Bioethics Discussion Blog: Patient Modesty: Volume 83

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Monday, December 25, 2017

Patient Modesty: Volume 83


And the discussion about inequality in certain aspects of medical attention and behavior by the medical system toward male patients continues..
For those arriving here prior to reviewing Volume 82, you may want to go to Volume 82 to refresh yourself on the ongoing conversations. Graphic: From Google Images ("Public Domain Review")  and my modification using ArtRage Studio Pro.


AS OF FEBRUARY 4 2018 NO FURTHER COMMENTS WILL BE PUBLISHED ON THIS VOLUME.  PLEASE WRITE YOUR COMMENTS NOW ON VOLUME 84.

183 Comments:

At Tuesday, December 26, 2017 2:26:00 PM, Blogger Maurice Bernstein, M.D. said...

To start this Volume 83, here is a great and pertinent 2014 article in Permanente Journal relative to the history of many of our blog thread contributors. It is titled "Best Clinical Practices for Male Adult Survivors of Childhood Abuse: "Do No Harm".

Here is the published Abstract. But go to the above link and read the full paper. It is absolutely pertinent to what has been discussed here and more.
----------------------------------------

Abstract
The health care literature describes treatment challenges and recommended alterations in practice procedures for female survivors of childhood sexual abuse, a subtype of adverse childhood experiences. Currently, there are no concomitant recommendations for best clinical practices for male survivors of childhood sexual abuse or other adverse clinical experiences. Anecdotal information suggests ways physicians can address the needs of adult male survivors of childhood sexual abuse by changes in communication, locus of control, and consent/permission before and during physical examinations and procedures. The intent of this article is to act as a catalyst for improved patient care and more research focused on the identification and optimal responses to the needs of men with adverse childhood experiences in the health care setting.

------------------------------------------

Frankly, I think that this can be an important topic to detail with my first year medical students. Perhaps none of the male students had childhood sexual abuse or adverse childhood experiences, however, from the start of their medical education and later patient management, I think this topic is essential and I am not sure that it is specifically discussed and detailed elsewhere in their beginning education.

Please read the full article and tell us what you think about its Recommendations. You know, these Recommendations would be pertinent for either patient gender. ..Maurice.

 
At Tuesday, December 26, 2017 3:42:00 PM, Blogger Biker in Vermont said...

Excellent article Dr. Bernstein. It is good to see some recognition of the issue. The one thing I would add is for the physician to also think in terms of the rest of the staff that the physician is including in the patient's care team. The patient might be comfortable with the physician but not some of the staff.

The article doesn't include non-sexual abuse scenarios but in your comment you include "adverse childhood experiences". Though clearly not at the level of sexual abuse, adverse childhood experiences can affect the patient's interaction (or lack thereof) with the medical system. I think it formed the initial underlying basis for my general apprehension of female medical staff when intimate exposure is involved.



 
At Wednesday, December 27, 2017 11:15:00 AM, Anonymous Anonymous said...

Please see below a 2009 Canadian pamphlet outlining sensitive care for childhood abuse victims. This, coupled with Kaiser's 2014 article (referenced by Dr. B. above), still causes me to wonder why no study or individual has championed the cause for male modesty/ dignity in almost a decade since the 2009 statement. Reginald

https://www.integration.samhsa.gov/clinical-practice/handbook-sensitivve-practices4healthcare.pdf

 
At Wednesday, December 27, 2017 7:26:00 PM, Blogger Maurice Bernstein, M.D. said...

I say that every individual who participates in the profession of medicine, from physician to all nursing staff, technicians, chaperones,scribes, in their interaction with any and all patients must follow the Core Humanist Values ((Swick, H. M. 2000.Toward a normative definition of medical professionalism. Acad Med 75(6):612–16. ):honesty and integrity, caring and compassion altruism and empathy, respect for others, trustworthiness. Every interaction with a patient (as well as the patient's family) must meet these values despite the nature of the illness and despite the behavior of the patient or family, despite the complexity or urgency of the illness and despite the financial or other burdens such as available time or other limitations. Beyond learning how to carry out their duties of work, each of these individuals participating in medicine must be taught at the outset these Core Humanistic Values and the necessity to follow them.

It could be these Values are minimally taught to all the participants. Also, what is essential is that each participant in the practice of medicine should be encouraged to be a "brother's keeper" and inform the "brother" and others if the Values are not followed.

Can this happen? It must. ..Maurice.

 
At Wednesday, December 27, 2017 8:24:00 PM, Blogger Maurice Bernstein, M.D. said...

p.s.- I forgot to type in the job (profession) of clerical staff who are active participants and often a very very close communicator with both patients and patients' family.

Also let's consider those participants in medical care who are a bit further away but by their decisions and actions can be very influential in the system such as administrators and their staff.

And, in these days of seemingly callous attitude by some politicians regarding patients and potential patients, they too should be following the Core Humanist Values noted in my previous posting. Do they get formal education in this regard or are they simply voted for and elected?

Am I missing any others who make an imprint on the care of and attention to patients? ..Maurice.

 
At Saturday, December 30, 2017 10:29:00 AM, Blogger Biker in Vermont said...

Dr. Bernstein, certainly everyone involved in healthcare should approach it such as you describe in your last two posts. The reality is that most see simply being polite as being all that is needed. As I have stated before being polite is not the same as being respectful and treating patients in a dignified manner.

Young people in school being trained for healthcare careers typically have very little experience in being patients themselves, especially as patients receiving intimate care. As most of us learn in life, reality rarely turns out to be what we thought it would be in theory.

I know it can't be done, but healthcare workers would come a whole lot closer to the ideals you note if during their training they had to experience intimate exposure to and treatment by opposite gender staff. It doesn't have to be with their fellow students. The treatments wouldn't even have to go beyond a certain point. For example, students could be prepped for a foley catheter without actually inserting the catheter. It is easy for healthcare workers to convince themselves that being the "professionals" that they are, that patients have no reason to be modest in their presence. Turn the tables as I suggest and they'll know that isn't true, and they'll be a whole lot more respectful of their patient's dignity when they finish school.

 
At Saturday, December 30, 2017 1:08:00 PM, Blogger Maurice Bernstein, M.D. said...

Biker, the 6 first year students I teach in my group are in the "twenties" years of age and though I know nothing about any personal health problems as I have read their autobiographies which they wrote for another course, I truly doubt that they have had no personal including bodily "self-exposure" to participants in medical diagnosis and care.

As I mentioned previously, coming up in the next month or so, we will be teaching them physical examination beyond the behavior of taking a patient's vital signs. They start with the abdominal exam, which after they are observed practicing on each other will be practicing further with real patients (with patient's specific permission at the time). Therefore, as an introduction topic to discuss with them before taking on practicing on each other or real patients, I will plan to offer a discussion on their own personal physical exam exposure to the medical profession and what their own experience was like and how their experiences may affect how they subsequently perform the exam on others.
In the past, I have only discussed what we expect as student attention to modesty issues but have not brought up their own personal history and experiences.

Let's see what I learn and what they learn.

By the way, if I didn't mention this before, I have had my genitals exposed to professional folks of both genders and never observed unprofessional behavior..and, by the way, I was a professional at the times. (Of course, you can argue that I was given VIP behavior but I know the potential difference and that was never the case!). As a child, I have no recollection but certainly didn't carry any upset feelings into adulthood. Let's see what responses I get from my students. ..Maurice.

 
At Saturday, December 30, 2017 2:53:00 PM, Blogger Biker in Vermont said...

Dr. Bernstein, a good thing to ask the students is whether there were observers, assistants, or chaperones present for those exams or other intimate exposure procedures. If all they have experienced is a private exam with a same gender provider they may not have appreciation for when others are there observing, especially opposite gender others.

 
At Saturday, December 30, 2017 3:58:00 PM, Blogger Biker in Vermont said...

Dr. Bernstein said: By the way, if I didn't mention this before, I have had my genitals exposed to professional folks of both genders and never observed unprofessional behavior.

Most of my intimate care opposite gender interactions have been handled in a professional manner. That doesn't mean I was comfortable with it or that I felt the interaction was dignified. A woman prepping me for a cystoscopy does not constitute care provided in a dignified manner no matter how polite she may be or how careful she is to make sure the door is closed or how careful the other women in the office are to not come in the room while she is doing it. That is the part the medical world just doesn't understand. Polite and professional acting is not the same as respectful and dignified.

 
At Saturday, December 30, 2017 8:26:00 PM, Anonymous Anonymous said...

Maurice

How you were treated in your healthcare will never alter our opinions of how WE were treated during our healthcare nor will it ever change our opinions on this subject. For every conscious patient who felt they were treated professionally I assure you there are 10,000 unconscious patients who were not. Furthermore, no type of instruction regardless of the duration nor the technique in my opinion will ever prevent a lapse in judgement of anyone in healthcare.

Personally, I despise the phrase lapse in judgement as I did not coin it for it comes from the mouths of administrative assholes looking for excuses to somehow define the temporary behavour of medical staff. It's just that they do this all the time only this one time they simply got caught. I guarantee that at some point in the future your students will have one of those lapses in judgement. How often I cannot say but I assure you they will.

The correct posture to assume is that in healthcare you can trust no one. Not only can you not predict positive outcomes but that you should not put your trust in them. It's just a business, they all hate their jobs and they hate their patients and many put on a fake face just because that's what they are supposed to do so as to go through the motions.

PT


 
At Saturday, December 30, 2017 10:22:00 PM, Blogger Maurice Bernstein, M.D. said...

PT. is it then your opinion that what I have been doing year in and year out for now 32 years teaching first and second year medical student how to become physicians not only a waste of my time but, in essence, a waste of the students' time since all they learn about properly interacting and examining and diagnosing their patients also something they will be eventually dumping all of this into a waste bin? Is the well established observation of "physician burnout" related to a general practice of ignoring patients or in reality because of professional, political, legal and patient demands to care for and diagnose and finally cure more and more patients in less and less time? I understand the mechanism of the "burnout" is the latter.

Yes, PT as i have noted here previously and on a number of other subject threads on his blog and which I agree with you, there are always a number of "bad apples" who appear in the medical bin but it is up to the public to see that they are removed and the healthy apples polished and used. ..Maurice.

 
At Saturday, December 30, 2017 10:30:00 PM, Blogger Maurice Bernstein, M.D. said...

For clarity, to correct a typing error: "Yes, PT as i have noted here previously and on a number of other subject threads on his blog.."
the statement should read "this blog". ..Maurice.

 
At Monday, January 01, 2018 5:11:00 PM, Anonymous Anonymous said...

Maurice


Do I think your curriculum teaching medical students includes subjects such as how to evaluate positive Murphys signs or perhaps Thromblytic therapy after 3 to 6 hours after onset ischemic stroke although that might be beyond what a 2nd year med student might be involved in. I certainly am not suggesting that what you have been doing for 32 years has been a waste of your time nor the students time, however, I am suggesting the curriculum as it relates to this blog is a waste of time. Do you really think they will get it?

After all what makes your students unique in comparison to other medical students across the nation? The 5th year resident at Mayo hospital who took a pic of a patient's penis with his cell phone and then forwarded it to his colleagues one might think would be beyond lapses in judgement at that juncture of his training. I believe I could look up your past medical students for the last 32 years and find evidence that some of them have had lapses in judgement. I'm not doubting my savy nor my ability to perform such a search, I'm suggesting the lapses are there.

I think it's disturbing that in the final analysis that attorneys have to tell physicians how to practice medicine as well as who gets to continue to practice medicine. I recall a lawsuit whereby a 12 year old patient died due to a ruptured appendix after the ER physician sent her home. The response from the hospital attorney was " well you could have ordered a CT scan, why didn't you." Furthermore, it's always the decision of an attorney who decides which physician has their license revoked and it's going to be attorneys as well that decide for the most part that male patients have been discriminated for so long in healthcare.

To further illustrate how stupid hospital administration, physicians and staff are as it relates to patient satisfication I'll ask you what do you do or how do you evaluate patient satisfication? I'll tell you how hospitals are doing it now, it's called Press Ganey. Not all patients are surveyed after leaving the hospital, YET ALL patients are charged for this service as its figured into their bill. What is the survey? It's a series of stupid questions such as " how did the food taste, did your doctor answer all your questions, was your call light answered promptly. " Hospital food is not supposed to taste good.

Press Ganey charges hospitals millions of dollars each year for this service. That service is passed on to you the healthcare consumer yet not all patients are surveyed, why? Don't you think hospitals could be proactive and maybe ask patients beforehand " How can we better serve you" what makes you comfortable?" Where are the questions relating to privacy? Hospitals will be reimbursed soon based on patient satisfaction scores and sooner or later physicians offices are going to be held accountable.This is all long overdue, too little and too late.

PT








 
At Tuesday, January 02, 2018 4:34:00 AM, Blogger Biker in Vermont said...

I've never worked in healthcare nor do I have insider info but on the Press Ganey surveys not asking pertinent questions it seems obvious. You don't ask questions that you don't want answers to. The current 90% female staffing below the physician level serves women's interests most of the time. At the same time few men complain about opposite gender intimate care. That makes it easy to pretend medicine is gender neutral, so neutral in fact that it would be a waste of ink to even ask relevant questions in the surveys.

For all practical purposes women run healthcare today. There may be mostly men in the corporate suite still but even that is changing now than enough women have worked their way up the hierarchy these past few decades. At an operational level it is primarily women deciding who gets hired. In nursing, medical technology, and services (CNA's, MA's) schools it is primarily women in charge of recruitment, admissions, and instruction.

Nursing is now one of the higher paid careers in this country. Nurses earn in the 90th percentile where I live and far above the median just about everywhere. Feminist groups will scream loud and clear if any attempt was made to make healthcare careers (below the physician level) more welcoming for men in that each additional man is one less job for women. The women who run healthcare are not going to allow Press Ganey to gather evidence that might jeopardize their near-monopoly. We know medicine is gender neutral they'll say, no need to confirm the obvious by asking patients what they think.

 
At Tuesday, January 02, 2018 3:39:00 PM, Blogger A. Banterings said...

Maurice,

By your very admission in response to a comment I made in an earlier volume, you said that you only teach 2nd year and do not know what happens in their 3rd and 4th years (and beyond). You even speculated that they fall prey to the hidden curriculum.

So we do not know how effective your teaching techniques are, because again, by Maurice's own admission, he (you) do not know what happens with the students beyond some anecdotal contacts made years later. This is NOT empirical data. In fact I argue that all schools care about is how many pass their boards.

Biker,

To answer your question; NO. Assault is NOT whenever someone feels their dignity has been trampled upon, there is a legal definition:

Intentionally putting another person in reasonable apprehension of an imminent harmful or offensive contact. Intent to cause physical injury is not required, and physical injury does not need to result. Source; Cornell Law School

The article that Maurice referenced, Best Clinical Practices for Male Adult Survivors of Childhood Sexual Abuse: “Do No Harm”, has the solution for ALL patients to be treated with dignity AND protect themselves:

The locus of control in the health care of the male survivor needs to be with him and not the physician...



-- Banterings

 
At Tuesday, January 02, 2018 6:29:00 PM, Blogger Biker in Vermont said...

"Intentionally putting another person in reasonable apprehension of an imminent harmful or offensive contact. Intent to cause physical injury is not required, and physical injury does not need to result. Source; Cornell Law School"

Banterings, the key word is "intentional". The medical world is operating within societal norms that currently say men should be comfortable with opposite gender intimate care. A woman doing an intimate procedure or exam or simply being there observing carries no harmful intent under those norms. It would only cross over to intentional if the man objects, or if in fact there was something egregious in their behavior that a reasonable person would construe as intentional.

 
At Tuesday, January 02, 2018 8:43:00 PM, Blogger Maurice Bernstein, M.D. said...

banterings, actually this year I am teaching first year medical students and yes I really don't know how they will be interacting with patients (and the other medical staff) when they move on from graduation. All I can do is try to get some important issues in their current and future relationship with patients. As an example, the following posting is a document I sent my students yesterday to review and answer before our next Tuesday class when we will be discussing their responses. I present this here because it is pertinent to our current discussions. ..Maurice.

 
At Tuesday, January 02, 2018 8:50:00 PM, Blogger Maurice Bernstein, M.D. said...

ETHICS/PROFESSIONALISM ISSUES IN 4 PAIRS OF STORIES
By Maurice Bernstein, M.D.
1. Can you find at least one ethical/professional issue common to both
of the two stories?
1A- As a 3rd year student on the hospital ward you hear the resident
asking the intern "Did you get the CBC on that gallbladder in 7321?"
What, if anything, do you find unprofessional in the
question of the resident?
1B- From JAMA "A Piece of My Mind"
The Knee
We are on attending rounds with the usual group: attending, senior resident,
junior residents, and medical students. There are eight of us. Today we will learn .
how to examine the knee properly. The door is open. The room is ordinary
institutional yellow, a stained curtain between the beds. We enter in proper order
behind our attending 'physician. The knee is attached to a woman, perhaps 35 years
old, dressed in her own robe and nightgown. The attending physician asks the usual
questions as he places his hand on the knee: "This knee bothers you?" All eyes are
on the knee; no one meets her eyes as she answers. The maneuvers begin-abduction,
adduction, flexion, extension, rotation. She continues to tell her story, furtively
pushing her clothing between her legs. Her endeavors are hopeless, for the full
range of knee motion must be demonstrated. The door is open. Her embarrassment
and helplessness are evident. More maneuvers and a discussion of knee pathology
ensue. She asks a question. No one notices. More maneuvers. The door is open. Now
the uninvolved knee is examined-abduction, adduction, flexion, extension, rotation.
She gives up. The door is open. Now a discussion of surgical technique. Now review
the knee examination. We file out through the open door. She pulls the sheet up
around her waist. She is irrelevant.
What are the ethical/professional issues apparent from this story? What is
the responsibility of the attending physician? What is the ethical issue, common to both stories?
(continued on next posting)

 
At Tuesday, January 02, 2018 8:54:00 PM, Blogger Maurice Bernstein, M.D. said...

