lesson, they would know that today's advertising about "caring" is simply telling the public that the medical community has a reputation for not caring for patients as individuals - just objects to be processed.
BJTNT
BJTNT
No, I don't think female physicians would be a viable option or an expectation to enroll as a recruitment for our cause. First, female physicians earn what they do only because they don't as a whole work the kind of hours that male physicians do. Secondly, they are the ones who tend to ambush male patients with female chaperones. I tend to think its a deliberate act not out of advocacy for the patient but rather in their mind they are protecting themselves from an attach or whatever. I just don't utilize female physicians, I work very hard to avoid any kind of female caregiver in any aspect, I simply don't care for their demeanor. I'm the consumer, the patient and I am the one who chooses since I'm paying for it.
PT
I think that reaching out to female providers would be an excellent idea. Dr. Linda Girgis comes to mind immediately, as an example of a female physician who is responsive and sympathetic to male modesty issues. She posted Robert Underhill's article "Why Men Patients are Forced to 'Man Up'", and in the responses she has consistently supported and defended male rights to modesty against others who fail to see the problem. Every personal encounter I've had with female providers -- except one, of course (the "chaperone" ambush that brought me to this blog) -- has been respectful and sympathetic.
From my own research and my own discussions with female MD's and executive staff, I strongly suspect that current med-school training is the real culprit: I've heard many times, including from Dr. Girgis, that students are taught ALWAYS to have chaperones, that it should be automatic and universal, and that is for their own legal protection. Bureaucratic solutions are always easy to implement, because you don't have to think case by case. Push-back from patients could help to challenge that training and mindset, but enlisting sympathetic, caring female providers could be even more effective.
RG
As I have said previously, the only chaperone I have used in my practice was a female for my pelvic exam of a female patient. Usually it was the office nurse but a patient's family member would be sufficient for me.
We teach the same to our first and second year medical students. As far as I know, the students are not taught to have a male chaperone and certainly not a female chaperone when a female physician examines a male's genitalia. The correct approach should be to have the one being examined to decide if a chaperone of the patient's selected gender should be present.
If a medical examination is to be subjected to accusation of criminal behavior then certainly room camera recordings only to be inspected by officials at the time of formal investigation of events should be available. ..Maurice.
Dr. Bernstein, standard recommendations to use chaperones for intimate exams don't speak to the gender of the chaperones. This is surely because those promulgating those standards know that most practices only employ women.
I have never had a PCP that had any males on staff. Until this year I have never had a urologist that had any males on staff. I just made an appt. for a full skin exam with a huge dermatology practice at a large hospital. 14 physicians (10 female) and 9 Residents (4 female) and otherwise not a single male staff member in that practice. None. A scribe and nurse accompany every doctor into the exam room so they literally have several dozen staff members supporting them, and every one of them a woman. As an aside, that appt.is in a couple weeks. Afterwards I will do a post on how I handled that situation.
It comes down to chaperone = female. Has anyone here ever had a male chaperone?
Maurice
Room camera recordings, Really! Who has those in their examining rooms without the patients knowledge? You see, you just explained the root cause of the problem, round and round we go where it stops nobody knows. You said " certainly not a female chaperone when a female examines a male's genitalia." Tell me where is there a male employee in a male physicians office aside from the male physician? I've never seen one! Why would you think a female physician would employ any male in her office. Maybe she could run next door and ask one of the guys in Domino's pizza! No probably not cause in her mind she would just ask her receptionist who just turned 19, who is busy chewing gum and on her cellphone Facebook if she could come in to the exam room and watch her examine a male patient! Genius just Genius and people think we should enlist the help of female physicians for our cause, Really!
PT
Maurice
We are on the 81st running of this blog and quite frankly I'm just flabbergasted at what I read, I guess I should just admit daily to myself that despite millions of years of evolution the concept of Homo sapiens is it really just a misnomer, that as a supposedly civilized society we really can't advocate for half of all people or is it too much to ask? I've indicated my dislike for attorneys but I think in the end those are the ones who might be able to pull us out of this bloody crap and I hope it's a bloody war with blood and guts everywhere. It's one that the discriminating medical industry deserves and I hope it's a costly one.
PT
PT, if all else fails, take the matter to court. That may be the best way to make changes if the responsible system fails to act.
As with regard to in room videos or patient taken videos, they should only be taken with both the patient and physician's approval. If both parties understand the reason for filming and if the patient disagrees with the decision, shouldn't the patient-doctor relationship be discontinued?
With regard to chaperones, they should only be present after discussion and approval of both patient and physician. If you want an example, as an internal medicine physician, last week at the free clinic with primarily Hispanic patients which I attend, a middle age patient needing a pelvic exam wanted a female gynecologist and it was arranged. She also needed at the time of the visit skin of her breasts examined and both she and I were satisfied with her mature daughter being present for that examination. The patient spoke only Spanish but her daughter was a excellent interpreter so I had my regular male interpreter for Spanish speaking patients leave the room for the breast exam.
Students, not in medical school should not be present shadowing physicians without pre-approval by the patient and if the patient is not made fully aware of reason for the student's presence. Actually the same criteria should apply to medical school student who are shadowing in the clinic or on the ward. And that should include both genders of students and patients.
The presence of Scribes, male or female to me is an "unprofessional" interference in the doctor-patient relationship and are only present for the time-saving money-making metamorphosis of "modern medicine". They, too, should be identified and approved by the patient if they are "needed" by the doctors, office or insurance system..
Anyway, this is my experience and philosophy. ..Maurice.
Maurice
In no way would I ever disparage or deprecate someone seeking care at a free clinic while requesting same gender care. If she were able to negotiate that on her terms, good for her. On the other hand I have excellent health insurance so I'm told which I'm paying for out of my pocket. Despite it being called platinum plus blah blah blah, I disagree. The mere fact that I'm a White male puts me in an entirely different category. Where do you think I can negotiate those kinds of terms? I'm not going to even begin to write about the lack of quality care one can expect these days let alone respectful care if you are a male patient. If you are a white male that health insurance card is meaningless.
