Patient Modesty: Volume 82
I think that the above image and words sets the tone of the conversation regarding male physical modesty issues which form most of the conversation currently on the Patient Modesty thread.
Thanks to Alternative Press via Google Images for the graphic for this Volume.
Continuing on with the Comments, here is the last one as of the time of creating this new Volume and it is by AB who professionally appears to know much of the ins and outs of the medical system. ..Maurice.
ATTENTION: AS OF DECEMBER 25 2017 PATIENT MODESTY: VOLUME 82 WILL BE CLOSED TO FURTHER COMMENTS BUT THE DISCUSSION WILL CONTINUE ON PATIENT MODESTY: VOLUME 83.
said...
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
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
posted by Maurice Bernstein, M.D. @ 8:48:00 PM
174 comments
174 Comments:
I want to add something which I have written in the past regarding dermatological examination of a patient who is totally nude for the examination. Sequential and systematic undraping of the patient is the most accurate way to discover skin lesions without the physical and emotional discomfort of the patient. By this method, more time and more careful evaluation of any lesions found is available and will be more tolerated by the patient.
As seen by the discussions here, there is much "old" methodology in all aspects of patient care which needs to be reviewed and revised. And much of the "old" deals with bias and lack of awareness by the professionals whose task is "patient care".
..Maurice.
I'll give my brief 2 cents on scribes. Many family physicians offices do not employ scribes simply because they cannot afford them as their volume doesn't warrant it. When I went to my urologist he had a male scribe in the room while the DRE was performed, I didn't have a problem with it. I have seen on the web male urologists with only a female scribe and I don't know how that would work but if I were the patient I would immediately voice my concerns and tell the female scribe to leave the room, Period!
I can say there are more female scribes than male for a fact, the ratio is about 85% female. In emergency rooms physician assistants are not assigned a scribe, nor are nurse quactitioners. I have seen the down side of this scribe business whereas a married male er physician was having sex with a young female scribe in the physicians lounge while both were working at a busy hospital er. The female scribe was terminated while the physician kept his job.
The observation I have is this, do male physicians enjoy surrounding themselves with females only at the expense of their male patients. I don't buy the point that women are cheaper to hire than males. You certainly don't see female physicians hiring male at their offices and female physicians staff for the exclusive privacy of their female patient, therefore both physician genders discriminate against male patients for several reasons. I have also heard of a female office manager whose husband was a physician on staff and she mounted cameras in his office cause she suspected her husband of having affairs with all the female staff! True story!
PT
I'm not sure the relevant issue is the procedure that a dermatologist uses to examine a male's genitals but rather whether such an examination is warranted unless a patient requests it (most men will know if there is a new or changing skin lesion in that area). According to the American Cancer Society (as reported here: https://www.verywell.com/penile-cancer-2328477 ), the probability of penile skin cancer is roughly 1 in 100000 and the 5 year survival rate if the cancer is detected and treated early is .65. On the back of an envelope, I believe this suggests that the joint probability that cancer is detected and treated successfully is about 0.0000065. In view of this statistic, I'm not convinced that routine checking is a good use of medical resources.
REL
REL and the Others: You may be interested in reading the document and associated videos from the American Academy of Dermatology
regarding the details of performing a complete dermatologic examination including detailing the modesty issues. Enter the address below, click and then open the resulting pdf file, you will see what I have reviewed.
https://www.aad.org/File%20Library/Main%20navigation/Education/Basic%20Derm%20Curriculum/PDFs/The-Skin-Exam.pdf
..Maurice.
Neither the pdf nor the video from which the photos were taken change my opinion of routine examination of the penis for skin cancer. Both focus on "how to" and take "why" as given. Both the pdf and the video are also seriously flawed. The pdf does not mention checking a patient's nostrils and the video shows the female dermatologist failing to check the patient's nostrils. Unlike the penis, a patient will be unable to examine his own nostrils. Back to my original point, penile cancer is among the rarest of cancers, is mainly squamous cell carcinoma (SCC), and is a disease of elderly men. Here is a link to a UCSF Dermatology sourced study that questions the validity of treating SCC generally among the elderly: http://dermatologytimes.modernmedicine.com/dermatology-times/content/tags/elderly-patients/surgery-discretionary-elderly-nmsc-patients?page=full
REL
REL, I presented the link to the American Academy of Dermatology (AAD) only to demonstrate concurrence with our teaching of first and second year medical students of the matter of sequential, area of diagnostic interest, undressing and exposure of a patient. With regard to whether squamous cell carcinoma suspected in any anatomical location in the elderly should not be treated is a different matter and one that, I as a physician interacting with patients should review the current literature and present the information I obtained to the patient since it is the decision of a patient factually educated by the physician to make the final decision of whether he or she accepts examination. In summary, it does appear that the AAD is concerned, by their document, in attending to all patients' physical modesty concerns.
And this is what we teach. ..Maurice.
That's great Dr. Bernstein. My point is simply that the modesty aspect would be much less important, and might not require any attention at all for men, if the exam didn't involve checking for penile skin cancer. The latter will almost certainly not be found and, according to the UCSF study, wouldn't warrant treatment in those cases where it would most likely be found. It's detection would not have value. bTW, please tell me if you know why the AAD materials, which constitute a "how to" manual, omitted checking the patient's nostrils?
REL
REL, the nasal grooves (alar) is noted in the text but not specifically described in the video exam. The nasal and buccal (mouth) mucosa are not skin but are usually examined as part of the general complete physical exam and certainly would be inspected also by an otolaryngologist (Ear, Nose and Throat specialist).
Again, with regard to penile examination for skin lesions, the risks of not examining (if there are any) should be known by the physician and presented to the patient for permitting the patient's informed consent to the examination. ..Maurice.
REL, my understanding is that the primary reason dermatologists include the genital-rectal area in total body skin exams is checking for melanoma which can occur anywhere. It may be a low risk in that area but for me if I am going through the trouble of seeing a dermatologist I will let him do a full exam. Others may choose to reject that portion of the exam. A good friend had melanoma found at the very bottom of his back, so not too far from the rectal area.
My caveat is that I will want the female scribe and female nurse to either exit the room or turn away as there is no medical reason for them to observe. The problem men face is not so much their doctors trying to be thorough but rather the female spectators that are often in the room. This assumes you have chosen a male doctor.
Thank you Dr. Bernstein. There still seems to be somewhat of an inconsistency in that the pdf mentions checking the mouth and the mouth is checked in the video; however, I don't want to belabor this issue further. I 'm also not inclined to celebrate incorporation of modesty features into an unnecessary procedure. On this board, attention to modesty has been promoted by pointing out that precipating procedures are sometimes unnecessary (e.g., hernia exams for young male athletes). I'm surprised that the AAD materials seem to include the "boxers" off part of a TBSE as routine. By comparison, breast cancer in men, like penile skin cancer, is very rare. Men are not routinely referred for mamograms.
REL
REL, in all my years in internal medicine since the latter 1960s, I have had only ONE male patient who had breast cancer. Hopefully, I didn't miss any others though certainly breast cancer in men is rare. However, what is NOT rare and for which a breast history and breast exam is worthwhile in men is that of gynecomastia. This is abnormal enlargement of breast tissue and may be a sign of liver failure (which can be associated with increase in estrogens in the male. It is important that the physician, by palpation (with the fingers) differentiates breast tissue from simply subcutaneous fat.
Tuesday, I will be teaching two groups of 6 second year students how to examine the lungs.. and don't worry, concern for patient modesty (yes, both male and female patients) will be part of my narration. ..Maurice. p.s.--and yes, the girl students will be wearing sports bras. Please..no comments on this bias toward a female medical student as compared with a female patient..but that is the way we are obliged to teach medical students---regardless of what comments I have received here in the past. ..Maurice.
Dr. B:
Its great and appropriate you teach your med students appropriate covering for patients, including the use of drapes. Watching the AAD videos I saw them demonstrate the exam with the use of drapes and gown. I saw how use of the gown slowed down the physician, although in the interest of patient bodily privacy. Sadly medicine has become so cost conscious that many medical centers and private practices have cut their supply costs to the minimum and forced their physicians to be as fast as possible. That directly impacts the use of gowns and drapes and appropriate practice for bodily privacy. If the clinic is part of a larger medical center that has a central laundry service a particular clinic may still offer cloth gowns, and may (but unlikely) use drapes. If its part of a teaching center gowns and drapes may be used. But in most outpatient clinics now at best the patient will get a paper gown. The physician, because of time pressure, won’t want to waste time on draping and fighting with gowns. The practice will converge to what is the most expeditious consistent with female patient privacy, disregarding male patient privacy.
At my old medical center the OB outpatient clinic was the only one one using cloth gowns routinely and towels. All others used disposable gowns, I never saw “disposable” drapes (and I inspected all our clinics every year). So, I would be most surprised if very many private Dermatology practices treat their patients in the manner the AAD deems suitable for students to learn. My guess is most practices tell men to strip to their underpants and proceed from there. I’ve never had the full body dermatology exam, but I have a male relative who has one each year with a very large well know HMO system and its a present naked arrangement.
Would be interested in Biker’s experience or anyone’s else. Seriously doubt private dermatology practices will respect male patient privacy. - AB
AB, I can certainly relate to what you are saying as my experience with physical examinations has nearly always have been without any gown offered, and draping wasn't part of it either (I don't think I've ever seen that). The one time (that I can recall anyway) when a gown was offered, it didn't fit properly so I ended up not using it. And the doctor, a woman, only seemed annoyed more than apologetic about the issue when I brought it up. No replacement gown was offered either.
Maybe this is part of the military health services "culture" but the expectation is once you're told to move into the examination room, you take everything off. Some providers will "allow" you to keep your underwear (or rather casually inform you that you can keep them on). When the time comes to do an examination of the GU system, you'll be asked to lower them.
Since I usually will not allow this part of the examination to take place (and definitely not if the provider is a woman), I make a point of keeping them on (and I will challenge the request if pressed). I believe it sends a clear signal of my unwillingness/uneasiness to be exposed, even if briefly (good reasons not withstanding).
Oddly, it has been my experience over the past 20 some-odd years in the military that, by and large, if the person examining me is a woman, the GU is tacitly skipped over (with perhaps some vague questions thrown in for good measure). Only the male providers (and even then, not all) have asked me directly. I can't say if this is just how things are done or if maybe they are picking up on the vibes I'm sending.
I haven't had a dermatology examination yet, or been referred to that specialty. It will be interesting as I do not imagine I'll ever allow a full body skin examination.
Dany
AB, my appt is next week. I will report back on how it was done and on the handling of the female scribe/female nurse situation. It is at a large teaching hospital which has surfaced a question for me. My appt. is with a 2nd year Resident so presumably he'd be going by the book with draping etc.
What I have come to find out is that the 1st year of their 4 year program is spent doing a PG year somewhere else, though I have no idea what that PG year consists of. This means my 2nd year Resident is only 4 months into his 1st year there. Now I am wondering if one of the other doctors (9 of 14 being female) will be supervising him or doing their own check after his. I am not going to call and ask as the person I spoke with when making my appt. was a bit hostile to my asking for only male staff. My experience has been that there is no point in arguing with low level staff who are protective of their turf. I'll just have my wits about me when I go there.
Going into this "having my wits about me" is the sad part of all this. Men who know how the medical system works and who have modesty concerns are forced to think through and strategize their interactions with the medical system. Those who don't know how it works are taken by surprise and suffer (usually in silence) some degree of embarrassment that truly was not necessary. For the most part women don't have to think about these things.
Re: the dermatology material. I was disappointed but not surprised to notice the instruction to bring in a "chaperone" whenever the patient and provider are opposite sex. No mention at all of prior explanation or sex of the chaperone, let alone patient consent to the spectator.
RG
Biker
Your PGY2 dermatology resident would have spent last year (PGY1) in Internal Medical most likely (although a few other specialties qualify but IM is the overwhelming most common choice and easiest to get). At a teaching Dermatology clinic (if the program truly is CMS regulation compliant) Residents must have Attending supervision for the “key and crucial portion” of the service. So the teaching facility may approach this in a couple different ways. Most likely the resident will examine you thoroughly and then report any findings to the attending (who is out in the hall somewhere). The attending will come into the room and examine any findings or if none, just do a quick look over. Or the attending could be present during the resident’s exam, but this is not a good use of the Attending’s time ($$) and therefore is unlikely.
If there is a medical student on the rotation that day, you may be “lucky” or “unlucky” as you please to first have the medical student examine you in the presence of the Resident. Then later the Attending comes in to double check. Your 15 minutes skin exam could end up being 30-45 minutes…
Because part of the CMS funded training for residents is to train them to document properly it is unlikely there will be a scribe. That is the residents “job” or if a medical student is present, the med student helps with the documentation, but resident still needs to ensure proper documentation. So unlikely they get a scribe to do this for them given the teaching program directives, costs, etc.
Therefore I would imagine it is unlikely you will encounter a scribe and probably not a chaperone either. But if they insist on a chaperone you can insist on one of the same gender. I think the medical center you are going too is more advanced than most in this country (about patient privacy) and probably will be able to accommodate your request (with at least a male medical student as chaperone, say).
Good luck. - AB
Thanks for the input AB. It is helpful to better understand the possibilities.
Yes they are a bit more progressive in some areas, especially Urology where there are a couple male nurses. In my and my wife's visits there I have seen lots of male nurses in different areas.
Dermatology may not be so progressive however. When making my dermatology appt I asked that any staff in the room with the doctor also be male but I was told they do not have any male scribes or nurses, and that there would be a scribe and nurse in the room. With 9 out of 14 physicians being female, it could be that women just have a stranglehold on that department.
I'll know soon enough.
Having decades of health care experience I know exactly what will happen, their response my response and if necessary my rebuttal. Which means I always win or I can set them up to fail in which case I win again. Why should patients like myself need to possess this kind of knowledge and I'll mention knowledge is power. We should know that no matter what the medical scenario we will be respected, your privacy should be respected and you should receive respectful care. But we know that will not always happen and will rarely happen. Never happened in my experience, that you have to be on guard when seeking healthcare. It's a pathetic posture to assume but I'm saying an important one.
If I see an unusual mole on my body and decide to have a derm look at it then that's all I'm letting them look at. I don't see what the big fuss is and if you agree to a full body exam then you are setting yourself up. Just say no I'm here to have you look at this mole on my arm face etc. Would anyone with facial acne need a full body exam with some bimbo standing there taking notes while someone performing the exam might just be too stupid or too lazy to remember to write findings down, like physicians have done 75 years ago. It's all part of the Dumbing down of healthcare.
It's the same dumbing down that physician assistants are now working in emergency rooms, nurse practitioners etc. They just let anyone these days practice medicine. Nurse anesthiologist, stupid stupid. Why does a urologist need 3 female medical assistants to perform a vasectomy. How many physicians does it take to change a light bulb? The answer is dumber than the question so I'm not going there but you get the point. BTW, I almost get the impression that some of these postings lately discuss future events that almost seem to illicit excitement over their future appointments in which case those discussions belong strictly on the voy forums. They have no place on this blog as I know there are Lurkers always looking for an exciting read. My advice, go someplace else and drop dead!
PT
I suspect that PT wrote the above last Comment, though "who knows" when only the pseudonym or letters are added to the end of the posting. Anyone can sign another persons pseudonym. The way around this is to sign in to blogger.com such as "Biker" has done and in this way we can all be assured that only one visitor is writing any specific Comment.Signing on to Blogger will give you an identification page but you don't have to put any personal information or address there. You can leave that page blank.
I think that identifying your pseudonym in that way is protective of what you write will not be taken over by someone else who is posting fully anonymously.
What do you think of this suggestion? I agree with anonymity especially in these personal discussions here but failing to register with the service is not the best way to keep what you write your writing! ..Maurice.
PT, you work in healthcare and have a significant knowledge base that most of us don't have. Knowledge is power and when it comes to the medical system patients often don't even know what questions to ask. The medical world does not freely offer up the details of how procedures and exams are done. Men in particular often go into it oblivious to the female-centric nature of it as concerns considerations of privacy and modesty. What feels like an ambush then often follows.
This is why discussions such as we have had on skin exams are incredibly helpful. You can go on the internet and find a video on the procedure and it'll just be the doctor and the patient, and they'll skip the genital/rectal part of the exam. They don't tell you that men might encounter a couple female staff members there observing. When I made my appt and asked for a male doctor for modesty reasons the female scheduler did not freely offer up that their protocol includes a female scribe and female nurse being present. She did not mention anything about how an Attending physician might also do an exam. Even knowing my concern she wasn't going to fully inform me. I am now much better prepared to represent my interests as a result of this discussion. In years past I've been the proverbial deer caught in the headlights unable to react, and so now I try to educate myself beforehand.
There is a continuum of medical setting modesty ranging from not wanting anyone to see you naked on up to not caring who sees you naked. We're all different in our comfort and tolerance levels. After a lifetime of locker room experience I'm not shy around men. A male doctor (or nurse/tech) doing an exam or procedure involving intimate exposure doesn't embarrass me. I am shy around women however, especially when they are more in an observer mode than being the actual caregiver. It seems totally inappropriate for a woman to just be there watching the doctor. I don't want female staff actually doing intimate procedures either, but I feel a woman just watching is far worse.
Educating men on how things are done is part of empowering them.
Maurice
Yes, that was me that posted, furthermore I'll vent my disdain and frustration over the very unethical and discriminatory process that men undergo during many medical procedures. Defining my future jargon so there is no confusion a Gay Circus Parade I'll define as any medical procedure whereby the male physician has present some female Bimbo that has no business being present during the medical examination/ procedure of a male patient. Any additional females present I'll define as Russian Midgets. I hope I've made myself clear!
Secondly, I have a very real hatred of Pedophiles. I have a very real hatrid of men sexually assaulting women or men and I have an equally real hatrid of women sexually assaulting men or women. I hate and despise men or women who seek gratification from medical procedures whereby members of the opposite sex are present. Those kind of people do absolutely nothing for the focus of this blog therefore I'll say again I wish and hope all those kinds of people I've described in my second paragraph please go somewhere and DROP DEAD!
