Patient Modesty: Volume 84
Currently on a bioethics listserv to which I read and contribute there is a discussion about policies within the healthcare system which attempt to protect the participants of the medical institution from demands of patients with regard to race and ethnic background. One response by a physician was that his hospital institution had a policy to
"employ people on the basis of their skills and competence and without regard to gender, skin color, religion, etc. and when patients or families make discriminatory requests they must be evaluated in light of this commitment. Some seemingly discriminatory requests may be accommodated if there are good reasons to believe they have good psychological or medical validity and if doing so can be accomplished without compromising patient care pr staff safety (e.g., a teenage girl requesting a female physician for a pelvic exam). In our experience, the overwhelming majority of these incidents occur with nursing staff and allied health personnel (like phlebotomists or ECG techs). Most never percolate up the chain so that senior folks hear about them and they are usually handled locally by juggling staff assignments."
I responded with : It ain't just a "teenage girl requesting " a gender selection of a physician or more often that of nursing and allied staff (including scribes!) performing or presence when genitals are being exposed. And in my 13 year ongoing Bioethics Discussion Blog thread on "Patient Modesty" it is mainly men who are demanding but very often not receiving their gender "discrimination" requests and are left either avoiding necessary medical care or leaving "care" emotionally upset. Although my blog thread is titled "modesty" there has been "no...none" racial or country origin demands ever mentioned or exampled.
Well, another listserv participant followed up with: "Maurice, maybe that is because discriminatory requests based on race or national origin are not necessarily associated with the heading of 'modesty' ?"
And so to start off this new Volume, yes, the title of this thread is "modesty" but is it true as the participant wrote it is inappropriate for me to infer that beyond this issue the writers here are free from racial or ethnic bias or any of the other issues of social inequality because of this thread's directed subject matter? Or are gender issues lengthily covered here may be or are related to other medical treatment concerns which could be described as attached to other aspects of social equality or inequality such as race and ethnic origin which also bothers my visitors? Repeating: Is the medical profession not offering all that it should be offering to patient desires to those writing here in terms of social quality, beyond poor attention to modesty. ..Maurice.
Graphic: From Google Images and modified by me with ArtRage 3.
THERE WILL BE NO FURTHER POSTING OF COMMENTS ON VOLUME 84.
THE POSTING OF COMMENTS WILL RESUME ON VOLUME 85.
posted by Maurice Bernstein, M.D. @ 10:04:00 AM
190 comments
190 Comments:
I would most appreciate if my contributors here expressed their views regarding the question I described in the lead-in to this new Volume. Thanks. ..Maurice.
Maurice
Gender bias is just as wrong as ethnic or racial bias although apparently many medical facilities don’t seem to think so. Just look at the cross section of the gender of their employees. Furthermore, I know of no physician at any hospital ( all physicians are employed by the hospital) who is acutely aware of exactly how employees are chosen and I can assure you it is not based on skill and competence. That is simply one of many lies that come out of medical institutions.
I know of a few accounts where the patient’s family refused to allow a black nurse to provide care for their white infant son. The hospital supervisor changed nurses for the patient. Hospitals continue to discriminate based on gender regarding all female nurses in L&D and in mammography. Yet on the other hand consider it discrimination when a male patient requests a male nurse for an intimate procedure. Is that your impression from the conversations you have via participants in listserv. Do they have a grasp of all the implications associated with the false impression that it’s only modesty related.
Those are the false inferences one receives from any modesty related topic when instead it should read gender discrimination. Most patient concerns never percolate up the food chain and if they did are quickly dismissed. I’ll continue with it’s not just requesting a same gender provider ( male nurse, tech) etc. it’s all the logistics associated with privacy issues such as being given a patient gown and having privacy to change into a gown. That is an expectation and that expectation is presented on every state board of nursing website yet from my experiences as a male patient that does not happen.
PT
Dr. Bernstein, I am sure there are people out there with preferences as to race, ethnicity, religion and sexual orientation, though I personally have never known anyone who commented on such. The closest I could come to such a scenario was some years ago I took my then late 80's father-in-law to the ER for a sprained ankle. The doctor assigned to look at him was a very young looking black female. It startled him on account he had never had a doctor that young nor a female doctor nor a black doctor. Though she was a bit of a curiosity to him he was fine with her being his doctor. It was just a new experience for him is all.
I personally could care less what medical staff race, ethnicity, religion or sexual orientation is. For example my PCP is a gay man. Doesn't matter to me. I as well don't care about gender for non-intimate matters. What does bother me is being forced to receive intimate care from female staff, especially lower level female staff and young female staff. No matter what many in the medical world may think, opposite gender intimate care is different than any of the other scenarios.
It seems to me that some folks on listserv should have heard of patient centered care, respectful care and core values. Be mindful that I didn’t invent these concepts, the institutions did. Furthermore, I’m not going to say that I resent intimate care from young females only for that might be construed again as discriminatory. It just seems that even when us male patients ask for anything that’s respectful, it’s discriminatory. To be clear I do not want intimate care from females of any age that way there is no age discrimination.
PT
So when a female patient requests same gender care, there is no discrimination but a male patient requests the same it's now discriminatory?
What's good for the gander is good for the goose!
Ed
My reading of comments now on two ethics listservs discussing the same issue admit that gender selection of the caregiver based on religion of the patient should be given attention to accommodate. You may be interested in reading
"Guidelines for Health Care Providers Interacting with Muslim Patients and their Families" http://www.ispi-usa.org/guidelines.htm
I would argue that if gender selection of those providing medical care to a patient is to be made it would be unjust (ethical principle: justice) to limit such provisions to any particular religion or ethnic background of the patient. ..Maurice.
I thought it has been reasonably established that requests for same gender care do not constitute discrimination. I personally would not consider the race, ethnicity, religion, or sexual orientation of my caregivers as something of concern to me. But life experience has taught me that human beings are sexual creatures. You cannot remove the sexual component from the relationship. I know that no amount of professional training can neutralize the sexual component. Females are human beings, and they bring that sexual interest into the patient/caregiver relationship, whether they realize it or not. While most caregivers put up the professional barrier between themselves and the patient, some are incapable of doing so. That's why we have the example of the Denver 5, which I think is only the tip of the iceberg. Then there are those who, being in the position of power that they are in, outright abuse their patients. That was my own patient experience.
I guess I should clarify. While the Denver 5 example certainly could be considered abuse, it really amounts to a sexual curiosity. This is where the prurient interests of the caregivers outweighed the dignity needs of the patient. That's where the sexual component comes into play. Given that females are infatuated with the size of male genitalia in our society, those incapable of separating the professional self from the personal self are prone to some really bad decision making. Then there those who take it a step further and deliberately abuse their male patients.
That is why I think that requests for same gendered care are not discriminatory, but protective of the patient concerns.
Mike
So a dermatologist with a female staff can legally show a black male the door if he wants same gender staff care but can't legally decline treatment if the dermatologist has difficulty detecting lesions on dark skin? REL
I find it a tad insulting that the ethicists Dr. Bernstein referred to think only religion can be an acceptable basis for gender preferences. Odds are they are only referring to female patients even then.
As noted in another post not all that long ago, we all judge people physically, clothed or not. In most cases those judgments are fleeting, barely registering on our consciousness if at all because by definition most people fall within averages or norms. There is nothing about them that bears further thought. It is only when people don't fall within norms that they catch our attention, good or bad.
Medical staff are people too no matter how well trained or professional they may be. They may have mastered hiding their judgments, but it is disingenuous for medical staff to say they don't judge.
When it comes to gender preferences not wanting to be judged is only one of the reasons a patient may have a preference. As already noted religion could be the issue. For some of us it is a prior bad experience that colors our preferences. In those cases avoiding the offending gender in intimate medical scenarios becomes the path of least resistance.
The medical world has long recognized and accepted gender preferences for female patients. It is disingenuous of them to not admit it. It is profoundly unfair and sexist of them to not think men are equally worthy of having preferences.
Until the 1960’s it was common in certain parts of the country to see discriminatory signs that expressed ordinances such as “Whites Only”, or Colored Entrance in Rear, etc.
These sign no longer exist, because of the Civil Rights Act of 1964 as well as various court rulings and local ordinances. While racial, and ethnic prejudice still exist today there is a general consensus that these Jim Crow Laws have no place in our society.
However, virtually any time we enter a public we are confronted with discriminatory signs. Some of them read “Women” and some of them read “Men”. Yet there is no public outcry against this form of discrimination because there is a general consensus in our society that there is a legitimate desire and need for physical privacy between the genders.
The argument therefore follows that to refuse medical care based on race or religion violates both American laws and mores. But even the Civil Rights Act, with its BFOQ provision, recognizes that there can be some exceptions regarding privacy between the genders. In these cases, it is the medical profession with its concept of gender neutral care that repeatedly violates generally agreed upon American values and practices.
In conclusion I would argue then that there is no justification for refusing a caregiver because of race, religion, or ethnic background but that societal norms provide us with a legitimate right to refuse opposite gender intimate care.
MG
I am asking the following question not to express my opinion at this time but only to delve further into the issue of discrimination and equality:
Do you think that a patient has as much moral right to request a physician or other medical attendants of a certain race as they are, on this blog, supported to request on the basis of gender? Is one request much more worthy from an ethical and humanistic point of view than the other?
(This should raise a bit of response on this blog thread!)
..Maurice.
Oops! I apologize to MG since I inadvertently posted my request above before MG's comment was received and published and so it appears after MG's comment which responds to my request.
One point: Is it illegal for a patient to REFUSE medical care by an individual based on that careguver individual's race, religion or ethnic origin even though it would be for an institution to reject to employ that healthcare provider based on the same factors? ..Maurice.
You can sense from the following comment from a writer to one of the ethics listservs there is another concern about patient's requests or "demands" which may even affect students who are actively progressing to become physicians.
I’d also be interested in policies and procedures for handling patients who make racist requests, e.g., for a provider of a particular “background.” While seasoned physicians may have developed ways of handling such requests, e.g., citing relevant hospital policies, a related, perhaps more difficult, issue recently arose. Some of our medical students, who have begun clinical rotations, informally report that as persons of color, they are constantly asked by (some) patients “Where are you from?" (Reply: LA, New Jersey . . .). “No, where are you from really?” While many simply shrug this off, others describe distress at the implication that they “don’t really belong here,” or in medicine, etc. Is this an issue that other medical schools are seeing/addressing?