PT
Regarding cameras in exam rooms; you best closely read those generic release forms so many university medical hospitals and general hospitals "require" to sign. There is probably a clause about recording appointments or procedures. Any time I see any new doctor I present a standard letter written by my lawyer stating that cameras are not permitted and you must permit anyone the doctor to be present takepart. I have also had it entered in my records that I will not deal with female doctors or female staff as a result of gross sexual attack by female staff in the presence of a female doctor who did nothing. Despite what some foolish receptionist might say , you may legally cross out any section of their release you do not ascribe to, sign and date it. I cross out everything except their ability to bill my insurance. I will not deal with interns or residents either. My education in 1964-1970 was equal to any top professional and I never expected anyone to give me a free education by observing, listening in, or privy to intimate personal discussions with my professors in professional settings. As far as giving future doctors a free education-bah humbug!! As I said once to a testy doctor trying to force the issue,I responded by saying that I charged $275 per hour consultation in my business so if the young buck was prepared to write a check that was a different matter. The best education costs a heck of a lot of cash and appreciation is only in relation to the cost. I am a paying client not some freebee-so let's be professional all the way. Lastly if you expect to addressed as DR.. address me as Mr.-don't try to play alpha male games and show respect to the client. In my business, I never addressed a client by their first mane so as to maintain a client/professional boundry and respect.If some wet behind the ears 20 something staff ever addresses me by my first name, trust me they will never do it again and I do bring it to the attention of both the doctor and office manager. Most staff in offices and hospitals are now growingly vocational school graduates who have never been taught by parents,educational institutes or their employer proper social or professional etiquette.
PT --
I had a shatteringly traumatic experience with a female provider who positioned a female "chaperone" at my right hip for the sole purpose of staring at my genitals for an entire 10-minute examination. That was a horrible experience, and I am still recovering from it, but it remains the ONLY negative experience I have had with female providers, before or since.
If you haven't read Dr. Linda Girgis's comments (see my previous post), please do so. She is articulate and eloquent in defense of male patients' equal rights to bodily privacy and dignity. My current therapist is female, and has been unfailingly supportive and understanding -- she's been on my side even when I wasn't myself; she's pulled me out of inappropriate self-criticism more than once and helped me remember that my feelings are legitimate.
If we as male patients are being systematically discriminated against, we can't afford to turn away allies of either sex, particularly allies within the medical system itself.
RG
Dr. Bernstein, if everyone approached medical interactions in the manner that you did, there probably wouldn't be a need for this forum.
PT, not to get you riled up even more, but when you referenced the just turned 19 year old receptionist being used as a chaperone, I thought to myself that here in VT and in NH (and maybe some other States), you can drop out of high school at 16, get your LNA license, and go to work. My understanding is that most hospitals require you be 18 but those 16 year olds are going to work in nursing homes and rehab facilities, and perhaps doctor's offices too. Even without being licensed as an LNA there is nothing stopping those 16 year old drop-outs from being hired as a receptionist in a medical practice and then being used as a chaperone. So, that very young looking girl coming into the room may fact be very young.
Coming back to your comments Dr. Bernstein about shadows,you may recall my couple posts about digging into that with my local hospital. I was never able to get further than the patient can refuse a student and that students wear a name tag identifying them as students. The problem is that the actual status of the students (high school, college. medical school, nursing school) is not made clear to the patient unless the patient asks and in the case of OR scenarios the patient may never even be told that a student will be present. The hospital hides behind the patient having signed a multipage form that includes the word student somewhere, and with that signoff happening in the pre-op area after the patient's glasses have been taken away.
My local hospital allows students as young as 14 to observe surgeries, with no limitations on the nature of the surgery or whether the 14 year old watches the prep process. The only constraint is whether the doctor they are shadowing imposes any limits. When I was trying to understand actual practice I came across the Student Doctor Network forum. Doctors there stated that there is no need for restrictions in the OR on young teens shadowing being the kids are just observing and have no impact on the actual surgery.
16 & 17 year olds from the local Tech school LNA program are doing their clinicals at the hospital, including working in the OR, and taking part time jobs there if they turn 18 during their senior year in high school.
During a time when most industries are using technology to cut costs, why are scribes present in medical offices? There seem to be many options such as this one: http://blog.iscribehealth.com/why-you-should-replace-medical-transcription-services-with-mobile-ehr Note that they even mention patient comfort as a motivation. It’s hard to think of another industry that isn’t trying to reduce labor costs.
REL
Biker in Vermont, I have read a number of your comments and find them very insightful; so I would ask why you would make an appointment for a full skin exam at a hospital with 14 female dermatologists and not a single male staff member which means there will probably be at least two women present for your exam.
Perhaps you are unable to travel far enough to find a male dermatologist; but if you can do so I think it would be well worth the trip because you would most likely feel a great deal more comfortable during the exam.
Another reason to avoid this dermatology group is their utter lack of concern for male modesty. And as long as a significant number of men use their services, they will see no reason to change. However, if the number of male patients decreased enough to effect overall profits, then they might decide to hire at least one male dermatologist and perhaps a male nurse or two. They obviously don’t care about male dignity or modesty but I can assure you they are quite concerned about the bottom line financially.
If you can go elsewhere, I would suggest you write or call the dermatology department to cancel your exam and tell them you would likely return to their practice if they were to hire some male practitioners. Perhaps even one call like this could start them thinking differently about the gender of their next new practitioner.
Wherever you do go for your exam, I sincerely hope you receive the most professional and respectful treatment possible.
MG
MG, except for the physicians themselves, dermatology practices, similar to urology practices, are otherwise almost universally 100% female staffed. Locally there are 2 dermatologists where I live, one male and one female, both with all-female staffs. Any other option is 1 - 2 hours from here. I was told that the local male doctor is not very thorough in his exams and so I discounted him.