PT
PT, I understand your anger toward those people you describe within your last sentence
but your words show that you have no alternate approach to create necessary change.
By the way, I taught 2 second year medical student groups this afternoon how to examine the lungs and right off I emphasized attention to patient modesty both male and female. Modesty is on the top of the checkpoint list of performing a pulmonary exam. After "Introducing yourselves", "washing your hands" comes #3:
"Appropriately drape patient and attend to patient's modesty during the PE." So proper draping is much more than simply to prevent chilling and shivering during the exam but to be attentive to patient modesty.
One of the two groups was my first year group from last year and at the end of the pulmonary teaching session, I gave them a 5 minute session regarding the concerns being discussed currently here on this thread especially regarding how male patient are ethically mistreated. Any my students know about this blog and thread from the assignments utilizing my blog last year. Only 5 students and 5 minutes but I brought out concerns and arguments presented here. And the left the classroom with the "words" of those writing here That's exactly what I did because I do feel that all your concerns need to be concerns of thoughtful medical students. ..Maurice.
The following was written by A.Banterings yesterday morning but due to a technical problem could not be published at the time. The following is what he wrote and reproduced here with his permission. ..Maurice.
Rel,
I am going to beat your dead horse.
The ATLS (Advanced Trauma Life Support) manual (up to 2009) always required a rectal exam (for internal bleeding). Trauma physicians use to have a saying, "There are only 2 reasons not to do a rectal exam: No fingers (the physician) or no rectum (the patient)."
When the data was looked at, they found that the rectal exam very rarely changed the course of treatment. In fact the physical discomfort and emotional harm were much greater than any benefit and thus it was discontinued.
I like to remind tTrauma physicians of their folly by saying, "There are only 2 reasons not to do a rectal exam: No EVIDENCE."
The same is true of the annual gynecological exam for women. According to Dr. Molly Cooke, the immediate past president of the ACP, the exam is "more of a ritual than evidence based practice."
Gynecologists still require pelvic exams for contraception prescriptions when NONE (PEs) are required. California has changed their laws to allow oral contraceptives to be sld OTC with screening by the pharmacist.
These practices were started before we had in-office urine tests to diagnose STIs and survives today simply "because we can..."
The Pittsburg incident demonstrated this mindset."
Part of INFORMED consent is knowing the risks of a procedure, alternatives, and the risks of not doing a procedure.
I had to reread Maurice's comment:
Again, with regard to penile examination for skin lesions, the risks of not examining (if there are any) should be known by the physician and presented to the patient for permitting the patient's informed consent to the examination.
This is very indicative of how physicians deal with the issue. He uses the phrase "consent to the examination." So is this just the penile exam or the entire exam? Most physicians take it as all or nothing. If you say "NO," then it is a refusal to the entire exam. (This is a bullying tactic.)
Maurice puts the burden on each physician to stay up on current protocols, but what good does that do when they are only "how to's" and NOT "why (or why not) to do."
-- Banterings
For those reading this blog thread titled "Patient Modesty" and would like to comment or make suggestions privately and directly to me about its content at present or in the future, I will remind you of my e-mail address:
doktormo@aol.com
Please write if you have confidential information or suggestions you want me to know or answer. ..Maurice.
I have a visit scheduled with a new provider (a neurologist) regarding numbness/tingling in my right thigh. Does anyone have any experience and/or information about neuro exams from a modesty standpoint? I cannot tolerate "chaperones" or other 3rd party observers. The provider is male.
Thanks.
RG
RG, as a physician who teaches first year medical students how to perform a complete neurological examination, I can tell you that wearing shorts is the degree of undress needed as long as the area of discomfort can be visualized and directly touched (palpated). Now in the event that your sensory symptoms are located in the upper and more lateral thigh, your physician should consider the possibility of meralgia paresthetica in which yjranterior-lateral nerve of the thigh may be involved and possibly pinched as it passes from the pelvis past the groin into the thigh. In that case, an examination of the right groin would be appropriate (visulized and palpated). If you are obese or as part of your daily work do a lot of sitting wearing a seat belt, compression in the right groin may compress the nerve and cause the symptoms. I am not making a final diagnosis here but only telling you why it might be necessary to lower your shorts a bit to fully examine the groin.
But again, there is no need for genital or rectal nudity. I hope this info helps. ..Maurice.
Maurice --
Your response was very useful, thank you. Meralgia paresthetica was in fact my PCP's diagnosis; your description of the likely exam will help me prepare for it. My plan is to discuss the issue of spectators and my reaction to them before any actual exam is initiated, to try and ward off the possibility of an ambush.
RG
RG
It is also referred to as the Bernhardt-Roth syndrome. There are many contributors such as diabetes, injury from a seatbelt during a car accident, old trauma. It is recommended that you should get an MRI, provided you don't have a pacemaker or some implantable metallic device. As far as neurologists go, I know many and I don't know of any one who utilizes scribes or has medical assistants in the room.
He may want to perform a physical exam as I mentioned the cause can be attributable to many underlying factors. I wish you the best of luck and I do know patients who have had very good outcomes with surgical and nonsurgical intervention.
Maurice. Sorry that post to RG about his condition was from me
PT
RG,
Here is another strategy: you can request a reasonable accommodation under the Americans with Disabilities Act (ADA). Simply tell them before hand that you have had traumatic (as in PTSD) experiences in healthcare including having "extra" people in the room who are not necessary for your care.
Here is a reference that supports this assertion that these frivolous people are harmful, see:
The United Nations Human Rights Council Report of the Special Rapporteur on torture and
other cruel, inhuman or degrading treatment or
punishment: "Applying the torture and ill-treatment protection framework
in health-care settings"
By Federal law, they have to "accommodate" your needs. This goes beyond the Patient Bill of Rights guarantee to be treated with dignity (which providers try to define your dignity), this is a direct federal mandate that you special protection under the law.
Under the ADA, you are under no obligation to prove your disability when requesting an accommodations.
Businesses must make "reasonable modifications" in their policies, practices, or procedures when necessary so that people with disabilities can be their customers. Source: ADA.gov
-- Banterings
Many thanks to Maurice, PT, and Banterings for your thoughts and advice.
In addition to the embarrassment and humiliation I experienced during my "chaperone" ambush a year ago, the incident triggered some repressed memories of abuse from my childhood which were disabling enough to require counseling. My therapist has advised me to avoid repeating such incidents at all costs; to that end, I have found the support and knowledge and experiential wisdom on this blog to be a real asset.
Maurice, never doubt the value of what you are doing by offering this forum for us to share experiences and help each other. I know that you're interested in using the blog to seek change, and that's important. But this "mutual aid" aspect of the discussion shouldn't be underestimated.
RG
Banterings
I always appreciate your wisdom. Regarding your last post,was that resolution 3542 passed in 1975 that you were referring to?
PT
Our campaign is directed toward having the medical community accept male modesty as routine. What about recruiting more advocates to our cause?
Recently, I wrote a comment on a blog thread exposing the status in the medical community of disrespecting male modesty. My purpose was to inform males that they don't have to accept the status quo with the responses "it's policy" and "we're all professionals".
It was an introductory message on the blog thread because the comments are 100% military related and 90% "war stories". It's a small affinity group in which I have posted a number of entries, so my name is recognized. I was apologetic for being off-topic. My reason was to introduce Urolift since all posters are male with most [all?] having served before 1975. This means that they are old duffers with statistically 50+% of them having BPH. Hopefully some of them will now recognize that they don't have to "suck it up" by accepting unnecessary female watchers.
I appreciated that one of the self-appointed moderators posted "acceptance", so maybe I can add another comment later on. There really is no moderator since the comments are posted seconds after submission. This policy of no moderator seems to work since there have been no trolls, maybe because it only has 2,000 comments to date [founded in 2004] whereas Dr. B.'s patient modesty thread probably has 13,000+ [82 vol. x approx. 160 per] postings [founded in 2006].
Do you think that posting on non-medical blog threads would help spread the word for the need to accept real male modesty in the medical community [not just tokenism and marketing by most facilities, offices, hospitals, medical centers and institutions {Dr. B.'s favorite name}]?
BJTNT
PT, RG, Maurice, et al,
I apologize about my recent posts. I have been having trouble with the HTML anchor tag (links).
Here are the links from my recent post:
The United Nations Human Rights Council Report of the Special Rapporteur on torture and
other cruel, inhuman or degrading treatment or
punishment: "Applying the torture and ill-treatment protection framework
in health-care settings"
Link: http://www.ohchr.org/Documents/HRBodies/HRCouncil/RegularSession/Session22/A.HRC.22.53_English.pdf
Businesses must make "reasonable modifications" in their policies, practices, or procedures when necessary so that people with disabilities can be their customers. Source: ADA.gov
Link: https://www.ada.gov/servicemembers_adainfo.html
Hopefully these links work.
BTW RG, a letter from your therapist will definitely qualify you for reasonable accommodations that you request. If the provider ambushes you, then this becomes a case of malpractice (the same as a surgeon "leaving his watch in a patient." Simply have this diagnoses included in your chart as part of your history and preexisting conditions.
Again, providers must treat this as any other condition like an allergy to antibiotics. Just as they must avoid dispensing antibiotics to you, they must also avoid retraumatizing you.
-- Banterings
Read today's,Oct.31, editorial in the Guardian by Sam Levin, "Hollywood actors speak of rampant problems of male abusers targeting men". Quite a comparison to the male abuse problem in medicine. Seems the only solution and course is legal action; perhaps then the medical industry will stand up and face facts. Interestingly no response from DR. Gange about his demeaning comments to me just a flopping cover up of his staff-what else is new in the medical industry.
Well I had my dermatology exam. I get brought in to a small examination room. A middle aged female RN comes in, gives me a cloth gown, says everything off except the underwear. I then tell her that I had asked for only male staff members be there for the exam. Didn't phase her at all and she says OK only the doctor will come in. It was clear she wasn't hearing a modesty concern for the first time, nor did it bother her in the least. As she leaves she pulls a curtain separating me from the door. I thought to myself these folks really understand modesty and privacy.
Then the doctor, a 2nd year Resident, comes in with a very perplexed look on his face and says 'You have a problem with women in the room? Is the concern (and he waves his hand pointing at my genital area)? I tell him yes I am uncomfortable with a couple women watching me being examined, would you say that to a female patient that didn't want a couple males watching her be examined? No answer and he proceeds to do the exam, skipping the genital area altogether. When he is done he goes to get one of the dermatologists to look at what he saw, not pulling the curtain when he leaves the room. After the 2nd doctor left I thought it was worth clarifying the issue as I wasn't sure he had understood me. I tell him just to be clear I'm OK being examined but that I just don't want an audience. He says of course and nods his head as if he understood, but I knew he didn't. He's not even a full fledged dermatologist yet and he's already oblivious to modesty, or at least male modesty.
My exam results get posted quickly and it says "patient was asked to disrobe to their comfort level" and "Patient refused genital exam". I have sent a message back saying those two statements are wrong, that I was told to leave my underwear on and that I did not refuse a genital exam but rather just said I didn't want female observers while it was being done. It'll be interesting to see if my record gets updated or I hear back from him. It will color any follow-up communication I do to the practice itself.
So the female nurse was understanding but the male doctor wasn't. Clearly this guy didn't have Dr. Bernstein as an instructor.
Banterings -
Many thanks for your excellent suggestion. I've contacted my therapist for a diagnostic note, which I will make sure is appended to all of my current and future medical records.
RG
Biker in Vermont
Maybe just maybe the 2nd year resident in his mind thinks he is a female. I mean you just don't know anymore.
PT
Biker in Vermont
My sarcasm was directed at the 2nd year resident. But now I'll be serious and dismantle the conversations. When you voiced your concern to the female nurse she went right to the physician or the 2nd year resident or both and complained about you. The manner in which the 2nd year resident responded back to you was unprofessional, however, I'm very surprised that any resident would sacrifice patient satisfaction at the expense of their attending physician's practice.
The female nurse if indeed she was an rn or lpn was minding her p's and q's for if she came across as a bully personally I would have complained to the BON about her in a heartbeat. Now is your opportunity initiate change. You should complain to your health insurance company, the attending physician and the state medical board. Any resident regarding less of what year of training are subject to state medical board investigation and discipline. He performed an incomplete examination which according to me was less than the standard of care. The fact that you refused the nurses' presence was your right yet you were ridiculed and punished by receiving substandard care. Now, it's your business with what you do but if you are willing to discuss this openly on this blog and you are sincere about change then you should do what I suggested.
What will be the end result, you tell the attending that you will not be back to that office in light of the unprofessional and less than standard of care you received. Explain your right to privacy, explain to the health insurance your concerns and initiate a complaint for less than standard of care. Go online and make a complaint to your state medical board for less than standard of care and list the facts. The 2nd year resident will be investigated and he will be notified of the investigation as an " open complaint" this typically will rattle any physician wether the case has merit or not. I'll guarantee someone will reach out to you and apologize.
PT
Biker — Thanks for reporting on your dermatology exam. It sounds to me like treating you with respect was regarded as perhaps just a nuisance by the second year resident. I’m more alarmed, though not at all surprised, at how ready, willing, and able someone was to place falsehoods into your medical record. REL
A woman wrote today directly to my e-mail address her experience as a patient and which I thought would be appropriate to put on this thread. I gave her this thread address. She OK'd posting but wanted not to have her full name published. I will call her Concerned Female (CF). The following is what she wrote me. ..Maurice.
I recently had surgery. To make a long story short, I am a little concerned. My surgeon was attracted to me. He used to always stare at me and act funny when I was in his office. When he examined me he did not wear gloves, even when his hands were "below the belt" (I needed umbilical hernia surgery). When I was in the hospital waiting for surgery, he came to me to check on me and in the middle of our conversation he just wandered off and just stared at me -- for like 30 seconds straight. He had this day dreaming look on his face like he was imagining us doing "something". Then he caught himself, got mad at himself and went on with what he had to tell me. Then he walked away. I didn't see him again until right before surgery. When he walked into the room I turned red. When he saw that I turned red, he turned red and then he walked away. I didn't see him again until after surgery. He would not come into the recovery room while my husband was there, I heard him speaking to the nurse outside my curtain but she's the only one who came in. Literally as soon as my husband stepped outside to get the car to bring me home, my surgeon came into the room to tell me that I was a good patient. Then he vanished. I also found out that one of his friends who works at his surgeons office assisted in my operation. This "assistant" surgeon never introduced himself to me. He walked into the pre-op room, looked at me out of the corner of his eye -- checked me out on the down-lo and walked away. (I'm thinking that my surgeon had his friend there so they could both see me naked together after I was unconscious). Two weeks later, when I went to the post op appointment, my surgeon was SO defensive towards me. He was so rude and acted like he thought I was going to fight with him. I didn't. Once he saw that I wasn't, he calmed down and became very nice again. He started staring at me again as I was getting ready to leave his office. The more I think about this, the more it creeps me out. I'm not sure what I should do. I read that hospitals usually take the side of their doctors bc he brings in money for them. Also, I know i will probably never see any of these people again so i'd like to just forget about it, but I'm still concerned. I think about him having full view of my naked body while I was unconscious. I know i am draped but they still had to prep my skin and apply the ekg pads. I wonder if any thing was unnecessarily done to me while I was out if it so my doctor and his buddy could have a good time. I know other people were around like the anatheologist but that doesn't mean that they couldn't still do stuff on the down-low. ..CF
Patient-Centered Healthcare
The American healthcare system is based on so-called patient-centered care.
The Institute of Medicine defines patient-centered care as;
Providing care that is “respectful” of, and “responsive” to, individual patient “preferences, needs, & values”, and ensuring that “patient values” guide all clinical decisions.
Next, let’s look at Pickers Eight Principles of Patient-Centered Care.
1. Respect for patients’ values, preferences and expressed needs
2. Coordination and integration of care
3. Information and education
4. Physical comfort
5. Emotional support and alleviation of fear and anxiety
6. Involvement of family and friends
7. Continuity and transition
8. Access to care
After reading this, I would have to say without a doubt, our American healthcare system talks the talk but does not come anywhere near walking the walk especially where men’s healthcare is concerned.
They throw out principals 1, 4, 5, and 6 (half the guiding principles), whenever a man walks thru their doors.
If one looks at patient-centered healthcare as a business, the patient would be the “Chairman of the Board” and has the final say. Their “Chief Executive Officer” would be their Primary Care Physician and be second in command.
Under their guidance, you have the department heads who in this case would be any doctor your PCP would send you to see.
Under the department heads, comes the employees who in this case would be the nurses, technicians, secretaries, anyone else that you come in contact with while in the system.
In order for patient-centered healthcare to work, you have to take a “team” approach guided by Pickers Eight Principles of Patient-Centered Care.
If you didn’t enter the healthcare field to help the injured and sick, please don’t take a position where you’d have exposure to sick people on a daily basis. It takes a special type of person to be in that position.
In order for this “team” approach to work, team members must be able to leave their egos at the door each and every day when they come to work.
You can’t be thinking to yourself that the patient thinks you can’t do the job, or they are prejudice towards you every time someone asks for same gender care or asks that you leave during an intimate exam. It’s their right and you’d know that if your patient interactions were guided by the eight principals of patient-centered care.
If the healthcare industry really wants this system to work for everyone, then healthcare workers, facility administrations, and regulatory boards and agencies better re-read the eight principals of patient-centered care and they will see what they have in place today doesn’t even come close to following those principals.
You ask any healthcare workers if they even know what the principals of patient-centered care are and sadly, they can’t tell you.
The more I talk to healthcare people the more convinced I am that the only way men will ever receive equal care that they deserve will be when a lawsuit is filed because most men are just not willing to put their fears aside for the greater good and just speak up if they are not comfortable with some aspect of their care. And the healthcare people are preying on that fear to keep things the way they are.
Oh well, the quest will continue for that one domino that when pushed over will cause an unstoppable tsunami that will bring about much needed change to our healthcare system.