2. Can you find at least one ethical/professional issue common to both
of the two stories?
2A- The third year student was asked by an intern to perform a urinanalysis
urgently as a preop on an elderly man who is being prepared for emergency
chest surgery. The student has a white blood count, urinalysis and a gram
stain of a sputum to do on three other patients which was requested as urgent
by another intern. The student is flustered by all these requests. He had
done a complete history and physical on the pre-op patient and there was no
symptoms or history of urinary tract disease so therefore to save time he
didn't spin down the urine and didn't prepare a slide and didn't look under
the microscope but just checked "negative" on the urine lab slip and then
went on to start on urgent the lab work ordered by the second intern.
What is the ethical/professional issue apparent from this story? What
dilemma might the student have encountered? What might have been the
consequences to the student which ever order he followed? If the student
didn't behave appropriately, what would have been the better approach to
resolve his dilemma?
2B- Dr. Jones has been 25 years in the practice of family medicine and has
just examined 60-year-old male patient Mr. Smith who has been Dr. Jones'
patient for many years. Mr. Smith came to Dr. Jones now with an insurance
form for Dr. Jones to complete relating to an alleged disability following a
recent automobile accident. The patient complains of a painful and stiff neck
since the accident. Dr. Jones knows that the patient has complained about his
neck many times over the years and an X-ray of his neck taken 8 years ago
showed some osteoarthritic changes.
Dr. Jones finds nothing suspicious of injury on physical examination and
patient's symptoms are similar to what he has complained about for years.
The patient is very insistent that Dr. Jones report on the insurance form that
he was injured.
Dr. Jones decides that he can't with certainty say that Mr. Smith was not
injured and moreover he doesn't want to lose Mr. Smith as a patient. Dr.
Jones writes on the insurance form that Mr. Smith suffered a "musculo-
skeletal neck strain" and attributed the disorder specifically to the auto
accident.

What are the ethical/professional issues present in this story? Is it
reasonable for Dr. Jones to have assumed that some injury to an already
"diseased" neck was inevitable and therefore his conclusion was valid?
Should Dr. Jones have even considered the possible loss of a patient in his
conclusion?

 
At Tuesday, January 02, 2018 8:56:00 PM, Blogger Maurice Bernstein, M.D. said...

3. Can you find at least one ethical/professional issue common to both
of the two stories?
3A- Mary, a second year medical student was paired with Jane to interview
and examine a County Hospital patient. Jane actually performed the entire
history and physical herself but Mary turned in a writeup based on Jane's
work. Mary did not participate because she felt she was too tired after a "big
night" with her boy friend. Mary, should have but did not inform her ICM
instructor about her non-participation because she felt that he would not
understand, be unhappy with it and diminish his evaluation of her.
What is the ethical/professional issue involved in this story? How about
Jane? Should Jane have reported to the ICM instructor about Mary's lack
of participation?
3B- Dr. Roberts has a patient with epilepsy who is not adequately controlled
on any of the current anti-seizure drugs. Dr. Roberts is aware of a formal
clinical study being performed in the clinic of Dr. Smith with a new
experimental anti-seizure drug that is being tested in hopes of benefit for
intractable epilepsy patients. Dr. Roberts does not inform his patient about
this study as an alternative option because of fear of losing the patient to the
other clinic.
What is the ethical/professional issue here? In an experimental research
trial is it ethical for a physician not to inform the patient about the trial on
a rationale that there is no proof yet that the experimental drug would be
effective for the patient?
4. Can you find at least one ethical/professional issue common to both
of the two stories?
4A- Bob has finished his second year in medical school and has just started a
medical inpatient clerkship in the beginning of the third year but knows that
he has to study for his part one National Boards which is upcoming several
days away. He needs more time to study but knows he has responsibility to
his clerkship. The interns and residents on the ward are looking to him for
his performance of the medical student duties. Bob is faced with a dilemma
since he knows the failing the Boards would be a further burden added to his
current life problems. He decides to notify the clerkship superiors with a
story that his brother has suddenly died and that he has to fly across the
country to join his family and attend the funeral. His superiors give Bob
their condolences and permission to be away from the clerkship for three
days. Now Bob has a chance to study without interruption and feels he has a
better chance of passing the boards.
What is the ethical/professional issue in this story? What is the greater
good, to participate on the ward for 3 days or to enhance the opportunity
to pass the Board exams? Is lying ever ethical?
4B-Mrs. Jones came to Dr. Williams office at 4pm with a cough and fever of
1 days duration. She had not eaten nor drunk fluids well for the previous
week because of some abdominal pain. Dr. Williams took her history,
examined her, got a blood count and chest X-ray. It was now 4:45pm. He
made a diagnosis of right middle lobe pneumonia and dehydration. The
cause of her abdominal pain was uncertain. He felt she should go now to
enter the hospital but that would mean he would miss his son's football
game which started at 5:30pm. He had promised for several weeks now to
attend. Dr. Williams decided to arrange hospital admission for Mrs. Jones
for the morning and send her home on oral antibiotic.
What is the ethical/professional issue of this story? If Dr. Williams made
the wrong decision, what would have been a better way to mitigate his
conflict?

 
At Tuesday, January 02, 2018 9:01:00 PM, Blogger Maurice Bernstein, M.D. said...

With the above reproductions of what my group will be discussing next Tuesday, I hope that you see that we are trying to get these beginners of the medical profession to realize that there is also a patient present and not just a disease or just themselves.

Will this all help? The students have a long road ahead with a lot of pressures of all sorts and believe it or not..they are just humans regardless of their upcoming professional title and work. ..Maurice.

 
At Tuesday, January 02, 2018 10:22:00 PM, Anonymous Anonymous said...

Maurice


I know that for many many years you having practiced evidence based medicine ( EBM) and as you may know it took on the form evidence based practice (EBP) which spread to nursing. That happened around 1991 so tell me why is it that after 26 years the idiots in nursing haven't figured out that all the unnecessary urinary catheters that they have placed over the 26 years have caused countless infections and deaths. Consumed millions in wasted healthcare dollars due to re-admissions. How would you or your med students like to enter a hospital and receive a urinary catheter that was unnecessary and as a result get mersa or c-diff. Want to know what a regimen of vancomycin costs.

Nursing industry=moronic idiots

Thousands and thousands of dollars that's how much vanco costs, all because the idiots in nursing abused something called a standing order. Definition of standing orders...These are orders that can be used on a nursing floor without notifying a doctor such as a portable chest x-Ray if the patient develops sob or a bmp ( basic metabolic panel), it's all for the convenience of the physician but nursing has abused it. We don't want the patient urinating on the bedsheets so we give everyone a foley cath so we don't have to change the sheets or go fetch the patient a urinal. Now Misty did a fabulous job regarding unnecessary urinary catheters on Dr Sherman's blog, however, what Misty does not know is that primarily male patients were the ones who received unnecessary catheters.

Have I ever told you how much I hate and despise the nursing industry

My question to you Maurice is that as an internal medicine physician have you ever been in the capacity to look in on an inpatient of your and/or question why some cares were done and that you saw that there were no specific orders coming from a physician? Have you ever been in the capacity to question why a patient received a urinary catheter and felt that it was unnecessarily placed? You see, the decision now that when patients have to be re admitted due to a hospital acquired infection the hospital has to EAT the bill and rightfully so.

Just how many people have died because nurses never wash their hands


What this all tells us is that evidence based practice is a failure, nursing is a failure. They had 26 years to get it right but couldn't so Medicare and insurances companies are now telling hospitals to get it right, the ATTORNEYS are telling hospitals to get it right. The ATTORNEYS are now telling physicians to get it right. Recently, in the news President Trump is telling the CDC not to use phrases such as evidence based. I hope he tells nursing too because they can't get anything right, failures after 26 years.

PT











 
At Wednesday, January 03, 2018 8:43:00 AM, Blogger Maurice Bernstein, M.D. said...

Urethral catheterization is an invasive procedure and requires the specific order of the physician. ..Maurice.

 
At Wednesday, January 03, 2018 9:56:00 AM, Blogger A. Banterings said...

Biker,

There is plenty of research that shows healthcare interactions have harmful consequences (such as PTSD). As I stated, it is not just by opposite gender caregivers, it is by ALL caregivers.

To solve the problem, we need to move away from the issue of opposite gender and make it about all caregivers.


-- Banterings

 
At Wednesday, January 03, 2018 12:16:00 PM, Anonymous Anonymous said...

Maurice you said

Urethral catherization is an invasive procedure and requires the specific order of a physician. "

No, I've seen a few Icu's whereby they were standing orders and everyone got catherized wether you needed it or not.

PT

 
At Wednesday, January 03, 2018 1:37:00 PM, Blogger Biker in Vermont said...

PT, it should be pretty clear that Dr. Bernstein has tried very hard to instill a good ethical base into his students. No doubt other instructors have too. That some students don't take those lessons to heart is on them, not on the instructors.

Just as beauty is in the eye of the beholder, what constitutes respectful and dignified medical care depends upon who you ask. I have noted several times that many in the medical world see being polite to the patient as synonymous with being respectful and providing dignified care. I say it is not the same, but they're not interested in what I think because they're the "professionals". To them my Master's degree and successful high level corporate career does not make me a professional capable of understanding respectful and dignified in medical settings. Instead it is the teenage CNA who is the professional. She knows what is respectful and dignified, not me.

It likely will take a landmark lawsuit to effect any real change. Until then those few of us so inclined will continue chipping away when and as we can. A piece of that is what Dr. Bernstein has done here which is provide a forum that has empowered me and others to find our voice.

 
At Wednesday, January 03, 2018 2:40:00 PM, Blogger Maurice Bernstein, M.D. said...

PT, I have never been involved in operating room activities or standards. However, if a standard of urethral catheterization of all patients within the operating room, it still would be the responsibility of the operating surgeon to be aware of the standard and be responsible to reject the procedure if not appropriate for operative management of his or her patient. ..Maurice.

 
At Wednesday, January 03, 2018 3:20:00 PM, Anonymous Anonymous said...

Last years Athena Insights article on “Are male patients comfortable with female doctors” generated plenty of comments. Food for thought for Athena & the medical community. Followers here may wish to comment on a recent article titled

“Chaperones in the exam room - who gets to decide”

currently at
https://www.athenahealth.com/insight/chaperones-exam-room-—-who-gets-decide

Speaking of chaperones, I wrote my large medical center’s Patient Rights for years. I can tell you in this country 10 years ago & even 5 years ago there was little to no mention in medical center’s Patient Rights of chaperone gender consideration. That is changing thanks to everyone’s efforts and patient pushback. I searched last night on this topic and now there are many medical centers noting patients have the right to same sex chaperone or provider and of course the patient’s right to decide. Here are just some examples:

https://www.medstargeorgetown.org/for-patients/patients-and-visitors/patient-information/patient-advocacy/#q=%7B%7D

https://www.saintfrancisbartlett.com/for-patients/your-visit/your-patient-rights

https://www.valleybaptist.net/for-patients/your-visit/your-patient-rights

https://www.thehospitalsofprovidence.com/for-patients/your-visit/your-patient-rights

http://www.airforcemedicine.af.mil/Portals/1/Documents/MTFs/Hill/2017_Patient_RIGHTS_and_RESPONSIBILITIES.PDF?ver=2017-11-01-103538-203

https://www.northshoremedical.com/for-patients/i-am-a-scheduled-or-current-patient/your-patient-rights

By the way, the UK has the “Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Regulation 10” which specifies for their national healthcare system:

-“Staff must respect people's personal preferences, lifestyle and care choices.
-When providing intimate or personal care, provider must make every reasonable effort to make sure that they respect people's preferences about who delivers their care and treatment, such as requesting staff of a specified gender.”

So we in the US are behind other nations in providing respectful intimate care.

fyi - AB

 
At Wednesday, January 03, 2018 3:41:00 PM, Blogger Maurice Bernstein, M.D. said...

By the way, with regard to PT's views of nurses, I did a little study on Google regarding the topic "I Hate Doctors" in 2007 and posted it as a thread. ..Maurice
-----------------------------------------

"I Hate Doctors and..." A Brief Study on Google Search
On June 30 2005, I started my posting with the following:

"A visitor came today to my blog from Google with the search words “I hate doctors”. While, I don’t know the true motivation and concern of this visitor, I think that this visitor’s search terms are consistent with the ambivalent feeling people have about doctors. Whether it is fair to characterize this ambivalence in the extremes of “love” and “hate” or some more moderate terms can be considered but obviously the ambivalence is a realistic phenomenon."

Today, almost 2 years later, there are now 84 comments to that posting which I titled "I Hate Doctors" and, of course, many, many more visitors who didn't comment. This has been one of my most popular postings. I wondered whether we physicians were the most hated people who are supposed to serve the public. So I went back to Google today and entered the words "I hate..." and finished the expression with "doctors" and found there were 18,300 sites using those words. Then I replaced "doctors" with "nurses" and then a whole bunch of other jobs and below is the results I obtained. I am not sure whether this study says anything significant about the publics opinion of these different classes of activities but I thought the listing would be of interest to my visitors. So here they are:
I HATE...
Doctors 18,300
Nurses 659
Lawyers 10,100
Politicians 994
Ministers 5
Police 704
Judges 676
Actors 623
Actresses 190
Plumbers 424
Used Car Dealers 127
New Car Dealers 7
Insurance Agents 10, Insurance Companies 684
Realtors 505
and then I put in the words "I Hate Men" 70,800
and naturally I tried "I hate Women" 54,500
and finally to establish the ambivalence between to hate and to love doctors I put in "I love Doctors" and Google said there were 9,760 sites with those words, a little more than half of the hated.

 
At Thursday, January 04, 2018 6:43:00 AM, Anonymous Anonymous said...

Maurice

That data is not significant but I'll say that in the real world hospital housekeepers do more for infection control than nursing ever would. On a more and equally important note regarding trust nursing is not the most trusted industry. On my list they are the least trusted and I don't know where I would place them on the totem pole but probably below thieves and prostitutes.

PT

 
At Thursday, January 04, 2018 12:33:00 PM, Anonymous EO said...

First, I would like to thank all the men that have been abused by the nursing industry for having the courage to post their experiences here. Keep it up, for when others see in writing what they too have experienced, this will enable them to become more proactive and at the least to attempt to defend themselves from being further abused via the female nursing brigade. I realize disclosure, even though anonymous, can be incredibly painful.
I especially would like to note PT's comments. I too have utter contempt, loathing, anger, and absolute distrust of the entire sickcare industry (the current medical model in the US is not "healthcare" by any stretch of the imagination)! Considering that (per Harvard) medical mistakes are the 3rd leading cause of death in the US, the disgusting arrogance of doctors, nurses, and other medical personnel would be laughable did it not lead to so many injuries and deaths. Female nurses, especially, cause many deaths via infection by running around where they have no business being, slithering about in their filthy scrubs to violate yet another male client’s privacy! Let’s just say that the Denver 5 have hundreds of thousands of like minded comrades…
Especially I HATE the nursing industry and have no trust in any nurse, but especially the female. I have several graduate degrees and decades of writing consulting experience in the US and Australia, including reviewing nursing essays. One might think that these dreadful papers were written by community college nursing students, but the ones I reviewed were written by nurses in BNS and MNS programs. The adage "dumber than dirt" should have been coined for these cows. Stupid doesn't even begin to describe this population. For example, I recall one cow that built her entire research essay about the results of 214 clients (I NEVER use the word patient as it subconsciously infers an inferior position on the part of the client, when it is and should be treated as the opposite). That particular nursing cow could not understand that 214 results against a background of 20 million were of no statistical importance! I could supply thousands of such instances of utter stupidity. These are the nurses that routinely kill clients in hospitals!
In particular, I'd like to note that I have always felt something very wrong, something prurient, in all hospitals and clinics I've had the misfortune to visit. After reading all 83 blogs, I know now that what I have always felt is yes, the salacious mind set of the female nursing brigade. Wasn't it in an earlier blog that someone mentioned a posting on Facebook wherein a female nursing student, close to graduation, was eager to graduate and thus start nursing work TO SEE THOUSANDS OF PENISES! Some 600 or more "liked" her disgusting remark! Wow, what a great reason to join the sickcare industry!
As a woman who understands the misandry rampant in the US, especially in the sickcare industry, allow me to state that these nursing cows are incredibly intrusive and arrogant when it comes to regarding wives as obstacles that stand in the way of their criminal entitlement to doing basically whatever they please with "THEIR male patients." We wives are labeled "insecure" when we insist upon same gender care for our husbands and here's another common cow comment upon a male client's hospital check in: "The wife was frowning so I had to assign a male nurse. The patient would have been fine with me providing intimate care but that damn wife sat in the corner frowning.” HOW DARE THESE STUPID COWS INTERFERE IN MY RELATIONSHIP WITH MY HUSBAND! For that is precisely what these female nurses are doing! From what I have learned over decades, the term “bad apple” as applied to nursing is misleading as it appears a majority rather than a minority of female nurses are morally and mentally unfit to deal with any living being!
I’ve got a few more paragraphs that will be immediately posted after this. E.O.

 
At Thursday, January 04, 2018 1:18:00 PM, Anonymous E.O. said...