Where I have an appt. is 1.75 hours from here at a large teaching hospital. They have 14 dermatologists, 10 of which are female, and 9 Residents, 4 of which are female. I asked for a male doctor and was offered an appt. with a male 2nd year Resident which I accepted. I asked for any other staff that will be present to also be male and was told they do not have any male nursing or scribe staff at all, and that there would be a scribe and nurse present. I expressed surprise that such a large operation would not have any male nursing or scribe staff and that it makes me uncomfortable to have two female observers. At that point I got a little attitude from the scheduler but did not pursue it any further. I just filed that away for a future letter I will write after my appt.
I assume that the nurse will first take a history from me before I see the doctor. My plan is to very nicely tell her that I have a favor to ask. I will tell her that while I am totally comfortable having a full exam by the doctor I am uncomfortable having two female observers present for the genital & rectal part of the exam. I will ask that the scribe be positioned facing away from me as there is no need for her to see me at any point in time. She can hear the doctor without facing him. I will further ask the nurse that she either leave the room when we come to that part of the exam or that she at least face away rather than watch. Those are things they can easily agree to do. Those two women aren't the ones who only hired females so with them I need to just focus on the things they can control. Afterwards I will write a letter about the female-only staffing, and include any other complaints about what I may actually experience.
MODERATOR'S NOTE: thanks to Medical Patient Modesty for her submission of the posting below. Since I don't approve of frank advertising on this blog, I deleted a physician's website link which her contributor added to his comment Write to MPM if you want the link. ..Maurice.
Hi everyone,
There are so many comments here about negative experiences male patients have with their wishes for modesty not being accommodated. I think we all should look at positive experiences male patients have with doctors who are willing to accommodate their wishes. I am looking at starting an online directory of patient modesty friendly doctors who have accommodated patients’ wishes for same gender intimate care, no general anesthesia, etc. Of course, there are many medical professionals who are not sensitive to patient modesty, but I feel we need to focus on medical professionals who have worked to respect patients’ modesty.
I was very excited to learn that a man who found Medical Patient Modesty’s web site 6 months ago shared how he decided to fly to Utah from Maine because he found an urologist willing to do his procedure under local anesthesia with no sedation. This urologist also accommodated his wishes for no female nurses. A male PA helped. Al from this blog also talked to this guy, BH on the phone. I have posted his story on the web page about standing up for your rights to modesty. I have copied and pasted his story below. I feel this man is a wonderful example. He took the steps to find a doctor willing to honor his wishes. I encourage all of the male patients on this blog to follow his example.
Like millions of men, I suffer from BPH. The prescription drugs have unwanted side effects, as does most surgery. A new technique called UroLift installs permanent implants within the prostate that open the urethra. I decided I wanted this procedure. Many practitioners offering this procedure insist on general anesthesia which entails an operating room full of people and there is zero modesty associated with the lithotomy position. I found the doctor, Dr. Steve Gange, a urologist in Utah, served as the lead investigator during the trials leading to FDA approval. He’s done almost 400 procedures since 3/2011 and is now the primary instructor for the manufacturer and travels all over North America lecturing and teaching other urologists how to perform the procedure. As a result, he has participated another several hundred UroLift procedures. He was the first urologist in the world to perform the procedure under strictly local anesthesia, and he continues to offer UroLift under strict local in his Salt Lake City office. It only takes 20 minutes for the local anesthesia to take effect and ten minutes for the procedure itself. I reported to his office at 8:30 am and was back in my hotel at 9:30 AM.
I elected to fly to Salt Lake City from Maine for this procedure because of my desire to maintain my modesty and Dr Gange’s expressed willingness to accommodate my concerns. Although we had emailed about this prior to my travels, to my surprise on the day before my scheduled treatment I got a message from the office manager that Dr. Gange would be assisted by a female nurse. I contacted Dr. Gange regarding this and reminded him of my concerns his response was immediate: he arranged to have a male PA assist in the administration of anesthetic and the procedure itself. And that is what happened. In the end, Dr. Gange shared that he would be happy to accommodate requests honoring male modesty for other male patients. I was very pleased with my experience and particularly how Dr. Gange accommodated my wishes for modesty. I strongly recommend him for any male patients who are modest. It was certainly worth going all way to Utah.
[WEBSITE OF PHYSICIAN DELETED BY MODERATOR]
- BH ( Male ) From Maine
If you haven't written to Medical Patient Modesty website, here is the address:
http://www.patientmodesty.org/index.aspx
..Maurice.
I dealt with Dr. Gange in 2010. Was I insulted and demeaned by him-total waste of time. Came to the appointment to listed to a cat fight going on with his all female staff. He wanted a scrotal sonogram so his or person made a referral to a female staff only at a hospital where they are all professionals[ha], then a ultrasound clinic, again all "professional" women. Dr. Ganges' major concern during the appointment was convincing me to have a DR exam which had no relationship to a hydrocele. Ps. Another male doctor was in the hallway hitting on another female staff. Avoid him at all costs!
Thank you *Reginald* for noting the CMS survey link on 9/22/17. I was unaware of this survey and have just completed it (travel prevented me doing it earlier). As I’ve advocated for years, patients need to speak up, complain, write their providers, their providers administrators, regulatory agencies (Joint Commission) and the government (CMS, OIG, State licensing, State Attorney General, etc.). By doing this continually health care providers can no longer SELF justify their discriminatory behavior by “we’ve never knew this was an issue”, etc.
A note about scribes. They are not medically necessary. They exist only for the CONVENIENCE of some physicians. If your physician has scribes you can tell him/her you do now want the presence of a scribe. The physician will, like most still do, have to document their encounter with you themselves (boo hoo). If the physician says they cannot provide service without the presence of a scribe that means it is more valuable to them to quickly document your encounter and get out of the exam room faster than actually address your reason for visit. Probably in the long run you may not be happy with such a superficial physician.