Regards to all,
NTT
REL, on the incorrect info in my record, my best guess is that it is mostly boilerplate language that they automatically use. I have seen that in my visit summaries elsewhere at that hospital. This is stuff that is clearly lawyer-written to protect the hospital by covering all bases. Odds are we all have erroneous info in our records due to these practices. For example for my upper endoscopy it said that I was explained the risks and alternatives to the procedure. No such discussion ever occurred.
Most people probably don't read their summaries let alone correct them. I've let other stuff I saw slip myself but in this case I wanted a correction on the modesty items. The correction they did was to just remove both of those statements. It instead lists everywhere but the genitals as having been examined. Nothing was added about my not wanting an audience.
PT, thanks for your input. The doctor was definitely not a good listener nor was he attuned to the concept of modesty. The nurse of course had to inform the doctor of what I said but I'm not convinced she complained about it. My long corporate career taught me how to quickly read and size up people. Certainly I could be wrong but I don't think my request bothered her at all. If it did she was good at not letting her body language betray her.
I am still replaying the whole thing in my mind as I decide what kind of follow-up to do. They did schedule me for a follow-up in 3 months.
NTT,
Just like the Hippocratic Oath, none of this is law. Of course the industry promises all this care and respect, but when you file a criminal complaint or civil suit, there is no law that guarantees you these rights. In fact what few rights you have , you signed away when you were told that "this is so that we can bill your insurance company."
-- Banterings
Biker
Thank you for sharing your dermatology experience at a teaching medical center. They correctly respected your bodily privacy and patient preferences, although it appears the resident already was a bit confused about your request before he entered the room. I suspect that occurred because of how the “nurse” conveyed your request to him. Whether she intentionally or inadvertently told him you didn’t want your genitals examined we’ll never know.
About the errors in your medical record. The HIPAA law requires the medical center to review your request for record correction and to notify you of their decision. So yes, you will get a communication back. If you don’t, that becomes a complaint to the Office for Civil Rights (they enforce HIPAA). And yes, it sounds like they use a template to start their reports, which is very common in medicine.
So you have a Dermatology clinic that you can receive your care at, in a manner that is basically respectful to you so that is good. They almost assuredly are a “provider-based” clinic, which means they are under the Hospital billing and very importantly, are under the CMS value based survey program. That means you will most get the standard survey about your clinic visit in a week or two. You will have an opportunity to type in comments as well. This is a good opportunity for patients to coherently convey how they feel they may be discriminated against or have a tough time actually receiving their patient rights. I would encourage good feedback to the institution. Men have to ask for accommodations whereas women are offered them automatically. That still is a discriminatory barrier.
As money is tied to the survey scores the comments back from patient’s are usually reviewed by Management to make sure their aren’t any red flags. A big red flag, that management typically doesn’t want to recognize, is that males are not being treated similarly to females. The medical center you go to I know is aware of such issues, hence why they make accommodations. They could always do more and all patients need to keep pushing for more. Patients should be asked their preferences about bodily privacy, not the other way around.
Good health. — AB
We really don't need to read any more examples of male modesty violations, but the following extract from KevinMD is a complaint by a female MD about her treatment by the male medical culture. My complaint is the disregard of male modesty by male MDs. In other words, there are many bad male modesty experiences, not just those experienced by us "outliers". We do interact with family, friends, and others not to mention what we read, observe, and analyze in medical settings to realize there are too many violations of male modesty.
BJTNT
"Women doctors: Speak up, because #MeToo
ANONYMOUS | PHYSICIAN | OCTOBER 29, 2017
I had a clinical supervisor who took advantage of his position and tried to kiss me. There were others who proceeded to massage my shoulders while I typed my progress notes. Worse yet, in a multiple hour hernia repair surgery, I was told that since I am the only female in the room that it is my job to hold the patient’s testicles throughout the entirety of the procedure.
The author is an anonymous physician."
Recent article on modesty in healthcare. I disagree with her last “bottom line” section. If the institution proactively provides accommodations to female patients for bodily privacy they do indeed have an obligation to do similarly for male patients. fyi
https://www.verywell.com/patients-medicine-modesty-healthcare-2615000
— AB
AB, I would say that the article you posted goes much further on male modesty than most mainstream articles. It actually talks about needing more male nurses, and the author was honest enough to say modesty is not on the radar of many healthcare workers. All in all a very good article I thought.
Read the article published in very well. Some points are valid and some the usual BS. Modesty of some kind is evident in all cultures saying that it does not shows a lack of any background in understanding the history of human societies. Any service industry understands what it's potential money spending clients want/demand and make sure they provide the type and style of demanded-not the medical industry which is controlled by males not willing to move past their male dominance. The client should be respectful in making their wishes known-what BS. DEMAND! If the medical industry was paying attention they would be making changes not sitting on their butts. You do not have to explain your reasons for wanting things a certain way-you are paying for it. If the medical industry and doctors get brought up short as not being superior individuals who are to rule over everyone else and know better they will back off. Doctors and everyone involved in the medical industry is no different or better equipped to make decisions in life; they are just the same and have the same faults. We have made the medical industry into a hocus pocus Wizard of Oz situation and it is now time for the client to take back control. Medicine is only an educated guess process based on the law of averages. Stop deifying this industry of fallible people.
The biggest change will occur when health insurance companies are taken off the stock market and prohibited from making a profit but can only operate on covering overhead only as seen in some European models. When both insurance companies and medical industry will now have to compete for clients by offering best coverage and service demanded by their customers- only then will there be a shake up in the attitude of the industry. Insurance companies were first traded on the stock market in the mid 1950's which then moved the whole industry into a mega assembly line production with little concern for the physical, emotional, psychological and spiritual well being of the client.
The article on verywell.com was written by a woman who in the past made some very disparaging comments about male patients. First, I do not believe any female has the right, credentials and has walked in a male patients shoes to give advice to any male regarding so called " modesty". In my opinion the term is simply not applicable in health care. Discrimination is first on my list, unprofessional behavior is second.
These are the only applicable terms that should be used to denote the experience of male patients in healthcare. No others apply, if your provider was male and your privacy was respected ie, no females crowds gathering, gawking, scribes etc. Then your experience was positive, untherwise it was unprofessional and or discriminatory. Notice on verywell that you cannot leave comments, this woman enjoys that and I'll mention further if you do a search with her name you will see what she wrote, the comments made and her rebuttals. No very nice since she hasen't a clue. Clueless! How can your average laywoman on the street have any idea what male patients experience everyday in healthcare.
PT
PT, you wrote: First, I do not believe any female has the right, credentials and has walked in a male patients shoes to give advice to any male regarding so called " modesty". But what about Misty and her attempt with her website and organization to provide ventilation and help to both genders?
..Maurice.
This isn't a male vs female or a patient vs provider war. It also isn't a theoretical world where anything less than a 100% solution isn't acceptable. That the author of that article may not have been male-patient friendly in something else she wrote doesn't matter. She went further in this most recent article than virtually anybody else. That is a good thing. People sometimes evolve their thinking and perhaps she has. Could she have gone further? Sure, but maybe we should be glad she went as far as she did. Something is better than nothing and just sitting back waiting for perfection could prove to be a long wait.
Maurice
I'm referring to the woman who wrote the article on verywell.com, she is a laywoman and can't even begin to compete with Misty on this subject.
PT
Maurice, Biker
She claims to be a patient advocate, tomorrow I will claim to be an astronaut. Pathetic! She claims to have become a patient advocate in 2004. In 2012 or 2013 she wrote many disparaging comments about male patient rights thus she has had 9 years to figure this all out. It's people like her that make me absolutely sick to my stomach. Despite many comments that were made she still doesn't get it and I disagree with everything she said on the recent post. I don't know what make me sick the most, her comments or the possibility that she gets paid for writing that crap!
If there is any woman that appreciates the extent of this problem from what I've read its Misty, however, no female can fully appreciate what male patients experience on a daily basis in healthcare, how can they. The writer on verywell should have just came out on her previous posts and apologized to all the male posters that she insulted. She could have said " you know, I didn't realize the problem that exists and I didn't realize this happens to men. " she could have ended it gracefully but she didn't, instead she became angry and tried to shut everyone down.
As I recall there were one or two female posters that joined in and were very derogatory towards male posters. The subject didn't even involve female patients as the subject if I can recall was about male patients getting healthcare, to man up! You have to be kidding me, you have to be kidding me that anyone let alone some female so called patient advocate can tell me to simply disregard discrimination, disregard unprofessional behavior. Where do they find these people?
PT
From the article in question. PT, which part of this do you disagree with?
How to Address Patient Modesty for Others and the Big Picture
Balance Genders of Providers - Male Nurses Needed: One big problem is that the healthcare workforce does not meet the modesty needs of the population. For example, as mentioned earlier, there are not enough male nurses. There are many reasons for this lack of male nurses, but you may be able to increase the numbers of male nurses by contacting your local nursing schools and asking if they can suggest a way to help you recruit more men to the profession.
Encourage Men to Enter Nursing: There seems to be a stigma attached to the idea of men becoming nurses, which is, of course, one reason the numbers of male nurses is so low. Talk about this with your friends in order to begin de-stigmatizing the idea. The more it becomes general conversation, the sooner the stigma will go away. Encourage young men you know to enter nursing as a profession.
Encourage Patient Modesty Issues to be Taught in Medical and Allied Health Curricula: Contact your local medical school and ask if patient modesty is accounted for in its curriculum for all its students - doctors, nurses, CNAs, and other allied health professions. If not, ask them who you can speak to that would recognize the importance of infusing modesty issues into the education of its students. Then make an appointment with that person and encourage them to add this issue to the curriculum.
Encourage Patient Modesty to be Addressed in Continuing Medical Education: Get in touch with your local medical society and ask if they have any initiatives to teach the extra skills this recognition requires. If not, then ask if they can help incorporate them, perhaps through continuing medical education credits for healthcare workers. While the society probably won't be able to make that happen, they will probably know which entity could.
Biker
As I said, I disagree with all she wrote. It is not my problem nor is it my responsibility to go out and do everything you or she mentioned. I did not create the discrimination and I'm not the one who created the unprofessional behavior, I'm the victim of it. This will all be resolved through a legal process. Btw, today I became an astronaut. I don't know Jack about propulsion systems, re-entry, maneuvering, vectoring or even spaceship design. I'm going to go as far as saying I can fly alien spacecraft too! Our patient advocate probably doesn't know jack about the logistics of a hospital, imaging modalities, patient rights, surgical intervention, core values, rules of EMTALA, hospital transfers, Hospitalists, scribes, medical procedures, trauma teams, Hipaa etc. Yet she has credentialed herself to be able to advise me, advocate for me and guide me through the medical process from start to finish. I'm flabbergasted at her skills despite the fact she was never a male patient.
PT
I can understand male patients’ frustration with how many medical professionals do not seem to see male modesty as important. However, MPM has helped some male patients take steps to ensure their wishes for modesty are honored. In my experience, only male patients who spoke up and took steps got their wishes. I encourage all male patients to keep on searching for a medical facility / doctor that is willing to accommodate their patient modesty requests.
There are two parts of this article: that I do not agree with and my rebuttals:
4.) You May Have a Phobia: Human beings have many phobias, and an extreme sense of modesty might be one of them. Phobias can actually be treated, just like a fear of flying in a plane, or a fear of heights, or claustrophobia (a fear of being in a closed space) can be treated. Do a search for a mental health professional who can treat your modesty as if it was a phobia. The fear of doctors is called "iatrophobia." The fear of being naked is called "gymnophobia." You may have one of these phobias, or both or neither. You may just have a general anxiety. But a mental health professional may be able to sort that out and help you get beyond your modesty.
My response: Many people who care about their modesty actually do not have phobias. Some reasons patients value their modesty are: privacy, commitment to let spouse be the only person of the opposite sex to see them naked, moral and religious reasons, etc.
Knowing that smart patients who are concerned with modesty, regardless of their gender, must take the steps necessary to get the care they need even if they find it embarrassing. Modesty is not a good enough excuse to avoid care, especially when problematic symptoms arise.
My response: I feel this is misguided. Patients should be able to get maximum modesty for procedures and same gender intimate care if they wish. Patients should not have to sacrifice their modesty for medical care, It may mean that you will have to drive farther or even fly to get your wishes for modesty. It is worth going as far as you have to find a doctor / medical facility willing to accommodate your wishes for modesty. Many men have avoided medical care due to modesty concerns and this needs to change. I am shocked that many urologists do not employ male nurses or assistants.
Misty
Misty
Thank you for your rebuttals as those are exactly my thoughts. Now I'm going to take this a step further to explain my position as I've said many times. Personally for me it's not about modesty at all, it's more about the double standard and all that entails. It's about the unprofessional behavior time and time again. Patients should not have to travel to another facility or find another physician and yes it's disturbing that urologists don't employ male nurses or assistants but I assure everyone that is all going to change.
PT
Misty
Forgot to comment on your last sentence regarding urologists. There is a thread on Outpatient surgery magazine you can see online an article called " You know you are a urology nurse when" with a list of 10 items, 2 of them are you've seen more penis than a mohel and the second is deck the halls with lots of foleys. This from a female nurse who worked urology.
If and only if there were a male mammography tech what would be two comparable responses. " you know you are a male mammo tech when " _______________________________________________, _________________________________________. Please fill in the blanks cause I can't even begin to think up of anything as unprofessional as what the female urology nurse said. I'm not expecting anyone to step in this trap, I'm just showing you this is only a glimpse of female nurses perceptions.
PT
One problem is that we are dealing with modest when that should be thrown out. This allows people of being accused of being "too modest."
The issue is patient dignity which is a subset of human dignity.
Using the term modesty makes it sound like the patient has a problem with the accepted norms, think how many react to women wearing burkas or hijabs.
When we change the issue to patient dignity, then it becomes the providers fault for not respecting the human dignity of the patient.
I have written about this in the past and even suggested that Maurice change the name of this thread.
I have seen some providers starting to address this as an issue of patient dignity.
-- Banterings
Banterings, dignity may be a better term than modesty, but when it comes to males the medical world considers being polite to patients and following a few protocols such as letting patients dress/undress in private as having provided them with dignified care. Dignified care has not been construed to include patients being able to choose the gender of their caregivers, at least for males.
Until such point as there is a major court case that catches everyone's attention the process will continue to be a series of very slow incremental improvements. Thus far the courts have erred on the side of female employment rights as trumping any kind of male dignity rights, but a single case may change that one day. We have seen court prioritize female guards vs male prisoners and with female staff vs male adolescents in residential detention facilities. Yet a single case can change everything if the right one comes along.
Biker
Are you sure about that " letting patients dress/ undress in private, I was never afforded that. When did they start doing that?
PT
This article came out today, might be of interest to followers here and to Dr. B. One can submit comments. I intend to submit one when time allows.
Note as a patient your initial consent is not irrevocable. You can always decline treatment, you can decline observers, shadowers, etc. Some of the providers commenting don’t seem to understand this. That and some of the other comments point to root causes for some problems patient’s experience…
http://www.kevinmd.com/blog/2017/11/physician-shadowing-immoral.html
- AB
PT, never once have I not been allowed to dress/undress in private, and besides decades of annual exams with my PCP, I have had at least a couple dozen cystoscopies, a year's worth of BCG & Interferon treatments, a couple ER visits, two ultrasounds, a vasectomy, four colonoscopies, my recent skin exam, and maybe others that I don't even remember at the moment. In every case I undressed and dressed in private.
PT,
I wanted to respond to your paragraph below:
Patients should not have to travel to another facility or find another physician and yes it's disturbing that urologists don't employ male nurses or assistants but I assure everyone that is all going to change.
I wish that this was true. But unfortunately, there are some doctors and nurses who will never change their stances on patient modesty. There are some medical professionals who are so set in their ways. For example, some urologists say no they are not willing to hire male nurses. I think male patients should just steer of those urologists and take their business somewhere else.
Of course, there are some doctors and nurses who were previously not sensitive to patient modesty who changed their minds because some patients spoke up.
It does not surprise me that some female nurses would make those comments about male patients. In fact, I was sad to see how one of my sister’s friends who is a nurse who included a picture of a coffee mug for nurse on her Facebook page last year that says I’ve seen more private parts than a prostitute. I believe that many nurses go through desensitization in nursing schools. On the issue of urinary catheters, we need to work to reduce them since most of them are actually unnecessary. Medical professionals should use bladder scanners more often for patient modesty reasons (only abdomen is exposed if a patient is wearing underwear or shorts) and reducing UTIs and other complications. It is MPM’s goal to start a campaign to reduce unnecessary urinary catheters.
There are actually some good female nurses who understand male patient modesty. In fact, a school nurse who contributed to the How Husbands Feel About Gyn Exams group (mainly for husbands who do not want their wives to have male gynecologists) shared about how concerned she was for male patients. She wanted to encourage more male students to become nurses. She shared that she did not want her husband to have any intimate procedures by female nurse or doctor.
Misty
In regards to the posting of an article on kevinmd.com concerning medical "shadowing"-spot on!
Good Morning:
FYI.
The comments section for the "Is physician shadowing immoral?" article on Kevin MD is now closed after 56 comments. :(
regards,
NTT
The comments on KMD are quite disturbing. They feel that patients MUST allow students. Ethically, it is the responsibility of the medical school (and not the patients) to provide the education.
The fact that students and providers do not realize that patients can say "NO" at any time is only setting themselves up for civil and criminal actions. There are at least 2 comments that reference the initial consent form without any regard to the patient changing their mind afterwards.
I am sure that PT will expand on the following:
To force, force as a condition of treatment, and/or have the presence of students (and other not essential to patient care) without consent (i.e. consent withdrawn later), etc. amounts to indentured servitude of the patient.
This is exactly the attitude that I have chronicled is previous volumes.
Even Michael W. Perry's (author of Embarrass Less: A Practical Guide for Doctors, Nurses, Students and Hospitals) comments are disturbing on how he does not "give teenage girls a choice, just tells them they will be naked." Unless I read the situation wrong, they can be covered with a sheet or drape while being cleaned and the gown put on over the sheet.