On Becker’s Hospital Review, I posted several comments (as Kat) via the link to the Denver 5. Basically these were the same I posted in previous blogs here, citing the state laws that labeled their actions as criminal. I didn’t even bother with citing the criminal acts as viewed via necrophilia statutes. Wow! There appear to be many nurses that are scared shitless they’ll lose their illegal access to any and all male clients. I was called very many ugly names, and here’s my favorite: “Oh fucking shut up you moronic c#*^!” The ugly comments have since been taken down by the moderator after I flagged them (as was my last post that was, yes, incredibly dismissive of the entire sickcare industry). WHY IN HELL ARE CRIMINAL ACTIONS BY THOSE IN THE NURSING INDUSTRY SWEPT UNDER THE RUG?! In any other industry, they would be fired, lose their credentials permanently, and be subject to criminal prosecution. BTW, my comment to the so called Patient Advocate at Denver Health, who promises a 24 hour response, was of course ignored! The old female gorgons that are in charge are the primary reason why such criminality is allowed to occur in a medical setting, but of course we must add physician arrogance and stupidity to the issue. I agree with the poster that said they don’t know their ass from a hole in the ground as it is correct!
Permit me to end with the obvious which the sickcare industry ignores: Many morally and mentally unfit females are attracted to the nursing industry for two reasons: firstly, they are quite stupid and a nursing degree is not difficult to obtain, and MOST IMPORTANTLY, THEY ARE ATTRACTED TO A CAREER WHERE THEY CAN VIEW UNCLOTHED MALES BECAUSE YES, IT IS PLEASURABLE FOR THEM. Sex is an incredibly strong drive and yes, such running about viewing nude male clients whom they are not assigned to is an act driven by sexual urges. That they don't abandon their assigned clients to run about and view a male client's elbow speaks volumes!
And Maurice, thank you for hosting this blog. I was the poster in an earlier blog that related a friend’s dreadful abuse at the hands of a female NP, who was later fired for trash talking clients after leaving exam rooms. She was fired (the medical group’s blog lied about this of course) because the CEO physician was fearful of HIPPA fines, not caring that she abused male clients. That was a real eye opener for me because it hit so close to home, and it wounded me as well. Like PT, I can’t stand passing a hospital, a medical building, mention of medical TV dramas, and idiot females in their filthy scrubs dispensing germs in groceries and Starbucks screaming “I am a nurse!” Geez…
Men, just know that there are other women such as myself that understand what you face in that sea of cows that predominate the sickcare industry. And PT, if you ever wish to write a longer article, I’d be happy to lend my editorial advice to such a project. A letter in the NY Times is a good start, but we need more exposure – we need to educate the public as to the level of abuse and criminality that the sickcare industry supports, especially the female nursing brigade. I’ve heard these cows termed “feminazis” by male clients and it is accurate!
I’m pretty busy with work currently, but it seems to me that as Denver Health is a non-profit entity, it might very well to be subject to FOIA. If the Denver 5 were males, they would have been fired, publically identified and shamed, as they were marched off to face the loss of licensure and criminal prosecution. The disturbance of a corpse shows just how ugly those cows are. So, if anyone has time to track it down, check on the FOIA as it applies to public health facilities. Actually, a decent investigative reporter could find out their identities. One of the most important actions that need to be taken is to publicly ID and shame such criminals! Criminals in other arenas face such exposure, and in health care it should be of paramount importance!



 
At Thursday, January 04, 2018 2:18:00 PM, Anonymous Anonymous said...

Maurice

Have you ever had an obese female nurse question your orders?

If so did you

a) Remind her of the Krispy Kreme dribble on her scrub top
b) Remind her that she is within 6 min of her hourly smoke break
c) Tell her to run along you have other more important things to do
d) All of the above

PT


 
At Thursday, January 04, 2018 5:02:00 PM, Anonymous Anonymous said...

E.O


I like your style, I like your anger cause it fuels me. The only way to deal with this issue is with anger. I'm retiring very very soon and what I want to be is a very severe problem for nursing. I want to be like some Lyme disease from hell, starting out as a rash but quickly becoming
an ulcer with severe fever, systemic then gangrenous. I want to enlist your help!

PT

 
At Thursday, January 04, 2018 5:29:00 PM, Blogger Biker in Vermont said...

AB, I looked at those patient's rights docs you posted. It is a step in the right direction, though it is really only going to apply to men in settings where chaperones are mandated being few men would ever request a chaperone.

There was one that did go a step further which bears noting. This was St.Francis Hospital-Bartlett. Theirs included actually asking patients about preferences:

Be treated in a dignified and respectful manner, supportive of his/her cultural, psychosocial, spiritual and personal values, beliefs and preferences. To assure these preferences are identified and communicated to staff, a discussion of these issues shall be included during the initial nursing assessment.


 
At Thursday, January 04, 2018 9:33:00 PM, Blogger Maurice Bernstein, M.D. said...

PT et al, in all these 12 1/2 years of the Patient Modesty thread expressions of anger and disgust with various sections of the medical profession has been repeatedly and very well expressed. But, though some ventilation of personal feelings is personally therapeutic and expressive to others, that method of discourse is limited in the direction of creating change.

Many elements of the medical system are at fault in creating the upsets repeatedly disclosed here. Certainly, in teaching ethical practice to medical students, we loose control as they move into the "hidden curriculum" of the latter two years of medical school and training beyond. The same must also hinder proper behavior to patients in all the other education programs for those to be involved in attending to patients--and, perhaps, the original education programs are also at fault along with inadequate attention in the business and legal and political aspects of the practice of medicine.

As moderator of this blog and thread, I think our goal here is to create rational approaches to remove the defects within the medical system. So let's continue to maintain a constructive format for these threads to work toward the above goal.

..Maurice.

 
At Friday, January 05, 2018 6:53:00 AM, Anonymous Anonymous said...

E.O. and PT, thanks for your guts in describing what many of us have sensed, but with our limited exposure to the medical community don't have the data to feel that competent to state which you so elegantly explained.

Recently both MDs [I hate doctors] and nurses [cows] have been taken to task, but I think the rest of the staff has contributed equally to the profession/occupation that doesn't treat patients with respect and dignity. My experience is that the staff are worse than MDs.

I tend to accept the condescending arrogance of MDs because they are the result of the selection process by medical schools. Since they have mastered the 3Rs {Read, Retain, Regurgitate] they are selected for medical school [all "A"s in undergrad work] and we are surprised that there are so many jerks [the term that fellow MDs use for them]. Remembering your college days, would you pick the geek that got all "A"s as your MD, thinking that he would treat you as a fellow human being? I once had a MD that was lost before [not after] the greeting [saying hello].

If the MDs were interested in patients as human beings and not just objects to be processed, MDs would use technology as an aid. In 1986, there was AI [artificial intelligence] software that "could diagnosis equal to the better internist". Why isn't it being used today? The big egos of MDs prevent them from thinking and accepting that a computer/robot could do a job as well as they do [actually better than most]. This software would be a great second opinion to the MD w/o fear that a fellow MD would recognize the bad diagnosis.

Then again, I could see the owners of medical institutions nixing the concept because it would impact their profits. The current business model is a bureaucracy plus a percentage profit. In other works, the greater the expense [more MDs] the bigger the profit. All the owners have to do is convince the government and health insurance companies of the "necessity" of added costs. How difficult is to convince insurance companies since the greater the costs for them the larger the premiums with the resulting higher profit [it's all about percentages].

In the proposed business model using AI, the waiting room [no waiting] would have 6-8 [as many as necessary] enclosed booths. Symptoms would be spoken [voice recognition] in the privacy of the booth, questions would be asked by the computer/robot, and a diagnosis made with a prescription to be approved by the MD from the privacy of his desk. A technician could help with the training of new patients, but how long would it take to talk and listen to a computer/robot [it might be easier than talking to some MDs]? Of course, the MD could always see the patient and/or override the diagnosis. Many, if not most, patients would soon appreciate the unlimited time the computer/robot allows and think "I love the 'personal' touch".

BJTNT

 
At Friday, January 05, 2018 9:17:00 AM, Anonymous Anonymous said...

Hi PT, I've sent my email to Maurice, so please feel free to contact me. I appreciate your anger also. Unfortunately, at the current primitive level of humanity, it seems that directing one's anger after/at incredible abuse is something we must engage as a motivator to fight the good fight. After reading the (now deleted) ugly words directed at me from others (probably nurses judging from the low mentality of the comments) I realize what this fight is:THIS IS WAR! The level of criminality among the cow nursing brigade is so broad that it rather boggles the mind as to how it has lasted so long! Time to take it down!!!
E.O.

 
At Friday, January 05, 2018 9:22:00 AM, Blogger Maurice Bernstein, M.D. said...

BJTNT, there is one "artificial intelligence" that I would like the system get rid of and that is direct to consumer drug commercials on TV and elsewhere. And there is no "little booth" for the patient to interact with the "provider of intelligence" and present all the facts to lead to a reasonable medical conclusion. One viewing these commercials get a blast of benefits for as yet personally undiagnosed named diseases or symptoms and because of federal regulations a blast of toxicity warnings. After raising all this fright and uncertainty in some viewers or readers, who at the outset did not actually have the disease but now is forced into medical introspection the commercial ends with one ambiguous and incomplete command "speak to your doctor". If this isn't artificial intelligence diagnosic function at its worst, I don't know what else to call it. It can end up producing an unnecessary patient burden to other patients who are waiting for a proper diagnosis and appropriate treatment from their physician. It is AI that serves the financial benefit of the drug companies.

By the way, there is no way that any artificial intelligence can be expected, as we do for our physicians, to provide empathy to the worried and ill patient.

Anyway, this is my opinion. ..Maurice.

 
At Friday, January 05, 2018 9:29:00 AM, Blogger Biker in Vermont said...

I don't hate MD's, nurses, or any other broad category of healthcare workers. Yes there are some bad apples but medical workers as a whole are not the enemy. Whether they are the physician with many years of education and training or the high school drop out CNA that has been trained to do a few low level tasks, all fill roles necessary for the system to function.

The system perpetuates a double standard that is self-serving. As wrong as that is I do not blame the individual nurse for taking a job that requires intimate opposite gender contact. I had a high level corporate career. Many in our society think it would have been better if a woman or person of color had my job but I'm not so altruistic that I'd of ever forgone my lucrative career in favor of society achieving a goal that runs counter to my interests. Nurses at my local hospital are in the 90th percentile for wages in this county. Most are women. Why in the world should I expect any of them to say "No, don't hire me, hire a man. I'll pursue a lower paying career."

I did not like the fact that I was prepped by females a couple dozen times for cystoscopies on account there weren't any male staff, but I don't blame them individually for doing the job they were hired to do. I blame the system instead. I can only blame them if they were inappropriate in their demeanor or actions.

All that said, I am not so naive as to not believe many do choose the specific roles/specialties they do because they enjoy the view. I think this is particularly the case with women working in urology and men in gynecology. Much of our problem here is that I doubt many male nurses are seeking jobs in urology. If they were and were being discriminated against by hiring managers, lawsuits would fix that problem real quick. So, in addition to men not speaking up we also have the problem of men not seeking careers in nursing and especially in places like urology.

Until enough men speak up and enough men seek nursing careers improvements to the system will be in small incremental steps.

 
At Friday, January 05, 2018 10:57:00 AM, Blogger mitripopulos said...

Check NY Times 1/5/18 for an article on men in nursing; very positive and feedback from male patients very informative regarding male patients being more comfortable dealing with male nurse.

 
At Friday, January 05, 2018 11:25:00 AM, Blogger Biker in Vermont said...

There is finally resolution to that awkward dermatology exam I had a couple months ago. It shouldn't have taken as long as it did but I think in the end they realized I wasn't going to let it go.

A week after the appt. I sent a carefully worded letter to the Head of Dermatology. This is a very large practice in a large teaching hospital. My exam had been with one of the Residents there. I did not hear back from them and after a month sent a letter to Patient Relations at the hospital, and included a copy of the letter I had sent to the Head of Dermatology.

About a week and a half went by with no acknowledgement from them. I had to go over there for something else and stopped by Patient Relations to ask when I was going to hear from them. The person I spoke to said there was no record in their system of a letter from me. She took me into her office to discuss my concerns and made a call to the Dermatology Practice Mgr. She didn't reach her then but did a short while later and sent me a message saying she'll get back to me after the Practice Mgr reviewed the matter with the Head of Dermatology.

A week goes by with no word from Patient Relations or Dermatology and so I follow-up again with Patient Relations via email. The next morning I get a call from Dermatology looking to reschedule my upcoming appt. from the Resident to the Head of Dermatology. I am unclear on how to interpret that. It could be he wants to apologize for the initial awkwardness and his non-responsiveness to my letter. It could also mean I'm the problem patient he'll personally handle rather than risk the Resident mucking it up again. We'll see.

Today I get a message from Patient Relations. Some changes have been made and some training is being done. Presently 100% of the scribes and nurses are female. Protocol had been that a scribe and nurse were present for all full exams. Going forward male patients who do not want a female audience can have full exams with just the physician present.

Another of the problems was staff being out of sync with each other as concerns patient instructions. Some training is being done to get them all on the same page. Patients are supposed to be told to undress to their level of comfort by the nurse. What the patient does is then a cue for the doctor as to genital exam or not. It didn't work that way in my case which added to the confusion. Not the best approach if you ask me but the doctors should at least be able to rely upon the nurses having given the correct instructions.

Lastly, Patient Relations pursued whether the patient can state males only when making the appt. and not have to repeat it again on the day of the appt. Currently the scheduling system can't assure all staff involved will get that info and so the patient will need to state it again the day of the appt. Addressing that in the system will be looked at.

All that I have accomplished here is that men who speak up will be accommodated. That's not as good as having male scribes and nurses or men being asked if they are OK with female scribes and nurses being present, but it is a positive change nonetheless. That male modesty exists has now been acknowledged in the Dermatology Dept of this hospital.



 
At Friday, January 05, 2018 12:43:00 PM, Anonymous Anonymous said...

Biker

Urology positions are simply not offered to men. Have you visited cna forums where this discussions occur? I have spoke with a number of male cna's and medical assistants. Their opinion is no one wants to hire them. Now, let's just suppose your comments are true, that perhaps in a medical environment there were no males just females. Female nurses, cna's and medical assistants know they don't have to be at all concerned when they are patients. Yet, they themselves cannot be professional to their male patients and I'm not going to list category after category in the manners in which they are unprofessional. Furthermore, if they wanted to they could find a male to provide intimate care but they won't.

PT

 
At Friday, January 05, 2018 2:16:00 PM, Blogger Biker in Vermont said...

PT, the hospital to which I moved my urology care last year does have a couple male nurses. For my cystoscopy last year I asked for and got a male RN to do the prep/assist the doctor. When making my appt. for this year I asked again for a male nurse and was told that's what they'll put me down for.

I do agree most urology practices don't hire males. Where I had gone for the prior 11 years never had a single male nurse, and it was a very large practice at one of the big hospitals in Boston. It would be hard for a medical practice to defend not hiring a male nurse applicant when most of their patients are males receiving intimate care. That there don't seem to be male nurses filing discrimination charges against urology practices is likely due to male nurses just not applying.

I have never been on a CNA forum and am not familiar with what CNA roles in urology practices might be. The only people I have ever dealt with were RN's, NP's, and MD's over the course of my several dozen procedures.

And yes I have been on the receiving end of unprofessional behavior, though that was the exception rather than the norm. I'd very much prefer to only deal with male staff but I can't fault the female staff that were just doing the job they were hired to do, so long as they are appropriate in mannerisms and protocols.

 
At Friday, January 05, 2018 4:53:00 PM, Blogger A. Banterings said...

Maurice,

In Volume 82, you asked:

"...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? ..."

If the encounter was not sexual, then there would be absolutely no need for chaperones.

Do you (as well as the whole medical education system) not train your students that patients (both male and female) may become aroused during examinations and how to properly deal with the situation?

Do you (as well as the whole medical education system) not train your students that they, the students (both male and female), may become aroused during examinations and how to properly deal with those feelings?

I don't think it necessary that I cite medical education texts to validate my statements.

The healthcare industry has told us for years that regardless of gender the interactions are not sexual. Now, the industry is poised to take the stance that same gender interactions are not sexual as patients began demanding they be treated with dignity. The problem is that they are attempting to solve the problem on false premises (like they have been doing all along.

What the request for same gender care and no voyeurs in the room does is shakes up the status quo, says I want you to show you take me seriously and respect my dignity.

That brings me to another issue with chaperones: How are they suppose to protect a patient?

First off, how would they know what a proper exam consists of? Even nurses are not trained to do this like physicians.

And what if the patient is distressed by the exam? Do they have the authority to stop the exam immediately and remove the physician from the room. (Like a medical student acting as a chaperone would ever do that.)

What if the physician does something in appropriate? Who does the chaperone report them to and how long after? Are they suppose to use one of those anonymous tip lines that healthcare systems have to report colleagues?

So who are chaperones really protecting?

The state of the industry today (ACA, MOC, EHR, etc.) is a result of what the industry has done to itself.



-- Banterings





 
At Friday, January 05, 2018 4:57:00 PM, Anonymous Anonymous said...

Biker,

Thanks for the followups on your urology visits at the new medical center. I recall they dictated your office visit incorrectly. Did they correct your medical record? They have a HIPAA law obligation to respond to your request for a correction to your medical record and to indicate to you their resolution of the matter. Did you receive this back in writing? If not, look up DHS/Office for Civil Rights and how to file a complaint. (In my former life I unfortunately dealt with the OCR many times. Do complain if they failed to address your medical record error.)

As for the other changes they made based on your comments - good for you! You kept pressing until you got some resolution. A large medical center has no defense against not hiring any male MAs or a male nurse in a Derm department for whole body exam chaperoning of male patients. I would point out your large medical center has in its other departments and clinics male MAs that could be easily recruited (via $) over to the Derm clinic so to accommodate both genders respectfully. They chose a work around instead of trying to hire male staff (draw your own conclusion what this means) but as you know it still favors the female patient and still disadvantages some male patients (who must proactively request a certain arrangement). Nonetheless, they are making an effort - you have moved the needle.

As I’ve mentioned in the past, the Urology dept. I go to at a large medical center has a male nurse and after I pointed to them the discriminatory issues with having zero male MAs in a clinic that has about 90% male patients several years ago they added a couple male MAs. But alas MAs turn over rapidly in health care and my last visit the department had no male MAs again. Because I previously worked in medical compliance and risk for many years the first time I raised the staffing issue with them I did not complain to external agencies - I gave them a chance to correct (which they did). I now need to evaluate if they have relapsed into previous practices and deserve to have more painful scrutiny. — AB

 
At Saturday, January 06, 2018 4:06:00 AM, Blogger Biker in Vermont said...

AB, when I sent a message to the Resident shortly after the exam stating he was incorrect on two key points what he did was remove those references altogether. Not quite as good as correcting them but at least the incorrect statements were removed.

At this point I will wait and see how my follow-up appt. goes. I will be disappointed if the Head of Dermatology doesn't apologize for not responding to my letter and for the overall poor handling of my initial appt.

As an aside in the message I got from Patient Relations I did get a "not by design or intention" comment concerning scribe and nursing staff being 100% female. No way would they ever admit to anything else, but I wouldn't be surprised if Dermatology has been told to get with the agenda and hire some males.