A note about chaperones. Chaperones almost always exist for the protection of the medical institution and the provider, NOT the patient (I know this from years of working Compliance and Risk Management at very large medical centers). They almost never benefit the individual patient, other than perhaps inhibiting in some cases rare hidden inappropriate behavior by the examining physician. Patients are better off getting educated about what the examination entails & what to expect and getting a physician they feel comfortable with where they do not need a chaperone present. If the clinical institution insists that a chaperone is their absolute policy, the patient should insist on a chaperone of the gender they prefer. This is part of your RIGHT to PERSONAL PRIVACY. You can also request a friend/family member serve as the chaperone but likely you’ll find the institution/provider will not find that acceptable (because chaperones, if used, are to protect the institution and provider, not you so they would view your friend/relative as not protecting THEIR interests).
Encouraging to see all the contributors who are advocating for changing the biased health care system! - AB
Why scribes? Tell me why MDs feel electronic health records are such an abomination. If an MD can type it would seem to me that an MD could enter patient data faster than hand writing which used to be acceptable without complaints.
Why a scribe? As I described in earlier posts, I selected a dermatologist who had a male scribe. After several years, he was replaced with a female scribe. I was told that the male was no longer employed. When I asked the MD to do without the scribe [which he did] he found two items needing attention requiring a female tech - the first time anything was found. The MD even said "it's probably nothing, but...". Lab results showed "nothing",so am I ungrateful since I viewed it as pure vindictiveness by the MD for challenging him. I changed MDs and didn't spent/waste my time trying to find a male scribe. I asked the new MD to view my groin before the scribe arrived. He even blocked the door so she couldn't enter - my kind of MD. And he found nothing again.
BJTNT
Since, physician Steve Gange, an individual whose behavior was not "in the news", it is, based on the conflicting descriptions written to this discussion blog,that it would be fair and appropriate for me to offer Dr. Gange, if he reads this blog, my offer to him to present a reply for publication. ..Maurice.
Hello,
I've been reading the latest posts re scribes with amazement. The GP that I visit in Southern CA uses a small (2 in by 4 in) plastic device attached to his computer. He speaks into it and it writes into the computerized record. He must sometimes enunciate clearly to avoid incorrect words being printed; otherwise, it is a fantastic time-saver. I'm listening as he's talking; and, I can make corrections or amplifications, if necessary. With the exceptions of some grammatical errors ("here" instead or "hear", etc.), the system is marvelous. He, I and the computer are the only ones in the room. He's a Dr. in his early 60's, accepting no new patients; nevertheless, he embraces computerized technology. I say three cheers for computerized records and voice recognition software. Other posters might encourage the Dr.'s they visit to get with the (software) program. What's a scribe, again?
Reginald
As an addendum to my previous post regarding the reason technology is not replacing medical scribes, here is a link to an incident last week in Florida where a physician becomes aware that there is a record of his words and behavior:
http://www.gainesville.com/news/20171010/police-look-at-doctor-after-patient-altercation
Notice how violent he becomes at the end of the video in an attempt to destroy the record.
REL
Dr. Bernstein,
I actually have communicated with Dr. Steve Gange via email and he was very positive toward male patient modesty. He shared with me he was willing to accommodate requests for male modesty.
Would you like for me to email him and ask him to respond to this blog?
Misty
what happened to the days when a doctor used a legal tape recorder and then another employee retyped the recording for the client's file. No one else had to be present to put more stress on the client with a third party listening or observing; bearing in mind that proper recordings can be admitted for legal purposes.
Read Gange's reviews and you will have a clearer idea reactions from clients not his self boasting which is stated in a number of critical reviews. His personal comments to me regarding a hydrocele during a first appointment were, 1] "That's the biggest one I've seen", 2] "This must be awfully painful", 3] "You must be awfully embarrassed". To his last comment I responded why should I be embarrassed by a natural occurring process--no response. Then he wanted to know if I was circumsized- as what that has to do with a hydrocele-idiot. All the while from the time I entered the room he pushed for aDRE asking me to strip off even before any discussion. That alone sent up a major flag. Then having to deal with the craziness of female only scrotal sonogram was the deal braker. Office never called to ask if I was making a future appointment or if I was interested in returning, especially after telling the coordination female person why were they so backwards that they did not have a male sonographer or male nurse in their "prestigious" practice. Again no response. This is a doctor referred by my general doctor as the best. Later over another matter I filed complaints with my insurance company and Medicare for his fraud forcing me into a testing which he said was mandatory by Federal gov't and Medicare!! Be carefull of medical practice in Utah. I also lived in Maine for 34 years and there are some great doctors in Maine from Havard, Yale,Boston and Tufts. Harvard medical center is #1 in the nation. The top rating in Utah is #53 and others lower.
Ps. I did have a scrotal sonogram 4 years latter at the "leading" center in Utah, U of U. I inquired in advance if they had a male tech, which they didn't. I asked if a male DR. of radiology would handle the process--yes, yes, and again yes. No remark that females are professional. However when radiology called to make the appointment I inquired if they could meet my doctor's orders for a male thech just to see the response. Again, the classic response, "We are all professionals". A quick call to my general doctor with the receptionist's name all was clarified when the head of radiology called back to schedule my appointment with a male radiology DR. However, dealing with a urologist in their system was dealing with an abusive and demeaning man who felt as a male survivor of sexual assault by female medical staff at age 20, I should "man up' as there would be female nurses,interns and/ or anesthesiologists present during the surgery. This was his DIAGNOSIS of my medical situation, I had to man up ; never addressed the hydrocele.There was no discussion of the medical situation. I told him to leave and not to bill BC/BS and then called the insurance company to contest and billing from him. The radiologist Dr. was a different story-most competent. I did ask why men are not given the choice of a male tech or radiologist. His response was that no one asked. I suggested that should be stated as an option when an appointment is made regarding a male because most people do not know how the system works and a little help with information would enable the hospital to corner the market in this field and thus increase revenue. Have no idea if this was received or implamented. I realize that because of my educational and business background I am so used to thinking outside the box I am stunned that other people do not.