I am going to read his book, I suspect that it is a way to justify this attitude. To say that the patient has no choice in the matter is total BS. There are other ways to do it.
Obviously society has to step in and set the rules on how patients are to be treated because healthcare continuously shows that the industry is not capable of meeting the expectations of society.
--Banterings
There are two primary issues with "students".
The first is not asking patients if it is OK. Most probably would say OK if asked so asking should not pose any significant hardship on their education/training.
The second is identifying exactly what they are. A high school kid is not the same as a Medical School student, yet patients are routinely mislead as concerns high school kids and college students.
Medical students wear short white coats and are professionally dressed and, in addition, wear a hospital badge with clear identification of the student's name and status. In addition, all medical students will identify themselves to the patient by name and responsibility. Whether in the first year or fourth year, it is the patient's choice to accept or reject the student. I have never seen a medical student ever simply "shadowing" and not actually participating in the workup or care of a patient. I suppose if the medical student is within the operating room watching the surgical or delivery experience one could call that pure "shadowing". And so, yes, as I have written here before, I have monitored first year students' experience within operating rooms at our Childrens Hospital "shadowing".
..Maurice.
Sorry Maurice, I will bring you up short on your latest post. What goes on at your institution does no go across the board. At the university hospital here in Utah, students,interns, residents, doctors[when ever they do] all wear long coats. In urology a doctor came in, introduced himself after setting down, lapsed into nonsense and said, "Oh, by the way, this is my side kick. He's an intern. When I questioned him as to if he was under or post graduate he replied 2nd year undergraduate. He got the door without a protest from the doctor and a side comment from me not to do that again to me. Another 5 minutes into he appointment the doctor got the boot for his abusive comments to an assault survivor. So sorry, but the blank statement students wear short coats and ID tags does not cover all institutions.
Maurice,
Read the comments on the KMD article on how providers and students believe that patients have no choice in regards to the participation of students in the healthcare setting. Only one nurse in the comments stood up for patients.
Before you argue as whether or not the commenters are actual providers or students, search the Medscape discussion board on the topic and you will see the attitude.
This attitude also proliferates on SDN (Student Doctor Network). Although the posters cannot be verified, the administrators (who are verified as providers or students) also share this (disturbing) attitude.
Ethically, the industry (guid) is responsible for its own advancement. From this end, facilities should have programs to identify when providers are seeking treatment and medical students SHOULD be part of their care. Peer physical exams should be re-instituted as well. This would relieve some of the burden from patients.
With the specialized training that providers receive in dealing with the body, they will understand better than the average patient the why and it would not be traumatic for them at all.
-- Banterings
Patients should not have to travel to another facility or find another physician and yes it's disturbing that urologists don't employ male nurses or assistants but I assure everyone that is all going to change.
PT,
In reference to the above, what information do you have have that shows a major change is about to take place? Is there legislation, perhaps a pending lawsuit that will bring about change? I certainly hope so! I am definitely excited to learn of a serious and long overdue improvement in the reproductive health and well being of male patients. We have been ignored long enough!
Mike (58flyer)
Banterings
Having worked at many major teaching hospitals particularly at level 1 facilities I can say that any patient at the time of registration could request non-teach. There would be a large notification placed on their patient chart that would say non-teach. Now, my opinions are mixed regarding medical students at hospitals. In one regard they serve a valuable function in that they can provide medical care when of course the attending is not there, however, with the invention of hospitalists there really is no need since hospitalists are usually in house 24/7.
I've seen the bad side of letting medical students run amok on their own. One resident was caught having sex with a nurse in the parking lot in his car. The nurse was a neuro Icu nurse and while she was having sex her patient was on a vent unattended. This kind of behavior was frequent and I know of many instances such as this. The ongoing joke was there was more sex going on at the hospital than the no-tell motel down the street. I've seen a number of residents insert chest tubes on patients after mistaking the medial border of the scapula for a pneumo. Maurice will know what what I'm referring to and there is a small mortality rate with chest tube insertions.
If it were me I would request non-teach as as pros outnumber the cons. I'm not at all suprised at the comments on KevinMD any I'm sure the posters are of a mixed variety of med students and nursing. For the comments by nursing it is a reflection of their own ignorance since they can't recite one rule from the nurse practice act. But in the end the patient has the right and will always reserve the right to refuse care and the presence of anyone during any procedure.
PT
Mike ( 58 Flyer)
I've always appreciated your comments here and on other sites. My position from a legal perspective has always been this, if a hospital provides mammography services which is an occupation that's 100% dominated by female staff and I know this to be absolute cause I spent 6 months researching this to be the case. Then what are that hospitals obligations to provide similar privacy in male intimate examinations?
I've also researched L&D suites across the country and despite the fact that virtually all employ female nurses there were a few and I mean very few that employed a male scrub tech and of course a nearly 50% mix of anesthiologists so L&D suites may or may not pass the litmus tests so to speak. I have spoke to several attorneys who look for pro bono work in causes that interest them and have said to me there are probable avenues to pursue, particularly among large hospital chains whereby one policy change would affect them all.
At one point I considered posting the attorney's email here on this site, however, I'll be honest with you I believe there are people who most likely read this blog who don't want change for a variety of reasons. My other points I made with the attorneys were every Internet posting of every unprofessional posting I could find. The Denver 5, the female ent incident, the female nurse in NY and hundreds of incidents I printed from Propublica so as to illustrate that for the most part it's not at all about modesty, but rather discrimination and concerns for unprofessional behavior.
So there you have it, hospitals can provide an intimate exam for women that that is the only occupitation in the United States that is 100 percent of female gender, why? There never were male mammographers so there is no past basis of unprofessional behavior that would warrant gender dominance in this work field or grounds for precedence. That is the basis that I am pursuing and I'll guarantee you that every hospital that provides mammography services has also seen male patients in their hospital who required an intimate procedure but that the patient was denied same gender in the performance of the procedure.
PT
PT
Thanks for your response. I wish you luck.
Dr. Bernstein,
I've been away from this blog for awhile. I am pleased to see it is still going strong. I've been generally healthy but a few recent encounters with health care providers have brought the modesty/professionalism issue back to my mind. Some good, some bad.
Mike(58flyer)
You may all be interested in the new thread I put up yesterday on including intractable dementia as part of a medical advance directive.http://bioethicsdiscussion.blogspot.com/2017/11/medical-advance-directive-emphatic-no.html By the way, I hope all my visitors have a medical advance directive which discloses a specific surrogate and how you want to be treated or not treated in terms of life support in case you are ill perhaps with a progressive and perhaps incurable illness if you have at the time no capacity to speak directly to the physician.. That document is presented to your physician, kept in your records and by general law must be obeyed as a part of legal patient autonomy in the United States.
That said.. how about discussing here on "Patient Modesty: Volume 82" my suggestion that an Advance Directive Regarding My Modesty Issues" also be submitted to your medical provider before the first visit. These documents, attested to by a lawyer, must be kept with the patients records and obeyed just as the medical advance directive is legally directive to the physician and others? Did anyone here think of this possibility in terms of "speaking up"? Hmmn? ..Maurice.
Hello Dr. Bernstein,
I've actually incorporated modesty/ privacy/ dignity considerations into an advance care directive. I, however, have not submitted this to my primary physician because I didn't want to have him consider the statements ludicrous. These statements include
1. URO-GENITAL AREA VIEWED AND/OR ATTENDED TO BY NECESSARY
MALE MEDICAL PERSONNEL ONLY (If this is not possible, I refuse
treatment and/or withhold consent for that procedure. If necessary, I
ask that I be transferred to a medical facility that can accommodate me.)
2. NO URINARY CATHETER
(I accept whatever risks that may seem to be involved in this choice;
and, I release physicians, surgeons, anesthesiologists, nurses, hospital
and its personnel from liability for any damages that might be caused by
my refusal for urinary catheterization, despite their otherwise competent
care. I would prefer an adult incontinent brief, instead. Measurement of
urinary output is of no concern to me)
3. NO PHOTOGRAPHY, VIDEO, ETC. OF BODY OR PROCEDURE(S)
4. NO OBSERVATION OF BODY OR PROCEDURE(S) BY VENDORS, SUPERVISORS
OR STUDENTS
5. IF SLEEPING, AWAKEN AND EXPLAIN PROCEDURE BEFORE ASKING FOR
AUTHORIZATION FROM ME OR MY AGENT TO PROCEED.
Dr. Bernstein, from your perspective as a physician, would a primary care physician find these requests absurd or medically ridiculous? (The above question is not a request for medical advice.) Additionally, what happens in the ER where the advance directive might not be readily accessible? Are advance directives meaningless in the ER, if one is not conscious or if one is without an advocate?
Reginald
PT,
I would like to ask you a few questions that may not be appropriate to ask here. You can contact me through Maurice or through my blog directly:
Blog: Banterings of a Mad Man
-- Banterings
Maurice
I'm not sure what the point is when no one ( medical institutions) follow those directives anyway. I walked into a full code once with staff doing chest compressions and giving epi and I said " did you see on her chart, DNR. The looks on people's faces, priceless. I have seen the consents signed for surgery by the patient which in the exact middle of every consent I've seen for decades that says " I do not give consent for observers and videotaping and right there during surgery was a student nurse that someone let her come in and observe. Most people half the time can't find anything the that stupid patients chart half the time anyway. But they sure know where that stupid face sheet is that gives more personal PRIVATE information about the patient than your credit card company has. That face sheet should be forever outlawed!
If you think that scanning any directives in the EMR well good luck with that if you find yourself comatose on a vent and that anyone would follow any kind of directive that says only male personnel must be present. Should you take that road trip from the morgue to the funeral home well your funeral will come and go without anyone ever seeing any advance directives that they will follow while you alive or dead. Just ask the Denver 5 nurses what their thoughts are on necrophilia and morality let alone any advance directives. If you hope they are going to awaken you before they do any procedure well keep in mind that hospital patients get very little sleep, why? Because of the noise nursing staff make. Awakening you every 2 hours for vitals etc.
In conclusion, if you want to know how dementia patients are treated in hospitals and nursing homes its probably not a good idea to ask the patients cause they won't remember. Most nursing homes staff mostly all female staff anyway but you can look on Propublica to see much of what has happenened to most nursing patients who has diminished mental capacities. Finally, I have a true story to tell as it illustrates just what happens to some patients. An older gentleman, patient, expired at a prominent hospital on Halloween night. The funeral home was notified to pick up the body which they did promptly the next day. The hospital house Supervisor received a call from the funeral home inquiring that they did not get the paperwork for the patients organ donation. The Hospital Supervisor said " I do not know what you are talking about, that patient was not an organ donor."
The funeral home said to the Supervisor " well he must have been cause his penis was cut off and he was lying in a pool of dried blood." At that point the police were called to investigate a possible homicide in the hospital for a patient that was transferred to the funeral home. Now, this is how stupid funeral homes are, the penis is not a organ that you donate, dead or alive. The nursing staff, hospital staff, physician staff for that patient did not know he bleed to death from his penis being cut and removed. To this day that homicide case has not been solved. The family has posted a $10,000 reward to solve this case. This happened in 1995. I doubt any advance directives were followed in this patients demise.
PT
Scribes. Currently many, if not most, health care scribes work for companies that contract with physicians and medical centers (to supply scribes). The company is responsible for hiring, training the scribe on the EMR, training them on HIPAA, Safety, their personal conduct, the HR stuff, payment, etc. Such contracted scribes are NOT medical professionals, are NOT trained in what constitutes a proper patient exam/procedure procedure and are NOT contracted to nor can provide ANY clinical care activity or function or hands on action. They are medical typists, data entry persons, and information collators. Such contracted scribes can cost as much as a medical assistant. They are sold as a way to increase patient volume while still theoretically giving the provider a bit of extra time with each patient.
Some clinics/practices use their medical assistants as scribes. Whereas they have some medical training (~9 months of education for a certificate) they are not necessarily proficient at typing and they also may not have been trained on what constitutes a proper medical examination by the provider (unless the provider has trained them properly on this information).
It is not cost effective to use anyone above a medical assistant or a contracted scribe as a patient encounter scribe.
Why do I bring all of this up? Some practices feel the scribe can also serve the function of a “chaperone”. In matters of allegations of improper provider contact the testimony of a contracted scribe would certainly be of little value & may be easily dismissed because of their lack of medical training (and their focus on entering data accurate into the computer). The testimony of the medical assistant function as the scribe at the same time may or may not be of value depending on whether they had training and knowledge of proper actions of the provider AND their scribe duties did not deter them from observing the alleged actions and the terminal was positioned so they could see the providers actions concurrently.
A facility with good risk management would probably prefer to have the scribe AND an official chaperone present when a chaperone was advisable (is three a crowd?). This of course is expensive and therefore a tough sell to the bean counters or practice owner and probably doesn’t occur in very many settings.
Take home messages - 1) you NEVER have to agree to the presence of a scribe and 2) that scribe may NOT be able to protect either the providers liability or your patient’s rights. You may see physicians utilizing the scribe as a “chaperone” with increasing frequency in health care - so be aware of their function(s) & limitations while you are exposed (if you let them stay). - AB
A. Banterings
I will gladly e-mail you from your home page the later part of this week, you will know it is me.
PT
Concerning AB's comments about Medical Assistants, it likely varies from State to State but in Vermont and New Hampshire there is no licensing at all of MA's. There are programs that will certify MA's so that they can represent themselves as CMA's on their name badge, but a run of the mill MA may not have had any schooling at all. Anyone that a doctor or medical facility is willing to call an MA is an MA.
As an aside I have yet to encounter an MA that knows how to take a blood pressure reading.
I do not consider anyone a medical professional whose role does not require at least a 4 year degree in that specialty. Below that level they have been trained to do certain tasks and perhaps trained in how to be polite to the patient, but they are not medical professionals.
Reginald,
I think your advance directives are great. I think it's great you put down urinary catheters because the truth is probably about 90% of urinary catheters are unnecessary.
Are you aware that there is a better alternative, bladder scanner that can measure urine output? Only your abdomen is exposed as long as you have underwear on. Medical facilities should use bladder scanners as much as possible instead of urinary catheters for the purpose of measuring urine output.
Misty
Hello Misty,
Thanks for the info re bladder scanning. Every little bit of knowledge helps.
Reginald
Hello,
What follows is an e-mail I sent to a research group called PCORI (Patient-Centered Outcomes Research Institute) and their response. They fund research appropriate to their concerns. I am not a researcher and do not have the requisite background. If anyone in the blog can devise a research study re same-gender care that is synchronous with their requirements, this may be a great opportunity. You can contact Ms Paterson at the address at the end of this article.
Reginald
Oct 25, 2:02 PM EDT
Hello,
I’ve recently read, Mayo Clinic’s article regarding “Women with past adverse childhood experiences more likely to have ovaries removed, study shows” by Elizabeth Zimmermann Young, June 7, 2017.
I’d like to interest you in pursuing a study of how adverse experiences in childhood affect Men’s Health Care - Specifically, Has a negative experience with predominantly female nursing personnel affected male use of health care in the US? Is same-gender health care an innovation whose time has come?
UPMC has already done a study of same-gender care with dermatological cancer patients (Please see http://www.upmc.com/media/NewsReleases/2016/Pages/ferris-eliminating-patient-discomfort.aspx). These patients’ responses seemed to be markedly in the affirmative – “when asked”, if they preferred same gender exams.
Presently, I’m following two internet sites which also seem to be focusing on this issue –
http://bioethicsdiscussion.blogspot.com/2016/12/patient-modesty-volume-78.html and http://www.patientmodesty.org/index.aspx.
Participants at these sites appear very concerned with exposure of the private parts of their bodies to opposite gender (and sometimes to unnecessary same gender) exposure. The following are excerpts from recent entries:
“I asked the RN why wouldn't they have sent in a male nurse to cath him. The answer was they'd do that if he had asked. I said most patients don't know asking is an option, and worse, most men are too embarrassed to ask.”
From a young woman
“Just because a man or woman is unconscious doesn't mean that they don't care who touches them or sees them. In fact, I think for many it matters MORE when you are helpless (to me as well). And for those of us that did make any noise about it, we just got a lot of problems heaped upon us and nothing was done to stop the behavior.”
Is there a possibility that you might consider a medical innovation study
in the area of same-gender intimate care; and, how both male and female patients might benefit from such care?
Thank you.
Carly Paterson (PCORI Helpdesk)
Nov 14, 11:27 AM EST
Thank you for your inquiry, and apologies for the delay in getting back to you. My name is Carly Paterson and I am a Program Officer with PCORI.
I think you raise a question that is very relevant to patient-centered care and clinical practice and the data from the study of dermatological patients provided an interesting set of findings. That being said, PCORI focuses on comparative clinical effectiveness research, or studies that compare options for preventing and diagnosing disease and providing treatment and care. It is difficult to determine if your proposed medical innovation study would fall within the scope of research PCORI is able to fund.
I think further discussion would be necessary regarding preliminary evidence suggesting an association between men receiving female nursing care perceived to be negative and the impact that this would have on their health outcomes. I am not familiar with that connection having been previously documented in the scientific literature. There would also need to be clarification of the options that would be compared through this proposed research to improve care in a way that is meaningful for patients.
I would be happy to discuss this further with you, if you feel the study you are considering is a fit for PCORI in light of the information provided.
Thank you,
Carly Paterson
PCORI Helpdesk [support+id149904@pcori.zendesk.com]
Reply Banterings comment of October 29,
How effective would the 'Letter from Therapist' be? I like the idea and it would apply to my situation. I could see a therapist about recent visitors during my colonoscopy, and my written complaint and written response. When I have this letter in my medical file, how much mileage will I get out of it?