This hospital is fairly progressive in terms of what we discuss here. That's why I was so surprised nobody in Dermatology wanted to acknowledge and speak to the issue until I got Patient Relations involved. Last year when I switched my urology care to there from Boston I went for my initial meet and greet appt. with a urologist which included an exam (just the two of us in the room). I expected my annual cystoscopy to be a 2nd appt. but he says given it is a long ride for me to get there would I like to have one that day and arranges it for an hour or so later. That facility is so big you can get lost and not knowing how to get to where I needed to go for the cystoscopy a nurse walked me most of the way there. I told her I would prefer a male nurse. She says that shouldn't be a problem and she'll tell them as soon as she gets back to her office. My request didn't phase her at all. In fact none of my queries related to this topic phased anyone in other depts I have interacted with as I moved all of my care there over the past year. Except Dermatology.

In conjunction with this year's cystoscopy the doctor has also ordered an abdominal ultrasound. I asked if there are male sonographers. There are. Being it is a teaching hospital I knew that even if I have a male sonographer maybe a female Resident will want to participate. I called over to the ultrasound area and asked whether I would be exposed for that procedure. I get connected to one of the female sonographers who looks up my appt. and says only my abdomen would be exposed. More importantly, my asking didn't phase her at all. Most places if you ask a modesty related question of female staff the response is either condescending, dismissive, or incredulous that a man would ask such a thing.

So, hopefully Dermatology will start catching up with the rest of the hospital in this regard.

One last aside, 13 years ago I was sent to the local hospital for an abdominal ultrasound as part of my initial bladder cancer diagnosis. I had no idea what that was or how it was done and at that point in my life didn't know men had any choice but to drop drawers on command of any woman in scrubs. It was all I had ever known. I get on the table and without asking she lifts up my gown fully exposing me before she puts a towel over my genitals. Now I know that is bad protocol, that I should first be covered with a sheet and then the gown pulled up from beneath it. There is no need to be exposed at all for an abdominal ultrasound, and it seems for this upcoming one the folks there know that.

 
At Saturday, January 06, 2018 8:05:00 AM, Blogger Biker in Vermont said...

I agree with Bantering. Chaperones offer no protection for the patient at all. They are only there to protect the doctor/nurse/tech against claims of impropriety the patient might make. Sadly there are some patients who would falsely make claims so I understand why chaperones are used but conversely it is extremely unlikely a chaperone would ever speak against their employer no matter what that doctor/nurse/tech did. Any patient that feels they need a chaperone to protect them from their doctor probably should find a different doctor.

I also agree that there is always a sexual component in the background of any intimate medical procedure. That is not the same as saying there is sexual attraction, though sometimes there will be on the part of one or both parties. Obviously some patients and some healthcare staff are going to be the recipients of sexual attraction more than others. Most of the time however sexual attraction on either side of the equation isn't the issue. The issue is more one of patients knowing they are being sexually judged.

Healthcare staff say they never judge but they're human. Regardless of the underlying medical issue, the young fit guy in Room 345 is going to get a different kind of attention that the old fat guy in Room 346. It is just human nature.

Averages and norms being what they are most judgements are going to be neutral and fleeting in a "seen a thousand just like that one" kind of way. The doctor/nurse/tech quickly moves on to other things mentally. For those new in their careers even neutral may be more than a fleeting observation which is partly why I prefer older staff. For the rest of the patients those judgements will be positive or negative and the attention span on the matter not so fleeting. Judgements always occur. It is just part of the human condition.

Doctors/nurses/techs are generally pretty good at maintaining their professional game face and for most patients that is all they want. Others of us would prefer that judgement be at least restricted to same gender staff. For me it is a basic modesty issue rather than where I perceive myself to fall in that negative-neutral-positive continuum.

 
At Saturday, January 06, 2018 11:11:00 AM, Anonymous Medical Patient Modesty said...

I wanted to respond to what Biker in Vermont said below:

One last aside, 13 years ago I was sent to the local hospital for an abdominal ultrasound as part of my initial bladder cancer diagnosis. I had no idea what that was or how it was done and at that point in my life didn't know men had any choice but to drop drawers on command of any woman in scrubs. It was all I had ever known. I get on the table and without asking she lifts up my gown fully exposing me before she puts a towel over my genitals. Now I know that is bad protocol, that I should first be covered with a sheet and then the gown pulled up from beneath it. There is no need to be exposed at all for an abdominal ultrasound, and it seems for this upcoming one the folks there know that.

I am sorry to hear about Biker in the Vermont’s experience. The truth is patients should wear underwear / shorts for an abdominal ultrasound. It is sad that many patients are not aware of this fact. Bladder scanner is the best alternative to urinary catheter. Probably about 90% of urinary catheters are not necessary. In fact, I talked to a former nurse who told me she was concerned about how many unnecessary urinary catheters were done in ER to trauma patients. The best way to measure urine output is through bladder scanner. Only your lower abdomen is exposed for a bladder scanner. However, you have to wear underwear or shorts to keep your genitals from being exposed. Putting towel on the genitals is not the best option for abdominal ultrasound since your genitals may be briefly exposed when your gown is lifted up.

Misty

 
At Saturday, January 06, 2018 1:52:00 PM, Anonymous Anonymous said...

What is the point of having a chaperone? To protect whom? Read the case of Dr Brian Finkel, Arizona abortion doctor sentenced to 35 years in prison for sexually assaulting 67 female patients. Some of his chaperones said nothing when the doctor molested his patients on the exam table. Even on a number of occasions his wife was a chaperone and even she said nothing when he molested his patients.

The female Ent physician in New Mexico who groped her male patients while the operating staff witnessed this and said nothing. What is the point of having anyone there if they won't self report? If you want to hear something even more ridiculous is the 5 nurses in Denver who gawked at the genitals of a patient while alive and again after he died. The state of Colorado says that the dead have the right to remain silent. Just what kind of crack does one smoke to come up with that law? Those nurses should have been charged with a class 2 misdemeanor, however, police officers there apparently don't know the laws.

In the state of Colorado police officers can take a non-mandatory 8 hr ceu class on laws concerning necrophilia. At this point I'm told by a reliable source that at this point none of the police force in Denver nor Boulder have signed up for this training. In many states I find that it is not illegal to have sex with a corpse. I believe anyone that is asked to be a chaperone should be required to take some kind of training regarding ethics and legal ramifications.

PT

 
At Saturday, January 06, 2018 6:20:00 PM, Blogger Maurice Bernstein, M.D. said...

PT, I fully agree with your last statement "anyone that is asked to be a chaperone should be required to take some kind of training regarding ethics and legal ramifications." Know the duties and the law, just like an individual who assumes the responsibility as a notary public must demonstrate. ..Maurice.

 
At Saturday, January 06, 2018 7:26:00 PM, Anonymous Medical Patient Modesty said...

PT,

I agree with you about chaperones. They are often employed by the doctor and there to protect the doctor most of the time. I am not sure if you ever read an article I helped to write, Do Chaperones Really Protect Patients? One female nurse anesthetist (see https://www.outpatientsurgery.net/resources/forms/2010/pdf/OutpatientSurgeryMagazine_1001_ent.pdf) actually reported Dr. Sparks and was fired by the hospital. I admire her for her courage in speaking up even though it meant losing her job. Many good nurses do not want to report abuse because they are afraid of losing their jobs.

I think each patient should have the choice of their personal advocate such as spouse present especially for surgeries where the patient may be under anesthesia.

Misty

 
At Sunday, January 07, 2018 7:31:00 AM, Anonymous Anonymous said...

Biker

Regarding your comments you said " The young fit guy in room 345 is going to get a different kind of attention than the old fat guy in room 346."

What kind of attention is the 22 year old female for her mammogram at 9:00 am likely to get versus the 48 year old female for her mammogram at 11:45. Since only female mammographers would be performing their exams it would be the same.

What kind of attention would the 19 year old pregnant female in room 212 get verses the 39 year old obese pregnant female in 215. The nurses in L&D are all female so it would be the same.

A 20 year old male trauma patient presents to the er post mva. How long does it take for the trauma team to conclude their exam and cover the patient up. When the nurses decide so.



A 20 year old female trauma patient presents to the er post mva. How long does it take for the trauma team to conclude their exam and cover the patient up. The nurses will cover them immediately.

A female gynecologist has a busy practice with an all female staff of 5. Would any of her patients be looked at differently from a sexual point of view.

A male urologist has a busy practice with an all female staff of 11. Would any of his patients be looked at differently from a sexual point of view.

It's 1970 and during a military induction exam 44 young male recruits are lined up in a large room and told to strip with 2 non medical female observing. Would any of these patients be looked at differently from a sexual point of view.

It's 1970 and during a military induction exam 44 young female recruits are each examined privately in a room without male observers. Would any of these patients be looked at differently.

It's a busy Micu ( medical intensive care unit) at a very large teaching hospital in Indianapolis. This Icu has all female nursing with a mixed variety of patients male and female, young and old. The nurses bathroom is covered from floor to ceiling with full nude foldouts from play girl magazine. Would any of this unit's patients ever be looked at differently from a sexual point of view.

PT









 
At Sunday, January 07, 2018 9:48:00 AM, Blogger Biker in Vermont said...

I agree with every word you said in your last post PT. There is a sexual component to all intimate medical interactions.

 
At Sunday, January 07, 2018 12:55:00 PM, Anonymous Anonymous said...

Biker

With the exception of the care of most female patients!

PT

 
At Sunday, January 07, 2018 3:26:00 PM, Blogger A. Banterings said...

PT,

You are correct that the police don't know the finer details of the law. Part of the problem is that police and healthcare are too cozy. Law Enforcement gets vip treatment. I am sure that both you and AB can confirm that.

Here is something that has been brushed under the rug; Dr. Sparks had her license reinstated by the NM board. The only mention of it is a single line buried in the minutes of one of their meetings. She is free to molest ...I mean practice again.

Furthermore, her lawyers use the threats of lawsuits to have news articles about her removed. There was also a mysterious flood of websites with references to someone named Twana Sparks that flooded internet search results and obscured news stories about her.


-- Banterings

 
At Sunday, January 07, 2018 5:46:00 PM, Anonymous Anonymous said...

A. Banterings

If I hear one more claim of sexual harassment in the news I'm going to puke my guts out. Our lovely Twana Sparks has wrote several books, one called "Diary of a hippocrite. ". How she overcame sexism in medical school. Now we all know the real story behind her but I'll just say that it speaks volumes about the culture at the hospital as well as the medical board.

PT

 
At Sunday, January 07, 2018 6:56:00 PM, Blogger A. Banterings said...

PT,

What is her support of a center that helps victims of sexual abuse...

see SASS rely on fundraising and contributions at the bottom of the page.

...talk about the fox guarding the hen house.

-- Banterings


 
At Sunday, January 07, 2018 6:59:00 PM, Blogger A. Banterings said...

I would like to ask the following question and see if we can create a detailed list:

What are some laws that PROTECT patients (like informed consent ant battery) AND what are some legal LOOPHOLES that allow abuse or harm patients (standing orders).

Be creative.



-- Banterings

 
At Sunday, January 07, 2018 8:49:00 PM, Blogger Maurice Bernstein, M.D. said...

Banterings, thanks for continuing what I think is important for this thread which is to find a way to make substantial changes in the medical system so that those aspects of gender inequality in medical care as fully described here for years can finally be eliminated. Again, my audience here is minimal (compared with KevinMD or NY Times or I am sure many other websites) and it would be great if my visitors here could also do what they can to make these threads even more attended. (The blog is totally non-commercial and I have nothing to gain except the pleasure that the participants of the blog have aided in creating needed ethical, behavioral and legal change.)

I would be interested in reading what AB suggests as other approaches here to create such change. ..Maurice.

 
At Monday, January 08, 2018 4:26:00 AM, Blogger Biker in Vermont said...

Bantering, a huge loophole as pertains to patient privacy is the boilerplate language in consent forms. It is so broad that pretty much anyone the hospital wants in the OR or elsewhere observing patients has technically been consented to by the patient when they sign that form. This includes students, including high school kids, equipment representatives, medical staff that want to observe, and every nurse on the floor who wants to make sure the good looking guy's catheter is OK.

My guess is the general consent form that has "for education purposes" language buried somewhere is what allows those medical reality shows to film patients lying naked on the table without the patient's prior consent. No way can an incoming ER trauma patient give informed consent beforehand. Yes the genitals may be blurred out when the show is aired, but the likely mixed gender crew has been given visual access to the patient during filming, and the editors and technical crew afterwards. The segment won't air without patient consent but what about the patient that doesn't consent? You can't undo the fact that they were filmed naked in an ER. But these shows being pegged as "educational" allows it to happen. And I doubt those films are destroyed when the patient doesn't give consent to air the segment.

I would also add that the hospital likely hides behind the consent form that the ER trauma patient will eventually sign to justify all of the curious onlookers (staff not busy with other patients, EMT's, police etc) that stand around watching.

 
At Monday, January 08, 2018 5:37:00 AM, Blogger NTT said...

Good Morning Everyone:

Banterings asked "What are some laws that PROTECT patients (like informed consent ant battery) AND what are some legal LOOPHOLES that allow abuse or harm patients (standing orders)."

One of the biggest legal loopholes that hurts males is that (BFOQ)bona fide occupational qualification.

If the rank & file is mostly female, and the people that do the hiring are also female, chances are, they'll use this exception to keep their rank & file happy and males out, even if the male is more qualified.

Regards,
NTT

 
At Monday, January 08, 2018 9:17:00 AM, Blogger A. Banterings said...

Maurice,

We have already made some changes. Biker and others who have written to facilities that have changed protocols. We now have another tool with ADA accommodations that a couple readers have had letters drawn up. My question is to expose other pitfalls we need to be aware of and other tools (like ADA accommodations) that patients can use that are out there but may not be known.

As to limited users, there are many people who lurk here but never post. These are people of influence. I have seen lexicons that have been used solely on this blog (and some used on my blog) being incorporated into policies and protocols. I know that someone had to be reading this site to use that exact verbiage.

One such example is that modesty is being replaced with the word dignity.

Please everyone, try to answer the question (I posed above), AND please feel free to answer more than once. This is how change occurs.


-- Banterings

 
At Monday, January 08, 2018 10:56:00 AM, Blogger Biker in Vermont said...

NTT, though BFOQ may be used to justify hiring females only in certain areas that predominantly or specifically serve women, I can't imagine anyone could use BFOQ as justification to only hire women in urology practices. It would seem BFOQ could be used for the opposite if only more men applied for such jobs or more male patients demanded it.

 
At Monday, January 08, 2018 4:50:00 PM, Anonymous Anonymous said...

Biker

Why is it that you assume men don't apply for these jobs? Have you seen all the resumes submitted at all these facilities? Who looks to hires employees, it is the vast seas of women at medical facilities that do the hiring. I've spoke with 3 highly qualified male cna's over the last several months about getting employment. All of these candidates were currently working part time jobs but we're looking for additional work and/or full time. They indicated to me they apply at many facilities only to be turned down. One cna described to me that he went to the interview well versed in a suit, while a female candidate also interviewed not professionally dressed with tattoo's all over her arms yet she got the job. Since I'm on the subject I'll let you know two of my pet peeves, medical staff going to the grocery, coffee shop etc in their scrubs, my second pet peeve are tattoo's. It's very unprofessional and they should never be seen on any health care worker. I want to ask them if they were ever in prison.

PT

 
At Monday, January 08, 2018 6:29:00 PM, Blogger Biker in Vermont said...

PT, I don't have an inside track on urology practice hiring efforts but assume that men would file discrimination suits if they were being passed over because of their gender. It doesn't make sense why they'd just accept discrimination. A total absence of male staff in a urology setting would be very hard to defend in such a suit if in fact there have been male applicants. Hard to prove that 100% of the male applicants have been less qualified than the females hired.

I wholeheartedly agree on the tattoos. They shout "UNPROFESSIONAL" in just about any venue, but especially in a medical setting. My wife was a surgical inpatient for a few days a year or so ago and the only bad nurse she had was a young woman all tattooed up. Just had a bad disinterested attitude and who failed to follow the doctor's release instructions which caused a problem Visiting Nurses had to fix afterwards. My belly twitch and the vacant look on her face said "druggie". The other female nurses she had were all good, but she said the best nurses she had were men. She had 3 in all if I recall, 1 in post-op and then 2 when she was in a regular room. She said the men were gentler and more attentive, and this was with a woman in her 60's, not some young chick they were trying to impress. Our guess was given the precarious position male nurses have with female patients that they just tried harder. The tattooed one however needs to find a new career.

 
At Tuesday, January 09, 2018 3:16:00 PM, Blogger A. Banterings said...

Biker and PT,

Please do not let the tattoo thing distract you from the person's qualifications. Although I do not have any myself, many that do are the most thoughtful, compassionate and creative individuals that you will ever meet. I have really long hair, but when really, really bad things happen, the people who call me in do not care about my looks because they know that I will contain, mitigate, and resolve the problem.

Maybe that is what healthcare needs; more people with tattoos.

Granted that there are those who are less professional, but the trend culturally is a shift away from that clean cut look companies demanded back when one could actually have a career and retire from their employer.

You never judge a book by its cover.


-- Banterings


 
At Tuesday, January 09, 2018 7:05:00 PM, Anonymous Anonymous said...

Regarding the 5 nurses in Denver viewing the genitals of a male patient before and after he expired, I was able to access the Colorado state board of nursing of those who have been reprimanded. I did not see 5 nurses who were brought up on any kind of violation or at least 5 nurses at the same time so apparently nothing was done.

A. Banterings

As you may know all hospitals that I'm aware of have strict dress codes. The dress codes includes color coding per department, nose piercings, etc are not allowed and neither are tattoos. For years nurses wore stupid scrubs that would literally say, I'm a sexy nurse blasted all over their scrubs. In my opinion as a male patient one could say that is sexual harassment. Now, my dad served in WW2 and was a paratrooper and of course has that tattooed on his forearm, 82nd airborne with a parachute, I get it. I Personally don't judge people with tattoos, long hair, short hair etc. Personally, I don't care, however, I agree with hospitals that it presents as non-professional so cover it up.

The hospital pays their salary and they have expectations they want to present to patients but as you know it appears that tattoos or not male patients don't get privacy nor respectful care. Now, if you can show me data that says medical staff with tattoos are always more respectful to male patients than those without then I'll go to tattoo school tomorrow and offer free tattoos to any female nurse who wants one.