It is all about this kind of professional (in this case, medical education) concern which may be "turning off" the professional interest or "cure" toward patient gender demands. What do you think?
I am personally concerned about what this listserv contributor is bringing up since, truthfully, all 6 of my first year group of medical student represent foreign ethnic backgrounds. I am pleased with all of them since their behavior is exactly what I have seen in those whose families were representative of long standing American culture. No difference that I can discern. What worries me is when my group moves on to the 3rd and 4th year clinical ward experience, how they are going to be treated by those patients who are demanding American ethnic backgrounds of those who attend to them. Do you understand my concern? Am I over-worrying? ..Maurice.
Dr.Bernstein, in today's hypersensitive society, it is fully possible the "where are you from" questions are simply curiosity rather than the prejudice that they are construed as.
I never ask personal questions of medical staff even if they are asking me personal questions. My wife's personality on the other hand is that of the super extrovert that engages everyone she meets as new friends. She has asked medical providers where they are from because to her it is a way of showing interest in them as a person, and she truly is interested in knowing them as people.
To your larger question of whether to be concerned, I think the issue is somewhat short lived. By that I mean there has been a vast demographic change within physician ranks and other medical staffing in recent decades at the same time a big demographic change has been underway in the country as a whole. Many people, especially amongst the elderly, may not see those demographic changes in their day to day lives but then encounter it in a big way when they are hospitalized. Their inquiries may be prejudice or they may just be curiosity. For younger people these changes aren't changes as it is all they have ever known and as such they are going to approach medical staff with a different mindset.
Sounds like snowflake territory to me and a topic that the moderator would not have permitted here if not put up by the moderstor. Patients probably trying to engage in pleasant chit-chat and perhaps not certain how best to do that. If the caregiver were white as a ghost but had say a southern accent, many patients might ask where are you from mesning Alabama, Texas, etc. REL
If all this racial or ethnic questioning and requests by patients were simply misunderstood trivialities, I am surprised why there is discussion on these listservs by members of medical institutions asking each other "what is your hospital's policies and procedures on this matter?" The patients' questioning and requests in this matter must be of some institutional significance.
By the way, I am glad I have read these listservs and extended the conversation here to areas of institutional concern beyond gender requests by patients. This broader dissection of institutional behavior may give insight into how they react to patient modesty concerns: such as putting gender requests down on the list and perhaps on that issue focusing to accommodate gender selection of caregivers only for "a female teenager" as an example.
..Maurice.
"Do you think that a patient has as much moral right to request a physician or other medical attendants of a certain race as they are, on this blog, supported to request on the basis of gender? Is one request much more worthy from an ethical and humanistic point of view than the other?"
Any such request is reprehensible; NO!
Ed
It does appear, Ed, that so far there is no response in which the desire for gender selection is associated with a desire or directed verbal expression for race or ethnic demands. Maybe others will write a view supporting the "right" of any patient to demand these other characteristics of their assigned healthcare provider. ..Maurice.
-----------------------------
By the way, since this is the most prolonged and vocal (in terms of posting comments) thread of my entire blog, I thought it might be of interest of some to take a look and perhaps Comment there on my new topic which deals with the professional and ethical role of psychiatry and psychiatrists of diagnosing President Trump. I have found an excellent professional article and request my visitors to read it and comment. Here is the address:
http://bioethicsdiscussion.blogspot.com/2018/02/president-trumpdiagnosis-and-if.html
Thanks for the offer but no need; I already know he's an idiot LOL!
Ed
Dr. Bernstein, for my part I am saying that some of the perceived slights are likely an overreaction given the current hypersensitive climate out there. Some probably are prejudice but not all.
I can assure you that if you had my wife as your patient she'll be asking you if you have kids or grandkids, how old the grandkids are, boys or girls. If you have an accent and an unusual name such as one of her surgeons a year or two ago, she'd learn that you came from Iceland and how you ended up at that hospital. There was another surgeon born here of parents from India and who was the same age as our daughter and with two kids as she came to learn that truly enjoyed her interest in him as a person. The human connection she made with him was such that he would stop by at night to check on her before going home. It's just her way of relating to you as a person. No more no less.
That said I can understand how a medical student or resident might find offense if they see it as her not knowing her place in the doctor-patient hierarchy. Later in their careers when they are established and comfortable in their own skin, they'd likely enjoy her as a patient. Most do.
Ed, let's not discuss Trump on this "Patient Modesty" thread and, in fact, since this is an ethics blog our orientation in true bioethics. And that is the basis for my new topic which I noted above. The new topic deals with the ethical role of psychiatry and their psychiatrists in the apparent need to describe the behavior of the President. Obviously many consider that there is a "need" but, in face of the psychiatry association's insistence for their professionals to follow the Goldwater Rule what should the psychiatrists who suspect pathology ethically do? I link and extract to a very good current article that tries to explain what would be the professional and ethical approach. Let's keep the Trump discussion there. ..Maurice.
Maurice
We should remember that when we are referring to the behaviors of the institution it’s not necessarily the institution, but rather the nursing staff who decides to what extent privacy is extended.
PT
PT, what you wrote is consistent with what the listserv doctor wrote which I reproduced in my thread introduction to the issue: "In our experience, the overwhelming majority of these incidents occur with nursing staff and allied health personnel (like phlebotomists or ECG techs). Most never percolate up the chain so that senior folks hear about them and they are usually handled locally by juggling staff assignments."
This lack of "percolation" is something we all should keep in mind as we complain about behavior of the staff directly attending to the patient. ..Maurice.
If anybody says not wanting care by other races or people of different religions or cultures is the same and wanting same sex care for intimidate care,then I would say that person is deliberately misunderstanding. I don't know if I could hold my own in a debate about it but I promise you, it isn't the same thing. One has to do with modesty. The other, prejudice.
Not sure if the severed heads were male of female. Perhaps there needs to be a study of the type of person that is taking up scarce positions in healthcare training facilities.
http://time.com/5134728/dental-students-severed-head-selfie/
REL
Preference for a same gender medical professional for intimate procedures is not the same as race or religious preferences since it is about modesty.
I encourage you to read the below paragraphs about discrimination from Doug Capra who wrote this article, Patient Modesty, Values, and Rights.
Don’t let someone tell you that your choice of one gender over the other for intimate care is discrimination, in the legal sense of the word. Don’t let them compare it to racial discrimination. A racist is someone who negatively stereotypes a whole race and/or thinks that race is inferior to his own. If, as a man, you believe that all women are inferior to men and can’t do the kinds of procedures you need, then, indeed, you are practicing discrimination.
But that’s not what most people believe who request same gender care. Most patients welcome basic care from either gender. It’s only for the most sensitive, intimate care that they prefer a same gender provider. Their assumption isn’t that both genders can’t do the job equally as well. For modesty and privacy reasons, these patients just prefer a specific gender. So -- don’t accept this “discrimination” argument if it’s used.
Misty
In the lead-in discussion a physician is quoted as saying: “that his hospital institution had a policy to ‘employ people on the basis of their skills and competence and without regard to gender, skin color, religion, etc. and when patients or families make discriminatory requests they must be evaluated in light of this commitment.’
First, I’m going to excuse this physician’s ignorance about the hospital institution because I know that most physicians just work in one department and/or a few floor units and don’t really appreciate how well their “hospital institution” practices what they claim is their policy. Because before we criticize patient requests we have to look at how every hospital institution is organized in America. All have Mammography imaging and a high percentage have Women’s clinics and Women’s imaging centers (almost none have Men’s Imaging Centers or Men’s Clinics). These women’s clinics will be staffed with 100% female RNs, MAs, Rad Techs & Techs (Mammography for certain will be 100% female, the other clinics will be nearly all female throughout the US). How can it be that an institution that hires people “without regard to gender” can staff clinics will ALL female staff? Any licensed Rad Tech can be trained to perform mammography. No newly license female Rad Tech has more experience in Mammography then a newly licensed male Rad Tech - so why do only females get hired for this intimate care job? Any male MA or RN can perform the necessary duties in a Women’s (OB/GYN) clinic. Yet nearly all of these women’s clinics hire only female staff (regardless of the sex of the physician).
Many physicians who work in Hospitals also have a private practice. 95+% of these private practices have only female staff. Why are physicians only hiring female staff?
So, for physicians and Hospitals to try and ascribe some discriminatory intent by the patient who asks for same gender care is hypocritical and in fact reflects the overt discriminatory system the Hospital and Physicians have created. They have, nationwide, recognized same gender care is important for female patients but then intentionally, nationwide, denied male patients the same care model, the same patient centered care.
Previously I’ve given reasons why they do this, but not one Hospital or Physician can provide peer reviewed evidence based reasons why it is acceptable for male patients to be given a second tier health care system and to have their patient rights ignored explicitly.
Let’s correct the discrimination by Hospitals and physicians before we blame male patients for desiring equity in the health care system. Until then physician need to take a hard look at their own hiring practices and a hard look at their own Medical Centers. There is discrimination all around. (And yes, as a Regulatory and Compliance expert I know all about the BFOQ exception, the Civil Rights Act and 35 years of court cases, but if one applies the BFOQ exemption for females, it must be applied for males in a public institution and vice versa). — AB
AB
Well said and I further that by saying that one only needs to look at the cases of Dr Twana Sparks and Dr Larry Nassar to to fully appreciate truly how F&$#ed up health care is.
PT
AB. excellent feedback to my thread "lead-in". But, from your previous "altitude" in the medical care system, do you think that the basis for problems is that the others in administration are just sitting and observing but "too high" to see injustices? Or does it have anything to do with the fact that there are too many "non-physician" administrators who have never have experienced a medical school education and never have had direct intimate medical professional interaction and attention to the sick? In other words, who, in most hospital or major clinic institutions is at the "top": business administrators or actual practicing physicians? Maybe, it would be appropriate for more physicians, in active practice, to be at the top whose daily activities bring them down to the bottom and where, as, in response to the description which the listserv writer wrote, issues requiring more just behavior need NOT to await "perculation up a chain". ..Maurice.
From AB's excellent post: "Many physicians who work in Hospitals also have a private practice. 95+% of these private practices have only female staff." Doesn't sound like replacing business managers with physician managers makes much difference. All seem to be concerned about cost cutting and, as I've pointed out before, they can get away with it if male patients cooperate. REL
Dr. Bernstein, I appreciate what you are saying as concerns physicians vs non - medical staff at the top of institutions, but physicians with private practices are fully aware that it is female MA's, LPN's, RN's and CNA's that they are bringing into the room to do intimate prep or otherwise assist with intimate exams and procedures for their male patients. Radiologists in hospitals can't not notice when all of the sonographers are female. I am guessing that you too only had female staff for your private practice.