The discussion about Dr. Grange, whom I do not know nor have ever had experience with nor am commenting on in anyway, raises the obvious question of what would be indicators a physician is concerned about not only female, but male patient modesty, privacy and comfort? As many to this blog have commented, one indicator would be whether the urology physician, clinic or practice has hired ANY male medical assistants, male sonographers and rad techs, male nurses, male NPs and/or male PAs? Since a urology patient spends as much or more time getting special prep & tests of their genitourinary system with unsolicited ANCILLARY people as with their solicited doctor, any doctor who professes concern for their patients privacy, comfort and modesty would have to address appropriate staffing of these ancillary people and services to accommodate both sexes preferences seamlessly.
As most male patients in the US know, there are just a VERY SMALL percentage of clinics, especially urology practices, where male staff are hired and choice to the patient is offered. So frankly unless the physician/clinic can demonstrate they have staff and processes to accommodate patient preferences, they are NOT concerned about patient modestly, they are not concerned about non discriminatory hiring, and they are just trying to lure more male patients in for more quick revenue. -AB
Misty, I would most appreciate that since you already have been in contact with Dr. Steve Gange that you would contact him about my blog and indicate that there have been conflicting information presented on my Bioethics Discussion Blog about his responses to the issue of modesty of male patients and that there have been conflicting information on this blog. Indicate that the moderator want "equal time" for his views (since this is a "discussion" blog) and that I hope he will come and present his views. He should sign in formally with his name to blogger.com and not appear as "anonymous".
The subject being discussed here is very important and we need to hear from all sides of the issue. So.. Misty I would greatly appreciate your help in communicating this to the doctor. Thanks. ..Maurice.
I have a question for dr Bernstein or anyone here. Would you consider the chaperone ambush others have talked about here (female with male patient) to be sexual harrassment?
To Anonymous from today: If, in fact, the patient had never approved of the presence of a chaperone provided by the physician before the chaperone entered the room, I would call the incident a lack of informed consent. If what is meant by "sexual harassment" is "Unwelcome sexual advances, requests for sexual favors, and other verbal or physical conduct of a sexual nature that tends to create a hostile or offensive work environment" (changing "work environment" to "medical exam environment", it would be dependent on intent and behavior of the chaperone and the absence of consent by the patient. To me, if the intent was benign (to be a simple unprejudiced witness) then without patient permission I would say it was attending without consent. And that would be unprofessional for those involved with the patient. I always notified my female patients receiving a pelvic exam that I would be calling in a female chaperone. I had no rejections.
On an entirely different topic but modesty related. 4 days ago I underwent a right cataract surgery operation and guess what I was told while in a room preparing for the surgery: I should keep my pants and shoes on under the gown I put on. This made clinical sense to me and I felt the experience would be "professional". So far, I am very pleased with the surgery results! ..Maurice.
I agree with Dr. Bernstein. Ambushing a patient with a chaperone is not sexual harassment. It is unprofessional and it does fail the informed consent test.
I am glad to hear how the cataract surgery was handled and that it went well. Some facilities/physicians get it. Others, not so much. A little push back in this regard can also yield results. When I had an upper endoscopy the Medical Asst who brought me to the room hands me a gown and says "everything off". I ask why. She says because of the sedation. I say I'm not being sedated and she then doesn't know what to do. An RN comes by and when I again question the need to be nude says I only need to take my shirt off.
Pleased to hear about Dr. Bernstein's cataract experience.
Along those lines, for my recent (first) colonoscopy, I asked to wear a jockstrap to preserve the most basic modesty. My ENT agreed and noted it in her directions to staff. Nobody gave me any trouble about it, and it was still on when I woke up.
Not sure where I stand with regard to unannounced "chaperones" as sexual harassment. The fact that mine did literally nothing but stand and stare at my exposed genitals for 10 minutes certainly felt like harassment.
RG
What made my experience with cataract surgery even more professional was that the "no need to remove pants and shoes" was part of the surgical protocol and no request was necessary by me. ..Maurice.
RG, the jockstrap sounds like a great solution, though I do have a question. My last two colonoscopies were without sedation so of course I was carefully covered the whole time. The first two I was sedated and at the time assumed there was no reason for my front to be exposed. Am I not understanding some aspect of the procedure once patients are sedated?
Dr. Bernstein,
It is encouraging to hear about your experience with cataract surgery and that they told you to keep your pants and shoes on. At some hospitals, they require you to even strip everything including underwear for cataract surgery. Hopefully, this ridiculous policy that underwear should be removed for surgeries that do not involve genitals will be abandoned completely.
I assume this was done at Outpatient surgery center.
Misty
HERE IS THE TEXT SENT TO ME TODAY BY MISTY RELATIVE TO A RESPONSE BY DOCTOR GANGE. ..Maurice.
Dr. Bernstein,
Here’s the email response from Dr. Steve Gange! Can you please post this in response to Mitripopulos on the blog?
Misty
From: Steven Gange MD
Sent: Monday, October 16, 2017 11:24 AM
To: info@patientmodesty.org
Subject: RE: Responding to Patient Modesty Blog
Misty:
1. I am not a blogger, and can’t tell how to sign into this one
2. The inflammatory remarks from a pt from 7 yrs ago really deserve no comment but if you’d like to register something run this by Maurice—maybe he would be willing to post on my behalf
In reference to comments made by Mitripopulos regarding an appointment with me from 2010, I would first say that I’ve never witnessed a “catfight” or a male staff member “hitting on a female staff person”, EVER in my 25 year career, so I call those comments, and the entire post, into question. In general terms, if a man (or woman) in a medical environment has modesty that requires an adjustment in standard practice that concern should be voiced (see the post from BH, who did just that); I among many physicians will always do what I can to maximize patient comfort, and make specific accommodations as I did for BH.
One final comment relating to Mitirpopulos’s post: an annual DRE is standard of care for a man 50+, and earlier if a family history of prostate cancer, so I believe my recommendation was valid
From: Medical Patient Modesty [mailto:info@patientmodesty.org]
Sent: Sunday, October 15, 2017 3:52 PM
To: ppmd@wucmd.com
Subject: Responding to Patient Modesty Blog
Importance: High
Dear Dr. Gange,
I really appreciate your willingness to accommodate male patients’ requests for modesty. I really appreciate what you did for Barry and his story is very inspiring to men who care about their modesty because so many men just avoid medical care due to modesty concerns.