PT


 
At Wednesday, January 10, 2018 5:58:00 AM, Blogger NTT said...

Good Morning All:

PT, those nurses aren't gonna be dealt with properly. One reason is Nurses are again thought to be the most trusted professionals in the United States, according to the 2017 edition of Gallup's annual poll. The poll marks the 16th consecutive year nursing topped the list as the most honest and ethical profession.

For the 2017 poll, Gallup asked a random sample of 1,049 U.S. adults to rate honesty and ethical standards for 22 occupations. The respondents selected ratings of very high/high, very low/low or average.

What a croc.

It also doesn't just happen to the boys.

A Washington (Pa.) Hospital employee who underwent an operation at her workplace filed a complaint in Washington County Court against the hospital, a physician and several hospital staff members, who were allegedly involved in taking and later sharing photos of her genitals during the procedure, according to the Observer-Reporter.

The woman, a unit secretary in the hospital's operating room department, filed a writ against multiple defendants in October and followed up with a 39-page complaint earlier this month.

The woman was a patient in the operating room for an incisional hernia surgery in September 2016. A scrub nurse allegedly used a cell phone to photograph the woman's exposed genitals as she lay unconscious on the operating table.

Dennis Brown, MD, the operating physician, and several others present did not stop the scrub nurse from photographing the patient and did not report her conduct, according to the suit. After returning from medical leave at the end of October, the plaintiff alleges the scrub nurse showed her the photographs. The woman later learned the scrub nurse had shown the photos to other co-workers.

The hospital fired the scrub nurse after the woman reported her conduct. The suit further claims the presence of a cell phone in the operating room placed the woman at an increased risk of infection.

After experiencing harassment and backlash from her co-workers, the suit claims Washington Hospital failed to protect the plaintiff from "an increasingly hostile and abusive work environment."

The employee-patient later took unpaid leave under the Family Medical Leave Act, and the hospital terminated her employment in October 2017, the suit said.

The plaintiff is requesting a jury trial and damages exceeding $75,000. A trial date has not been set yet.

Seems Becker's Hospital Review can't handle the truth as I replied to the Denver 5 story as to the current way female healthcare workers treat their male patients & they didn't have the guts to post it. All I asked for was give men the same level of Choice Privacy, and Respect they give women.

We MUST find a way to get this issue out of the cyber world so we can't be shut down so damn easy.

Regards,
NTT

 
At Wednesday, January 10, 2018 2:37:00 PM, Anonymous Anonymous said...

I wrote a response to the Facebook page of Denver health regarding the 5 nurses viewing the patients genitals while alive and after the patient expired. Here is what they said back. " Hi $&@(?, thanks for writing us. The case resulted in employee training to reinforce the Code of Conduct.The action violated out policies and Code of Conduct, which is why those involved were suspended with immediate notification to authorities including the Denver police and the Colorado state board of nursing. We are proud of our 7,000 plus employees who strive each day to care for those in need. In the event an individual or individuals fails to meet our high standards of care immediate action will always take place. "

It's apparent that the police did nothing due to their ignorance of the laws and equally obvious the Colorado state board of nursing did nothing either since I find no actions taken. Basically the 5 nurses were placed on paid administrative leave following an investigation. One of the nurses resigned probably out of fear they may lose their job and after 3 weeks of the remains nurses were brought back to work. I assure you they were not suspended but rather on paid leave. Now if you are ever looking for a smoking gun then this case is it since it involves unprofessional behavour on a male patient alive and after he expired, I mean come on does it get any more pathetic this this.

I have e-mailed the Colorado state board of nursing to ask who the director of that agency is. I want to ask this person why no actions taken. The director of the Colorado state board of nursing answers to the governor of Colorado. Furthermore I intend to ask the governor why the police department took no action and finally intend to approach the CEO of Denver health. You may see the post and the response on the Denver Health homepage. I will keep everyone undated on responses.

PT




 
At Wednesday, January 10, 2018 2:56:00 PM, Blogger Maurice Bernstein, M.D. said...

PT, I am proud of you and what you attempted and I am proud of the others writing here who demonstrate efforts to make changes in the behavior of the medical system and its components all the way down to the physicians, nurses, techs, aids, scribes and chaperones. There is no value to "moaning and groaning" except for a valid value from the beneficial effect of self-ventilation.
..Maurice.

 
At Wednesday, January 10, 2018 6:23:00 PM, Anonymous JF said...

PT. If the questionnaire doesn't ask the modesty questions, just write in concerns/ complaints anyway. If it was traumatic just add " I won't seek help again because I never want to be humiliated like this again.

 
At Wednesday, January 10, 2018 6:56:00 PM, Blogger Maurice Bernstein, M.D. said...

A visitor with the acronym JF just wrote, presumably inadvertently to now closed Volume 81 which I am reproducing below. ..Maurice.


Male patients should have their modesty protected but females also have modesty violations to. I think the medical world protects our modesty more, but still not enough. I'm a CNA and have always been a stickler about keeping doors shut and curtains pulled.

 
At Thursday, January 11, 2018 4:33:00 AM, Blogger NTT said...

Good Morning:

PT, I've emailed the Colorado state board of nursing twice already asking why the Denver fab 5 haven't lost their licenses. I've been ignored so far.

Regards,
NTT

 
At Thursday, January 11, 2018 9:16:00 AM, Anonymous Anonymous said...

NTT

I too have e-mailed them twice asking for the name of the director and I've received no responses. I intend to call them today as I would like to have a response reminding them their goal is to protect the public. If necessary I will direct a response to the governor of Colorado as they oversee this agency. Currently, I'm drafting several letters to the leadership at Denver health and this morning I read the comments on Beckers hospital review regarding the incident that E.O mentioned.

FIOA as E.O mentioned in an earlier post as you all know is the freedom of information act, I will consider pursuing this if I cannot myself learn of the identities. I am at this point questioning if the Colorado department of health was notified of the incident. To be honest after reading everything I can on this incident it appears that all agencies are running away from this like a scalded cat. I have placed an additional post on Denver Health's website. I specifically asked " What are you doing proactively to prevent this from ever happening again.

I will make every effort I can to learn all the specifics of this incident that occurred at Denver Health. I have enlisted the help of an attorney in the state of Colorado to give his legal insight on the exact criminality as it relates to necrophilia. Once I have all the information and the specifics I plan to approach many major newspapers to do articles on this subject and be assured that my goal will be to have them present other incidents as well, Dr Sparks, the cell phone incidents in Pa and New York, Mayo and Propublica so as to illustrate that these are not isolated incidents. Finally, I let Denver Health know that I intend to use this incident to set an example.

PT








 
At Thursday, January 11, 2018 9:28:00 AM, Blogger Biker in Vermont said...

I'm glad to see another woman, JF, join the discussion, even moreso being she is a CNA. So few people who work in the industry post here. She is right. Women are not immune to having their modesty disrespected, though it pales compared to what men deal with.

JF, as a CNA you are likely on the front lines so to speak given bed baths and assisted showering are mainstays of CNA roles. My understanding is that CNA's are trained to believe that if they act confidently, pull the curtains and use proper draping techniques doing bed baths that the patient will have maintained their dignity. Is that true in your experience? For me there is no way I could ever maintain my dignity if a woman bathed me no matter how polite she was or how professional she acted. I have long thought that the female instructors at these schools have never actually talked to a man about how he feels being bathed by a woman.

 
At Thursday, January 11, 2018 5:53:00 PM, Blogger A. Banterings said...

PT,

I agree that employers have the right set dress codes.

My point was simply that healthcare needs a different type of person.


-- Banterings

 
At Thursday, January 11, 2018 11:49:00 PM, Blogger mitripopulos said...

Check on the story of University of Maryland Hospital dumping a woman in a hospital gown in below average temps outside the hospital. We all know the honor and integrity of health care-ya.

 
At Friday, January 12, 2018 9:06:00 AM, Blogger A. Banterings said...

A new way to fight.

Greetings all,

I have raised the stakes in this battle. I am using the Weinstein momentum. Time to call out the abusers.

I started a Twitter account to fight. See it here:


-- Banterings

 
At Friday, January 12, 2018 9:09:00 AM, Anonymous Anonymous said...

To all

The director for the Colorado State Board of nursing is Sam Delp, 1560 Broadway, Denver Colorado 80202. I will mail him a letter today and I'll post his response.

PT

 
At Friday, January 12, 2018 10:58:00 AM, Anonymous Medical Patient Modesty said...

It's encouraging to see a CNA who understand patient modesty issues contribute here.

It is also encouraging to see that PT is sending the Colorado State Board of Nursing. Hopefully, Sam Delp will respond.

I wanted to let you all know that there is a patient modesty discussion about male patient modesty going on at this web site.

 
At Friday, January 12, 2018 2:27:00 PM, Blogger mitripopulos said...

Banterings, Great logo; sums up everything and my attitude up clearly.

 
At Friday, January 12, 2018 2:49:00 PM, Blogger mitripopulos said...

Banterings, Great logo; sums up the situation very well and reflects my attitude of dealing with the medical industry. MP

 
At Friday, January 12, 2018 6:07:00 PM, Blogger A. Banterings said...

I ask everybody who is on Twitter, Facebook, Instagram, or other social media to share and spread my posts.

Let us get the word out!!!



-- Banterings


 
At Friday, January 12, 2018 6:08:00 PM, Anonymous Anonymous said...

A. Banterings

Well Done!

PT

 
At Friday, January 12, 2018 6:46:00 PM, Blogger Maurice Bernstein, M.D. said...

...and you might want to add a link to this blog thread! ..Maurice.

 
At Saturday, January 13, 2018 5:35:00 AM, Anonymous JF said...

What if the man didn't give consent. It isn't sexual misconduct in the legal definition but isn't it an ambush?

 
At Saturday, January 13, 2018 7:08:00 AM, Anonymous JF said...

Does this topic come up at staff meetings? If it doesn't it should.

 
At Saturday, January 13, 2018 8:55:00 AM, Blogger NTT said...

Good Afternoon Everyone:

Hello JF and welcome.

It's my understanding unless it's life or death, if a patient is mentally competent and says no and they do something anyway they could be charged with battery.

If I'm wrong please someone that knows correct me.

Great job on the twitter link AB.

Regards,
NTT

 
At Saturday, January 13, 2018 9:18:00 AM, Blogger Maurice Bernstein, M.D. said...

JF, you have written your one or two sentence comments on Volumes 81 and 82 both of which were CLOSED to further comments I have deleted them. If you want to publish a comment write it on this Volume (Volume 83). Also, if you have more to say, write more than just one or two sentences. You can write in one posting up to 4096 characters. Reading your views, to me, is easier if it wasn't broken up into one line separate postings!
Thanks..all pertinent responses to this thread are welcome. ..Maurice.

 
At Saturday, January 13, 2018 11:44:00 AM, Anonymous JF said...

The chaperone pretty much has to protect the doctor but really she's protecting herself.

 
At Saturday, January 13, 2018 1:23:00 PM, Blogger Biker in Vermont said...

JF, can you comment based on your CNA experience about the thinking is as concerns female CNA's bathing or showering male patients? I understand the conventional thinking to be that the man's dignity is retained if the CNA approaches it in a confident manner, is polite, and does the basics such as pull the drape. That totally ignores whether the man is fundamentally uncomfortable with a woman bathing/showering him. It is as if they are telling the man he feels his dignity is intact rather than asking him.

 
At Saturday, January 13, 2018 2:15:00 PM, Blogger NTT said...

Hi JF:

If doctor's offices & hospitals are going to use chaperones and they deal with intimate issues and the opposite gender, then they are obligated to have both gender chaperones available during working hours and tell the patient the policy on chaperone use beforehand, so the patient can decide whether or not they want to proceed before they get ambushed.

The adult patient should always have the last word as to whether they want scribes and/or chaperones involved in their care.

Regards,
NTT

 
At Sunday, January 14, 2018 3:32:00 AM, Blogger Biker in Vermont said...

NTT, your comment on chaperones may be what they should do, but medical offices are not legally required to do that. I believe courts have ruled quite the opposite as concerns male prisoners, the taking of urine samples for males in halfway type settings and even for males in juvenile facilities. Terms other than chaperone have been used but in all cases it is women supervising or observing men and boys in states of undress.

Courts generally have not held that males are entitled to intimate privacy though I believe there have been cases in nursing home or similar settings in favor of preferential hiring or retention of male staff for the intimate needs of male patients. That's still different than giving males the right to intimate privacy. It only upholds the rights of employers to do so in limited circumstances.

 
At Sunday, January 14, 2018 8:14:00 PM, Blogger Maurice Bernstein, M.D. said...

In the January 10 Los Angeles Times a report about sexual harassment of female physicians:

http://beta.latimes.com/business/hiltzik/la-fi-hiltzik-medicine-harassment-20180110-story.html

Hmmn.. now who here is going to write an article about sexual harassment of male patients?

I think based on what has been going on in the past year regarding sexual harassment in various aspects of government, press, entertainment and more.. all centering around female gender as those injured, it should be time to add patients and as profusely described here, male patients into the harassment basket. ..Maurice.

 
At Monday, January 15, 2018 7:14:00 AM, Blogger NTT said...

Good Morning All:

This morning I sent a detailed email to the author of the LA Times story Dr. Bernstein references above about how not only harassment between healthcare workers should be looked at but also the way nurses treat their patients. Especially female nurses and their male patients.

I gave him links to multiple stories including your story Biker about Why Men Patients are Forced to Man Up in the Medical Setting and a link to this website so he can get a better understanding of the problem.

Time will tell now if he's willing to run with it or not.

Regards,
NTT

 
At Monday, January 15, 2018 7:25:00 AM, Blogger Maurice Bernstein, M.D. said...

NTT, GREAT! ..Maurice.

 
At Tuesday, January 16, 2018 2:34:00 PM, Blogger Majo said...

The problem is,that their reasons for choosing the profession
(nursing,tha is) are questionable to begin with. I watched
a video about a nurse that regrets her decision and dislikes
her job. You might dismiss anything that's on You tube, but
comment section is very telling. I'm struck by the number of
people that chose nursing for the low qualifications required
in relation to salary. Then there's all the stress and relent-
less bullying. Still, many sounded pretty self-centered. And
also the odd comment from a patient that is shocked they are
so frustrated and thankful not to be under their care!
Really recommend watching, https://youtu.be/9YvT-Oymhtw

 
At Wednesday, January 17, 2018 5:08:00 AM, Anonymous JF said...

I want to be part of the solution, contrary to what many of the bloggers think, women get unnecessary exposed and humiliated to. I guess I have to plead guilty about thinking guys don't have as much modesty as we do because my brothers never did. I haven't been with a lot of guys but the ones I have been with didn't seem like they were modest euther. My stepson when he was younger ( when he was my stepson.) was modest. I have a younger male cousin who is/was modest. I'm NOT indifferent to male humiliation. I just didn't know.

 
At Wednesday, January 17, 2018 9:19:00 AM, Blogger NTT said...

Hi JF:

Welcome. The more voices we have the stronger we become a force for changing the system to benefit all.

Regards,
NTT

 
At Wednesday, January 17, 2018 12:52:00 PM, Blogger Biker in Vermont said...

JF, I am interested in hearing your perspective on CNA training (in school and on the job) as concerns male modesty. CNA's are on the front lines when it comes to intimate care of patients.

 
At Wednesday, January 17, 2018 1:32:00 PM, Anonymous JF said...

I haven't worked at hospitals or clinics. Just nursing homes or assisted living homes. Most of our patients/ residents are elderly. If a man or even a woman is able to do their own shower, they are allowed to do so. Some of our residents are only there at the facilities because they need someone to cook for them and wash their laundry and give them their meds. Maybe they can't drive anymore either. Usually in nursing homes, its women that don't want male CNA's taking care of them. Then we trade around to accommodate. There are far more women at nursing homes than men.

 
At Wednesday, January 17, 2018 2:16:00 PM, Blogger Biker in Vermont said...

Thanks JF, but more specifically how have you been trained to respond to a male patient that expresses a modesty concern or whose body language indicates he is uncomfortable with intimate care from a female?

 
At Wednesday, January 17, 2018 2:31:00 PM, Blogger Maurice Bernstein, M.D. said...

You all might be interested in my blog thread "Why Can't A Woman be More Like A Man" begun in November 2006. Here is the link http://bioethicsdiscussion.blogspot.com.ng/2006/11/why-cant-woman-be-treated-more-like.html

Interest series of comments by me and others. ..Maurice.

 
At Wednesday, January 17, 2018 6:06:00 PM, Anonymous Anonymous said...

KevinMD has an article pertinent to this discussion; https://www.kevinmd.com/blog/2018/01/patient-accused-doctor-sexual-harassment.html

Scribes, chaperones, and cameras in the exam room are in the discussion.

Ed

 
At Wednesday, January 17, 2018 7:47:00 PM, Anonymous Anonymous said...

To All


I am awaiting responses from the Colorado state board of nursing as well as the Colorado attorney generals office regarding the incident at Denver Health. If they don't respond I'll take that as they don't care or it's irrelevant which in my opinion is ever better which just illustrates how unprofessional issues with male patients are swept under the rug. Currently, I'm in the process of crafting letters to many news organizations and along with my letters I intend to include printed instances of every instance of unprofessional behavior that I can find. I'm like to get suggestions or if anyone wants to recommend which news organizations I'd appreciate it.

PT

 
At Thursday, January 18, 2018 1:18:00 AM, Anonymous Anonymous said...

Here is a 2018 journal/article some might find interesting. I unfortunately can’t figure out how to comment back to the journal yet as they need to start stressing appropriate staffing to handle male requests. Of particular note in the references at the end, the American Academy of Pediatrics recommends for young adults/adolescents “the patient’s wishes and comfort” should determine the GENDER of the chaperone. What common sense. That same common sense needs to be applied to adult patients. Unfortunately we all know it is a rare clinic that staffs to handle patient choice.

https://professionalboundaries.com/articles/Practical-Professional_Issue-14.pdf

TO Banterings - congratulations on starting with Twitter.