Thanks, Still Standing
To “Anonymous” who wrote about contacting the PCORI. Good idea. On the surface Carly is clueless why such research would be valuable. In a nutshell here are some reasons excerpted from a long letter I sent to the Joint Commission last year about the lack of diverse staffing at their accredited medical centers):
“The Joint Commission promotes the provision of equitable care, and respecting the patient’s values, beliefs, and preferences. To accomplish this accredited Hospitals and their clinics need diverse staff, in all areas where patients are served. We both know this is important because when an healthcare institution and healthcare providers respect patient’s cultural and personal values, and beliefs/preferences the healthcare encounter becomes more comfortable for the patient, which can build trust and enhance communication which is critical for better treatment, outcomes, and satisfaction. Health care can be improved, health costs can be decreased. It is well known that men do not seek healthcare as readily as women and many reasons have been posited for this. I’ve given you one reason above, many men encounter a totally different system of healthcare than women. I believe the Joint Commission should play a big part in the creation of equitable care and reduce discrepancies in patient rights to ensure both male and female patients are treated with dignity and respect.”
So there are MANY healthcare relevant reasons to study this issue and to get EVIDENCE of its impact. Medicine is evidence based supposedly and this area, i.e., how men are treated, lacks evidence supporting the current system design. Unfortunately all grants are obtained with some preliminary data included in the application. Literature review is one part of the argument for funding, but, and this is the catch 22, some preliminary data must be obtained (long time ago I did medical research and held grants - been there, done that). So without those initial (presumably enticing & favorable) studies a grant application would be unsuccessful.
Still I applaud the effort to contact them. Every time someone raises the issue people are forced to consider it could be a problem. And there are lots of publications and grants just waiting to be harvested in this topic. - AB
I came across this article this evening in AORN, its from last year. 153 Nursing Students were surveyed about their experiences, if any, regarding patient abuse and ethical issues. ALL 153 reported observing at least one ethical problem during their (hands on real patients) clinical training. I repeat ALL observed at least one instance. This is very disturbing and reflects the culture in medicine. One can see why men’s preferences would be so ignored/dismissed with this attitude. Just fyi. - AB
https://pdfs.semanticscholar.org/9c5c/537802f152c91ed084e2289d9dcf706983f5.pdf
Something just occurred to me recently, as I've been reading the growing cascade of high-profile sexual harassment complaints. Many of them involve men exposing themselves to women, masturbating in front of them, etc. In addition to the harm that such repulsive actions cause to the immediate victims, it seems to me that they also help to perpetuate the mistaken idea that men as a group have no modesty. Therefore, men who ARE modest become second-hand victims of such harassment. I don't mean to take attention away from the women who are directly affected by these incidents, but I think we would do well to add our voices in condemning the men who do these things.
RG
To Still Standing --
Re: letter from therapist
I have just obtained a revised letter from my therapist, listing my specific diagnoses of anxiety disorder and PTSD, brought on by the presence of an invasive "chaperone." I took a copy to my recent initial visit with a (male) neurologist and it was well received. He said he doesn't use "chaperones" anyway, so it might not be the most conclusive test case, but he did listen respectfully and the mention of nameable diagnoses seemed to make an impression.
RG
RG
Recent admissions and accusations seem to be centered around male perpetrators who have money and are well known. Therefore the common denominator is money and that is all that it's about. What about all the female teachers this past year that have had sex with their students and arrested. Where is that news media, where is the news media for women who also grope men. As a healthcare employee over the years I've been groped by several female employees and yes several of them were female nurses, of whom some were married. I should have ran to HR so that I can collect my million dollars. What about collective news media on women this year who aledged rape but later admitted they lied. How about the women who claim their physicians groped them but that it was never substianted.
Women continually complain their workplace is always about sexual harassment. I can remember a time when ( again) I'll recite the story that a bathroom in a nurse's station was covered from the floor to the ceiling with full nude foldouts of nude males from play girl magazine or the countless scrubs worn by female nurses that literally shout " I'm a sexy nurse" . If you are going to have this kind of news media coverage on the subject that women need to be exposed as real perps. Where is the coverage with female nurses and their behavior? Where is the coverage that there is a high number of female nurses crossing boundaries with their male patients. A violation of the nurse practice act. When it's so bad in Arizona that the State board of nursing has had to conceal board reported nurses violations. So much for transparencies.
I see and read the news everyday and lately the sexual harassment issuers I just filter out for when the day comes that the bad that women do are mentioned, then maybe at that point I'll pay attention. Otherwise it's just filtering as usual. Remember, that men are always at fault. Nice guys finish last, women like the bad guys. All men who work in healthcare are GAY, according to women who work in healthcare and I'll tell you right now that is the farthest thing from the truth. All men have no modesty. Who says that, women. Who started the notion, women. Which women? Women who work in healthcare, why? You should ask them, after the perplexed look you will get a lie as a response. The response women have for men with modesty issues will all be, they have a small penis, but then that's what they say if you drive a large pickup truck or drive a corvette. Yet, if a male has no modesty issues than he is a creep and just wants females to see him exposed.
Now, would it be fair to say there are no male mammographers because women are modest and that they all have small breasts? Yet the plastic surgery business performed 12 million procedures in 2007 and most were breast enhancement alone. What were the number of men that same year seeking penis enhancement surgery? Many articles have been published making fun of few men who do seek these procedures by female news reporters. Of those men seeking those procedures some were doing so due to war injuries obtained in the gulf wars. According to one female reporter it's ok for women to get breast enhancement surgery, however, she commented that men should not even if they were deformed from injuries and she pointed to a death reported in Stockholm resulting in death during the surgery.
PT
To RG from November 16
That sounds like some positive feedback. My incident of visitors is at Joel's blog: http://patientprivacyreview.blogspot.com/
That is my letter to the VA and I have their letter in response, so I could complete the paper trail with a letter from a therapist. Could you post your therapist letter? What industry words and phrases are necessary to carry weight and get results?
Article on why Men are not interested in the health care debate. Has many good points, missing some big ones readers here would note. It appears one has to be on Facebook to comment and I only do Twitter, not Facebook. Some may wish to submit comments.
fyi.
https://www.huffingtonpost.com/entry/why-men-dont-care-about-the-healthcare-debate_us_5a0a0e87e4b060fb7e59d2f7
-AB
Thank you AB for posting the link to that survey (from AORN) regarding patient abuse. It was an interesting read. I wonder what the comments would be if this went up on AN.
To the poster Still Standing, well done with your complaint. It looks like you are making some change, albeit small. Glad to see the VA administration was receptive to your concerns.
It's not nearly enough, but I suppose it is a start. I'm still aghast by the one doctor who told you one of problems was that the patient(you in this case) was not being sedated.
So his solution to resolve the issue of unwanted/unwelcome visitors walking in on a medical procedure is to sedate the patients? Presumably so that they won't know about or remember it afterward. What the what?!? Did I completely misread this?
Dany
Yes, the doctor said the first problem was that I was not sedated. When we were wrapping up our conversation I did ask if I had his opinion correct and he verified it.
When he said this I was glad he was speaking truthfully. I wanted him to be honest and he was.
Subsequently I spoke at length with two others (Case worker and Nurse Supervisor) and asked them if they agreed and they emphatically said 'no.' Of course, they may not have been as honest as the doctor was.
I guess it is common and acceptable for the staff to act differently once the patient is sedated. Staff should feel free to talk about their new car or listen to music, but not take visitors. I just don't want the respect switch to be thrown to the OFF position.
Still Standing --
The thing that annoyed me the most in your article was that the Nurse Mgr. you spoke with could be so "proud of the service and respect they provide for the female veteran" and yet perfectly okay with not providing the same for male veterans. I ran into that "gosh, we just don't have enough male staff" response when I was complaining about my "chaperone" ambush at my group practice (BTW, my story is immediately below yours on the Patient Modesty site). But they did respond by changing their policy to require same-sex "chaperones." So -- a little progress, if one is willing to keep the pressure on.
Regarding my therapist's letter: for privacy reasons, I would prefer not to post the exact content, but the basic gist was that being exposed to third-party witnesses triggered symptoms of anxiety disorder and PTSD. My piece on the modesty site provides some additional info about my case.
RG
Check 11/18/17 New York Daily News for article about nurses taped laughing at dying WWII vet calling for help as he was dying. Anyone wonders why medical "professionals" are so mistrusted.
Mitripopulos
These kinds of videos, nothing new. The American Nurses Association tells you with a big shoehorn every year that nurses are the most trusted profession. What you saw in that video, the lack of care, the laughter, the delay happens everyday at every nursing home, every hospital, old news! But what's pathetic is that we in this country spend over 3 trillion dollars for each year for healthcare. In that video you just saw 3 Trillion dollars hard at work.
Let's divide up the genders and split the cost. At 1.5 Trillion dollars what am I getting for my healthcare insurance, I have healthcare insurance and I hope everyone on this blog has it too! For male patients we don't even get the basic rung at the bottom of the ladder, privacy and respectful care. How much more over the 1.5 Trillion dollars would I have to pay to be treated respectfully? The American nurses Association has been feeding that crap down our throats for years that they are soo professional. But everyday we see something different on the news, but remember the news is not a litmus test for the medical industry. Remember, this crap happens every minute of the day at over 20,000 medical facilities across this country. Some get caught, many don't. So again, why cannot male patients receive comparable respectful care for the 1.5 Trillion dollars that we spend each year. Female patients from what I read get their monies worth!
PT
Happy Thanksgiving (in the United States).. but you know..I have a feeling that we should give specific thanks to the news media and all the women who are currently "coming out" and describing their experiences with sexual harassment which their response to their employers are limiting their entry or progress into their profession.
With this beginning change of attention in the American culture, why can't men (and those reading and writing to this thread) to do something analogous. It would seem that the way those writing here and perhaps many others are being in a way "sexually harassed" by the way they may be being treated by a host of different medical professionals in which the behavior of the profession may be also limiting the men--limiting in obtaining a prompt, emotionally comfortable and effective medical workup.
What do you think about this analogy I just presented and whether the present and seemingly expanding behavior of the women and the media should be attempted and copied by men who may be under analogous sexual misbehavior by "their superiors"?
Maybe men should now be publicly describing their experiences---or do you think the media finds the issues of women and their employers a more attractive subject to write about? ..Maurice.
Maurice
Do you think mainstream America would be ready for this and what vehicle could we use to launch this? I somewhat touched on this a few posts ago but I'll take this opportunity to mention a site called ALLVOICES. A soon to be website where anyone can use this platform to reach out to any human resources department to complain anonymously about harassment. It could be used as a tool to bring up the issues presented here. Personally, I think the recent news media is the result of feminists groups going after wealthy men in politics and entertainment. In the end I still believe legal avenues that I am pursuing will bring attention to this long overdue issue.
PT
I want to bring up an article presented on outpatient surgery magazine. This article will only validate the stratospheric ignorance that exists within the nursing industry. Infection control is everyone's business and it should be since over 100,000 patients die each year from hospital acquired infection. That is an infection you did not have when you entered the hospital and mainly results from nurses not washing their hands. In each surgery suite are special air laminar flow systems utilized to lower patient infections. The downside is that the more people that are in a surgical suite during surgery the greater the risk for infection. The infection rate will increase when staff enter and exit the suite during surgery. Prior to surgery these are a set prescribed staff involved in your surgery already in the room most of the time.
Then their are surgical staff who like to make social visits in the surgical suite where you are having surgery. Their names are not on the preoperative sheet, they are in the suite to be nosey! They serve no function but to be nosey and increase your risk for infection. The article from outpatient surgery magazine is called OR foot traffic. The article mentions social visits but only mentions about putting chimes on the door to alert the operating team as to how many times staff needlessly enter. That is stratospheric ignorance. Imagine your surgeon trying to perform surgery on you and a doorbell keeps ringing. How about telling surgical staff to keep the &uck out of surgeries that you are not assigned to. A perfect example is the recent case in Pennsylvania where half the hospital staff entered the OR suite to take cell phone pics of a patient having penile surgery. What do you think his potential infection rate would be?
Outpatient surgery magazine only used the term social visit but really people! You see your coworkers all day long but you just have to go visit them when they are assigned to the cysto room. Outpatient surgery magazine loosely defined the term social visit when really it's an unauthorized visit by staff not involved in your care. An unauthorized visit that violates that patients privacy and increases their infection rate. Sadly, you will never know who makes these social visits during surgery since their names will never show on the preoperative sheet.
PT
PT is the article readily accessible to all via a internet link? You are quite right regarding the "ins and out" presence in operating rooms. However, to my observation, all who enter are at least appropriately dressed for general sanitation in the room. ..Maurice.
Maurice
At some point I will include my PH.D dissertation on laminar flow on this blog. Essentially it is the micro-organisms in the air particles that settles on the wound as well as surgical instruments which cause infections. Surgical scrubs are not sterile, nor are the shoe covers hats and masks that are worn. Surgical staff, nurses, scrub techs etc. leave the surgical suites to the cafeteria for breakfast, lunch and dinner and then return to the surgical suites with the same outfits, scrubs, shoe covers hats and masks. They also go outside to smoke and return to the surgical suites with same said gear.
Micro-organisms collect on their clothing and becomes airborne once they re-enter surgical areas for social visits. Might as well have your friends come on over as well as pedestrians on the street, what's the difference. Are surgical staff truly appropriately dressed for the party and if they are by surgical standards what about where they go in that clothing before they enter your surgery room when they have no business being there. The site is outpatient surgery magazine. How to limit foot traffic in your OR.
I could go on and on regarding how your pediatric child could be hospitalized and end up with RSV while an inpatient. I could go on and on how you could be exposed to C-Diff, Mersa or HIV while an inpatient, but from the nursing standpoint they couldn't care less because they have seen it all. Their idea about being proactive is putting a door chime on every surgical door. That allows them to keep doing what they have been doing all along, being where they have no business being.
PT
Maurice
I'm throwing a bone in on the mix, I know it's not modesty related but simply an after thought to my last post. I hope you and everyone on this blog had a great Thanksgiving holiday.
During a long neurosurgery I once saw the anesthiologist eat his lunch on the small foldout table of the anesthesia machine. So much for infection control.
PT
"appropriately dressed for general sanitation" Employees might as well be in street clothes for the way they ignore the germ theory. Until the medical community owners decide that proactive management, not health administrators/bureaucrats, are required who would train, retrain, train again, and continually train supervisors and employees with penalties for sanitary violations, infections will cause an unacceptable number of deaths, not to mention illnesses.
By the way why is it still germ theory when it should be germ law in the taxonomy of hypothesis, theory, principle, and scientific law? Maybe that's why the health administrators ignore sanitation, other than write paperwork, since it's just a theory.
BJTNT
Response to RG November 18
RG, I am glad to exchange comments with you because when my incident occurred I had your article in memory, and it really inspired me that I might do more than complain, I might get something changed.
I got the impression that they usually have someone call the patient and tell him we are sorry and it will never happen again. But with your article I had some direction to write a complaint that did get something done.
I used the conversation with the Nurse Mgr. in a follow-up letter in which I complained about male veterans not getting the individual health care that female veterans get. We'll see how far that goes.
I have a few dollars set aside, I'm going to get a therapist letter too.
Best Regards ─ Still Standing
Still Standing --
I'm delighted if my article was of some help to you. I've gotten a great deal of support from the good people on this blog and the Pt. Modesty site, so it means a lot to be able to pass on a little of that.
I just sent my PCP's office a copy of my therapist's diagnostic note, with instructions that it be placed in a highly visible location in my electronic chart. That way, any providers I see there will have the documentation right in front of them when I have the talk about "chaperones." Thanks to PT for suggesting that I get my diagnosis in writing.
RG
This reported at NBC wants to know about female nurses being sexually harassed. But by whom? Are physicians next on the chopping block? Most nursing areas are nearly 100% female, who are these evil perps. With an epidemic of boundary violations committed by female nurses certainly it must be the male patients fault. Her e-mail address is Elizabeth.Chuck@nbcuni.com, sexual harrassment has a very broad definition and maybe if she spent time as a male patient she would be better informed.
PT
"Patient Modesty Volume 82: Enough said?"
That is my question I would like to pose to my visitors and writers? Should there even be a Volume 83? What more and what further constructive towards a goal is there yet to display here on this thread?
Have we reached the end of the "railroad tracks" and there is no further to travel but simply to "look back"?
What is your opinion after 82 volumes? I am not suggesting cutting off this thread but I would like to read what further is there to "travel" by this blog route?
As moderator.."just wondering". ..Maurice.
Dr. Bernstein, certainly there is a repetitive nature to the discussions, but keeping the forum alive is still very worthwhile. I'd guess that everything that could be said had been said long before I stumbled upon it maybe two years ago, but being able to join in the discussions helped me as I found my own voice. That is was still going after so many years affirmed for me just how real the double standard is.
I wouldn't be surprised to learn that there are many within the medical world that read it, but choose not to join in the discussions.
Dr. Bernstein, I agree completely with Biker's comments. This forum should be continued. Both this and the Medical Modesty site have raised awareness as to how bad the double standard is and how it negatively affects the healthcare of men. In my own healthcare I have felt empowered to speak up for change, and it has had some positive results. As I age I am finding that I am in greater need for health related services.
I had hip replacement last year and I discussed with my doctor the abusive experience I had as a juvenile (which I also detailed on allnurses). He said he understood and would do what he could to make the experience go as well as he possibly could. I couldn't get an all male team but the prep nurse was male, both anesthesiologists were male, the doctor was male, and the first assistant was a male PA. Both the scrub nurse and the circulating nurse were female. I was introduced to the scrub nurse by the prep nurse and he said he would personally recommend her for his own care. I found her to be an exceptionally warm and caring individual. I felt as ease with her and just wanted to trust her. Right before surgery the doctor came to the prep bay and said there would no catheter placed (to my great relief) and that a male scrub nurse was now available if I wanted that. I said no as I had already made up my mind and was comfortable with that choice. No doubt I would have opted for the male if I had not been introduced to the female nurse. I also didn't want to break up the team. I looked around at the people in the OR as I was being moved to the table. The doctor said this the team, there will no one else coming or leaving until the surgery is complete. It was just those 6 people, no students, observers, reps or anyone else. I felt safe. Those anesthesiologists were a real fun pair and had me and the rest of the staff laughing. Next thing I knew I was in PACU.