I posted BH’s story on this doctor’s patient modesty blog at http://bioethicsdiscussion.blogspot.com/2017/08/patient-modesty-volume-81.html#c8964636327226889199. Right now, the discussion is mainly about male patient modesty. The doctor who moderates this blog is Dr. Maurice Bernstein, a medical school professor. Both he and I were concerned when one person (
Mitripopulos) said he had a bad experience with you. Read all of the comments on the blog after my comments about BH’s case. BH asked me to use his initials instead of Barry.
Dr. Bernstein wanted me to get in touch with you and would like for you to respond by commenting on this blog. Here’s what he said.
Misty, I would most appreciate that since you already have been in contact with Dr. Steve Gange that you would contact him about my blog and indicate that there have been conflicting information presented on my Bioethics Discussion Blog about his responses to the issue of modesty of male patients and that there have been conflicting information on this blog. Indicate that the moderator want "equal time" for his views (since this is a "discussion" blog) and that I hope he will come and present his views. He should sign in formally with his name to blogger.com and not appear as "anonymous".
The subject being discussed here is very important and we need to hear from all sides of the issue. So.. Misty I would greatly appreciate your help in communicating this to the doctor. Thanks. ..Maurice.
I think you also would be a great contributor to the blog. We would love to have more medical professionals contribute to this blog. Thank you for your time!
Thanks,
Misty
As to the sexual harassment comments, it could be considered sexual harassment depending on how the chaperone acts. Think back to the person (sorry I forgot exactly who) had the chaperone staring at his genitals, he complained, and chaperones were retrained to stand by the head for support.
At the very least it is considered "bullying" and may even arise to the level of assault.
An assault is carried out by a threat of bodily harm coupled with an apparent, present ability to cause the harm. It is both a crime and a tort and, therefore, may result in either criminal or civil liability. Generally, the common law definition is the same in criminal and Tort Law.
This is supported in a number of texts I have previously cited (repeatedly), including Joan Emerson's "Behavior in Private Places", the "Senate Intelligence Committee report on CIA torture", the United Nations' "Commission on Human Rights: independent experts issue report on Guantanamo detainees", and Phillip Zimbardo's Stanford prison experiment, to name a few.
Wait until you see what is happening in Pittsburg.
-- Banterings
Well Dr. Gange, I wondered how you cover your backside. Since you are sequestered in your office or an exam room how would you be aware of what a client sees and hears while sitting in the waiting room facing your front end staff and counter. Besides my wife was with me and thought your staffs performance was unbelievably rude, thoughtless and socially unacceptable. As far as an annual DRE, you pushed that 5 different times during an appointment regarding a hydrocele. The appointment was for nothing but a hydrocele. What you foolishly were unaware of was that I had already known in 2004 what the issue was regarding hydroceles and you had nothing to offer or discuss except an ultrasound and a DRE. I walked out with more concrete info and information for reference from a Tufts educated and trained doctor than you could have ever offered. I did notice that you didn't deny using female only techs and had no sourcing for anything but female staffed ultrasound clinics. The unprofessionalism was so profound from not only you but your whole staff that I would not have anything to do with you. I hope you realize the large number of negative reviews regarding your office on the internet. Since you were not in the hallway when I was passing to an exam room you would never have seen the exchange between your staff to know if another male staff was "hitting on" a female staff member. It also was surprising that you did not deny your demeaning and insulting comments such that "you nust be very ashamed". As a doctor I would hope you have some idea about the possible size of hydroceles instead to making your client fell like an abmormality by saying, "that's the biggest one I ever seen". But then again you were a self serving male with little awareness of your own personal rudeness.
Ps. Dr. Gange, A hydrocele is not a result of prostrate cancer and there is no prostrate cancer in my family going back to my great grandfathers. You were far too anxious to do a DRE even without presenting a reason for it. And you known to you, I have been dealing with a highly qualified ethical physician for 33 years of my life until moving to SLC and dealing with questionable medical personal. You are not the only case of being less than hope for in Utah. Please remember I reported the referring physician for fraud who also was your personal doctor.
Mitripopuos, you have now appropriately expressed your personal response to Dr. Gange's recollection and description of his practice. The next step in a constructive discussion would be to look for a common agreement, not of you personal case, but with regard to the general issues of modesty and their solution.
Misty, it would be great if you could inform the doctor how to sign on to this blog and the thread and encourage him to express his opinions more specifically regarding the concerns of the other visitors who write here. Tell him a missing voice in this discussion has been that of the medical professional and that his views would be of value in the issues presented here. ..Maurice.
Biker --
I was under anesthesia for my colonoscopy, but my understanding is the same as yours -- the procedure itself does not require frontal nudity. But since rear nudity is required, the standard is to wear nothing under the gown. My goal was specifically to prevent genital exposure during any positioning or transport, and to be honest the benefit to me was purely emotional and psychological -- i.e., taking back some level of bodily privacy where I could.
RG
Hello RG,
You may wish to read my colonoscopy statement on Misty's patientmodesty.org, if you need to undergo another colonoscopy in the future. I was unsedated, wearing modified boxer shorts backwards- absolutely no genital exposure. Watching the procedure on the monitor was an added attraction. You'll never want sedation again; and, you'll never question what happened while you were sedated.
Reginald
Misty communicated my last posting about the need now for a general discussion of the patient modesty issue with hopefully the contribution of a physician. Misty wrote me after sending that posting and Mitripopulos' response to Dr. Gange who them sent the following reply to her today:
This person is literally picking a fight and I refuse to respond further. I’d hope such posts would be screened and deleted since they are irrelevant to the mission of the blog.
Steven N Gange MD FACS
I agree, specific and individual identified ad hominem remarks do not contribute to the overall discussion. Yes, identified individuals and their behavior as investigated and documented in the news media by reporters can be used to support a visitor's views and provide an entry to further discussion. But that is different than "he said, she said" type of continued narration.