The medical hierarchy is likely to become more female as women slowly work their way up that hierarchy. Those women will be a mix of medical and non-medical. The new (2017) CEO of the large teaching hospital in NH I use is a female MD. My local hospital is in the midst of a search to replace the current CEO that has announced his retirement. This being Vermont political correctness is such that for sure they will only hire a male if they can't find an acceptable female. They'll never publicly say that of course but for sure that is what they are doing. If anything, short of court rulings causing change, the trend we are on will be even less male-friendly as women take over the top spots in hospitals.
Maurice
What you are suggesting has come and gone. I recall in the 70’s and 80’s physicians used to hold top positions as the CEO etc. The model now is the CNO ( chief nursing officer) is about 85% female, the CFO( chief financial officer) is 50% female and the CEO is 50% female with a nursing combination and MBA.
Physicians that are employed within the hospitals (groups) are the hospitalists, ER physicians, Radiologists and a pathologist or two and finally the surgeons. All other physicians that come into the hospitals have privileges. Finally, there are the directors of each department which are radiology, respiratory, surgery, laboratory, emergency and nursing. The directors of these departments are 90% female. It is the directors of these department who decide on the hiring. The job of Human Resources is simply to decide if their license etc of the prospective employee is up to date.
Now, if you are a patient in a hospital and you have a concern you can ask to speak to the charge nurse, the house supervisor or a patient advocate. Typically, once you leave the hospital, discharged and you send in a complaint it will usually fall on deaf ears. The top administrators being the CEO, CNO and CFO do not concern themselves with patient complaints and if they receive a complaint it is forwarded to the director of the department. Thus the only leverage you have as a patient is when you are a patient.
PT
PT and others,
Thanks and please keep educating us.
BJTNT
So PT and AB what is the solution (the most realistic and effective) for this male patient potential and currently practicing medical inequality and how does the solution get started? ..Maurice.
Hello,
CMS, along with Yale U., is doing a study re hospital harm. The sub-topics are mainly medical harm; nevertheless, alerting them to the harm done by male indignities might be useful. Participants at this site might want to identify the direct psychological harm men encounter when same-gender care is not available and, the indirect harm men endure by eschewing medical care due to a lack of same-gender medical staff. The website is https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/MMS/PC-Currently-Accepting-Comments.html (Scroll to hospital harm).
Reginald
PT, when I had my recent dermatology complaint, Patient Relations went to the Section Chief, Dermatology who is a dermatologist and what I was told was the Practice Mgr. I looked her up and the Practice Mgr. is actually the Sr. Mgr, Surgical Services. She oversees Dermatology, Plastic Surgery, and Urology. She has a mgt. background and MBA, not medicine. Based on her resume I would say she is 31 or 32 years old. Would she be one of those Dept. Directors you referred to?
Oddly, urology at this hospital seems to be male-friendly. Last year I had a male nurse (upon request) for my annual cystoscopy. Perhaps more importantly it didn't phase the women at all that I had to make my request to. Conversely I was treated like there was something wrong with me when I made my request for male staff in dermatology. What will be interesting to see is if this Deping some males, or at least make for an attitude change. I'll know in about 10 months when they contact me to make my next appt. and I again ask for male staff.
Maurice
Regarding the legal disposition of Dr Larry Nasser I e-mailed the New Mexico State Medical Board and asked how such disparities can exist between him and Dr Twana Sparks. As expected I got no response, currently I am drafting letters along with examples I have printed from the internet and will be sending them to many news organizations in this country. We will see what happens.
PT
PT, I am all in favor of what you are doing and intend to do. In medicine, we look forward for the patient to tell us their symptoms, if possible (unless they arrive unconscious) so we know a better way to diagnosis and treatment. Also important in medicine is comparing outcomes of similar pathology, try to understand pathogenesis and established treatments. Both of these operations are necessary to progress to a productive goal. And certainly, providing reasonable gender equality in how medical care is carried out is certainly a worthy goal. ..Maurice.
Biker in Vermont
In the hospital setting it may be common to see a Director over numerous departments. For example, a nurse who is over the emergency room, surgery and endoscopy. Another example, a Director over respiratory, Cardiology and EEG. I have worked at over 20 hospitals and very few Directors I’ve seen have an MBA, most just have a BSN ( bachelor Science in nursing) and in the case of respiratory Directors they have only a certificate.
Now from my experience it is very unusual for a manager that oversees patient care areas such as surgery, intensive care etc to not have a nursing background. You will see this in non hospital settings such as Urology clinics, Dermatology as well as family practice clinics whereby the manager just has a business background.
No disrespect to you Maurice but it’s a well known fact that most physicians do not make good businessman. There is a good reason for that, they are too busy practicing medicine and don’t have time to count the beans. Thus, they hire people who have a business background so as to maximize profits, evaluate growth, hire employees etc.
To answer your question Biker, yes she is the Director and all patient complaints are looked into and resolved by the Director. Now some patient complaints may begin in another department with a patient care issue such as a fall. Typically, these complaints are first directed to the Director of Quality who then forwards the complaint to the relevant department Director. There may be a lengthy investigation into the complaint. I’ll say that patient complaints have gained a lot of momentum vs 30 years ago an$ they are looked into more so than in previous years.
There is a good reason for this, Press Ganey, patient surveys, patient satisfaction, the Joint Commission etc. Additionally, Medicare and reimbursements are now quality related. I was once one of those people who investigated patient complaints and they are taken seriously and yes I’ve seen many employees terminated from patient care related issues. I have never had a derm exam and I can’t say I have experience in that area. I’ve never seen a Dermatology department or anything related to dermatology hospital related. Virtually all dermatology related surgeries are performed in the office and perhaps a few are performed at an outpatient surgical clinic.
PT
Thanks PT. The Director who handled my complaint does not have a nursing background but must be a true MBA wonder to have the position she does in her early 30's. Probably heading towards a hospital CEO position someday.
We'll see next year if she did anything more than appease me when I learn if they have any male scribes or LPN's. Regardless there won't be any female observers for my exam. I would add that these exam rooms are so small that no matter where they are positioned they will see everything.
PT,
Responding to your post on 2/7, have you considered contacting any of the TV news magazines, such as 60 Minutes or 20/20? These shows have been around for a long time, and the viewership must be in the millions.
Beyond the Sparks fiasco, and I'm sure that alone would be a great news segment, the airing of the gender imbalance in healthcare that we all talk about here would go a long way towards a solution. Most people, men and women, have experienced modesty violations. Reaching such a large number of people that these TV news magazines represent would likely get discussion going on a large scale, along with many new ideas for resolution.
Mike
Mike
Yes those are my intentions along with a number of recent events in the news, the Denver 5, Incident at a hospital in Penn., the upstate nurse in New York and many examples from Propublica.org. I’m mailed packages to writers I’ve selected at many news agencies and I’m hoping it will ride the coats of all this sexual harrassment,
PT
I think what might be helpful is a person making a complaint be given a copy ( sort of like a receipt ) and that way it can be seen whether or not it makes its way up the chain of command. If I were the guy told that he alone, on the face of the earth, was the only male embarrassed by intimate care by women.... Actually I don't have to be that guy. I'm a woman, but I'm angry just like PT is. About my own modesty violations, and violations my friends have told me of and what I have read on the blogs. Just like RG, I don't consider it protection to have a medical chaperone seeing everything. I think it is in itself abuse. I'm ok with a chaperone at the head of the table, but I know that doesn't provide any privacy for a guy. The other thing I wanted to mention is about the white bigoted couple who didn't want a black nurse attending to their infant son, if I were in management I would let the nurse decide. Just tell her what was said, tell her I was on her side and does she want to take care of the baby or not.
58flyer
Included in the packet will be a copy of this website, tigerhawk.blogspot.com. Just to help illustrate how ignorant, pathetic, deviant and retrograde the nursing industry has been and continues to be.
PT
Sorry about that. Tigerhawk.blogspot.com/2005/05/nurses-secret-weapon.html
PT
PT, I'd reconsider using that Tigerhawk site. The story being told is from 1968. Better more modern day examples because anyone digging into current day nurse training is not going to find a school that teaches the spoon technique.
Biker,
That just furthers my theory that a medical education "kills" the conscience. This was proven in Milgram's Obedience to Authority and the Stanford Prison Experiment. It also explains why physicians were the largest professional group to join the SS.
How could any person with a conscience think that the "spoon" could be acceptable in any year?
...and to do that to an injured, incapacitated person. This from the compassionate professionals of nursing.
So what has changed since 1968? If that is what they consider compassionate care, we need a lot LESS of that.
And what of teenaged boys who that happens to when "the wind blows?" How does a teenaged boy reconcile being injured, incapacitated, probably not sure about the changes his body is going through, and a nurse hits him there with a spoon.
I am surprised they just didn't jab it with a fork...
In 2012 we were still talking about medical students doing pelvic exams on anesthetized without specific consent. The incident at UPMC was justified by being educational.
Medicine is like a vicious dog. The solution is to muzzle it, put it on a short leash with a choke collar, AND the patient holds the leash. The medical profession has proven (ad nausium) over the last 180 years (I use the time that J. Marion Sims started his experimental operations on slaves) that it does NOT know what societally acceptable ant ethical. It only operates in its own best interest under the guise of compassionate care.
This is why healthcare is being pushed to becoming a consumer product. Society is pushing it that way so that patients can protect themselves.
The internet has show society the lies that physicians told because their sacred knowledge was no longer locked away in their medical libraries. The response is "because I am a doctor" no longer instilled trust, because ONE LIE IS ENOUGH TO QUESTION ALL TRUTHS.
Furthermore, lest we forget we are doomed to repeat.
The ONLY person to ever apologize for conducting pelvic exams on anesthetized without specific consent was Peter Ubel.
-- Banterings
I wanted to let you all know that a woman, Peggy50854 has joined a discussion about male patient modesty. She has labeled men who value their modesty as cry babies. I did not like her attitude and responded. Some other men responded. As a woman, I find it sad when women criticize male patients who desire to have maximum modesty or all male team.