MORE GENERALLY - On the matter of ethics and honesty in medicine that PT comments on often. Yes, there are, in every hospital, dishonest, unethical people. In my positions over decades I dealt with all manner of inappropriate activity, despicable behavior, & disgusting things. Fortunately it is a small fraction of practitioners and staff that are outright bad offenders. I never tabulated full statistics but my rule of thumb was ~1% of our staff were potentially bad actors - I just needed to find them asap. We had zero tolerance for inappropriate behavior and terminated enough people that I’m sure I was not overestimating. (And yes, the bad actors were reported to their respective boards, the police, the DEA, FBI, etc. as relevant, terminated and/or removed from the medical staff, etc. We didn’t tolerate this crap).

I’m not saying 1% of staff are abusive or sex offenders. But the constellations of all things that could happen in a large medical center (e.g., inappropriate behavior, all manner of HIPAA violations, drug diversions, abuse, theft, etc.) is certainly a reality, it exists. And yes, as PT says, the public doesn’t hear about most of these incidents. Its really bad for business.

A quick thought about change. I posted some info on chaperone policies several weeks ago as evidence change is occurring. Every time dozens of comments are received on any article where patients are treated differently or inappropriately it helps the dialog. Every time patients stand up for their rights and complain it effects change. I continue to advocate in many ways for equity in healthcare. Great to hear so many of you are taking action - its making a difference. — AB

 
At Thursday, January 18, 2018 6:45:00 AM, Blogger NTT said...

Good Morning All:

PT, here's a list of major newspapers across the country.

National:
The Wall Street Journal
The Washington Post
USA Today

Local:
The Boston Globe
The New York Times
New York Post
New York Daily News
The Philadelphia Inquirer
Atlanta Journal-Constitution
Tampa Bay Times
Miami Herald
Pittsburgh Post-Gazette
Detroit Free Press
Chicago Sun-Times
Chicago Tribune
Star Tribune
The Denver Post
The Dallas Morning News
Houston Chronicle
The Arizona Republic
Las Vegas Review-Journal
The San Diego Union-Tribune
The Mercury News
Los Angeles Times
Honolulu Star-Advertiser

Regards,
NTT

 
At Thursday, January 18, 2018 12:26:00 PM, Anonymous Anonymous said...

NTT

Thank you for the news references, I've purchased books and books of stamps and large envelopes. I'll keep everyone posted.

PT

 
At Thursday, January 18, 2018 2:23:00 PM, Blogger A. Banterings said...

PT,

The Atlanta Journal-Constitution is leading the fight against doctors who abuse (see link).

-- Banterings

 
At Thursday, January 18, 2018 7:33:00 PM, Anonymous JF said...

I don't know if you will agree with this action or not. I didn't take this action myself because the woman at fault has 4 kids and I don't know if I'd be justified in doing my idea or even what the outcome would be. If and when medical staff needlessly exposes and embarrasses a patient, request names when you request diagnosis. Then pull the person up on Facebook. Often they will be there and often you will be able to find her guy. Private message HIM about what she did.

 
At Friday, January 19, 2018 10:10:00 AM, Blogger A. Banterings said...

JF,

Instead I would call her out on FB for what she did. I would also ask if she would allow her spouse be treated in such a manner.


-- Banterings

 
At Friday, January 19, 2018 12:49:00 PM, Anonymous EO said...

Good day all. I was motivated by PT to post comments re the fab 5 pervs on Denver Health's Face book page. Here's what I posted.
"I agree 100% with Steve. Those 5 female hags should have been fired, had their nursing licenses permanently revoked, and they should have been arrested for their crimes. REVERSE THE SEXES - IF MALE NURSES HAD COMMITTED ACTS OF VOYEURISM ON A DYING/DECEASED FEMALE CLIENT THEY WOULD HAVE FIRED, HAD A PERMANENT REVOCATION OF LICENSES, AND BEEN ARRESTED! The 4 hags who were not assigned to the client abandoned their assigned clients to slither around and view a dying man's genitals! But, this wasn't enough for them - they had to unzip the body bag of said client after his death and view this poor man's genitals once again! As Steve says, this sort of sexual voyeurism happens all too frequently. IF DENVER HEALTH TRULY CARED ABOUT PROTECTING CLIENTS, THEY WOULD PUBLICLY ID THOSE FEMALE HAGS! IT'S GONNA HAPPEN! IN ANY OTHER ARENA, CRIMINALS ARE PUBLICLY ID SO WE CAN PROTECT OURSELVES FROM THEM! SOONER RATHER THAN LATER, THE FIVE CRIMINAL HAGS WILL BE ID ACROSS THE WEB! I'LL BE OPENING A NICE BOTTLE OF MOET!
By protecting the IDs of the five pervert hags, Denver Health is SUPPORTING their criminal actions. Your pious platitudes are meaningless! Let's be real: those 5 female hags followed their sexual urges to view a male's genitals - NO AMOUNT OF "EMPLOYEE TRAINING" OR BS "ETHICS CLASSES" WOULD HELP SUCH FEMALE NURSES THAT OBVIOUSLY HAVE VERY LOW MORALS! And unfortunately, female nurses, supervised by old female gorgons, are getting free passes to commit sexual voyeurism on any hapless male client that strikes their fancy!"
Now today, as I checked their Facebook page, the "review" section has been deleted! Surprise, surprise!
I think what I'd like to point out is that sickcare entities, are SO FULL OF IT! Their endless, meaningless, pious platitudes about how they respect their "patients" and that most of their healthcare workers are so wonderful - what a crock! I notice that someone posted about the mentally ill young woman being thrown out from an ER into a Maryland winter night, essentially naked (only socks and hospital gown that was falling off her as she wandered in the street.) When caught, the hospital's response was the same meaningless crap about failing in their duty to this patient, etc!
I think I'm checking the correct Facebook page. Looks like Denver Health is running scared as THEY ARE TRYING TO SILENCE THE VOICES THAT POINT OUT CRIMINAL ACTIONS IN THEIR FACILITY.
One more point: Why in hell does America allow for criminals such as the Fab 5 Pervs to keep working and abusing male clients all the damn time? That is, why are female sickcare hags given a free pass to commit crimes in medical settings? In any other arena, they would be dealt with as the criminals they are! Thus, we must also look at the corruption of the entire industry, as well as the corrupt female centric nursing brigade.
EO

 
At Friday, January 19, 2018 1:38:00 PM, Anonymous Anonymous said...

A. Banterings


Interesting read, however, anytime sexual misconduct is mentioned in healthcare it's just assumed that it was a male physician. Patients can be assaulted sexually by anyone in the hospital, even by other patients. Society seems to put the brunt of this issue on male physicians and I think it will only get worse, particularly after the gymnasts scandal. There is a much bigger picture here to appreciate.

PT

 
At Friday, January 19, 2018 2:22:00 PM, Blogger Biker in Vermont said...

JF, I'm not sure if you are talking about a co-worker or something in your personal life, but if a co-worker I would first speak to them in private about what they did. If the response you get is inadequate or inappropriate, then I would report her to your supervisor. If it is in your private life then for me the 1st step would be to make a complaint to the Dept. Head of that function. If like with my recent Dermatology complaint when the Dept. Head did not respond, I elevated it to Patient Relations where I did get action.

 
At Friday, January 19, 2018 3:00:00 PM, Anonymous JF said...

All that would accomplish would to be blocked. If a woman leers at a mans body or a womans body, let her husband or boyfriend be told. Maybe it's come up before. A lot of men would be very angry and then she isn't getting off scott free anymore.

 
At Friday, January 19, 2018 6:13:00 PM, Anonymous JF said...

I haven't been trained. If a man has the ability to wash down below I give him the rag and turn away. If they can't I will wash him. Probably he doesn't care at that point. I remember when I had major surgery some years back.My pastor was visiting me and my nurse came and gave me a shot on my bum. I was so sick, I didn't even think about it, until I looked at him again and HE was embarrassed.

 
At Friday, January 19, 2018 7:30:00 PM, Anonymous Anonymous said...

Hello, I've submitted a research request to NIH's All of Us Research program. The request states: A study to produce evidence that men would increase their utilization of health care, if same-gender care was offered to them (especially for intimate care)? If a male attendant was available, would more men seek help? Could health care be made more accessible (because more men would seek help, especially those with cultural sensitivities) and equitable (because men would be afforded the same option as women- i.e. women attendants for mammographies but, no male attendants for male urology)?
Others may wish to submit a similar request for research of vote for this one. Please see https://allofus.nih.gov/
Reginald

 
At Friday, January 19, 2018 9:49:00 PM, Anonymous Anonymous said...


What parallels can be drawn between Dr Twana Sparks and Dr Larry Nassar, None! Dr Larry Nassar will spend the rest of his life in prison and likely die there. He has lost his medical license and his assets will be divided amongst those who will sue him. It's said that he likely molested about 120 female gymnasts.

It was said that Dr Twana Sparks performed unnecessary genital exams on her male patients and would slap her male patients genitals exclaiming, Bad Boy, Bad Boy while the entire operating room staff would burst out in laughter. Despite this behavior going on for years Dr Twana Sparks still has her medical license, she still has a job and still acquiring assets and she did not have to go to prison. Why?

Dr Twans Sparks patients were male patients and Dr Larry Nassar's patients were female. Big difference. What we can infer from this is that as a male patient you have no rights. You are less than a Dog! That's right you have less rights than a dog. There are laws concerning animals cruelty laws but nothing concerning rights for the male patient therefore you are less than a dog.

PT

 
At Saturday, January 20, 2018 4:31:00 AM, Anonymous JF said...

Biker, No. Not a coworker. I was a patient in the Emergency Room. A pelvic exam and the problem behavior was the scribe/chaperone. Looking on from the foot of the exam table. A woman leering at another woman. Even if she wouldn't have leered,I should have been allowed to remain covered up while she was at that end of the table. Also I was already uncovered when she entered the room to bring the portable lamp in. She shut the door behind her but they don't have to leave the door open for a patient to be seen from people in the hallway. There was no privacy screen or curtain between me and the door. So far as I could tell, nobody was in the hallway in that exact moment.

 
At Saturday, January 20, 2018 5:26:00 PM, Blogger Maurice Bernstein, M.D. said...

I just put up a new thread "Difficult Patient vs Difficult Doctor"
http://bioethicsdiscussion.blogspot.com/2018/01/difficult-patient-vs-difficult-doctor.html

A brief review of the subject by a first year medical student is the basis of the thread.

Your comments there would be welcome but look to other issues in the "difficult" doctor-patient relationship rather than simply repeating the specific modesty concerns which is being thoroughly discussed here on "Patient Modesty". ..Maurice.
p.s.-I suspect the student who knows I posted his document will be looking at your comments---so be constructively medically tutorial rather than simply "ventilation" of your feelings. Save that for our thread here. ..Maurice.

 
At Sunday, January 21, 2018 6:24:00 AM, Anonymous Anonymous said...

AB --

Thanks for posting the lengthy discussion of "chaperones" from The Practical Professional. If you find out how to leave comments, please let us know, as I have a number of responses I'd like to report.

Personally, I found myself growing more alarmed and dismayed by this material the more I read. The strong impression I got is that there is an active, increasing push in both the medical and legal fields to mandate "chaperones." Attorneys like Jon Porter, whom they quote, are advising doctors to have witnesses in the room any time sexual organs are being examined, regardless of the patient's or doctor's sex (see page 4). In addition, seven states now apparently "mandate the use of chaperones during intimate exams" (also page 4), and some state medical boards do as well (see page 2).

The general tenor of this piece puts me in mind of the presentation by Amanda Kay, which strongly endorses universal "chaperone" laws across the country. A few of us left comments on that page, but here's the link to it if anyone else wants to check it out or contribute:

http://jdc.jefferson.edu/mphcapstone_presentation/135/

Since I ended up in therapy for six months after my one and only encounter with an unannounced "chaperone," I am extremely worried about what the future holds. I'd like to know which seven states now legally require "chaperones," and which other states are now considering them. Which state medical boards have such mandates? In all of those states, what (if any) provisions exist for exempting patients such as myself from going through that involuntary torment? I have a diagnostic note from my therapist, clearly linking anxiety disorder and PTSD to "chaperones," but who knows how much weight that will carry?

I am seriously considering hiring an attorney to research those questions for me. My wife and I are planning to retire in a few years, and I am extremely anxious to avoid surrendering my right to determine who sees my exposed body if we move to a different area.

RG

 
At Sunday, January 21, 2018 8:07:00 AM, Blogger Biker in Vermont said...

JF, you have a legitimate complaint about your ER experience, but best to direct that complaint to the hospital where you can make specific suggestions on protocol improvements. For example, something as simple as installing curtains in front of the doorways so as to shield the patient from the hallway. Staff being required to knock and be granted access before entering in non-life & death situations. And so forth.

I will note to you in response to a comment you made. The fact that a man cannot wash his own genitals does not mean he no longer cares about his dignity and is not going to be embarrassed. All it means is his condition is such that he can't wash his own genitals. You of course are just doing a necessary job that you were hired to do, but please don't assume he doesn't care. Maybe he doesn't but maybe he does.

 
At Sunday, January 21, 2018 8:16:00 AM, Blogger Biker in Vermont said...

A few months ago someone here commented that the word dignity might be a better choice than the word modesty. That made sense and I've tried doing it myself.

It has occurred to me that there is a subtle, or perhaps not so subtle bias against men as concerns the word modesty. In articles that touch upon modesty, women will be described as being modest. Men will be described as having modesty issues. There is a huge difference between the two descriptions. For women it comes across as a normal state of being. For men adding the word issues conveys something abnormal. The modest man has issues. The modest woman does not.

For these reasons I am going to be careful to never describe myself or other men as having modesty issues. I will say I am modest or go the route of using "dignity" phraseology.

 
At Sunday, January 21, 2018 9:29:00 AM, Blogger Biker in Vermont said...

RG, the seven States are Alabama, Delaware, Georgia, Montana, New Jersey, Ohio & Tennessee, though I think the mandate may be that a chaperone has to be offered, not that a chaperone must be present.

 
At Sunday, January 21, 2018 10:31:00 AM, Blogger A. Banterings said...

Perhaps somebody can answer this question (especially NTT or PT),

Is the "fiduciary duty" of a physician (to put the welfare of the patient above their own and above all else, even at a cost to the physician) written in law anywhere?

Reason I ask is because I could not find it written anywhere explicitly. I have found a couple laws aimed at financial consultants that do not explicitly say they are targeted at financial professionals, but rather all professionals that may be applied to physicians.

I have also found piecemeal laws that create a fiduciary duty, but only in a limited scope. One such example is the Stark Law (more about the Stark Law here:).

If the fiduciary duty of a physician was law, then we would not need the Stark Law.

We hear (from physicians) that they have a "fiduciary duty" OR have taken the "Hippocratic Oath," but that means NOTHING unless it is a LEGAL requirement. That is just ADVERTISING FLUFF.


-- Banterings

 
At Sunday, January 21, 2018 10:46:00 AM, Anonymous Anonymous said...

Biker --

Thanks also for your comment about "dignity" vs. "modesty." I hadn't picked up on the way the latter is used differently for men than for women, but as soon as I read your comment, I recognized it. I've been saying things like "I have modesty concerns," but I think "dignity concerns" does sound stronger, so I'm going to try some retraining too.

RG

 
At Sunday, January 21, 2018 10:56:00 AM, Blogger Maurice Bernstein, M.D. said...


Dignity of a person means that the individual is "worthy of respect". And "dignity" means
. . having our identity accepted, no matter who we are
. . . recognition of our unique qualities and ways of life
. . . acknowledgement—to be seen, heard, and responded to
. . . belonging and feeling included
. . . freedom and independence and a life of hope and possibility
. . . being safe and secure
. . . being treated in a fair and evenhanded way
. . . being given the benefit of the doubt
. . . being understood
. . . an apology when someone does us harm
as defined by a scholar regarding the definition and application of dignity Dr. Donna Hicks http://declaredignity.com/:
Dr. Donna Hicks is an Associate at the Weatherhead Center for International Affairs, Harvard University. Dr. Hicks was Deputy Director of the Program on International Conflict Analysis and Resolution (PICAR) at the Weatherhead Center for International Affairs at Harvard University for nine years.

My opinion is that modesty is an individual's own decision with regard to how their personality, behavior and physical appearance is seen or not seen by others. There are degrees of modesty and all are defined by that individual. To ignore a patient's modesty issues to me represents a removal of a patient's dignity (and all person's basic "worthiness of respect"). It is this conscious removal of a patient's dignity with no absolute excuse which is the basic issue being discussed on this blog thread. ..Maurice.

 
At Sunday, January 21, 2018 11:07:00 AM, Blogger Maurice Bernstein, M.D. said...

One thing more to add: those who ignore the patient's inherent dignity must do so by calling and proving that the patient's appearance or behavior is "undignified" and therefore doesn't deserve attention to that list of dignity definitions listed in my prior posting. If the healthcare provider cannot prove such a decision, there now enters the question as to whether the healthcare provider has now set themselves as "undignified" and will be subjected to all the actions applied to those with that classification. ..Maurice.

 
At Sunday, January 21, 2018 2:23:00 PM, Anonymous JF said...

Chaperones are not the way to go, period. What if the patient refuse a chaperone and are then sexually abused or harrassed by the provider? What if patient requests a chaperone and the provider becomes inappropriate? The chaperone CAN'T speak up without endangering his/her own job! It's SO onesided on the providers side. My theory would be video cameras to be installed. The medical staff should have no ability to remove the cameras. It would never be veiwed by anybody unless an accusation of abuse occurs. Available by a judges order only, and veiwed by a same sex medical professional who doesn't know either party.

 
At Sunday, January 21, 2018 3:46:00 PM, Blogger A. Banterings said...

Maurice,

"To ignore a patient's modesty issues to me represents a removal of a patient's dignity..." as you state is then a Human Rights' violation.

The 1948 Universal Declaration of Human Rights enshrined this principle in its preamble: ‘recognition of the inherent dignity and of the equal and inalienable rights of all members of the human family is the foundation of freedom, justice and peace in the world’. Source: Human Dignity Trust

Note: The Universal Declaration of Human Rights (UDHR) is an historic document that was adopted by the United Nations General Assembly at its third session on 10 December 1948 as Resolution 217 at the Palais de Chaillot in Paris, France. Source: UN's Universal Declaration of Human Rights

-- Banterings

 
At Sunday, January 21, 2018 4:39:00 PM, Anonymous Anonymous said...