I was there for 2 nights and it was obvious that the nursing staff had been briefed on my situation. The floor nurses were nothing short of amazing. There were several dressing changes and all were done without exposing me. One nurse went as far as requesting that the physical therapy department send a male PT. I got a little careless with the urinal the first night and spilled some on the bed. The nurse changed the linens and my gown and never exposed me. Truly amazing staff. My other hip needs replacement soon and I am not in the least bit worried about it.
So I can say that this and the other modesty sites were the reason I felt empowered to speak up. Thank You Dr. Bernstein for hosting this forum and thanks also to Dr. Sherman and Doug Capra.
Mike (58flyer)
We posters and readers do appreciate all your hard work Dr. B. Maybe someone would be willing to be moderator for this blog thread. Sorry, I'm too old.
BJTNT
PS - There will never be "enough said". Only mandatory changes [lawsuits and laws] will change the culture. We patients have no leverage that we can place on the medical community administrators to effect systemic change that will respect patient dignity, not that there aren't 20-40 %{?} of the employees who have their own strong value system that overrides the culture in the medical industry. These are the employees who receive letters of appreciation and the health administrators use these letters to pat themselves on the back.
Has anyone ever had thoughts of doing physical harm to medical staff who carelessly violated their physical privacy during medical procedures? If so how do your thoughts play out? There are laws on the books that make it a felony to assault a health care worker while delivering medical care to you, but what about laws on the books when a health care worker assaults you? When a healthcare worker physically assaults you unfortunately it is not a felony. Now, it is a felony when a healthcare worker takes a cell phone pic of say your genitals but how many healthcare workers are actually arrested for this felony? To my knowledge only one healthcare worker has been arrested for such a crime and that was a the female nurse in New York who at the hospital she worked snapped a pic of her male patients genitals nine months later.
Personally, I believe any healthcare worker involved in illegal cellphone pics of their patients should spend a federally mandated 30 days in jail. To further illustrate my point say a nurse initiates a cell phone pic of you. That is a felony wether the nurse shows the pic to anyone or not yet it's ok to bring medical or non-medical staff to view a an intimate procedure of you, what's the difference if it involves a pic or not. I am proposing to several attorneys that I've been communicating with to do exactly that. Propose laws on the books that a 30 day mandatory jail sentence be imposed to any healthcare worked involved in illegal pics of their patients. I do know of quite a few patients who were physically assaulted by medical staff and those staff most of the time were terminated, but that's as far as it went to my knowledge.
It only illustrates the disparaging power differential that medical staff assume over patients. The is the care you are receiving, that you are paying for that does not live up to the expectations of falsely presented ethics, falsely presented in the patient bill of rights and jokingly presented in core values that no one can recite let alone aware even exists. As long as the money flows wether it is a for profit or non-profit hospital does not matter. Everyone and I mean everyone in healthcare hates their job, the nurse to nurse bully tactics, nurse to physician bully tactics, nurse to patient bully tactics and physician to patient bully tactics. I can say in administrative meetings nothing and I mean nothing is ever ever said about " how can we improve the perception to the patient that they are receiving high quality care ".
PT
Yes, Biker, I do believe there are those in the medical world who come to my blog thread on Patient Modesty but just don't directly contribute their view of the discussions here.
An example: A physician kidney transplant surgeon who visited here last year but then at the time, did not directly comment here but wrote me the following:
" I also teach first and second year medical students, and feel that treating the "whole person" is important.
BUT, that does not mean that being sensitive to a patient's modesty means that I should do a less than adequate exam. I know this is my personal bias, but I am struck by how extreme some of your bloggers are in their feelings about modesty (maybe still on a normal curve, but 3 SD from the mean). The blogger who objected to the dermatologist looking at his buttocks, and the reply that one should see a doctor who listens to one's lungs through a shirt is a case in point.
I recall seeing a 50ish year-old male patient for a kidney transplant evaluation. I am NEVER someone's first doctor; they all have a PCP, and a nephrologist, and likely a diabetologist and/or cardiologist. So I should never make an obvious, easy diagnosis. In any case, as I went to examine this patient's lungs (without his shirt on), there was a 4x5 cm (2 inch!!!!), pigmented, multi-colored, irregularly-bordered lesion over his left scapula. Had he tatoo'd "I am a melanoma!" Under it, it would not have been more obvious. It was a 2nd year Med student diagnosis. Why could this have happened? Because no one bothered to have him take his shirt off to be examined.
Is this common? I don't know. Is this negligent medical care? I think one could make the case. We biopsied the lesion in the office (superficial spreading melanoma), excised it, waited two years, and successfully transplanted the patient. But I think there's a take-home message here.
Hospitals do not hire female breast surgeons and mammographers because they care about women's modesty. They do it as a marketing technique. If there was a substantial number of men who would preferentially see doctors with male nurses, and it was a financially significant number, you can bet that hospitals would create all-male clinics. But then don't misunderstand, and think it has anything to do with the sudden onset of sensitivity."
It is my opinion, as Moderator, that except for occasional sexual perverts within the profession, most physicians are tuned toward attention to patient physical modesty but along with concern about time spent with a patient while other duties await. And it does also relates, as this surgeon suggests, about finances within the provider system. The solution would be to prove to the medical system that men and their physical modesty concerns are NOT statistical outliers and get together (as women are now apparently doing regarding sexual advances by employers) and pressure the system for attention and change. ..Maurice.
Hello All:
PT, I liken the problem men have with female nurses to the problem our male high school students have with their female teachers.
Both sets of women know what they are doing is illegal and wrong but they also know that 9 times out of 10 the worst that will happen to them should they get caught is a slap on the wrists, suspended sentence, and some community service time.
Until the attitudes of the people in the criminal justice system change and these incidents that are happening now on a regular basis to men and boys are looked upon as real crimes, nothing will change.
Their attitudes aren’t going to change until people get tired of seeing these things happen and demand change.
When a female teacher rapes her male student, judges are of the opinion, the boy had the time of his life so what’s the harm.
It’s the same thing with male patients and their nurses. So, what she took a picture of his privates and showed it around. Where’s the harm the judge says.
Until we as a civilized society have had enough and force lawmakers to re-evaluate and change the laws to force judges to give mandatory prison sentences to these women, nothing will change.
I’ve been begging lawmakers to take away a judge’s discretion in these matters and force mandatory jail sentences to be handed out. It’s the only way to stop this crap.
What’s really sad is we have all these women who have spoken up against the way men have treated them yet nowhere have we heard once how men are being mistreated by female healthcare workers on a daily basis all over this great country of ours.
Men have become the silent voice in this country and it’s all their own doing.
Women no longer take crap from men & stay silent. Men should do the same & speak up loud and clear we’re not going to take this crap from healthcare workers any longer.
The politicians won’t know there is a problem unless you tell them then tell them again until they listen to you. A politician that doesn’t listen to their voters, shouldn’t be in office.
This website has been a safe haven for men and a great stepping stone. But now the time has come to strike while the fire is hot and bring this problem out of the shadows and into the light of day and get it dealt with.
I’ve told my political representatives over and over again what the issues are and how the laws must change. I’ve also told them without support from them, change won’t occur and if it doesn’t, don’t look to me to support them in their bid for re-election.
Balls in our court. What we do with it will decide how this issue will play out.
Regards,
NTT
Dr. Bernstein, I don't doubt but that the kidney transplant surgeon you quoted is correct as concerns it being more about the money than any altruistic values concerning modesty. That just reaffirms that until enough men speak up, they will continue to face a sea of women at every turn.
I do disagree with your comment that most physicians are attuned to patient physical modesty. If that were the case the norm wouldn't be for urologists (and most others) to have 100% female staffs. They'd literally have to think that no men have any modesty issues to justify that. What I think instead is that physicians and their staff are attuned to being polite to patients and that they think being polite is synonymous with being respectful in this regard. It is not.
Using a recent example, the dermatologist I saw cannot possibly be attuned to patient physical modesty if his protocol is to have a female scribe and female nurse standing there observing him examine his male patient's genitals. If he literally assumes men have no modesty how can he possibly be attuned to their modesty when in his mind it doesn't exist?
Maurice
The transplant surgeon whose comments were " Hospitals do not hire female breast surgeons and mammographers because they care about women's modesty. They do it as a marketing technique "
Now I started working in hospitals in 1975 after graduating from college and I personally knew the very first female mammographers hired at several major hospitals. These hospitals did not have any female breast surgeons let alone female radiologists as most mammography equipment only started showing up in the very late 60's. Back in the late 60's very little marketing was done by hospitals meaning they just didn't do marketing back then like they do now or for that matter the last 15-20 years.
Most new techniques involving fine needle or core biopsy were done by radiologists with specialized training and there were very very few female radiologists back then let alone any female radiologists even trained to perform the antiquated stereotactic breast biopsy on equipment back then. Female staff were hired exclusively to perform mammography by directors for privacy of female patients. It was never a marketing tool, it was never female patients demanding that they be done by female techs.
Since the 60's the decision to hire female mammo techs was exclusively based for female patient privacy. There was no marketing decisions whatsoever. I can tell you that is absolute as I personally knew the first female mammo techs hired to perform this new modality at several large hospitals. Over the years mammo equipment quickly advanced such as Xeromammography and digital mammography and with that came ever increasing regulatory compliances and quality control. Much to the point that it became very difficult to make a profit in mammography that is hospital based.
Due to financial constraints as well as radiation regulatory compliances most off site free standing mammography clinics offer state of the art mammography equipment staffed again by all female staff with a twist. Board certified female radiologists trained in the latest techniques of breast biopsy as well. You the patient are offered in most of these facilities a pink gown to wear while you wait for your mammography or breast biopsy. Mammography is the only occupation at least in healthcare in this country that is 100% performed by female gender.
If the commenting surgeon still thinks it was a marketing technique then what are his thoughts on L&D suites. That a marketing technique or what about urology clinic, don't see any male nurses or medical assistants there. Is it that 95% of all nurses are female a marketing technique too! Is all of healthcare these days just a marketing technique. I've worked at well over 25 hospitals in my life and have never known any staff with marketing degrees working for hospitals. I know of one staff but he was a physician recruiter. That really doesn't count.
PT
Let me ask a question to our group. If there were none of the "criminal" nursing behavior as suggested by PT et al, would men be comfortable with effective diagnosis and management and care regardless of the gender of the provider? Does my male visitors here believe that every single interaction between a healthcare provider and the provider's patient has sexual behavior of either party an ominous background subject in both parties mind? And does this ongoing concern actually hinder the hopefully main goal of the interaction: diagnosis and cure? If so, this subject should be as #1 on the entry list similar to medical insurance details.
What do you think? ..Maurice.
So the transplant surgeon regards participants here as three standard deviations from the mean (a common reference in applied statistics to observations regarded as outliers). Then the surgeon relates an experience with a male kidney transplant patient who also has a very large, previously undetected melanoma to justify checking/inspecting male patients. My guess is that probability of the surgeon's experience with this patient may be a nearly unique experience; i.e., one that involves a tail much further removed than 3 SD's.
REL
Dr. Bernstein, I don't think every opposite gender intimate medical encounter has a sexual component to it, but I do know that sometimes it does. Been there. In reaction, avoidance becomes a practical solution going forward.
I would also say that outliers are at much greater risk. Outliers are those that stand out in a positive or negative way. It is just human nature.
Regardless of what the actual frequency is of medical encounters being sexualized, part of the issue for me is simply the double standard. I resent the expectation that I am supposed to be comfortable dropping my drawers on command from any woman wearing scrubs when those women themselves would never tolerate that same expectation directed at them by male staff. I am not a second class patient.
Maurice
I'm going to answer your questions in parts. First though I'll say that I have never merely suggested criminal behavior by nursing staff. It's documented on the web and by police intervention. Why would you not first question female patients or better question female nurse potential patients in their regards to the idea of a male performing their mammogram.
You will never know the number of female patients who has passed you up on say their well woman exam or a screening breast exam. You will never know those numbers will you? I know essentially all female nurses would never accept a male performing their mammogram ( if there were such a thing as a male mammographer). But, they certainly are not going to ask a male nurse to perform an intimate procedure on a male patient and certainly will get mad and belittle the male patient if he refused her.
Why are female patients particularly female nurse patients not the focus of these questions that you are posing. Male patients are not the cause of this yet our heads are on the chopping block when we voice these concerns. Have you ever been accused of any kind of inappropriate sexual behavior as a physician? If not, are you befuddled if you knew that potential female patients passed you up only because you are a male.
Finally, I believe I should ask you this question. In a fair and perfect medical world female patients should have to undergo the same presence of male staff, that means male mammographers, male chaperones during their gyn exams. When this is the case then and only then I believe you are entilited to ask the questions that you've asked.
PT
Maurice
Honestly, I couldn't care less if you discontinue this blog. For I well know the solution for male patients to receive the same considerations as female patients. I can tell you it will never come from societal interaction, it will never come from awareness to the medical industry from this blog, it will never come from equilibrium within the job market. It will only change through legal intervention and when it does it's going to be very expensive to the medical industry itself.
I have come to utterly despise the entire medical industry with a level of hate, disgust and anger that is infinite. It literally makes me sick to my stomach to even drive by a hospital and notice the building. It makes me sick to my stomach as I'm turning through the channels and some stupid medical show appears. It makes me sick to my stomach to see stupid bimbos shopping in their scrubs at the grocery. It makes me sick to my stomach when I go to my favorite coffee shop and there are nursing students from some stupid little nursing school that's probably not even accredited sitting there talking very loud in reciting trite medical verbage. I just want to go over to them and tell them to shut the Fuc& up and go to a library.
I can't really quantify the level of nausea, disequilibrium this subject causes me. I feel sorry for a lot of posters on this blog and the petty crap they had to endure as patients. It's not petty when a boy is rendered impotent because some female nurse felt it appropriate to strike his genitals because of some reflex, but it just goes downhill from there. To make matters worse you get some physician on this blog citing information on this blog when many of them Don't know the facts let alone the difference between their ass and a hole in the ground. I have seen soo much inappropriate behavior by physicians, nurses and staff over the years that I've never really wanted to have to recite it.
PT
PT, I understand your need for ventilation but from my teaching potential for doctors-to-be, what should be my approach with regard to setting them out on the proper ethical track? Or you think, their motivation for entering medical school to become physicians has already been contaminated or even based upon some sexual interest which will exacerbate further as they become more responsible for attending to their patients?
If so, what should I be telling them? What you are writing is important in the practice of my current responsibility in teaching first year medical students. ..Maurice.
Hello Mike (58 Flyer),
You related a very positive modesty situation regarding your hip surgery. Would you like to indicate the doctor's name and the hospital's. Their efforts should be acknowledged and recommended. Thanks.
Reginald
As Moderator, I would like to define criteria here for identifying specific physicians or institutions. Although I don't want this blog to display advertising as advertising and I don't want this blog to make specific negative remarks about named healthcare providers or institutions unless their names are already in the public news (since these individuals or institutions may not be aware of what is written here and thus can't respond.) However, simple identification of a physician and institution which meets the beneficent goals set by those writing here and that of the moderator can be simply identified by name and community. I hope this explains my response to this matter.
..Maurice.
Dr B., I'm sorry to say that you are irrelevant in teaching the proper ethical track to med students. You are the professor that students will do what's necessary to get the grade, but their morals were formed long before your influence.
I thank you for your referral to the article on jerk MDs. It's just that there are too many jerks. The MD selection process is flawed since it doesn't weed out the jerks. Med school administrators select applicants by reading paperwork and by the MD panel that interviews the applicant. The process could be improved. How about getting references and have a professional interview the references [professional because the interviewer has to leave the office and visit the references] and also get "throw-offs" [referrals from the references] and interview them regarding the applicant?
Surely many of the insecure non-MD personnel could be sifted out during interviews and training. Why wouldn't the insecure be attracted to this work? They know that they will have the power to control patients with impunity. If the goal was to eliminate the insecure, interviewers could detect them with appropriate questions and evaluation of the responses.
Unfortunately, there's no pressure yet for change in the medical culture, but wait until the politicians and lawyers/judges get involved. The culture could change if the owners of medical institutions decided to replace administrators with proactive managers. MDs are so naive that the administrators get them to defend the status quo. Just because MDs have mastered the 3Rs [read, retain, regurgitate] doesn't mean they have learned any common sense in their long trip thru academia.
Some excuses MDs use for not showing leadership in advocating for patients:
We can't allow patients to be customers because the customer is not always right. Advocates are not claiming that. Wow, did that administrator take advantage of the MD who wrote that article.
The delivery of medicine is too complicated for outside evaluation. Big egos are difficult to overcome.
Many medical schools have their own version of the Hippocratic Oath which means it's now just a strong suggestion.
Why do MDs only feel responsible for patients during their touch labor? I guess because MDs are taught not to get personally involved.
I {MD} only want to see patients.
BJTNT
Thanks Biker for bringing up the subject of medical assistants. The following are the requirements for MAs in CA, which is another way of saying anyone can be an MA:
BJTNT
Medical Assistants
Training Without Certification
Medical assistants are unlicensed individuals who perform non-invasive routine technical support services under the supervision of a licensed physician and surgeon, podiatrist, physician assistant, nurse practitioner, or nurse midwife in a medical office or clinic setting without the need of receiving a certification. The supervisor must be on the premises in order for the medical assistant to perform non-invasive technical support services.
A medical assistant gains experience by training in one of two ways:
Per Title 16 of the California Code of Regulations section 1366.3(a)(1), training under a licensed physician or podiatrist, who shall ascertain the proficiency of the medical assistant; or under a registered nurse, licensed vocational nurse, physician assistant, or a qualified medical assistant acting under the direction of a licensed physician or podiatrist who shall be responsible for determining the content of the training and proficiency of the medical assistant except that training to administer medication by inhalation shall be provided by a licensed physician or respiratory care practitioner; or
Per Title 16 of the California Code of Regulations section 1366.3 (a)(2), in a secondary, postsecondary, or adult education program in a public school authorized by the Department of Education, in a community college program provided for in Part 48 of Division 7 of the Education Code, or a postsecondary institution accredited by an accreditation agency recognized by the United States Department of Education or approved by the Bureau for Private Postsecondary Education under Sections 94130 or 94311 of the Education Code. A licensed physician or podiatrist shall serve as advisor to the medical assistant training program. The instructor in a public school setting shall possess a valid teaching credential issued by the Commission on Teacher Credentialing. The instructor in a private postsecondary institution shall meet the requirements of Sections 94310 and 94311 of the Education Code and any regulations adopted pursuant to those sections.