Misty
PT, what I am trying to say is that if we want current practices to change examples from 1968 aren't going to speak to what is happening today. The medical world can't change 1968 practices but they can be pressured to change 2018 practices. If you could find a modern day example of males being whacked with a spoon then the 1968 reference would be of value in that it would speak to it being a long standing practice still ongoing.
I had my first really rude experience as a cross between a male patient and a deer in the headlights. Reading this blog prepared me somewhat, but my instinct to cooperate and follow the directions of an authority figure are pretty strong.
I was scheduled for my third prostate biopsy and wanted to avoid the female ultrasound technician that was in the first two biophys. I had endured the common ridicule from a gender-toxic woman in scheduling when requesting same gender health care, and had finally written a letter requesting a male tech. I had actually got a phone call telling me it was all set up.
After an interview, on the day of the biopsy, the urologist (male) put me in the care of some woman who never looked at me. As she was very busy setting up I asked her "Are you the ultrasound technician?" She replied "No" without looking at me. Soon a second woman joined her and I asked the same question and she said "I am also a nurse," also without looking at me. At one point she did look at me and said "While we're waiting for the doctor you can take off your pants and lay on your left side."
My instinct was to do it but I managed to say, "I made arrangements for a male ultrasound technician. What happened to those arrangements?" The second woman turned to the first and said "We have to get BJ for his comfort." They then turned and walked out while the urologist was walking in. She said to him "We will send in BJ for his comfort." The urologist looked shocked. It may be the first time he has seen a male patient escape the humiliation.
Neither woman introduced themselves and they didn't have name badges. All set up to be hard to complain about. They didn't put out a gown or offer to leave the room. They didn't make it easy for me to request it either. I never had this treatment before.
When BJ came in he seemed to be walking on eggs. I don't know if that was the way he is or if he was told something about me. He started by opening a cabinet and bringing out a gown and a towel. He and the urologist left while I changed. BJ used the towel to cover my hips. I was really treated as an individual.
I dodged the bullet this time.
SS
Part I
Maurice et al,
I am going to definitively show that even when procedures are done correctly, they can produce psychiatric trauma (such as PTSD) in patients. Now we can reasonably conclude that routine exams create a cumulative psychiatric trauma even if one refuses to accept that a single exam encounter produces psychiatric trauma.
Here is the paper from The American Counseling Association: "When Treatment Becomes Trauma."
Here are some excerpts:
Menage (1993) studied 500 women who underwent obstetric and gynecological procedures, and found that 100 women described the procedure as being “terrifying” or “very distressing,” while 30 met the full criteria for PTSD (p. 221).
Studies of patients in this setting have yielded alarming results ranging from 18.5% to 59%, with measures taken up to 9 years following the ICU stay (Stoll & Schelling, 1998; Schelling et al., 1998; Schelling et al., 1999). ...there is an increasing body of evidence suggesting a dependent relationship between ICU admission and the later development of PTSD, irrespective of the events preceding ICU admission” (Hatch, McKetchnie, & Griffith, 2011, p. 1).
While diagnoses and related procedures have been shown to elicit serious psychological reactions in patients, the environment in which medical treatment takes place can also influence their emotional well-being. For many people the hospital or other clinical setting is an environment that is very different from their own; indeed, the physical surroundings, reduced personal agency and volition, and personal symbolism and history can influence a person’s experience in the setting and can contribute to a stress response.
People can experience unease surrounded by equipment, monitors, unfamiliar spaces, and a general lack of privacy. While most acute care and other clinical settings strive to create environments that are as comfortable as possible, they are in the end still clinical environments – and this fact can be difficult for some to overlook.
Powerlessness. Most adults have become habituated to having a certain level of personal power and autonomy in their lives. They decide whom to allow in their personal space, and they choose the timing, frequency, and duration of physical touch. While we are not devoid of all decision-making power when we enter the hospital setting, we still are expected to acquiesce to procedures that are in our best interest, as deemed by our physicians. Strides in patient-centered care are important, yet many adults have been socialized to yield to those with more training and education. Perceived or actual powerlessness can incite strong psychological responses, including PTSD, depression, and anxiety (Jones et al., 2007). While adults do have the ultimate authority regarding decisions about their care, the experience of being “under the care” of others can affect perceptions of personal power.
Here is another article about trauma from forcing procedures: https://qz.com/1146836/doctors-who-ignore-consent-are-traumatizing-women-during-childbirth/
...Continued
Part II
So what is the solution?
As I stated the patient needs to, (and WILL be) in charge of the PATIENT-physician relationship. (Note patient is first.)
In 2008, Robert M. Veatch wrote the book: Patient, Heal Thyself: How the New Medicine Puts the Patient in Charge NEJM review).
ioethics has reformed medical practice by elevating patient autonomy over physician paternalism. Robert Veatch was a leader of this movement, but in his view, the transformation has stalled. In this book, Veatch follows patient autonomy to its logical and outlandish conclusion. He articulates a “new medicine,” a truly revolutionary vision of a world in which “literally every decision a physician makes — the pattern of every practice — will have to be altered radically” and “reconceptualized.”
Veatch's proposals are so startling that readers of this review may doubt my characterizations, so I will quote liberally, starting with its excellent title — Patient, Heal Thyself. This injunction captures Veatch's two main points: Patients alone are in charge, and they have no choice but to assume this active role. According to this “manifesto,” doctors “will no longer be seen as capable of determining what will benefit their patients. It is patients themselves who, in the world of the new medicine, have to take charge.”
To defend this astonishing position, Veatch starts from the assertion that “literally every medical choice — no matter how mundane — inevitably requires value judgments,” and says that “physicians make them only by imposing their personal and often idiosyncratic views on their patients.” For instance, nonmedical values influence when a cast is removed and whether cholesterol should be controlled through diet or drugs.
In the 2017 Guardian (UK) article, I'm reinventing mental health care by putting patients in charge, the authornotes:
A feeling of powerlessness dominated my experience of mental health services. And this feeling was at its worst when I was sectioned. Sectioning replicated aspects of the traumatic experience that initially caused my suicidal crisis. I felt trapped, captive and utterly out of control. I couldn’t escape.
Disruptive technologies are leading to huge structural changes in the traditional healthcare system. For thousands of years, only physicians have been able to acquire and access medical data and make medical decisions. This “ivory tower” of medicine was built on the firm knowledge that physicians know best what’s good for the patient, and can’t benefit from patient input. Patients were just the subjects of healthcare, not partners.
Access to health data has leveled the playing field, arming patients to make informed decisions about their health. More health information is available via Google and crowdsourcing through social media communities than even the most trained physicians possess. Thanks to direct to consumer genomics and sophisticated health trackers, patients can acquire more detailed data than their clinicians. Patients are finding new ways to take advantage of this data.
(The following also applies to Difficult Patient vs Difficult Doctor.)
...Continued
Part III
The 1979 article, Hospital Patient Behavior: Reactance, Helplessness, or Control? concludes:
Hospitals are commonly regarded as unpleasant places to be. The reason is that, as a total institution, the hospital creates a depersonalizing environment that forces the patient to relinquish control over his or her daily existence. It is suggested that patients cope with depersonalizing loss of control by assuming “good patient” behavior or “bad patient” behavior. Predictions are offered as to who will show which behavior pattern under which circumstances. However, a review of these patterns suggests that some “good patients” may actually be in a state of anxious or depressed helplessness, whereas “bad patients” are exhibiting anger and reactance against the perceived arbitrary removal of freedoms. An analysis of the behavioral, cognitive, affective and physiological correlates of these patterns, as well as the behaviors they elicit in staff, suggests that both the “good patient” and the “bad patient” sustain health risks. It is argued that a more informed and participative role for the hospital patient can eliminate or offset many of these risks and actually improve the level of physical and psychological health in the hospital setting.
Again, the solution is the patient in charge.
-- Banterings
A question for the more medically astute folks here. In a few weeks I am scheduled for my annual cystoscopy of which I've had many. I am also scheduled for a retroperitoneal complete ultrasound. That's something new for me.
13 years ago I had an ultrasound as part of my bladder cancer diagnosis. The female tech lifted my gown totally exposing me and then put a towel over the genital area. In retrospect I realize there was no reason to expose me at all. I could have been covered over first and then the gown pulled up from underneath the towel.
A retroperintoneal complete ultrasound looks to be more than that bladder ultrasound. Does that procedure include genital exposure? It makes a difference whether I insist upon a male sonographer or not. I'm not concerned about the gown lifting aspect being I won't let that happen until I've been covered over first.
Thanks
Biker: A retruoperitoneal ultrasound study simply is an ultrasound with the transducer (probe) adjusted and located on the surface of the body to show up the retroperitoneal organs and structures such as the kidneys and ureters, retroperitoneal meaning they are not within but are outside the abdominal cavity lined with the peritoneal tissue. It requires relocating the probe on the abdomen or back or side of the patient and adjusting its transmission parameters to a more superficial depth than when the intra-abdominal structures are to be visualized. There should be no difference than how you were covered or uncovered previously. Here is the link to Radiology Penn Medicie regarding retroperitoneal (specifically renal ultrasound):
https://www.pennmedicine.org/~/media/documents%20and%20audio/patient%20guides%20and%20instructions/radiology/renal_ultrasound.ashx
..Maurice.
Maurice
That is true however their could be a need by the radiologist for a trans rectal ultrasound in some cases where the retroperitoneal structures are not well visualized. In which case the patient would be advised of the necessary additional views.
Biker
If those additional views are required ( transrectal) then you would have a sheet over you and you insert the probe. You would remain covered and the inserted probe would be tilted by the ultrasound tech for viewing of additional structures.
Just to help everyone here appreciate the technique of ultrasound it’s not feasible to try to visualize retroperitoneal structures through the bony pelvis posteriorly ( from behind) due to the sacrum, coccyx and large innomiate bones. Therefore structures within the lower pelvis are best visualized from the front ( anteriorly) or through the rectum ( transrectal). Sorry for the anatomy lesson.
PT
PT, thanks for the reference. I have seen it before.
Biker, the year doesn't matter. In 1968, you wouldn't have found any nursing school that officially taught the spoon technique. It's not official or standard of care, then or now, nor will you find it in any nursing practice manual. It was just some individual nurse instructor who thought it cute to introduce to her students the idea of dealing with an embarrassing reality of male care. It may have been more of a tongue in cheek comment which she meant as humorous. Unfortunately, some of the nursing students took it as official standard of care and may have missed the subsequent discussion of "oh, by the way, don't really do this, it's a joke, unless you want to lose your nursing license." Sometimes the mind picks up a point and digests it while missing the "hey, I'm only joking" part.