Biker --

I attempted in an earlier message to let you know that I am from one of the 7 states that had "chaperone" laws on the books. I won't identify which state (for anonymity reasons), but in that state the law must be about "offering," rather than "requiring," as you suggested, since I am free to seek a provider who will not impose one on me for intimate exams.

That does seem much more realistic as a statewide law, and I'm hoping that's the case with the other six.

Would you mind telling me where you found that information?

Thanks.

RG

 
At Sunday, January 21, 2018 4:41:00 PM, Anonymous Anonymous said...

Maurice

The definitions of Dignity that you posted, where did you find those? I don't think Dr Hicks fully comprehends the implications of the word as it applies to male patients. That word or its definitions as I go down the list does not apply to male patients in healthcare, never did.

PT

 
At Monday, January 22, 2018 3:49:00 AM, Blogger Biker in Vermont said...

RG, I got the list of States from the 3rd paragraph of the article at this site http://www.tarutislaw.com/blog/news-events/post/chaperones-recommended-or-required

It is a law firm looking to drum up business. They are trying to infer that the chaperone is required when in reality it is only the offer that is required.

 
At Monday, January 22, 2018 7:19:00 AM, Anonymous Anonymous said...

A. Banterings


The Stark law is primarily intended to prevent kickbacks and nothing else. Any hospital that seeks new vendors for services requires that vendor to sign paperwork acknowledging the Stark law, that the law is to be abided by both parties. Any physician in private practice can make the decision not to see a patient and some simply say, not accepting new patients.

Then there is a law called Emtala which basically says emergency rooms cannot turn patients away based on their ability to pay, however, the law gets more complicated should the patient requires transfer or say someone (patient) is dumped on hospital property with say a gunshot wound to the head. The hospital is required to provide basic medical care, emergency medical care or transfer the patient to another facility that can provide that care.

The fiduciary duty you mention does not exist in written law and even in the Good Samaritian law offers legal protection for those with a medical background offering care. Finally the Hippocratic oath is not worth the paper it is written on.

PT


 
At Monday, January 22, 2018 8:04:00 AM, Blogger Maurice Bernstein, M.D. said...

Moderator's Note: Surabhi, the first year medical student, who wrote the document which I published in the new thread "Difficult Patient vs Difficult Doctor"
http://bioethicsdiscussion.blogspot.com/2018/01/difficult-patient-vs-difficult-doctor.html
has just responded to Banterings comment there.

The purpose of this note here is to remind our visitors here, if writing on the "Difficult" thread, not to carry over a heavy discussion regarding patient modesty issues over to that new thread as the visitor responds to Surabhi and continues the "Difficult" discussion. There are a host of other "difficult" behaviors of both patient or physician to detail. Of course, writing on that new thread, visitors there can be referred to this Modesty thread for further detailing if necessary.

The reason for this Moderator posting by me now is to remind all that there is a host of other etiologies contributing to any unfortunate disruption of the necessary medical and humanistic relationship between patient and physician or medical system. It is these other important defects that need to be dissected out and discussed. OK?? ..Maurice.

 
At Monday, January 22, 2018 10:07:00 AM, Anonymous Anonymous said...

Hello,

I have what might be VERY GOOD NEWS. All of Us Research Program
National Institutes of Health (All of Us is a service mark of the U.S. Department of Health and Human Services) has sent me the following message: The stage of this idea has changed from "Pending Approval" to "Ideate" :
Idea: Would same-gender care increase the utilization of health care by men in the US?
Author: Reginald. This may be the opportunity that we've been seeking. If this idea gets enough votes, NIH will make it a research project. This could be an excellent opportunity to affect change. I encourage everyone (and your friends) to vote. Go to the site below and click on the triangle under "vote". One must register and then vote. There is no cost. I do believe that this is the time to act and to stop just cursing the darkness. Let's get the highest number of votes and then get dignity/ modesty recognized. One might cynically say that nothing will happen; however, why not give it a try? Registering and voting takes little time and costs nothing AND the National Institute of Health is a tremendous mover and shaker of health care in the US. If you have the time to lament or complain on this site about the lack of dignified male care, you have the time to vote. With a few hundred votes, this issue could get national (NIH) attention. Please go to https://allofusresearchpriorities.ideascale.com/a/dtd/Would-same-gender-care-increase-the-utilization-of-health-care-by-men-in-the-US/195301-44880#idea-tab-comments

Reginald

 
At Monday, January 22, 2018 1:35:00 PM, Blogger Biker in Vermont said...

Thanks Reginald. I registered and voted. Are there other places this can also be posted to?

 
At Monday, January 22, 2018 6:15:00 PM, Anonymous Anonymous said...

Reginald

That was a good job, I too have cast my vote and left a comment.

PT

 
At Monday, January 22, 2018 6:21:00 PM, Anonymous Anonymous said...

To all

At this point I have not received a response from the Colorado state board of nursing nor the Colorado atty gen. office. Apparently, they don't seem to feel they have a responsibility to the public nor to protect the public. That's fine, I'll just let all the news agencies know I tried to contact them along with the public's comments being removed from the Denver Health Facebook page. Looks like they are not so transparent. They are going to learn something, the pen is mightier than the sword.

PT

 
At Monday, January 22, 2018 6:25:00 PM, Anonymous Anonymous said...

Hello Biker,

I don't use social media; however, this seems like a great place to spread the word - friends tell friends who tell friends, etc. Other websites' comments sections are also possible places - the Dr. Linda Girgis site comes to mind. Spreading the word about voting is essential. Again, the website is https://allofusresearchpriorities.ideascale.com/a/dtd/Would-same-gender-care-increase-the-utilization-of-health-care-by-men-in-the-US/195301-44880#idea-tab-comments.

Reginald

 
At Monday, January 22, 2018 6:43:00 PM, Anonymous Anonymous said...

Hello again,

I've received the following e-mail from All of Us Research. I'm not sure of its import. Possibly, the comments are too caustic. Maybe those wishing to vote could do so without caustic comments. Let's not shoot ourselves in the foot. Reginald.


[ALL OF US RESEARCH PRIORITIES COMMUNITY FORUM] - [Mark Abused] - Would same-gender care increase the utilization of health care by men in the US?

ALL OF US RESEARCH PRIORITIES COMMUNITY FORUM [noreply@ideascale.com]

To: Reginald

Monday, January 22, 2018 6:19 PM

The following idea reported as being inappropriate. It will be removed when enough people flag it.
Idea: Would same-gender care increase the utilization of health care by men in the US?
Author: Reginald

Reginald.


 
At Monday, January 22, 2018 8:43:00 PM, Anonymous Anonymous said...

Reginald

Since when does quality patient care become caustic? These days quality patient care is a Hugh metric. Are you sure that site is real and I just wonder who are the members who decide what is inappropriate? I'm just continually amazed at people who want to derail any progress if any that's made and you can just guess who those people are.

PT

 
At Tuesday, January 23, 2018 3:55:00 AM, Blogger Biker in Vermont said...

PT, assuming there are female physicians/nurses/techs that are seeing Reginald's proposal and not liking it, they could well try to get it shut down. Anything that advocates for men is a threat to the status quo that overwhelmingly favors females.

 
At Tuesday, January 23, 2018 9:12:00 AM, Anonymous Anonymous said...

Hello again,

Thank you for voting for the NIH All of Us proposal re same-gender care. The proposal has received 9 votes. The highest proposal has received 55. Many more votes are required to move to the top. Please encourage your friends to vote. Comments are not necessary. The comments section should be germane to the proposal - i.e. its feasibility, value to US health, etc. This is not the place for anecdotal encounters with health care. If the proposal moves to the study phase, I'm sure a questionnaire will be developed with a free-response section for personal comments. However, the proposal must get to the top first.

I'm not sure who has the power to "disqualify" an idea or for what reasons. However, comments that seem "reactionary" might lead the powers that be to view this idea as coming from some "fringe" group with unknown and/ or "questionable" motives. We're trying to convince the NIH to invest time, talent and treasury towards an important and pressing issue. I still believe that our cause is better served with honey than with vinegar. For now, I do feel that our best chance for recognition is to deal with what we can control - voting. This is the first step in a multi-step process. Let's get the most votes. We'll deal with what comes next when we've succeeded in doing this.

I believe that the website is legitimate. I became aware of it from my NIH e-mail subscription. Its footer states "All of Us is a service mark of the U.S. Department of Health and Human Services". If others would like to investigate its legitimacy, please do so and inform us of the findings.

My initial post regarding this proposal gave the URL below. It's the fastest way to get to the registration section (clicking on the triangle) and to the voting. The Comments Section appears prominently but, a comment is not required. Please encourage your friends to vote. Comments are not necessary; however, if one chooses to comment, please make the comment relevant to the proposal's usefulness to improving healthcare sans personal experiences. Again, thanks for your participation. Reginald. URL follows.
https://allofusresearchpriorities.ideascale.com/a/dtd/Would-same-gender-care-increase-the-utilization-of-health-care-by-men-in-the-US/195301-44880#idea-tab-comments

 
At Tuesday, January 23, 2018 11:51:00 AM, Anonymous Anonymous said...

Biker

It appears at the bottom of the page US department of health and human services. They can flag it, throw cold water on it and dump it in the trash and honestly I hope they do but rest assured that too will be brought out.

PT

 
At Wednesday, January 24, 2018 9:34:00 AM, Anonymous JF said...

I'm not trying to be negative, but often when there are male nurses and CNA's, they really seem to be GAY. They often have wives or girlfriends, but they have that look about them and sound gay and have feminine body language. I think the reason people are made naked for surgeries is because patients are high risk of going to the bathroom in their pants, so patients should put on disposable pull ups when going to surgery.

 
At Wednesday, January 24, 2018 10:01:00 AM, Blogger Maurice Bernstein, M.D. said...

To My Visitors: What does the Nassar conviction and sentencing now tell us about the medical profession and behavior. Should every patient in the future consider the medical profession a source of potholes of evil intent and behavior which should be actively avoided? If not, then what? ..Maurice.

 
At Wednesday, January 24, 2018 11:14:00 AM, Blogger NTT said...

Good Afternoon Everyone:

To answer your question Dr. Bernstein, the conviction is a black eye on the profession.

But this black eye will go by way of all the other black eyes the medical profession has received and just be swept under the rug like the others. This like the others won't be talked about publicly too much longer now that he's been sentenced.

By next week, things will be back by healthcare standards to status quo as if nothing ever happened.

The US healthcare system has proven beyond any shadow of a doubt they are incapable of policing themselves.

There's an dark side to the medical profession that no one in the healthcare industry wants to acknowledge exists much less deal with it and remove it once and for all.

That's how the unscrupulous doctors and nurses are allowed to flourish and violate patients time and time again.

Theses people know how the system works.

If they're caught violating a patient, and the news hasn't gone public yet, the current way the healthcare system handles it is quietly move the offender to another position or let them go. Then pay the patient they violated and the employee for their silence.

Until this way of handling the "problem" stops, nothing can change.

The only way change will come and this dark side removed, is with outside oversight that will ensure stiff penalties to anyone who doesn't report an incident and, those that are caught and proven guilty, receive appropriate prison time and permanent loss of license to practice their craft.

The system is broke. It's time to admit it, then work together to create a system everyone has trust in and works for everyone.

Regards,
NTT

 
At Wednesday, January 24, 2018 11:14:00 AM, Anonymous Anonymous said...

JF


I think your comments are absolutely False. I have worked in healthcare for over 40 years at nearly 25 hospitals and known most staff on a first name basis. In all those years I've only known 2 male nurses who were gay and they let everyone know they were gay. What does it matter? I say that because that is the defense female nurses use against men in nursing which incidentally fortifies their excuse against men asking for same gender care.

Furthermore, you say you have only worked in nursing homes yet of the 3 nursing homes that my mother was a resident of for over 12 years did not employ one singer male, in any capacity! How many gay women work as a nurse or cna? What does it matter. I've seen many many patients undergo surgery who were allowed to kept their underwear on. I have never seen disposable pull-ups anywhere being utilized and I have been involved in thousands of surgical cases at many hospitals.

Finally, I will say that I have a great distrust against nursing homes, abuse is rampant. Just visit Propublica.org to see that it is all females engaged in abuse and sexual abuse against patients. Recently, a male patient was dying as female nurses and a cna stood by and laughed at a nursing home, YouTube it. I can't tell you how many times money was stolen from my mother as well as other items.

PT



 
At Wednesday, January 24, 2018 11:24:00 AM, Anonymous Anonymous said...

Maurice

Re: Nassar conviction

Same crap different day

PT

 
At Wednesday, January 24, 2018 11:52:00 AM, Blogger Biker in Vermont said...

Dr. Bernstein, the Nassar situation is just a reminder that the people within the medical realm are a cross section of humanity. There are saints and sinners amongst them, same as in every other profession.

Nassar is also a reminder that sexual predators try to hide themselves within target rich environments. Many healthcare workers never come into contact with patient intimate exposure, or perhaps not opposite gender patient intimate exposure. Its just not part of their specialties or roles.

For others opposite gender intimate exposure is all that they do, or mostly what they do. In those cases, it is not unreasonable for patients to at least be aware that some in that specialty have chosen it for all the wrong reasons. Not all, but some.

 
At Wednesday, January 24, 2018 12:08:00 PM, Blogger Biker in Vermont said...

JF, I could care less if any of the males providing me intimate care are gay. Might he be attracted to me? Possibly, but no more so than heterosexual women providing me intimate care might be. The difference is 50+ years of locker room experience has made me totally comfortable being exposed to or with other males. I am not so foolish as to think I haven't shared many a locker room with gay guys.

Conversely I was raised to be modest around women and have not spent a lifetime being exposed to women I don't know. For my intimate care I will take a gay male nurse over a heterosexual female nurse. It is not a sexual event for me and so I defer to my personal sense of modesty and comfort.

As an aside, my new (last year) primary care provider is a young gay PA. I was incredibly impressed with him and came away from my first exam very happy that he was my new PCP. His sexual orientation is a non-issue for me.

 
At Wednesday, January 24, 2018 12:15:00 PM, Anonymous Anonymous said...

Ref: "At Wednesday, January 24, 2018 10:01:00 AM, Blogger Maurice Bernstein, M.D. said..." - q.v.

Females need to have their patient advocate with them at every doctor visit until they gain enough experience to recognize that not only is something wrong, but the maturity to get up and leave. Even with female MDs.
BJTNT

 
At Wednesday, January 24, 2018 12:52:00 PM, Anonymous JF said...

I live and work in Orlando Florida and many of the hospitals around are Adventist Hospitals. Adventist in name only though. I bet a large number of the management team don't even know who Ellen White was. People have accused us ( the Adventist church.) of her being our god. Her and her husband James and his friend Joseph Bates founded the Adventist church. All those years ago - Ellen White talked about male medical staff should attend to male patients when it came to intimate care. Female medical staff should attend to female patients when intimate care is involved. You don't have to take my word for it. Google for yourself about what she said. I haven't always known what she said and was surprised. I've taken care of men and women. I HAVE heard a lot of friends and coworkers admit to liking a male doctor doing pap tests on them.

 
At Wednesday, January 24, 2018 2:46:00 PM, Blogger Maurice Bernstein, M.D. said...

I just posted a potentially controversial and challenge on "Difficult Patient vs Difficult Doctor" which would be pertinent to the topic presented on the "Patient Modesty" threads. Perhaps some visitors here would like to go to the other thread and comment there since it fits a bit more with the topic of that thread title and context.

http://bioethicsdiscussion.blogspot.com/2018/01/difficult-patient-vs-difficult-doctor.html

..Maurice.

 
At Wednesday, January 24, 2018 5:42:00 PM, Anonymous Anonymous said...

Dr Larry Nassar- 175 year in prison

Dr Twana Sparks-0

PT

 
At Thursday, January 25, 2018 11:41:00 AM, Blogger A. Banterings said...

Maurice et al,

I have commented on the Dr. Larry Nassar conviction that maurice asked about (above). You can find my comments on the thread Difficult Patient vs Difficult Doctor (here). It is very pertinent my analysis of his statement prior to receiving his sentence.

-- Banterings

 
At Thursday, January 25, 2018 1:49:00 PM, Anonymous JF said...

Sorry Biker. I hope I didn't come across as gay bashing because I'm not against gays. I agree its often a dignity thing. It would be just as upsetting for many patients for a care giver to be repelled at the sight of their body. I'd be one of those patients. Until I learned that my religious beliefs said we shouldn't go to the opposite sex for intimate care, it didn't matter to me whether it was a woman or man doing that kind of check up. It's the extra person I object to. Even then I just object if they are witnessing from the foot end of the exam table. Mostly I never go to those kind of check ups unless there's symptoms. PT. I don't wanna get into a debate about the male staff and whether or not they are gay or straight. Let everybody draw their own conclusions about that. What you said about nursing home staff sexually abusing elderly seems crazy to me. I'm not saying that someone somewhere didn't do what you said. But it's not a typical thing. 80 to 90 year olds just don't seem sexually attractive to me and the people I have worked with.There have been rare exceptions. One male house keeper was going in ladies rooms and was seen looking at them naked. It was immediately turned in and he was immediately terminated. A bogus reason was given for the termination however.

 
At Thursday, January 25, 2018 1:50:00 PM, Anonymous Anonymous said...

Hello,

At last some hospitals are recognizing patients' need for modesty / dignity, at least relative to hospital gowns. Please see https://www.statnews.com/2018/01/25/hospital-gowns-design/?utm_source=STAT+Newsletters&utm_campaign=901dbd8c85-Daily_Recap&utm_medium=email&utm_term=0_8cab1d7961-901dbd8c85-149726657

Reginald

 
At Thursday, January 25, 2018 3:00:00 PM, Anonymous JF said...

Sexual abuse should be treated the same. Regardless if it's a woman doing it or a.man. or whether the victims are male or female. Maybe she'll humiliatite the wrong guy and she'll find herself laying beside the street with her knee caps broken and cracked ribs and her dress ripped off.

 
At Thursday, January 25, 2018 8:50:00 PM, Blogger Maurice Bernstein, M.D. said...