I still think we should try to get those in the medical profession to write to come to this blog, read what has been written and then provide the rest of us with their explanations and opinions. ..Maurice.
Reginald --
Thanks for your message. I did read your discussion of non-sedated colonoscopy, and briefly considered it, but ultimately decided that I preferred having no recall of the procedure or any attendant discomfort. My provider was actually better than her word about staffing, keeping me covered, and providing verbal and physical reassurance due to my high levels of anxiety.
RG
Mitripopulos
It's very unfortunate you went through all this with that urologist, they don't seem to get it. I have been visiting various urology websites and one website I found quite disturbing. The website referred to their urology clinic as " Nuts and Bolts" with pictures of nuts and bolts referring to the bolt being the penis and the nuts being the testicles. Furthermore, it gave all the names of their staff, all 8 medical assistants were female and the medical assistant who performed the urodynamics was female. What is wrong with this picture?
I can only imagine the laughs the staff must get with that. Could you come up with an analogy referring to a mammography clinic or perhaps a gynecology office in that regards? Would it be tasteful, professional? No not at all. I've suggested that any hospital that provides mammography and L&D services would be an ideal facility to initiate a lawsuit claiming gender discrimination. That there would need to be a male patient who was not given a choice of gender for an intimate procedure, thus discrimination. I would imagine some attorney would be willing to take cases like this. Instead of inviting physicians, particularly female physicians we should be inviting male attorneys to this blog for legal advice. Getting their take on the logistics for such a lawsuit.
Maurice, no offense to you personally, but I'm already Sick of any other medical person giving their opinion on such a sensitive issue with this continual discrimination and unethical treatment of male patients. Obviously, you've seen lately how male patients are treated with recent events in the news and I've been suggesting for how many years on this blog that this is a common occurrence. I always got the impression that no one believes me or are quick to dismiss such claims of occurrence. I'm just makes me Sick to my stomach to even blog about this Crap let alone read about it.
In conclusion, yes I lead a very busy life as I'm sure everyone else does too. I do intend on giving an e-mail address as I want to look for attorneys and invite them to this blog. The only way for change is through legal intervention and agin I'll mention that with decades of working in healthcare the only thing that these people understand is money. When it affects their bottom line, that is when you get their attention and real fast.
PT
Maurice et al
Forgive me but I thank that Dr. Gange has displayed the hubris that has been discussed on this very blog. It seems that he is taking the age old position , I am a doctor and healthcare is gender neutral.
If healthcare was gender neutral, then providers would be "nullo" (a step beyond or extreme neutering). It is that failure to enter a discussion about the treatment that the person received that created the situation in the first place.
Mitripopulos made no bones about what happened to him and Dr. Gange was given every opportunity and courtesy to respond, even if in general terms. You and I had the discussion on anecdotal evidence. Even if the treatment does not rise to the legal definition of abuse, the patients (contributors here) feel like they were abused and that is still a failure on the part of the provider.
You have labeled these cases as outliers, but exactly how many patient need to be abused by the system before the providers should care? Is there a discrete number or should it be a percentage of patients?
Look at the Pittsburg incident:
...A "crowd" of UPMC Bedford nurses and doctors "lined up at the door" of the operating room to take photos and videos of the man's genitals while he was under anesthesia, according to the report....this is a significant number of the staff...The material taken on personal cell phones "had no clinical justification," and staffers "shared those videos and photographs to others uninvolved with the patient's care," very compassionate...A couple of the employees in the room tried to curb the situation and stop the photoshow bad does it have to get until doctors and nurses actually try to stop this?,...I did say, 'Stopthat worked so well,... I could not hold anyone back... Source: CNN!
These were not outliers. This was system wide corruption. Statistically, these were no outliers. This was also a teaching facility.
(Forgive Maurice, this is not a personal attack on you, but I am critiquing what you have said.)
To say that you never personally experienced it with your patients and referring to the victims as outliers seems like an attempt to deny what really happens.
Again I ask; How many patient need to be abused by the system before the providers should care? Is there a discrete number or should it be a percentage of patients?
--Banterings
Banterings, my "outlier" suspicion was based on assumption which needs statistical verification if applied to the entire country or the world. Certainly, the ones writing to this blog thread cannot be called "outliers" sine virtually everyone who has commented here and expressed an opinion are in no way "outliers" to the Patient Modesty thread. They are the majority or even more..the entire population!
With regard to your last questions Banterings, "How many patient need to be abused by the system before the providers should care?" I would answer, with emphasis: "one!" That is why, as I believe I have previously written, if the patient is concerned about the healthcare provider's response to the issue presented, pass this experience to the state licensing
board or to equivalent boards if in a country other than U.S. Simply writing to this blog thread is insufficient. ..Maurice.
The dermatologists in this 2015 survey-based study ( http://c.ymcdn.com/sites/www.aocd.org/resource/resmgr/2015SpringMeeting/ChenSpr15.pdf )
seem to regard the most significant barrier to a total body skin exam as patient embarrassment ); see the table in the document. I suppose something other than patients who are outliers must have given them this idea.
Thanks PT for trying to bring the board back on track. What seems to be needed here is a real focus on how to go forward.
REL
REL, it is amazing that they could put a lot of effort into a study without actually analyzing the reasons behind the primary reason patients refuse full skin exams, embarrassment. They don't mention accompanying staff (scribes, MA's, nurses) gender at all.
Biker -- Good point and it is amazing given the reported dominance of patient embarrassment as a barrier. My own experience is that all of the term scribes have been women and have been positioned within arm's length. The PA and scribe got into some kind of "tiff" during my most recent appointment :>). Technology with voice recognition can replace scribes and thereby (1) provide a transcript of the patients conversation with their doctor, (2) eliminate another observer in the exam room; (3) meet EHR reporting requirements, and (4) reduce costs. Why this isn't happening, I don't know for sure. REL
Hello,
Maybe some progress with same gender care has been made. Please contrast REL's 18 Oct posting re 2015 Dermatology Exam with the 2016 UPMC study (http://www.upmc.com/media/NewsReleases/2016/Pages/ferris-eliminating-patient-discomfort.aspx). The glaring omission from the 2015 study was the gender of the physician. How might this have affected the results of the study, especially for intimate areas?