To illustrate my point, in my law enforcement career, I served as a firearms instructor. We were teaching a Glock transition course from the traditional revolvers to the semiautomatic Glock. The Glock has a polymer frame, in other words, plastic. The Glock, along with similar polymer framed guns are sometimes called "Tupperware' guns. So, here I am with a group of veteran officers teaching the part about disassembly, or field strip, cleaning, and reassembly. Somewhere along the way, it was proposed that since the Glock is a "Tupperware" gun, you could just field strip it, and put it in the dishwasher. It's an old joke but since the heat phase changes the tolerances by a few thousandths, if you do that you will never be able to reassemble your Glock. The gun is essentially destroyed. So I made that comment to the group with the admonishment, "do NOT put the Glock in the dishwasher to clean it." Sure enough, one of the officers in his mind only heard the words "clean in the dishwasher" and proceeded to do just that. He was not known as the sharpest tack in the drawer. And he shows up the next day wondering why his Glock won't go back together. I caught heat for that one.
So, back to the spoon technique. A nursing student or maybe more than one, picks up on the comment as standard of care and somewhere along the way does just that. Then you have an injured patient with a nurse saying "that's what they told us in nursing school."
Then there is the nurse who thinks "if it's OK to whack his penis with a spoon, then it must be OK to punch him in the scrotum." In my situation, I would have gladly taken the spoon.
Mike
Mike
The reality of it is I know of someone who told me this was commonplace. This conversation as I recall took place in 1974 and that he described it had happened to him in the late 60’s as well as others he knew. These sites I presented I’m sure may they might lead you to believe it was all a joke and perhaps just was maybe an urban legend. Yet, that is how they become urban legends because there is truth to them.
PT
Thanks all. PT, I think I'll ask for a male sonographer after all then being I don't know the specifics of what the urologist asked for.
Mike,
I concur with PT that this was part of the hidden curriculum of nursing. I too have heard this story in other places. I don't know to what extent it was practiced.
-- Banterings
Hopefully a number of those nurses were written up and fired her hitting a guy there. It's hard for me to imagine that being allowed. I also can't imagine the guys not punching their lights out for doing it.
PT,
While the "spoon Technic" might not be all that prevalent anymore, I can relate an anecdote that happened to a fellow military friend only three years ago.
The story, as I recall it, is that he was experiencing pain in one or maybe both his testicles and decided to present himself to the military clinic.
As luck would have it, my friend was seen by a female PA and, as these things go, he had to let her perform a testicular exam to see what was going on with his testicles.
As my friend put it, the PA was a "good looking girl" and, perhaps as expected, he quickly became aroused. I have no way to verify if this is true, other than my friend's word, but what followed is about has shocking a story as I have heard in my lifetime.
Upon realizing this, the PA grabbed his - now erected - penis in one hand and swiftly brought down her other hand on top of his penis' head. I can only assume how painful this would be.
According to my friend, this is known as a "mushroom caper" in the (Canadian ) military clinics. I asked him what he did after and he said he felt so embarrassed about getting aroused, that he didn't make any complain. I guess he felt like he deserved it.
And this is the more insidious side of events like this. How many health professional feels this kind of action are "justified" faced with an erect penis? How many unwitting male patient feels it would be something they deserved and, presumably, not make any complain about it?
What really bothers me about this is the fact that this PA probably did this before and "got away with it." Now granted, it's probably a rare occurrence but still... What kind of F'ed up person things it's okay to intentionally hurt a patient like that?
Dany
I can only imagine that if this had happened today at some hospital and made it to the news. The nurse would have her license revoked, arrested and the hospital would be sued. It is said that we learn from the past, some don’t like hearing about this practice. I saw read it, embrace and read it again, it’s your career this is what you asked for. Sometimes when you pray for rain you have to deal with the mud too.
Yet, it’s buried deep in the internet, somewhat denied and often referred to as urban legend. Yes, the older nurses have heard of this practice,however, they will pretend to not know about it or that it was simply a suggestion. Fact is it happened perhaps more than you realize. Maybe someone realized that nurses are too stupid to know better and that is why they added physiology to their coursework.
If you look deeper into the website the author will actually taunt males to respond, until someone said “ what happened to first do no harm” and someone mentioned if it were ok to slap a female patient if she appeared arroused. After that the comment section was closed. I do intend to resurrect this subject over and over and over to every news agency I write to. I believe it’s relevent to the subject as it shows just one small part of a tremendous disregard to male patients.
PT
Still Standing, I had meant to respond to your post of a couple days ago. Good for you standing up for yourself! I wonder if the doctor being shocked is because he's not used to men advocating for themselves or because he doesn't understand men wanting dignified care.
Biker in Vermont,
It's one thing I have noticed, with many doctors. It's as if they purposely give vague and very generic information about tests. I sometimes feels like they are misleading their patients on purpose, just so to avoid causing any kind of fear or anxiety.
I would err on the side of caution and ask, as you chose to do, for a male ultrasound technician. Failing that, keep your underwear on.
When I was referred to a urologist for my hematuria (two years ago), I had a lot of questions to my GP. They mostly related to what I should expect. I wanted to know what I was walking into. But this GP who, presumably, spent years learning his profession turned out to be, as I put it, "as dumb as a doorknob" because all of a sudden, he didn't know anything.
Just about every question I had were answered by "I don't know," "I'm not really sure," or "you really should ask the urologist." At the time, it really annoyed me until I clued in that he was doing this just so he wouldn't cause any more anxiety (which I was having at the time, to be honest).
I put it all together - or rather it hit me on the head - at a follow up appointment with this GP when all he cared about was the result of the cystoscopy test (hell, I hadn't even done the KUB ultrasound test yet). As soon as he got the results of that specific test, he was ready to declare me fit for duty. So much for not knowing what to expect. He knew what was going to happen, and he chose not to tell me.
This is one of the many reasons I find it really hard to trust most doctors. They see their job as pushing you toward whatever specialist they think you need and you're on your own after that.
Granted, some onus is on patients to ask questions but, in most cases, we have no idea what we're getting ourselves into. How are we supposed to know what questions to ask?
Dany
Dany, in years past I didn't know what questions to ask. Now I try to anticipate things and ask questions but sometimes we don't know what we don't know. Keeping patients in the dark is a winning strategy for the medical system because most men will just sheepishly go along with whatever indignity is thrown at them. That was me too for many years.
Dany
I hear what you are saying but with all due respect the physician just writes the order and unless you are in an emergency room it’s up to your insurance company to decide where you get the test. Truthfully, the physician most of the time has somewhat of an idea how the test is constructed, he/she has no idea who is performing the exam is if the person performing the test is respectful.
PT
PT and Banterings,
I'm sure it happens even today even more than we realize. It is hard to talk about, much less complain about. Like many other men, or, in my case, a child, we blame ourselves. Like I brought this on myself. It is me, I am the problem, I failed to control myself. I got what I deserved. I didn't report it, I was only 16 at the time, who am I to complain, this adult nurse knows what's right, my father had passed away suddenly the previous year at age 38, I had no father figure in my life, my mother was dealing with her own issues from that, I couldn't talk to her about it, so I lived with it for 29 years until I was able to reveal it to a therapist. I wonder to this day how many other young males were subjected to this by that nurse. I could have prevented it knowing what I know now. Wonderful thing hindsight is.
Dany,
"mushroom caper"! Wow, even a name for it! Must be a recognized practice. A friend of mine and fellow officer was wounded in Vietnam. He related how he got an unwanted erection during some procedure in his subsequent care and got hit with a ruler! The guy serves in the military, gets wounded in action, then gets subjected to that by a nurse whom he has to give his trust to! Makes you wonder who the real enemy is! I'm sure SHE never put herself in harms way.
JF,
It's not allowed, it's illegal. But guys rarely complain. And it's hard to punch someones lights out when you are suddenly struck like that when you are giving your total trust to this nurse and she does that. In my experience I just curled up into the fetal position in overwhelming pain and shock and disbelief and I'm sure most other guys did the same when it happened to them.
I recently googled "58flyer eek! there's a woman in my room!" which is the title of my thread on AllNurses. Amazingly, it showed up even though the thread has been long ago closed. In it I disclosed my experience with the technique of harming a males genitalia during the course of rendering care. I am still amazed at the responses brought forth from the participants of the forum. Some related shock that it would happen, others related their own knowledge of the practice on their relatives and others.
I can personally speak of my own experience with this barbaric practice and the effects it can have on the life of an individual.
Mike
PT,
I'm not convinced the GP who cared for me at the time was all that ignorant. Or that he only had a superficial understanding of the specialty. I would be surprised if I was the first patient presenting with hematuria he dealt with or referred out. This also suggests he would have been familiar with the kind of test results coming back from the specialists. Not so much the results per see (as these will vary with each patients) but the tests themselves.
Along the same line of thoughts, it is also unlikely I was the first military patient the urologist I went to had to deal with. In fact, the doctor told me that typically, the military likes to have certain tests done (he was about to bring up the cystoscopy at the time). I don't know if that was a slip up, or if he was only using this to "encourage" me to comply and accept the test.
If you add up the behaviour of the GP when I got back to him (where he only cared about the cystoscopy results, and pretty much dismissed the rest), the whole thing seemed a little fishy to me.
I am still left with the feeling of having been lead by the nose (if you will). I would have much preferred a frank and open discussion about what to expect. And I think this GP could have had that discussion with me, but chose not to.
Maybe he thought he was doing me a favour by not giving me too much information (so as not to worry me ahead of time) but in the end, he ended up loosing my trust. If I ever get posted/deployed in that area again, he is one doctor I will do my best to avoid.
Dany
Maurice,
I would like to ask you a question: has your blog changed the views of any physicians, nurses, or other providers that you are aware of?
I ask this because we (here) see no providers posting and saying "I saw the light." What we do see is the occasional one who was mistreated for their own healthcare or those denying the problems in the system the majority of your posters talk about.
I have to imagine that over the 10 years that some of your students or colleagues have lurked on here or told other providers about the blog. You probably get emails from providers afraid to agree with us for fear of retaliation.
Your views have even changed.