First, we are at 162 Comments on Volume 83 and amazingly, the population of comments has developed in a period of just 1 month! And if you scan through the comments you see that there has been a lot of constructive discourse..which does make me happy. In view of past failure of publication by Google's blogspot.com when the numbers get too high, maybe over 200, we will soon (maybe 180) move on to another Volume. I realize, switching to a new Volume affects continuity accomplished through simple scrolling but I don't want to lose comments as I have had experience in the past.

Now, I want to apologize for delay in posting those who wrote here today. It is because I was teaching the abdominal exam to two separate groups of six first year medical students. A long day for me. They were examining each other and yes, attention to patient modesty was high on my agenda. Also communication with the patient as the exam proceeds is essential. One of the rules I teach them is whatever technique they are using: auscultation, palpation or percussion they should remember they know where their hands or stethoscope is on the abdomen so they shouldn't stare at the abdomen and their hands but look at the patient for signs of discomfort. An important lesson in communication. Does your doctor on examination pay attention to you or their hands or equipment? This all part of the important nuances for an effective and patient attentive examination. Except for learning to take the vital signs a couple months ago, today was the first more intimate contact learning with a human body. This is where much of what has been discussed here begins within medical education. I hope they learn and remember the importance of looking at and listening to the patient as they "lay on hands". ..Maurice.

 
At Saturday, January 27, 2018 11:35:00 AM, Anonymous JF said...

This here isn't about modesty especially but is a concern anyway. Whenever the people in supervision positions are bullying the staff under them, problems get hidden. One time the nursing home where I worked got a new administrator. She told are nurses to write us up. We asked her what specifically was the concern and she got huffy and said she trusted our nurses. One certain nurse kept write up papers on her med cart. She so relentlessly nit picked and hartassed that we had no time to get our showers done. That was the one thing that escaped her notice. She stood outside the breakroom the whole break period with her med cart. For two years our residents didn't get showers on our shift except on that nurses day off. There is a difference between strict and bullying. Also at the same nursing home, it was shift change and one of the patients was in severe pain. The charge nurse was a total bully and every single CNA was afraid to approach the nurse to ask for help for the patient. That was 2nd and 3ed shift CNA's and none of us could approach her.

 
At Saturday, January 27, 2018 9:47:00 PM, Anonymous Anonymous said...

In no way do I condone the criminal behavior of Dr Nassar, however, I believe he was made an example of after hearing the testimony and watching the court proceedings. After allowing over 100 of these Olympians come into the court room and confront their accuser. I use the word Olympians since that is what they were referred to. They may call them Olympians but they swing from monkey bars for a living after all, I have more respect for the packagers and distributors of Hostess Ho Ho's.

Additionally, while surfing Yahoo over the past 3 years I now recall that the girls swing from monkey bars also posed almost nude with their pictures displayed on Yahoo. I should have complained about sexual harassment. While we have Dr Nassar serving serious prison time and everyone calling for the departure of the top executives to step down I'll ask who stepped down at Gila Bend medical center since everyone there knew about Dr Twana Sparks exams. No one stepped down, she didn't lose her job nor go to prison. She molested more male patients over 10 years I'm sure than Dr Nassar molested. These patients of Dr Sparks were poor, hardworking people in the community. Yet they were never identifiied thus not bring the opportunity to heard in heard in court.

PT

 
At Saturday, January 27, 2018 10:25:00 PM, Blogger Maurice Bernstein, M.D. said...

PT, here is a news item I found which should even irritate you more:

http://www.scsun-news.com/story/news/politics/2016/06/27/sparks-elected-national-democratic-delegate/86443290/
From Silver City Sun-News
June 27 2016:


SILVER CITY — Silver City author and surgeon Twana Sparks was elected as a national Democratic delegate at the Congressional District 2 post-primary convention in June. She was raised and educated in New Mexico, and has been practicing medicine since 1985.

A pledged Bernie Sanders delegate, she says, "I've never done anything political but vote until this point in my life, but an honest, compassionate, intelligent presidential candidate is a rare find, so I got involved."


And where is a mention in the article about her "unprofessional behavior" in the past? Nowhere.

The article ends with "Sparks lives in Silver City with her spouse, Martha, and two Chihuahuas. With other supporters, she opened the Silver City for Bernie Campaign office in September 2015 and it has been staffed daily since."

I can see where PT could get his blood pressure elevated? By the way, PT have you had it recently checked?? ..Maurice.


 
At Saturday, January 27, 2018 11:43:00 PM, Anonymous D.B. said...

I attempted to find the NIH comments/voting page concerning same gender care and had no luck. "Page not found" was all I could get. I am not extremely tech savy but I can copy and paste. When I did, it still came back not found. Has the site been taken down already? I would really like to post my comments/views, if its allowed. IT may well be a fault of mine but I am concerned enough to ask. DB

 
At Sunday, January 28, 2018 7:01:00 AM, Blogger Biker in Vermont said...

Sparks apparently retired about a year and a half ago so at least we can be assured she isn't sexually assaulting male patients anymore.
http://www.grantcountybeat.com/news/news-articles/28722-grmc-board-of-trustees-hears-the-positive-side-of-some-negative-news

What bothers me more than Sparks herself (I won't dignify her status by calling her Dr.) is the OR staff and mgt. of the hospital that looked the other way and/or joined in the laughter while male patients were sexually assaulted. The ensuing publicity was such that people in the community could choose to not have her as a doctor, but here we are years later and anyone going to that hospital has no way of knowing if those nurses, techs, and even other doctors that went along with her "exams" are still there. Clearly those others either share Sparks' perversions or they have no moral base.

This is what makes many of us cautious. The medical world does not police its own. What are the odds that any hospital would dig deeper into an applicant's background that had previously worked at the Gila Regional Medical Center? Or Denver Health of body bag penis fame? Or the Univ. of Pittsburgh Medical Center that had the cell phone circus in the OR taking pictures of some guy's genitalia? And so forth any of the other hospital based sex scandals? Staff rarely gets more than a slap on the hand and then sent back to work. It is as if the only problem medical centers have with this kind of behavior is the media getting wind of it causing bad publicity.

The real question before us is why does the medical world tolerate disrespectful and undignified treatment, if not worse, of patients so long as the patient is unawares that it is happening?

 
At Monday, January 29, 2018 6:17:00 AM, Anonymous JF said...

People are often cowards when it means going against the crowd. I've been guilty of keeping quiet myself, when I shoukd have been getting in someone's face. With her being a doctor, there may have been some intimidation going on and the staff felt unsafe telling her anything. What I wonder is there anyway for us to force the issue? I think she should be made accountable.

 
At Monday, January 29, 2018 5:12:00 PM, Anonymous Anonymous said...

Maurice


Thanks for asking. I've been on 10mg lisinopril po X1 daily. I have several months ago saw posts about her entering politics but I'd like to mention perhaps the comment that she has made was the most interesting. She said " I have suffered professional". Now I guess everyone can draw their own conclusions as to what she meant by that.

JF

Sadly, crowd dynamics enter into these situations but it should be mentioned that all the articles I've read mentioned this had been going on for over 10 years. Now I can't even begin to imagine the kind of a culture that plays out this long in a medical center.

PT

 
At Monday, January 29, 2018 7:07:00 PM, Blogger Maurice Bernstein, M.D. said...

I just want to put in my 2 cents about an ongoing issue for me as moderator who first has to approve for publication all comments written on my blog. I wish all those commenting would register with Google such as A. Banterings and Biker from Vermont. I always feel responsible and must be alert when I get a posting where the text ends simply with a name or initials and is not registered with Google blogspot to feel confident that what was written was actually written by that very person with that name or initials. Registering does not require presenting the program with any further information about yourself. But it will make my attempt to present valid comments much easier. I appreciate all your comment activity but I want to make what you read here text which represents the opinion of the writer whose acronym ends the text. ..Maurice.

 
At Monday, January 29, 2018 8:45:00 PM, Blogger Maurice Bernstein, M.D. said...

Oops! I meant pseudonym in my last sentence. ..Maurice.

 
At Tuesday, January 30, 2018 12:36:00 PM, Blogger A. Banterings said...

Greetings all,

I just got a "thank you" text from a friend up north of me had an infection that was not responding to oral AB, so he had to go in for IV ABs. By the time he got in his bed, it was 10PM (2nd shift). A male nurse. The gentleman was here on a visa from China. Gave him a gown, told him he could keep his underwear on. When he returned and asked about the gown, my friend said "this is not working." The nurse was OK with that.

The other 2 shifts were female nurses, but felt sure that he could request a male nurse IF he had to have intimate care. The one female nurse commented about him wearing his clothes (sweat pants and tee shirt) and said "...as long as you don't have to go down for test. He politely corrected her and said "I would still be wearing them."

A nurse came in with his meds and a student nurse behind her. He told the meds nurse that he was delusional because there was a person in the room who could not be real because after 5 minutes she would have introduced herself and said why she was there. According to him, she was very timid even as he tried to talk to her. He did give her the advice to introduce herself. Although not his intention, it was a rebuke of the meds nurse because she did not introduce her until after that.

On the consent form, he crossed out and initialed the part about being photographed. The admissions person said nothing about it. He said one thing conspicuously missing from the patient rights part was the right to participate in his care. He did not right it in as it is a federal law.

The male nurse could not get the infusion IV started, and after 2 painful sticks (which included poking and twisting), he asked how long he (the male nurse) had been doing it. He said a year, and would call for an IV nurse. The ER was so busy with flu patients, the male nurse said he was going to try again because the IV nurse would not be there for hours. My friend asked if there was anyone else who could do it, and another female nurse who was nursing only a little longer said she had a better success rate. My friend told her she had ONLY one shot at it. It was painfully successful.

He also noted that there were other nurses and people in other positions that were foreign nationals, but not many. This goes to an argument that I have had with many other physicians that threaten "If we all quit, what will the country do?" My response is that there are already staffing companies bringing in physicians and nurses to make up for staffing shortfalls or during strikes.

He is at a "Big Healthcare Corporation" hospital that is apparently already doing this. Couple this with the recent discussions about immigration and the common sense consensus that the country should be bringing in immigrants with skills that benefit the country (as opposed to violent criminals), and you can see how this creates an atmosphere where power is shifting more and more to the patient.

He is still there and will be updating me on how things progress. I will update everyone here.


-- Banterings


 
At Tuesday, January 30, 2018 9:18:00 PM, Blogger Maurice Bernstein, M.D. said...

PT et al who are not registered and sign their writings with a pseudonym, on thinking back on what I last wrote I want to make it clear that I don't intend to limit publication of views on this blog because the writer is not registered. I just want you all to know that with every posting from you I am challenged to find the context of what is written to be consistent with views held in the past and that someone else has not taken your pseudonym submitting a different view.

I may be paranoid since I do get plenty of spam messages which are easily identified and easily prevented from being posted. It is the all the other unregistered messages ending with that specific pseudonym that I have to take care that they are from the same writer.

If anyone can help me with this logistic issue of being a moderator, I certainly would appreciate your suggestion since my goal is to keep the narratives here free from attempts to disrupt valid communication. ..Maurice. p.s.- I think this is the first time I brought this issue of mine up.

 
At Thursday, February 01, 2018 4:03:00 PM, Anonymous Anonymous said...

Another KevinMD article touching on issues germane to this thread.

https://www.kevinmd.com/blog/2018/01/metoo-moment-pediatrician.html

Ed

 
At Friday, February 02, 2018 2:48:00 PM, Blogger Biker in Vermont said...

Here's the 3rd and final chapter of my dermatology saga. Went for the follow-up appt., but with the Dept. Head rather than the Resident I had for the 1st appt. Their idea, not mine, but a welcome one.

An MA brings me to the room, then an LPN comes in to take history and give me instructions. I get the correct instructions about undressing this time. When she is done I tell her that she and the scribe need to leave when it is time for the genital/rectal check. She thanks me for the reminder and says she already had that on the screen.

Though I offered they only had to leave for the genital/rectal part the doctor comes in by himself. He was very polite, fully explained things to me, and he did a full exam, but I could tell he was walking on eggshells a bit. For sure he knew I was the one who complained to Patient Relations a month ago. I actually liked the guy and will see him again in a year unless there is reason to see him before then.

The one thing that did go wrong, which alternatively is why he was walking on eggshells was a privacy breach by what I presume must have been the scribe. She apparently hadn't gotten word she wasn't coming into the room. I literally had just finished completely disrobing and was about to put on the gown when there is a knock on the door and she says "OK to come in". I say loud enough for her to hear "No, not yet". She apparently wasn't listening for my answer, opens the door and pulls back the curtain. I try to cover myself with the gown while yelling at her loud enough for everyone to hear "I said no, not yet". She hastily retreats while apologizing saying she didn't know I wasn't ready. I yell again "That's why I said no, not yet". I have no way of knowing who all heard me out in the hallway but anyone out there surely did, and this is a pretty busy place.

Because I wanted to get a positive relationship with the doctor established I chose not to say anything to the him about it but I suspect he heard the exchange himself or knew of it before he came into the room. Word spreads fast with that sort of thing. Him being the Head of Dermatology likely means he isn't taking new patients, so if there is a silver lining to this saga it is that it caused me to jump to the front of the line so to speak and be put on his roster.

A very small step in getting male modesty recognized but a step nonetheless. Men can now have full exams without female observers if they say that's what they want.

 
At Friday, February 02, 2018 9:12:00 PM, Blogger Maurice Bernstein, M.D. said...

Biker, I don't understand why you couldn't keep your underwear covering your genitals and buttocks which would be briefly lowered only at the time of the male genital and rectal exam and then immediately raised.
There is no rationale for totally undressing your genitals until their exam is to be undertaken. By the way, I don't see the need for a scribe in the room for a male genital exam. If the exam is normal the description is that one word, normal. If there is any abnormality found, the few words needed to describe can be added when the exam is concluded. ..Maurice.

 
At Saturday, February 03, 2018 5:15:00 AM, Blogger Biker in Vermont said...

Dr. Bernstein, yesterday was my first full skin exam ever so I don't have any other frame of reference. My prior visit was supposed to have been a full skin exam but apparently the LNA bungled the instructions and I upset the apple cart saying I didn't want two female observers.

Their protocol is that the LNA gives the patient a gown and says to undress to your level of comfort. The doctors take their cue whether to do a genital/rectal check based on whether you left your underwear on or not. That's what I was told by Patient Relations in my complaint resolution.

Their protocol is also that a scribe and LNA (of which they only have females) will be present for the full exam. That's the part I got changed. Now a man can say no to their presence. As I was leaving yesterday my doctor was at a station in the hallway giving the scribe the input from my exam just as you described can be done.

In any physical I have ever had with my PCP, the underwear stays on except for a brief lowering as you describe. That's also how it has been done with exams by urologists. PCP's and urologists have never had other staff present in the room for exams.

 
At Saturday, February 03, 2018 7:32:00 AM, Anonymous Anonymous said...

Biker — Thank you for your courageous actions. I’m especially pleased to hear about ecpressions in a loud voice. The eggshells effect you produced is, in my opinion, exactly where we need to be going. Best, REL

 
At Saturday, February 03, 2018 12:16:00 PM, Blogger Biker in Vermont said...

Nothing courageous REL, just an old guy that grew weary of being a 2nd class patient. As recently as a couple years ago I'd of quietly suffered through the presence of the scribe and LPN and I wouldn't have pushed back as I did on that woman just walking into the room. Instead I'd of tried to make believe none of it embarrassed me.

 
At Saturday, February 03, 2018 1:18:00 PM, Blogger 58flyer said...

This discussion about dermatology and scribes comes at a fortuitous time for me. I will experience my first dermatology visit in about 2 weeks. The subject of scribes has got my attention. I have visited other medical specialists in my time, cardiologists, urologists, neurologists, and some more I can't think of right now. None of them have ever used scribes. What is it about dermatology that a scribe is needed?

I used to fly gliders with a doctor who would use a pocket voice recorder when he examined his patients, and then either he or his assistant would transcribe his notes into the patient records. This seems more practical to me as it would eliminate the stress of an extra person in the exam room. My wife related her experience with a dermatology clinic. She said she was examined by a nurse practitioner and, as she called it, a note taker, who was using an iPad. The note taker I took to be a scribe. Both were female, but my wife said even at that she was uncomfortable with that second set of eyes and ears in the room.

From what I can find on the web is that a scribe is basically a secretary with some training in medical terminology, human anatomy, and pharmaceutical terminology. Oh, and they have to have good typing skills. The scribe is not, from what I can find, a licensed clinical professional. I have seen the term "certified medical scribe" used so maybe there is some kind of formal training and certification. I will have to look into that further. But at this point in time I believe that a scribe is just a glorified secretary. What qualifies them to be present during an intimate exam of a patient of the opposite sex? Of course, we have to ask the question of male scribes being present with female patients, but I think we know the answer to that! Has the disrespect of male patients really reached a new low, or is there something that I don't understand?

Mike

 
At Saturday, February 03, 2018 4:56:00 PM, Anonymous Anonymous said...

Biker -- Well courageous in my book. The theorem is both old and simple: Fear breeds respect. After your efforts, I say, QED. Oh and don't worry about an effect on quality of dermatological care such as it is. Mortality rates for melanoma now are the same as half century ago; only the cost of care has changed. REL

 
At Saturday, February 03, 2018 6:49:00 PM, Anonymous Anonymous said...

There are no education requirements for a medical scribe. Years ago medical transcriptionists had some terminology training and their job would be to transcribe recorded reports from radiologists, surgeons etc. Today, when radiologists speak into a microphone a written report is made instantly, thus all transcriptionists lost their jobs due to this new technology. Very soon in the near future medical scribes will be a thing of the past as new voice recognition technology will post automatically to the EMR. Medical scribes often violate HIPAA despite the fact that they sign an agreement that will abide by the laws. Additionally, many scribes often make mistakes and remember all they are doing is documenting what the physician mentions about the patient. For example, ruq( right upper quadrant) pain x 2weeks, nausea, vomiting. No Murphy signs although patient guarded. Hello folks, how do you screw that up? Well they do.

PT

 
At Sunday, February 04, 2018 10:19:00 AM, Blogger Maurice Bernstein, M.D. said...

As of February 4 2018, there will be no further Comments posted on Volume 83. Please write your Comments now on Volume 84. ..Maurice.

 

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