Reginald
That "study" on dermatology was interesting to read. Of course, the cynic in me can't help to noticed two points: 1) as pointed out by Biker in Vermont, there is no mention of other person present during the assessment - which would definitely heighten the feeling of embarrassment for the patients, and 2) there wasn't any correlation made between the gender of the patient vs. the gender of the providers (it would have been interesting to compare same gender vs. opposite gender and how it affected this feeling of embarrassment.
The latter point, most of all, seem to suggest a political (or perhaps systemic) will to refuse to acknowledge an important issue.
Dany
Maurice,
My last question was rhetorical.
My point about the statistics was that if that attitude is so prevalent, especially at that respected institution, then it is safe to assume that that is problematic across all institutions.
This is not the only news story of these practices being so wide spread. Simply to say that this institution is an outlier in the set of institutions, is paramount to sticking one's head in the sand.
Now we need to survey all institution?
I believe that looking at Pittsburg as a sample would definitely dispell all myths that there is not an industry wide problem.
-- Banterings
Banterings --
What is the Pittsburg story that you've referred to? Did I miss something?
RG
Dany, I am often amazed at how surveys and analyses somehow miss seeing the elephant in the room. Speaking to these dermatology studies, that things like gender of the physician and who else is in the room (and their gender) aren't made the focus of the study itself is incredible. They are trying to figure out why people often don't get the full exam, yet the obvious doesn't occur to them.
Perhaps that's the problem. Medical school attracts many of our best and brightest but somehow for far too many (especially the females) the education process strips away their understanding of basic human psychology and their ability to read body language. In our society the vast majority of men and women are raised to be modest in front of the opposite gender. Were not most of the physicians raised that way themselves?
I do understand physicians buying into the "we're professionals" mantra that they assume automatically makes the patients comfortable in opposite gender scenarios. However it is hard to understand how the "we're professionals" mindset extends all the way down to the scribe, medical assistant, and CNA, yet it does. Patients who object are told that this lowest rung of the medical hierarchy are professionals. It is as if they assume donning scrubs makes patients set aside their upbringing and worldview.
It is no wonder then that the physicians and other very bright people who do these studies can miss seeing the elephant in the room.
RG:
Checkout this CNN link for both stories.
http://edition.cnn.com/2017/09/15/health/upmc-denver-patient-genitals/index.html
Regards,
NTT
Biker,
You nailed it.
BJTNT
Biker,
If you read previous volumes you will see where myself and Ray proposed that the conscience is removed, suppressed, etc. to the point that distinguishing what is acceptable and what is not disappears. We reference much of the research that looked at how the nazis could operate the death camps.
In an interesting note, physicians joined the Nazi party earlier and in greater numbers than any other professional group. Source: Medicine, Ethics, and the Third Reich: Historical and Contemporary Issues
edited by John J. Michalczyk
-- Banterings
I cannot speak knowledgeably on the distribution of genders in hired medical scribes. It is my impression both male & females are hired to be scribes. At my old medical center, in the emergency department we hired scribes to assist the ED physicians but there was no requirement they only be female. This was the only location where we allowed scribes. Nationwide I don’t know if there is a trend toward one sex or another for scribes, I don’t think there is.
Medical assistants in private practices and clinics is more sinister matter. MAs assisting as a chaperone, for example, always mean the physicians/NP/PA is also present with the chaperone/MA when the patient is naked. As such there should be ZERO reluctance to hire males to perform this duty, if medicine is gender neutral and patients have no preferences (which of course we know is not true for BOTH sexes). The “risk management” issues of a male being alone with an unclothed female are removed in the chaperone situation. Most of the other MA duties in clinics, say a Dermatology clinic, never involve the MA being alone with a naked patient (the physician is always present, at least). (Urology is a special situation which I’m omitting admittedly). So again, no “risk” barrier to hiring male medical assistants in such clinics. But unless others can provide evidence to the contrary it is my personal experience and impression physicians and clinics almost always hire female medical assistants if they will be in attendance with naked patients. Its way more than just happenstance - it is a preference for most physicians. So the question is why is there this preference?
Reasons include 1) the belief men are NOT entitled to the same or any bodily privacy respect as are women (see recent articles above on how its okay for the whole department to view male genitalia), 2) the belief female MAs will not be as great a “risk” as male MAs, 3) physicians can and DO pay females less than they would males, so they can save $ by not hiring males. I think all of these are contributing factors, but they all hinge on #1 being valid and enforceable.
Finally, a comment on the naked Dermatology exam. Standing naked for 10 minutes while the Dermatologist examines every square inch, possibly with a “scribe”/“chaperone” present is a really poor medical practice. There is NO medical reason a patient should be made to remain naked for the entire exam. If that were true every physical exam one got would require being totally naked the whole time. Its absurd. Dermatology needs to modernize and stop their archaic practice that violates basic bodily privacy considerations. All patients need to speak up about practices that make them uncomfortable. And you do NOT have to agree to the presence of an observer/scribe/chaperone. That is your decision. The physician will tell you if she/he feels comfortable performing the exam without their chaperone present. You are paying for this service. —AB
AT 177 COMMENTS TO VOLUME 81, IT IS TIME TO MOVE ON TO VOLUME 82 TODAY OCTOBER 20 2017. ..Maurice.
CNA's are the same as nurses aide's. Male or female. It's just more often than not, guys that take those kind of jobs are womanish or gayish. Not all but more often than not.
We get our modesty violated also. Yes, female nurses and CNA's are more common than male nurses and CNA's but then there's doors being opened showing our naked bodies to people in the hallways or doing intimate care in front of family and visitors regardless of gender. As far as that goes, even if that visitor is same sex, I'm still not ok with them seeing everything.
Part of the reason women are given better draping is young girls will literally CRY! Guys have a better ability to hide their feelings.
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