-- Banterings
Maurice et al,
In the April 2017 AMA Journal of Ethics, the article How Should Physicians Respond When Patients Distrust Them Because of Their Gender? explores the issue and concludes that patient requests must be honored. It states with citations:
Shared gender-specific life experiences may engender trust and help patients to communicate symptoms and concerns to gender-concordant clinicians [1-4]. Patients with gender-concordant clinicians are more likely to undergo cancer screening and utilize other preventive care services [5-8]. By contrast, patients who receive gender-discordant care may have worse clinical outcomes [9], particularly if they delay care or unwillingly consent to gender-discordant care and subsequently withhold information that is important to the diagnosis and treatment of their medical condition [10-12].
But the ugly head of paternalism rears itself. Although the section titled "Team-Based Approach to Gender-Concordant Care Requests" talks about individuals' roles in promoting gender-discordant care, I can just picture the attending, clerkship director, a bunch of medical students in a room with a patient wearing only a gown trying to get them to acquiesce. Note: NO WHERE does the article recommend AGAINST "ganging up" on the patient or NOT to bully them.
Again:
Attending physicians...That is, when feasible, physicians should ask patients’ permission to have students involved in their care, using language that helps patients understand the parameters...
So what is when feasible? Many physicians would argue with the average appointment time being 15 minutes, 10 of those minutes would be explaining the student. The answer should be "in all situations except where there is an immediate emergent need." This is hinted at in the statement:
The most important reason to refuse a request for gender-concordant care is when a patient’s health is potentially compromised (e.g., urgently needed medical attention is delayed) [27].
We also need to define urgently needed. A friend of mine from up north had to go inpatient for IV antibiotics. his physician wanted him to go to the ED immediately (it would have taken 24 hours to get him a bed). Instead he had a discussion (which he said should have been longer and more forceful) about the possibility of home infusion. He also took a few hours getting there so that he could go home and get his own clothes, a ride there (not leaving his vehicle there), etc.
Continued...
Part II
A lead in to the section "Questioning Gender-Concordant Care Requests" states:
Yet, even requests that reflect a patient’s sense of entitlement and privilege rather than a position of individual or social vulnerability should still be considered as potentially falling within patients’ right to be treated fairly in clinical encounters.
How about this reason: BECAUSE IT IS MY RIGHT TO DO SO...
Do you want to talk about a sense of entitlement, privilege, and (dare I say) The 'A' Word (Are Doctors Arrogant?).
This is the same with informed consent/refusal, searches of personal property. Quite simply IT IS MY RIGHT TO DO SO. The police cannot conclude that one is guilty because they exercise their rights just like physicians cannot conclude one is incompetent because they exercise their rights.
Are we not ENTITLED to our rights in our free society and do they not constitute a PRIVILEGE? This is transference. Just like my position on MODESTY vs DIGNITY; it implies that the patient is asking too much as opposed to healthcare not giving enough.
So now we have a definitive answer from the AMA on gender-concordant care. I also provided research on how treatment becomes trauma and why the patient should be in charge.
We did our job, now medicine just needs to get on board.
-- Banterings
Banterings, with regard to physicians or others within the medical system writing here--all these years since 2005--the answer is very, very, very rarely. JF is certainly the most recent and then there is AB and PT but these current contributors don't appear to have significant opposing views of all the other visitors writing here. Again, may I suggest you and the others "spread the word" about our blog thread and encourage others in the medical profession to express here their views and even defend them if contrary to what has been written all these years. If they don't want to write directly to the blog, they should write me directly: doktormo@aol.com and I can publish what they write me without any identification if that is their desire.
I, as well as you and the others here certainly would like to read their views.
..Maurice.
Hello,
Posters here may wish to leave a moderated comment at the Medical News Today site,
https://www.medicalnewstoday.com/articles/320900.php?utm_source=newsletter&utm_medium=email&utm_country=US&utm_hcp=no&utm_campaign=MNT%20Daily%20Full%20%28non-HCP%20US%29%20-%20OLD%20STYLE%202018-02-13&utm_term=MNT%20Daily%20News%20%28non-HCP%20US%29#post
The title of the article is "What Happens during a Testicular Ultrasound?" Interestingly, the author is female and the reviewer is a female MD.
Reginald
Reginald
I’ve pointed out a number of mistakes after leaving a comment. 1) the doctor ( radiologist) never performs a testicular ultrasound and wouldn’t know how. 2) The Doctor never wipes the ultrasound gel from the scrotum, you the patient would do that. 3) The ultrasound tech would perform the procedure.
Additionally. The ARDMS which is the licensing agency for ultrasound located in the state of Minnesota actually sets no standards on how the exam is to be performed. I’ve always said the testicular exam could be performed exactly in the manner with which a transvag us is performed on a female. But you know the female techs have to turn it into a peep show.
PT
PT, looks like they are not going to accept comments from folks like us. Neither your nor mine were posted. The one they did put up from Reginald was probably their house limit for dignity based comments, though in your case you were correcting them at a factual level. They probably don't like that either.
Dany,
Referring to your post of 2/12 at 4:41PM. That event, the "mushroom caper" happening only 3 years ago to your friend might still be actionable. I don't know Canadian law but here in the US 3 years might be getting close to the limit of the statute of limitations. I am frankly astonished that this kind of stuff is still happening. For me, my experience happened 44 years ago, a little late to try to get redress for it now. I didn't, I couldn't, talk about it to anyone for 29 years.
No doubt, the PA you referred to probably made this a regular habit and may have done it to many, many, men. It maybe even a continuing practice to this day. The recent sex abuse events in the US which have made the news shows that even long ago abuses can be redressed. Please check with your friend and see if he is willing to pursue this. The statute of limits may have run, but there is still the possibility of civil action. 3 years is pretty darn recent as sex abuse goes. No doubt he remembers it as if it happened yesterday.
It is easy to blame oneself, I know as I blamed myself for a long time. But that demon remains in the closet, growling to come out. Hopefully you can convince your friend to pursue this. Explain to him that it's never too late to report sex abuse. Yes, he was conflicted at the time, blaming himself, but there is no excuse for a medical provider to do intentional harm to a patient for a recognized physiological reaction. If he does nothing, how many men will suffer the consequences in the future? It will go on and on until someone puts a stop to it. Why can't he be that someone?
At the end of your post you ask "What kind of F'up person thinks it's okay to intentionally hurt a patient like that?" A great question no doubt. That brings to mind the famous quote about the triumph of evil being that good men take no action to stop it.
Mike
I stand corrected. Our comments were put up. It would be nice if the author or reviewer would respond to any of them, hopefully affirming that men should have the option of having male sonographers. It would be particularly good if they responded to PT's comment that testicular ultrasounds should be done in the same manner that transvaginal ultrasounds are. Personally I find it amazing that female sonographers will keep females covered up for transvaginal ultrasounds, and then leave their male patients exposed.
OOPS! I apologize NTT, I pushed the delete button by accident and, of course, I did want to push PUBLISH. Below is what NTT wrote. ..Maurice.
Good Afternoon All:
Biker, they keep the Ladies covered up because they don't have anything they don't have themselves.
They uncover the guys because now they've got something they want to see & they also look forward to embarrassing him if they can.
They must put the probe into the female then cover her up or have the patient do it for them.
For scrotal ultrasounds, if no male is available they should have some sort of open frame the man could place over his groin area. Something like one of those tray tables they put over your lap. Then place a sheet or towel over the framing for privacy. He should even be allowed to gel up in private then she can reach underneath take the probe handle & do the test.
The covered frame would keep her prying eyes out and those of a chaperone she will likely bring with her.
Just a thought.
Regards to all.
NTT
I had my first visit with a Dermatologist on Wednesday. I was referred by my PCP in order to remove a small cyst on my back that has been bothering me for years. The Dermatologist in in the same practice as my PCP. When filling out the forms there was a question as to whether this was my first visit with Dermatology and if I have ever had a complete skin assessment. After the usual encounter with the medical assistant who took my vitals and asked the same questions I had already answered on the forms, she took me to another room and asked me to remove my shirt. I was kind of put off by that as I believe my first encounter with a physician should be done with the patient fully dressed in order to properly establish the relationship. Strike 1, but I complied anyway. The doctor walks in accompanied by to 2 females, neither of which is wearing name tags, and neither was the MA mentioned earlier. All he does is look at my cyst and says it will have to be scheduled for surgical removal at a later time. Well, that turned out to be a non-event. I will have to see what happens during the next visit and see if he wants to push me towards a full skin assessment.
Mike
Mike, couple of things I would have done differently.
1) ignore the command to take off your shirt until after meeting the Doc.
2) insist on being offered a gown and then you decide whether to actually wear it.
3) When the Doc walked in with the two assistants, politely ask their names and professional qualification and then ask the Doc why are they here?
We as patients need to establish the rules of engagement for every encounter no matter how innocuous it is.
Ed
Ed, I fully agree. In no way should the patient behave like some "object" (a symptom or disease that requires diagnosis and treatment) but should behave as a "subject" of a disorder or concern of one degree or another and that the patient is NOT the disease but a living human just as the healthcare provider and their assistants are humans and patients have the ethical and legal right to be an active participant in the dynamics of the relationship. If the healthcare providers after listening to the patient's requests find the requests incompatible with the process, the patient should be informed and decide whether to continue participation. ..Maurice.
Mike, this past Monday I had an appt. with a PA at an orthodpedic surgeon's office to remove stitches from a finger following minor surgery a couple weeks ago. An early 20's woman comes for me in the lobby and brings me to a room. I get the expected "how's the finger" questions then she grabs my hand and starts removing the stitches. She wasn't wearing a name tag, didn't introduce herself, nor did she mention the PA I had an appt. with. I stopped her and said "And you are....? Then she giggles (yes giggles) and tells me she's Denise, one of the medical assts., that she'll be removing my stitches and then the PA will be in to see me. Very unprofessional. I sent a message to the practice noting what had transpired.
With your derm visit, if one of the two women had an iPad she'd of been a scribe. One was likely an MA or LPN. If not a scribe, the other was likely an MA or LPN trainee or a high school or college student shadowing the doctor. As I noted above, stopping everything and asking who/what they are is in order if they are so unprofessional as to not introduce themselves. In any event, you can be sure their protocol includes bringing at least one woman if not two into the room for full skin exams so best be prepared to say you only want the doctor and male staff in the room.
Knowing several people who have or have had melanoma, having a full exam is not a bad thing. It could save your life. You just need to be prepared to speak up about the female observers.