BJTNT, in Vermont there is no licensing or regulation concerning Medical Assistants. All you need is a medical practice willing to call you one. The only restriction is that they cannot perform functions that require a medical or nursing license.
I am not in agreement with some of the recent posts that are pretty harsh towards physicians and nurses, and even Dr. Bernstein personally. Could most medical staff be better advocates for their male patients? Absolutely, but don't we the patients have some responsibility here too to speak up and advocate for ourselves? Before I found my voice I was real good at pretending it didn't bother me. Most men are. In an ideal world they shouldn't need to be told that males deserve respect too, but society as a whole hasn't bought into the concept yet. Most men haven't bought into the concept yet. Like it or not we here who will speak up and advocate for ourselves are the outliers.
BJTNT, after all these years in teaching (32), I try to be observant of the fine details of each student in my 6 first or second year student group in terms of behavior and their interaction with their patients, their student colleagues and myself. I think most demonstrate their intent to change from a life of a non-professional into a life as a medical professional despite their, unknown to me, prior moral thoughts or behavior. I don't think they are "faking" their behavior to be able to "move on" through medical school. But I could we wrong, since I and I know the medical school itself rarely get feedback years down the road regarding my students professional outcomes (except, of course, as a newspaper story!)
But, you know, I have to be honest here. As I may have mentioned here previously, I am profoundly dismayed and disappointed that, in recent years, at USC Keck School of Medicine where I teach, we have had two MD deans of the medical school demonstrate immoral behavior which I assume was not something new and could be a demonstration of failure of what they were originally taught as medical professionalism and perhaps their "morals were formed long before" they themselves began medical school.
And that is why, I agree that all patient's men or women should feel free to "speak" to their medical caregivers regarding their personal desires and any conflicts they observe in how they as a patient are being treated.
All patients should look at themselves as in my academic role as observers and teachers of medical professionalism of those who have accepted one of the titles within the medical profession. Teaching should not stop at graduation and it should be the patients who continue the teaching. ..Maurice.
Returning to the main focus here -- at first glance, the prospects for progress in male patient modesty don't seem good. Driven by economics, medical facilities can staff with women and make men put up with it. However, the success of this strategy depends entirely on patient retention. I believe that aggressively speaking up is our best approach. Make sure the facility knows why you are leaving, that you are not coming back, and do it in a voice loud enough to be noticed by staff and perhaps other patients. I notice that the cancer center industry is growing and seems to be marketed entirely on patient experience. Clinics look like resort hotels in mild climates with spouses in attendance. No claims of better outcomes are advanced and probably for good reason (https://blogs.scientificamerican.com/cross-check/sorry-but-so-far-war-on-cancer-has-been-a-bust/). Their outcomes may be no better than the local butcher shop replete with grey metal furniture. I believe the market can also respond to male modesty needs once that issue is better understood as affecting the bottom line. I left one urology clinic after one visit and apparently just in the nick of time (http://articles.latimes.com/2013/dec/18/nation/la-na-nn-reno-hospital-shooting-20131218). I left Western Urological Associates in Salt Lake City after one visit (Dr. Gange's clinic at the time though he was away giving a paper on Urolift; I didn't meet him and have nothing good or bad to say about him.). I don't believe it will take many permanent exits by male patients to catch the attention of entrepreneurs in this profit-seeking industry. We need to respond to a bad experience by making sure they know they are losing a paying customer forever and why.
REL
REL
From BJTNT today. ..Maurice.
If I correctly understand the question, as a male I would accept a female MD for intimate care because of her education, training, and hopefully experience, but reject females for all other intimate care if I had the choice.
The main reason for my rejection of females is the sense of entitlement and arrogance in the medical community. The employees see themselves as acolytes of the demigod and therefore the patient's only response when the employees say "jump" is "how high". After all, the staff are "experts" and the good guys, so patients shouldn't bother them with worthless questions and non-conformance since they know what's best for patients. Even lying is acceptable when it's best for patients [and of course the experts get to decide "what's best"].
As I stated volumes earlier in this blog thread, I accepted a female MD. When a new medical franchise opened in my area, I asked to interview an MD and found her acceptable. Would I have been allowed to interview a second MD? Maybe. I stayed with her until she left the state. Several years later, I noticed that she lost her license because she over prescribed opioids [none for me]. I still have a favorable opinion of her.
Years ago, I called a major university in SoCal with a medical school and expressed my interest in being a patient. All responses were positive including selecting my MD {I made the mistake of only talking to the phone answerer} . I was sent two resumes of MDs [residents ?] w/o experience and assigned to one. Who am I to expect that I could select my own MD when a receptionist can assign one?
For years, I attended meetings of the CA med board in SoCal. Everything was pretty much decided ahead of time, but even then the pubic was asked to leave when time came to vote. I assumed this allowed last minute comments. When told to return, the vote was not announced. Although there were always 20-25 attendees in the audience, I was always the only one to leave when the public was told to leave. Only the board members talked, so why the cost of 20-25 attendees - oops, I keep forgetting the delivery of medicine is about the community itself.
Once, when the lawyer for a MD desiring reinstatement read a formal request that was blatant nonsense, the MD himself violated decorum by pleading his case. Somehow, the chair forgot to kick me out [probably because there was rarely a member of the public present and even more rare that real discussions took place during the formal meetings]. The discussion was quite interesting, but the chair remembered protocol for the vote and requested that the public leave. I wonder if she lost stature with the board for allowing me to stay during the discussion.
BJTNT
I know that today, for example, this thread Volume 82 has had visitors from Canada, Australia and United Kingdom. I look forward towards visitors from outside the U.S to give us an idea of how the gender modesty issues described by the U.S. men are similar or different in these other English speaking countries. ..Maurice.
Hello Mike (58 Flyer),
You related a very positive modesty situation regarding your hip surgery. Would you like to indicate the doctor's name and the hospital's. Their efforts should be acknowledged and recommended. Thanks.
Reginald
Yes I will Reginald. The Doctor is Joseph Locker, M.D. and the hospital is West Marion Community Hospital in Ocala, Florida. Dr. Locker works at the Orthopaedic Institute in Ocala. www.toi-health.com They are a part of the Ocala Health System. www.ocalahealthsystem.com I am very pleased with them.
Mike(58flyer)
Mike (58Flyer)
With all do respect but, you had to inform them of the past abuse you received. I can't but wonder how it would have proceeded without their knowledge of your history with MONSTERS masquerading as health care workers. In other words they had to be informed that they had to be at their best behavior or rather I should say at a professional level. I'm assuming you were under anesthesia and did not receive a spinal block.
You say you were treated professionally but that should be the standard, the standard of care. As you may know my length of tenure working in healthcare as I've been in literally thousands of surgical cases. I have heard some of the most disgusting comments made about patients once they were unconscious by the surgeons. The most benign comment I've heard was after the nurse informed the surgeon that the patient was an attorney the surgeon said " ok we will not give him any pain meds once he arrives in PACU."
I do not know why the nurse mentioned the occupational status of the patient or that why it would matter, just appreciate the fact that there are many people working in healthcare that a) are assholes b) unfit for employment c) should not be taking care of patients. I have always appreciated the fact that negative comments made about patients affect the care they receive, particularly when groups of staff hear the negative comments.
PT
I know that today, for example, this thread Volume 82 has had visitors from Canada, Australia and United Kingdom. I look forward towards visitors from outside the U.S to give us an idea of how the gender modesty issues described by the U.S. men are similar or different in these other English speaking countries. ..Maurice.
Hope so . .
but not sure that your software can identify the many that routinely browse with a vpn. REL
Because of the context of many of the postings here regarding the "good" and "bad" behavior of the medical system and how the "bad" seems to have connection with $$$, I thought you might be interested to read and perhaps comment there a new thread I put up about whether cataract surgery at the request of a dying patient was ethical and simply palliative care or was another example of the medical system directed to $$$. Here is the direct link to that thread:
http://bioethicsdiscussion.blogspot.com/2017/12/palliative-care-vs-just-busine.html
..Maurice.
PT
After keeping the demon of sex abuse locked up inside me for 29 years, I finally got the help of a therapist. One of his suggestions for coping with healthcare in the future was to be sure providers knew of the past incident if there is any chance of exposure. That has been good advice so far and this past Monday I had a hip injection and informed the 2 women who were to perform it. They did an awesome job and never exposed me. I have since sent a thank you letter to management expressing my appreciation. I want to do my part to reinforce good behaviors. Since it's the Christmas season I plan also to send some candies or chocolates to the front desk so all can enjoy. I want to them know patients appreciate great care. I don't want to be the guy who complains when things go bad but never expresses appreciation when things go great.
Now when I had this same injection done about 3 years ago, I advised the female tech of my modesty concerns but said nothing of the abuse. She went to other way with it, springing an observer on me. The she exposed way more than she should have and the doctor was also female. While cleaning the betadine off following the injection, she ran her hand between my scrotum and thigh. So I got exposed to 3 females and was inappropriately touched. All completely unnecessary. I complained to my orthopaedic doctor and he changed to a different radiology group. I plan to inform future providers of the abuse history, no matter how hard it is to discuss.
To answer you question, I did have the spinal block, but also was under general anesthesia.
Mike (58flyer)
Biker erroneously wrote the comment below to my new thread but I know he meant it to be posted here. However, I suggest you go to the new thread and see if you agree with him there. Post your response there ..Maurice.
Dr. Bernstein, I did do a comment on that other thread, keeping it just to medical care in general and not going down the modesty/dignity aspects of medical economics.
The economic incentive as concerns maintaining the double standard discussed here is different in that it is for purposes of reducing expense rather than increasing revenue.
The medical world does not yet acknowledge how many men avoid or delay healthcare due to modesty/dignity concerns. Few male patients ever speak up. That being the case in conjunction with them knowing that most women do care about staff gender for intimate procedures and exams, the medical world does not see any benefit in having some degree of excess staffing so as to accommodate the few men that they know it is an issue for.
It comes back to nothing will change until enough men speak up.
..Biker in Vermont
Hello:
Dr. Bernstein you asked, “If there were none of the "criminal" nursing behavior as suggested by PT et al, would men be comfortable with effective diagnosis and management and care regardless of the gender of the provider?”
Not an easy question to answer. Removing the non-conforming behavior from the nursing element is a tall if not impossible task to perform.
You also will always have men that because of their upbringing alone, will prefer same gender care over just female care.
If the healthcare system were to encourage more men to enter the nursing and technician fields and the public saw that this endeavor was producing positive results, you might see some tolerance on the part of the male population. Especially on the part of men who have not had any prior experience with the medical community.
For those of us that have had prior dealings & know what goes on behind those brick & mortar walls, the tolerance is long gone and the “system” won’t get another chance at these guys. For these gentlemen, the only answer is hiring more male personnel and having them available on all shifts in case a man asks for same gender care.
The healthcare industry has brought this problem onto itself because they haven’t listened to their male patients for many years and at the same time, the quality of the people they have been hiring has been less than stellar shall we say.
Another thing I’ve run into is there are guys that don’t want anything to do with same gender care and are afraid by some men speaking up in favor of same gender care it will get forced upon all men. I keep trying to reassure these gentlemen that all men are looking for is the same right to choose that women have had for years.
It’s sad, when most men will rise to the occasion without thinking about it to defend their country, their loved ones, and step up when asked but when an intimate medical issue comes up & they know they aren’t comfortable, they clam up. Many are afraid if they talk, they’ll be treated worse by their healthcare worker. This is especially true in urology departments where most employees are women.
We have got to get past this & put the kind of pressure women have been using on local, state, and federal officials to hear us out on this issue if we ever expect the healthcare industry to take us seriously.
There are mid-term elections coming up all over the country next year. If some of those people that will be looking to be re-elected knew that without support of men’s healthcare issues they might not get re-elected, I bet they’d listen pretty closely.
If women can bring pressure to bear on the system and cause change, WHY CAN’T MEN?
Regards,
NTT
Continuing on with NTT's dissertation, do you think the issue being discussed on this thread deals with "social injustice"? There is no equal protection for men with regard to modesty in the medical system while there has been no sexual protection for women in the work environment? Do you find both examples equivalent and both equally needy to restore to "social justice"? ..Maurice.
Dr. Bernstein,
We also have visitors from other countries visiting Medical Patient Modesty’s web site often. I got a very interesting email from a man in Australia the other day. Patient modesty is definitely an issue in many countries. I wanted to copy and paste some parts of his email. I have omitted his name and email address. He was very upset that his wife could not be guaranteed a female gynecologist for her C-Section.
Here in Australia we have a public health system where everything is covered under 'medicare' in which we are not required to pay anything for the c-section. My wife is planned to have a c-section under that. On the other hand, if we go through private than it will cost us around $6,000 to $10,000.
As we are new immigrants with a casual job, we can't afford it.
The problem is that the hospital that we come under have mostly senior male obstetrician. We have informed the doctors on our periodic visits regarding our concerns but they are of the view that they can't guarantee that and can't change roasters of doctors/nurses bcoz of one patient.
I encouraged him and his wife to fight and refuse a male gynecologist and to go to another hospital if necessary. I helped with a similar case several years ago. One lady in Colorado who was on Medicaid was told she had no choice about who would deliver her baby. I encouraged her to drive 45 minutes to another hospital that accommodated her wishes that no males would be part of her childbirth.
Sadly, I have observed that Medicaid patients have a harder time getting their wishes for modesty honored because some doctors will not accept new Medicaid patients.
Misty
Maurice
I believe you have it reversed, there is no sexual protection for men in the workplace. About a decade ago a large corporation organized a sexual harassment training within the company. The company made a male employee walk through a gauntlet of women employees who groped him, to illustrate how women are supposedly treated. The male employee sued and won only to be rewarded $2000.00. Now, many human resource directors believe men cannot possibly be sexually harassed in the workplace.
You reference it as a social injustice that male patients are not afforded the same physical privacy as female patients. It goes beyond unfairness, injustice or inequalities. It's a big civil rights issue, it's discrimination illegal and immoral. Many female nurses reference their male patients as honey, sweetie etc. is that not sexual harassment. Every patient who is admitted to the hospital receives a wristband that gives at least two patient identifiers, their name and dob, financial account number and medical record number. How do you get honey or sweetie out of that? Would you refer to your female patients as such? Why can they not refer to you by your name or at least Sir? Seems odd to me the recent dramatic increase of female teachers has not been addressed in the news at all.
PT
PT, with your years of experience, you should submit an article to the New York Times and get something going in a big way. I am not kidding. Somebody has to "say something" to a big audience and why can't it be you? Again, I am not trying to dismiss your views or say all this sarcastically. PT, I mean it and I am sure all those corresponding here would agree and cheer your accomplishment if it was published and then more of benefit happen. We can't just complaining on a few blogs. PT what is your opinion of my suggestion? ..Maurice
Maurice
I have a retirement party coming up soon and believe me I'm going to do exactly as you've suggested.
PT
There is no equal protection for men with regard to modesty in the medical system while there has been no sexual protection for women in the work environment? Do you find both examples equivalent and both equally needy to restore to "social justice"? ..Maurice.
Dr. Bernstein, I am unaware of there being no sexual protection in the work environment for women. Where I work we have annual training in the areas of security awareness, diversity, and sexual harassment. What constitutes sexual harassment is carefully defined. And it applies equally to everyone. Major lawsuits have been won in this area. Personally, I am all in favor of prohibiting sexual harassment of women in the workplace and wouldn't condone any of it. Is that what you mean when you say sexual protection? If that is the case then I don't agree that both examples are equivalent. The lack of equal protection for men with regard to modesty is exactly what we have been discussing all these years with very little improvement that I have seen. I'm just not seeing where women don't have protection, whereas men have to put up with what amounts to legalized sexual harassment in medical facilities all across this country.
That said, I like your idea to PT that he publish an article in a major news publication, assuming that they will publish it, so it can receive widespread attention. I have some ideas in that area too if you care to hear them.
Mike (58flyer)
Dr. Bernstein, perhaps I have misunderstood your question, but there are laws/regulations to protect women from sexual harassment in the workplace. That said I realize in many setting many women did not report their harassment out of fear or for other reasons, but there were protections in place if they chose to avail themselves of it.
Men in theory have the same legal protections in the workplace even if society doesn't take it seriously. However workplace reality is that women are far more likely to be sexually harassed then men.
Sexual harassment protections are something apart from what we talk about here concerning patient rights to only be exposed to only those for whom it is necessary to be exposed, for only so long as you need to be exposed, or to be exposed only to the gender of your choice (emergency situations excluded). There are no laws or regulations that specifically address that for men or women. Some may point to HIPAA type stuff but it truly is not specific in the manner I just spelled it out.
What we are instead dealing with here is policy and protocol on a voluntary basis. Use of words like respect or dignity are left to be defined by medical staff, not patients. Differing applications of those words based on patient gender are deemed acceptable to medical staff based on their perceptions of what is appropriate. There are no laws/regulations that define respect, modesty, or dignity in medical settings.
Let's present PT with a series and summary of the points which, by consensus here, are important for PT to include in his presentation to the New York Times.
For example, I will start with an initial trauma, which has been often mentioned here, and that deals with the unexpected and unwanted exposure of the male genitalia of young students to female school nursing or other staff. Is this the beginning of the life-long symptomatology or does it even begin earlier with with familial behaviors at home?
What I am getting at is that to solve a medical problem, as an example, one has to consider the timeline of the pathology and that includes when and how the symptoms started. Following that is the course and the consequences.