I was wondering how the young medical technicians can be so callous about the male patients’ predicament and thought of the Stanford Prison Experiment which investigated the psychological effects of perceived power. Even though that experiment had scientific flaws, it is relative to a twenty year old woman with six months of technical training entitled to having me, a grown man, disrobe in front of her to get my medical care.
I think it is the situation, and not their personalities, that drives this behavior. Is it like the Milgram experiment, where random participants complied with orders to administer electric shocks on others.
The other day I saw one of those History Channel documentaries about the holocaust which was actually not about Hitler and is a credible documentary. I am not saying the holocaust is being repeated in the health care system, but a small part of that ‘doc’ [the whole ‘doc’ can be seen here: Engineering Evil Inside the Holocaust https://www.youtube.com/watch?v=tztIL5voX6U&feature=youtu.be] is relevant to the male patients’ predicament in getting health care.
The part I’m talking about starts at 26 minutes into the documentary [https://www.youtube.com/watch?v=tztIL5voX6U&feature=youtu.be&t=1575 ] where they discuss a concentration camp for women as it was in 1939.
The director of the memorial discusses how the Female SS Guards changed in the first week of working at the camp.
“They came the first day and they used to say ‘hello’ to everybody and they had civilized modes of moving around. And then after three or four days they learned to de-civilize somehow, to change their whole way of moving around. Then they started to act like SS Guards.”
You put them in an environment where the others have their dignity and their rights removed, and what is not normal becomes normal. In the health care system, men have their dignity and rights removed.
About one hour and ten minutes into that same doc
[ https://www.youtube.com/watch?v=tztIL5voX6U&feature=youtu.be&t=4242] they talk about the normal life and humanity of the male and female guards.
They had the usual cultural ethics of life back home: “Keep your dogs leashed, do not have female guards visit you unsupervised.” They had book clubs and lots of social, outdoor activities.
The guards did not lose their humanity in their private life, but they did lose the humanity they felt toward the prisoners. Perhaps ordinary men and women do have the capacity to do the evil things that happened in those camps.
In a similar way the ordinary women who become medical technicians or office workers in a doctor’s office, have the capacity to ignore, or even secretly laugh at, the male patients’ embarrassment and humiliation. After all, it provides material for professional humor.
The problem is the system.
Respond to Vermont Biker from Feb 12.
" I wonder if the doctor being shocked is because he's not used to men advocating for themselves or because he doesn't understand men wanting dignified care."
I was assigned this urologist five or more years ago. He has answered my medical question with sarcasm: one yearly visit he did not do the DRE and I asked him why and he said "Most of my customers don't like the rectal exam."
Sarcasm is not a good service to provide. It is a medical question and give me a medical answer. Eventually, someone else at the VA told me the new policy was not to have exams that relied on a doctor's opinion. One doctor may interpret a rectal exam differently than another doctor, so the new policy is to rely on things in a test tube that can be transferred to a chart. Like the PSA blood work. Doctor Steven Kessin's book "Doctor, Your Patient Will See You Now," mentions this as a widespread trend in all of medicine.
In December I had my telephone interview with this urologist to set up this p. biopsy; I told him I wanted a male ultrasound technician and he responded "I will alert the nursing staff."
I think he is aware that his patients want dignified care but that it is not his problem. I think he is not used to men advocating for themselves and has actually never seen a patient successfully send women out of the room and get a male in.
Next week I have another telephone interview with him, when he tells me the result of the biopsy. During that interview I will use my new status to ask him again, "why is the DRE no longer important." To see if he'll actually answer my question now that he's seen me advocate for myself.
Once again, sarcasm is not a good service to provide.
Wish me good fortune on the lab results!
─ SS
Ed, good points. Thanks. I've been going to this practice for 14 years now and have noticed they have gotten better in many respects, some of which I suggested, including the part about greeting the patient and identifying the caregiver. They recently brought a Dermatologist into the practice but he is located in a separate building. I suspect he is not onboard with the overall way the rest of the practice operates. Now that I know how to get managements attention, they will be getting a critique letter.
Biker, thanks for your always insightful comments. Neither female had an iPad and I made it a point to look for one. One woman was clearly older, perhaps 40, the second one looked to be mid 20's, and I wouldn't suspect she is a high school age girl but she still could have been in some sort of training program. Both were wearing medical scrub outfits. I agree with the need for a full exam. I have spent my entire working career outdoors and most of my activities are outdoor. There have been plenty of opportunities for the sun to have damaged my skin. I have many age spots so I would like to get it checked out. So if the doctor suggests it, I will take him up on it, but it will be without the female audience. They leave or I leave.
Mike
Still Standing -- Very interesting post and I find the notion of young female medical staff simply succumbing to a "power trip" vis a' vis male patients quite appealing. I know I've seen it and suspect others here have as well. I wonder if this realization and recognition that their environment is an important factor might suggest the best approach for male patients to follow. Good luck with you test results. REL
Interesting thoughts Still Standing. Given the wide breadth of the healthcare industry, I have to believe access to exposed males has to be behind the choices some women make. Big difference between working in the ER vs OR vs Med-Surg units vs dermatology vs pediatrician offices and on and on. Some choices such as urology bring with it intimately exposed males one after another all day long whereas taking a job at an OB-GYN practice means they'll never see an intimately exposed male. Its not like this isn't known before they apply for a job.
I know 3 young women currently pursuing medical careers. One is a CNA working at a residential facility for mentally ill women. She is pursuing becoming a psych nurse because that is the audience she wants to work with. One is in an RN program and her goal is to be a NICU nurse. One is in a physical therapy program and her goal is to work with disabled veterans. Did the women working in urology have that as their goal when going to school? How many people would go to school to be a nurse, tech or other kind of healthcare worker without having a goal in mind as to what they might want to do? Certainly the goal can change as they get more exposure to different facets of healthcare, but with healthcare jobs having been relatively abundant for a very long time, it would seem most could have found the kind of role they wanted.
This is why I have a hard time accepting that male intimate exposure means nothing to the women who choose roles, especially in urology, that bring them in regular contact with exposed males.
I want to remind my visitors here of a discussion primarily between Banterings, a first year medical student Surabhi and myself regarding "Difficult Doctor vs Difficult Patient" which looks at the overall perspective of the patient-doctor relationship. Your contributions there in general views of that relationship (leaving gender problems in our thread here) would be welcomed. ..Maurice.
By the way, I have added to the above thread the consideration of the behavior of "nudge" by the physician with regard to patient decision making which may evoke some constructive comments there by my visitors here. ..Maurice.
Still Standing,
Have you looked at my blog where I explore this very issue.
-- Banterings
A question here for folks as to how they see the overall trend relative to what we discuss here. I see three that are going in opposite directions.
On the positive side more men are going into nursing and other non-physician fields. They will continue to be a small minority of the total for the foreseeable future however.
Secondly on the positive side is how very modest today's young men are even with other men. Older guys grew up with mandatory gang showers etc. and are generally accepting of exposure to other men. This has been discussed before using locker room dynamics as an example of the stark differences between old and young guys. The speculation is thus that as young men age and enter the medical system that they will demand more respectful and dignified treatment than currently exists.
In the opposite direction is modern day feminism. Feminism used to be about equal rights, and for very valid reasons. Today the feminism of their daughters and granddaughters has a decided anti-male aura about it, and it has found its way into the healthcare system. It seems every week there is another article in KevinMD written by a female medical student, Resident, or newly practicing MD that is playing the victim card. Male patients, MD's, Residents, medical school instructors, and/or the men from long ago with their photos on the walls of medical schools are the source of their victimhood.
Modern day feminists celebrate the increasing numbers of female urologists and that women can now go to a female urologist if they choose. At the same time they label male patients as sexist if they only want to see male urologists. I came across a summary of a study done by a female Chief Resident urologist looking at the issue of female urologist acceptance. Her conclusion was that 80% were accepting of female urologists. Her conclusion however gave us her true feelings:
"While most patients did not have a gender preference for their urology provider, a subset of patients did express a preference (ie patients with incontinence). Interestingly, other sensitive subjects such as erectile dysfunction were not associated with gender preference. As the female component of the urology workforce grows, a reasonable effort to meet patient preferences should be made while attempting to disabuse patients of stereotypical views."
So men need to be disabused of their sexism in not wanting female urologists? Yet female urologists routinely are celebrating women now having a choice. It isn't sexist for a woman to only want a female urologist, but men need to be disabused of such notions if they only want male urologists.
This third trend will have powerful forces behind it as women slowly take over the physician ranks. There are now more women in medical school than men and they are slowly achieving more of the higher mgt. rankings in healthcare. If young female physicians do not see males as the equal of females, things will get worse rather than better for men.
What do others see the long term trends as being?
I am all for gender equality both inside and outside of medicine. ..Maurice.
Biker,
In response to your post on 2/20 at 8:58 AM, I do think it's great that there are increasing numbers of female urologists. After some of my experiences with opposite gender care, my wife is becoming increasingly aware of her own discomforts with care by men. In her past that's just the way it was, most physicians were men, so she never considered looking for a woman for her gyno stuff. She has never been abused by medical staff however but has made note about over casualness about her privacy by both men and women providers. In my area, there are a number of female urologists and female nurse practitioners specializing in women's urology. Good for her.
I have to ask about the quality of the "study" done by the female Chief Resident urologist. Was she specifically doing a study about the general acceptance of female urologists across the general population or specifically among women patients? 80% seems rather high if she is studying the acceptance by men. I can see 80% acceptance by women. The question of the gender of her chaperones would make a significant difference in the acceptance rate by male patients. Did she state the source of her information? Any study can be manipulated to achieve the desired results of the author of the study. She obviously wants acceptance, but still desires that men "disabuse" themselves of stereotypical views. Makes me wonder what her definition of stereotypical views is. No doubt that feminism is clouding her views.
I think it's going to take legislation to level the playing field in healthcare.
Mike
Dr. Bernstein, I'm all for equality too. Unlike those feminists of old who worked for equality, today's feminists have shifted to anti-male rhetoric and are wanting superiority rather than equality. My premise is that it does not bode well for men in healthcare.
Young female urologists that applaud female urologists for women and decry men as sexist if they only want male urologists is not exactly an equality mindset. As this new wave of feminists slowly comes into positions of power in healthcare systems what are the odds they will have any empathy for men's issues such as we discuss here? They're certainly not going to put any emphasis on recruiting more male nurses, techs etc.