So let's dissect this one side of the conflict (that of the male patient) and also dissect the other side which is the pathophysiology of the behavioral response of the members of the healthcare system who are involved. What are the natural and unnatural mechanisms which lead those members to behave as they do.
So let's help PT with, hopefully, a major initial achievement--telling the story to the public at large by means of the New York Times.
..Maurice.
Dr. Bernstein, for many of us that grew up in the 50's & 60's it certainly began with school and sports physicals conducted by females with no provision at all for privacy. More important is that it still happens today for those boys that for whatever reason get their physicals at school rather than with their own physician. It might be a bit better in that physicals are not done in semi-public settings anymore but if he wants to play sports he is still dropping his drawers for a female NP and her female assistant and is still getting a hernia check that girls are not subject to.
For some the initial trauma may have been when they were unfortunate enough to be hospital inpatients as children. At age 11 (& having begun puberty) I was bathed w/o any draping by a woman in full view of anyone & everyone. That I remember it 50+ years later speaks volumes.
Why I still remember those experiences is because as a child my exposure was not treated as a public event at home. And this was in a big family in a small house. As soon as I was old enough to dress myself and bath myself my mother and grandmother never again saw me naked. My privacy was respected at home but not at school, and not when I was in the hospital.
A key point then is that it matters for children too. Treating them as if their exposure doesn't matter can have lasting effects.
I recall an article in the past year or so written by a young female pediatrician that thought she was being sensitive to the modesty concerns of her teenage male patients by her having written an article explaining why she needs to do genital checks. She thought if they understood the medical necessity that the modesty concern would dissipate. That exam is with a female assistant present too and by policy, a parent. Mothers are allowed (not required) to face away during the genital check but a parent must be in the room. I wrote back that a better policy would be to send her "why you need a genital check" missive ahead of time rather than him hearing it for the first time when he is standing there in his underwear, and that the policy of a parent being required to stay in the room be communicated when the appointment is being made so that perhaps the teenage boy's father might bring him instead. She did not reply.
My read is that female physicians, nurses, and other staff, especially young ones, just don't understand boys and men. They haven't had pubescent and teenage sons of their own and their boyfriends and husbands aren't old enough to have had much experience as patients. It is all theoretical for them.
Dr Bernstein,
I found myself nodding emphatically with Biker's comment regarding women care providers being, in essence, clueless about male modesty. And, sadly, the few that do are trained to normalize or dismiss it out of hand as it might create barriers to care ("not helpful" is often used to explain and justify it). This goes back to the concept of subjective reality or a shift in perceptions.
And yes, past traumatic events certainly can lead someone to become extremely weary of any exposures. The surprise DRE a female doctor sprung on me at 16 years old certainly did it for me. But even then, it wasn't the first time I had to deal with inappropriate (or rather poorly handled) situations in medical settings. These negative experiences left me with quite a bit of distrusts toward medical care providers (and all ancillary staff).
Granted, being from Canada, my experience isn't the same. Universal care (such as it is) means that school nurses aren't as involved as they are in the United States. In fact, many schools don't have one (and it's okay, they are not needed). School physicals? Nope. Screenings? Nope. My only interaction with a school nurse (and that was in High School) was for Sex Education classes. And having quite a few nieces and nephews, I can affirm that it is still the case today (not just when I was in school).
Another big difference is chaperonnes. That's almost never heard of here. I certainly never had to deal with this (so far, anyway). Again, casual inquiries of my siblings and how care is provided to their children tells me that it is not a thing either. With the caveat that pediatric care will often require a parent, at least until puberty. One of my nephew, who just turned 15yo, would never put up with having his mom or dad present when he gets a physical. And even that, it is done with only the doctor present (I know, I asked... And I got a weird look for my trouble too - as in why would there be anyone else?).
[On a side note, I will mention that said nephew isn't too keen on getting genital exams either. The puzzling part was he didn't even know he could say no; that he had the right to refuse to consent to that, and he can't be forced. Now he knows.]
Dany
I realized I left out a few things in my last post, so here goes...
My own life experience might not be all that useful to read but maybe it will highlight some fundamental differences between the USA and Canada. I was cared for by a (male) pediatrician until I was almost 15 years old. At that point I decided I didn't need him anymore and flat out refused to seem him again (much to my mother's despair - but I digress). And yes, a teenager can do that here.
Other than the [insert very derogatory term] of a doctor I had to go see at 16, I was without a "regular" doctor until I joined the military. That's a whole different ball game but, while we are required to have medical examinations on a regular basis, I have never had much trouble putting my foot down (so to speak) and decide how far the exam was going to go.
In what is now close to 25 years of active service (and still going), I have never - yes, I said never - allowed anyone to assess my genitals. And other than two providers (a doctor, and a PA), most accepted my decision without arguing (or were wise enough to keep their objection to themselves). Ironically - or perhaps I should say as expected - the two providers who weren't going to take no for an answer - that is, until I got a little angry with them - were women. To me, that says a lot but I'll readily admit being biased here.
Other then my recent run in with a urologist, which I have posted about here already, that's pretty much it as far as medical exposure. And while I'm really not happy about certain aspects of the care provided to me (namely being turned into a training dummy without being made fully aware of the fact OR having consented to it - which, believe you me, will not happen again), I can't really complain much. At least not yet. Then again, my usual go-to PA guy has been talking me up about prostate exam so... Oh gawd!
As far as providing information for PT, I would say keep it simple; the issue, at the core, is one of respect and human dignity.
Dany
Dany, first I want to express my appreciation for identifying your home and medical experience in Canada which "runs" the provision of medical care a bit differently than that within the United States and I also assumed maybe different attitudes between doctor and patient and vice versa. Gender differences as applied to medical care of their residents in countries with other cultures (such as Muslim) would be also of interest to be written here by blog visitors located there. ..Maurice.
Here is my posting from a February 2007 version of our Patient Modesty thread that may be of value to read and discuss here dealing with why men are treated differently than women in the medical system.
=======================================
At Friday, February 23, 2007 7:14:00 AM, Blogger Maurice Bernstein, M.D. said...
To get an answer to js md's question, I posted his comment on a bioethics listserv and got the following response from an ethicist who provides us with a little unfortunate American history background which parallels the issue that js md brought up. ..Maurice.
Maurice,
In 1838 a "free person of color" contested statute that imposed on persons like
himself a unique vulnerability. If he could not pay fines imposed on him, the
county sheriff had the power to "auction him off" to the highest bidder to work
off his fine. White folks were not vulnerable to this indignity.
The court faced a problem - did this violate the State's equal rights provision
forbidding the imposition of unequal burdens on citizens of the State?
Of course, this raised the vexed question whether free person of color were
citizens and the court answered "yes" but not equal citizens, since women and
children were citizens but not equal to male adults...
Anyhow, and to the point, the court opined that the distinctive provisions
applying to blacks did not offend the constitution [because] blacks were not as
sensitive to degradation as whites.
Seems to me like a similar rationale is
used today for asymmetrical privileges.
====================================
We;;. that 1838 court argument could be used, if taken to the courts regarding physical modesty issues contrasting men vs women. How is that for an argument? ..Maurice.
Dr Bernstein,
The attitude is different; I'd like to think it is one of mutual respect and, dare I suggest, acting in good faith.
I wouldn't want to leave the impression that Canada's healthcare system is so much better but, I think there are a few things we do right.
Respecting patients' modesty in medical setting, sadly, does need some improvement.
Dany
Thinking more about a NYT article, one could latch onto the current media frenzy concerning media/entertainment/political personalities sexually harassing staff and others. Though the floodgates have opened with abuses being aired and demands for change, what was happening was an open secret for many years. Everyone in those circles knew it was happening and chose to just look the other way. Some may have justified the silence saying that the victims got something out of it in terms of career advancement.
The basis of an article could be drawing a parallel between that harassment and inappropriate medical staff behavior talking about patient bodies & genitals in the OR & nurses lounges and of staff "sneaking a peak" so to speak. It could be pointed out that while everyone in the medical world knows it happens that they too choose to look the other way, often justifying it by saying that the patient doesn't know it is happening so no harm no foul. Sometimes they justify it as staff using humor to deal with the pressures of the job. Examples could be given of when individuals carry it a step further with photographs and social media postings.
The above could be posed in terms of both male and female patients as victims. It might be better for the double standard for men to be a separate article focusing on the differing standards of handling male exposure and provider gender choice.
Good Evening
Along the lines of what Biker has said, you could throw in a reference to female school teachers preying on our male children. It's all over the news but nobody talks about it much less put those perverts in prison.
Regards,
NTT
Not sure sn NYT article can build momentum for male modesty issues when what may be perceived as more important signs of discrimination are getting attention:
http://www.dailymail.co.uk/news/article-5192915/Prostate-diagnosis-shame-Men-wait-four-times-long.html
REL
REL, I am not sure that the difference in time for a pathologic diagnosis to be made between female breast cancer and the delayed male prostate cancer is necessarily an example of true gender discrimination. We have no screening test for prostate cancer which is as likely, by itself, to be as promptlyy highly suggestive of cancer as that of the mammogram. Further, the pace of diagnosis and treatment is probably different in the United Kingdom's health program than in the United States.
I want to know if there is a difference in physical modesty issues (male vs female patients) in the U.K. compared to U.S.A.
..Maurice.
NTT, your example of female teachers preying on male students is another good example of a societal change. I highly doubt there haven't been many female teachers quietly dismissed over this for years, but now suddenly the media has decided it is OK to report it and the legal system has decided it is OK to prosecute. Another open secret not previously talked about.
The question then is whether the media is ready to talk about inappropriate behavior on the part of medical staff.
Just as we learned some years back that many pedophiles hid in the priesthood, as Scout Masters etc., now we know some female pedophiles have hidden in our Middle & High Schools.
Might the media be ready to ask the question why female nurses choose the specialties they do? Such as urology?
I'm not sure about what constitutes gender discrimination or the validity of testing in either suspected prostate or breast cancer cases but I'm sure that neither of us is a urologist :>). I believe the word "perceptions" i used is the key to momentum and expect that the headline will generate perceptions along the lines I suggest.
REL
Biker:
I'm tracking a dozen of these cases & so far only one judge in Texas decided enough is enough & wanted to make an example out of that teacher in hopes of sending a message to all the other female predators out there. He gave her 10 years in prison.
Everybody else that's had their case go to sentencing, so far has only got probation & community service.
Regards,
NTT
This may sound silly but since physicians go to medical school to learn to become physicians, would anyone advise that all potential patients should have an education course available to learn how to be a patient? Such a formal course might eliminate some of the conflicts in understanding or behavior. The course for patients might include patient responsibilities but also responsibilities of the physician and staff. The course would teach the law and the ethics of the patient-medical care provider relationship.
With this knowledge as background for every potential patient, tools for the patient like "speaking up" before, during or after would all be part of the patient's armamentarium to carry with them.
How is that for an approach to a solution of the issues described on this Patient Modesty thread? ..Maurice.
Great idea Maurice. I think many potential patients don't have any idea of what to expect when they enter the medical environment. They are caught off guard, they don't know what their rights are, they don't know the talk, they don't know the walk. I know I once put medical personnel, particularly nurses, on some kind of a pedestal. I gave them access to my body and soul in a way I have never given anybody else outside of an intimate relationship. After the abusive experience, I was seriously confused. I wanted to trust them, but I couldn't, at least not for a very ling time. Fortunately I was in great health and really didn't need much except for physicals for employment and for my pilot's license. I feel I am still learning how to deal with medical providers.
Mike (58flyer)
Maurice
When a person is admitted to the hospital they are given several pieces of paper. Your rights and responsilibities as a patient are the titles of those two pieces of paper. Within those rights that are listed it says " you are entilited to dignity and respect ". Now, I don't need to be reminded of all the patients who are drug seekers, have Münchausen syndrome or by proxy, assault staff and just want a place to stay because they are homeless or like being waited on. I've seen enough of these kinds of patients to last me a life time, however, there is a common denominator I have noticed that those kinds of patients display, outright rudeness.
Yes, rudeness and I'll tell you it works. The first thing hospital staff will do is in one way or another bully you in a variety of ways. As a patient you never want to be outwardly kind and polite for if you do you will be taken advantage of by the bully club. Be assertive in what you want and how you want healthcare delivered to you. Finally, to answer your question Maurice I'll suggest perhaps a short summary patients should receive about the logistics and how healthcare is delivered, what to expect and how long,
PT
Dr. Bernstein, unless the medical community was prepared to acknowledge the severe male-female imbalance at the nursing/tech/CNA etc staffing levels and acknowledge that many men are just as modest as women, it is hard to see where patient training would be anything more than patients need to be compliant. Yes they would be told to ask questions if they have any but I can't imagine patients ever being told that they can have some say in who will be there observing, let alone the genders of the medical staff.
I envision such training to focus on all staff are professionals that don't see a patient's penis any differently than they see his elbow, including the CNA, Medical Assistant, and even food service worker that barges in while a patient is being examined.
Where the medical community could instead do a great service for patients is in having literature and/or videos that explain exactly how procedures are done. For example, if you seek to find out how a full skin dermatology exam is done, whether the physician is a male or female, videos never include a genital or rectal exam. The patient has no way of knowing beforehand whether he is laying down on an exam table or is standing up for that part of the exam, nor the extent to which he will be draped or how long that part of the exam will take. The videos and literature never say that a female scribe and medical asst or nurse will be there observing. Only the doctor is mentioned in literature or shown in videos.
Another example here. For highly invasive procedures such as urodynamic studies where there are a number of different kinds of tests that might be done, a patient would be hard pressed to know beforehand that he might be expected to stand there fully exposed in front of two women observing when leakage occurs in a pressure test.
In this day and age of seemingly unlimited information it is hard to accept that when it comes to intimate medical exams and procedures that it is extremely difficult to find patient education literature or videos that actually informs patients.
Has anyone found on YouTube, for example, what you find as a video which provides a valid and complete description of the law and ethics in medical system-patient relationships and what options patients have to make their voices heard? If not, maybe, beyond that article in the New York Times, such a YouTube video would be of value. I scanned YouTube for something like that but I may have missed one. How about the use of Facebook or Twitter to present patient advocate view and patient education? Sad to say, this blog doesn't have the "readership" of those resources. But wherever, the orientation of the presentation should be EDUCATION and NOT simply discussion.. the latter of which we have plenty here,..Maurice.
Not sure that having a patient take a education course would do much good . Allowing the patient the choice of gender would eliminate a lot of the problems presented here .
Here is a small cut from a hospitals patient rights info .
1. XXXX-health centers and hospitals will reasonably respond to requests and needs for treatment or services within their capacity .
2. Patients have the right to designate their visitors , and people involved in their care .
If they won't honor your request tell them to refer to number 2 and refuse the people you don't want involved with your care and why . Read their patient bill of rights and be prepared to confront them .
Take care.....AL
This is why the problem is Not getting fixed: Too much of the focus is on the gender gap in healthcare. The problem is not gender, it is healthcare providers themselves. If a male urologist is willing to not hire male nurses, scribes, MAs, etc., AND will bring a multitude of females in to the exam room of a male patient, what makes any rational person think that replacing them with men will be any better?
Now you will have a male physician, nurse, and scribe, ALL willing to bring in 2 female nursing students, a female resident, a female scribe in training, an all female news team with camera crew, an all female...
The definition of insanity is doing the same thing over and over, AND expecting a different result.
The problem is the AMA; they created a monopoly. Medical education and hence healthcare is standardized. Very few physicians practice outside the box. See:
How the AMA hijacked Medicine
The American Medical Association and
Its Dubious Revenue Streams
The AMA Betrays Patients and Doctors… Again
Nursing, Physician Control, and the Medical Monopoly
The American Medical Ethics Revolution
Physicians, nurses, med students, and other providers have the same arrogance and sense of entitlement regardless of gender. The solution is to put the patient in control. By this I don't mean let them take their business elsewhere (because of the AMA monopoly, there is no elsewhere). I mean really put them in charge.
The only way to change the system is to break it. The way to break it is to smash it. There needs to be severe consequences for infractions of patient dignity, both civil and criminal. A good starting point is the book The Criminalization of Medicine: America's War on Doctors.
I would not be comfortable being naked in front of an audience of voyeurs in the exam room no matter their gender. Bringing in extra
people unannounced when the patient is in such a vulnerable (undressed) state is an assault.
This is where change begins.
-- Banterings
Banterings, it may not be what you mean, but what constitutes assault can't be up to each patient to decide. If medical staff are going to go to jail every time a patient feels their dignity was violated, nobody in their right mind would choose a medical career.
Hopefully you mean there needs to be actionable regulations concerning patient consent for the presence of observers and similar kinds of dignity related matters. Both sides of the equation need to understand what the rules are. Even then the devil is in the details. We routinely sign off on forms that allow for students and observers now. It is just that virtually nobody reads what they are signing.
There are elements in both the current comments of Biker and Banterings which come together as a realistic description of the current practice of medicine, the responsibilities of physicians and the duties of the patients.
I think all my visitors here will find the description of "Treat Me Right" in the dissection of the proper,effective and ethical doctor-patient relationship in an article which can be accessed at this linkLhttps://adkteamtalk.wordpress.com/2012/05/22/treat-me-right/ ..Maurice.
Just a note of anticipation to all our visitors: we will be moving on to Patient Modesty: Volume 83 in a few days since we are already in the 170 plus Comment range.
By the way, if you haven't noticed because you came directly to this thread, the blog has reached a total of 1000 threads (which does include all 82 on Patient Modesty) since starting in 2004. Here is the address to the celebratory thread:
http://bioethicsdiscussion.blogspot.com/2017/12/the-1000th-thread.html
Finally, best wishes for the holidays including a healthy and happy New Year..and the happiness should also be part of the way we are all treated as we try to stay healthy. Am I speaking a universal wish? ..Maurice.
ATTENTION: AS OF DECEMBER 25 2017 PATIENT MODESTY: VOLUME 82 WILL BE CLOSED TO FURTHER COMMENTS BUT THE DISCUSSION WILL CONTINUE ON PATIENT MODESTY: VOLUME 83. ..Maurice.
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