Gender equality does not mean female physicians/staff for women and female physicians/staff for men, yet it seems that is how they view equality. Some of them are looking forward to physician ranks becoming majority-female, which is the trend we are on. I am glad that there are now female urologists so that women can have a choice, but I object to the notion that I need to be disabused of my still wanting to see only male urologists.
Good Morning All:
NBC is running a story today about the MeToo movement as it pertains to #MeToo in medicine: Women, harassed in hospitals and operating rooms, await reckoning.
https://www.nbcnews.com/storyline/sexual-misconduct/harassed-hospitals-operating-rooms-women-medicine-await-their-metoo-moment-n846031
The movement has men running scared right now but, if they are not careful, this will come back to bite them in the rear-end as men who own and operate companies that women need to work with and at will simply refuse to work with or hire women. There are already some professional women who have said their movement has set women back 30 years because they cannot get their male counterparts in business to work with them anymore.
What goes around comes around.
Female urologists can label me as sexist all they want. It’s my right to choose. For any urological event, I will always look for and choose a male doctor over a female doctor every day of the week and Sunday’s too. 😊
If today’s young man is more modest, all the power to him. As you said, as more men enter the medical system they may demand more respectful and dignified treatment than currently exists. Which in turn may force your Chief Resident Urologist, to rethink her position on same-gender care.
So as the push to balance the gender scales in medicine goes on, I bid thee all farewell for now.
Regards,
NTT
NTT & Mike, I'm also glad there are female urologists now for women who want them. I'm just wary of what the impact of current male as 2nd class citizen feminist thinking is going to be in healthcare.
On the #MeToo stuff, I have read that in corporate settings men are backing off on mentoring young women out of fear of being accused of something. One accusation and their career is over, so they are taking a self-protective position via avoidance. Sad. I mentored many women during my career, but I suppose I'd be wary now too. One of my retirement jobs is that of a small town elected official. In that capacity I visit many properties but we don't do any site visits unless there are two us (both men) so as to preclude a he said she said scenario. In a way its our own version of requiring a chaperone for our protection.
NTT, that article does a great job of portraying all women as victims and all men as potential perpetrators, including male patients. That is not going to help our cause.
Good Morning All:
Biker, our cause is just. We must stay vigilant and true to our convictions. We insist on same gender care during intimate medical interactions no matter what some pumped-up female healthcare workers say.
They're feeling their oats right now but for the #MeeToo movement, what goes around comes around also.
If this is true, here is yet another care of male patient abuse at the hands of female nurses.
Dateline Staten Island NY.
Gentlemen says he visited the outerborough infirmary on May 16 last year for what he expected to be a routine EYE operation.
While waiting on the gurney to go into the OR, a 67 year old FEMALE nurse decides she wants to take some liberties with her male patient.
The nurse placed gauze pads on top of his gonads for "no medical reason," then proceeded to squeeze his tool every time she picked one of the pads up, the lawsuit claims.
The male patient of course was "too shocked and embarrassed to speak," at the time according to the lawsuit.
Then apparently after the procedure, his gown came apart while he was washing his hands exposing his rear-end. His wife reached across and was about to tie it back closed when the same nurse that put pads on his gonads told his wife she advised against closing the gown that air needed to circulate. There was no medical reason for his buttocks to be exposed.
His wife ignored her & closed him back up.
The nurse is being sued along with Staten Island University Hospital, by the patient via a Manhattan attorney for $14M due to a failure to investigate, discharge or reassign the offending nurse.
Lawyer claims the nurses behavior was intentional and non-consensual, and the experience caused his client deep personal trauma, distress, embarrassment and anxiety.
Damages are sought for "deep personal trauma, distress, embarrassment and anxiety," in addition to punitive damages for "willful or wanton negligence," according to the court filing.
His lawyer goes on to say "With all the news about sexual harassment, I think it especially important that institutions like Staten Island University Hospital be held fully accountable for how their employees behave."
Hopefully this victim and his lawyer won't let them off the hook. It's time to make an example of them so everyone sees just how bad men are treated when they use medical services.
That's it for now.
Regards,
NTT
Biker -- Your concern about the future for male urology patients may indeed prove valid. Following a chain of logic, one question that comes to mind that may ultimately tell the tale is the following: Can a urologist today limit practice to male patients? Would it be legal? REL
Hello:
Hi Rel.
If a male urologist wants to specialize in male related urological issues, I see no problem with it other than if he's going to specialize in men only, he's going to have to have some male staff or he will wind up limiting the number of patients his practice sees.
There are female urologist's out there that only deal with women's issues.
What's good for the goose is good for the gander.
Regards,
NTT
I don't think that any physician (medical or surgical) should limit their practice to either gender of the patient. Ob-gyn physicians obviously are limited by the gender of those to whom they "lay on hands" but there is often a male who is related to the female patient (husband et al) for whom that physician cannot ignore in the overall decisions and management. A urologist is the same since both genders have urological problems and both genders have family of either gender concerned about diagnosis and treatment.
Our medical students are taught from the outset that they are going to be involved both with patients and family comprising both genders.
The issue REL raises is not about legality. With regard to urologists or all physicians and surgeons it is about REALITY. Physician of both genders will be interacting with both genders irrespective of the physican's surgical or medical provision of care and should be attentive to the wishes and requests of "all" genders, genetic or beyond. ..Maurice.
I wanted to respond to this question:
Can a urologist today limit practice to male patients? Would it be legal? REL
Yes. There is nothing wrong with this. In fact, there are so many all-female ob/gyn practices in the United States that only employ female doctors and can give you a 100 percent guarantee that your baby will be delivered by a female ob/gyn. You can check out the all-female practices we have on our all-female ob/gyn directory . I know of two female urologists who have practices that only deal with female patients (one in Houston and one in Florida). I think this is an excellent idea.
Sadly, there are hardly any all-male staffed urology practices. There is one in San Antonio, The Urology San Antonio Men's Center for Health & Wellness and you can check out an article about that practice at https://www.bizjournals.com/sanantonio/blog/morning-edition/2013/06/urology-san-antonio-develops-mens.html. I appreciate how sensitive those male urologists are to male patient modesty and I wish there were more like this practice. More men would seek medical care if there were more all male staffed practices that only dealt with male patients.
I wanted to respond to Dr. Bernstein’s statements below:
I don't think that any physician (medical or surgical) should limit their practice to either gender of the patient. Ob-gyn physicians obviously are limited by the gender of those to whom they "lay on hands" but there is often a male who is related to the female patient (husband et al) for whom that physician cannot ignore in the overall decisions and management.
I disagree. Doctors should be able to limit their practices to one gender if they wish especially if it involves intimate medical procedures. Also, there are some family practice doctors who chose to not do intimate procedures on opposite sex patients and they refer their patients to another doctor of the same gender (male doctor for male patients and female doctor for female patients) due to moral convictions and other reasons. Doctors should not have to violate their convictions. It is true that ob/gyns deal with husbands, but they do not examine husbands. I strongly believe that husbands should be involved in their wives’ medical care of course. In fact, I have worked with numerous husbands who had a big part of their wives’ medical care. For example, one husband helped his wife to find an excellent female ob/gyn who was willing to work to accommodate their wishes that he be present for her hysterectomy. Many men want their wives to be involved in their urological care as well.
Misty
Dr. Bernstein -- Perhaps my inquiry was misunderstood. I was inquiring about legality without intending to dismiss other issues. When you say "The issue REL raises is not about legality." are you saying then that you know that a physician is acting within the law if he/she limits his/her practice to one gender? Also, I don't see anything unrealistic about a male urologist specializing in male patients. You seem to be asserting that a physician having some characteristics in common with a patient is of absolutely no value in treating the patient. Has this issue been studied? Women apparently believe otherwise as female physicians have come to dominate the ob/gyn specialty. Moreover, I've seem some youtube videos where a woman explains how to cope with BPH that are so far of the mark as to be comical. As I've mentioned here before, the only non-bloody mess catheterization I've experienced was done by the only male (a PA) that has treated me. He indicated that he'd gotten good at it by practicing on himself. Apparently, having a prostate really helps in that regard. REL
Let me clarify. I wrote "I don't think that any physician (medical or surgical) should limit their practice to either gender of the patient." What I was unclear about is what I meant by "patient". I look at and we teach that a "patient" is not only the sick person in the doctor's office or the one who is pregnant but is an element of a family if there currently is one in the patient's life. Therefore an obstetrician's "patient" is both the wife and husband and, of course, even the newborn of whatever gender is delivered. The same goes with all: "family medicine", internal medicine, general surgeon or surgical specialties. We doctors must always keep in mind that the "patient" includes the family, if present and of whatever genders. However, gender selection for treatment by a physician ethically and even legally should be at the discretion of the physician unless he or she accepts being non self-employed. This is just like the physician can select what specialty to engage in such as being a gynecologist and not engage in obstetrics. But whatever the specialty, it is also the family of the patient, all genders, which must not be ignored and whom the physician is aware and may need to include in the treatment and outcome. All medical students learn to consider the biopsychoSOCIAL aspects of the illness of their "patient" does include interacting with the family. ..Maurice.
One more point to make with regard to the issue of gender vs the professional duties of physicians. As I noted above, the patient interaction is really, except in fortunately rare but not very rare medical cases, an interaction with family composed of both genders in matters of the results and consequences of therapy including the death of the loved one. It is how the physician has behaved in interacting with these family members during therapy that affects the final outcome as personally experienced by the physician.
There are times when the "gender" of the patient being treated changes during medical or surgical treatment. It is when the live patient lacks the capacity to make their own medical decisions and a family member becomes the legal surrogate to make those decisions. In those situation where, as an example, a male urologist treating only male patients will be interacting with a female family member who will be the patient's "spokesperson" and decision-maker. What the professional relationship of the physician to that female family member was in the past can affect the immediate surrogate decision.
I apologize if I belabored this matter of gender selection by physicians but I wanted every reader here to realize that there may not be a simple "single gender" to which the physician is applying his or her skills. Yes, most often there is a family! ..Maurice.
Maurice
I agree with most of what you’ve said, but let’s flip the viewing perspective. The prospective male patient may see a male or a female urologist and vice versa, however, the male patient will never see a male medical assistant and neither will the female ob/gyn patient.
PT
Maurice
One more point to make and I’ll reference your comment “ But whatever the specialty, it is also the family of the patient, all genders which must not be ignored and whom the physician is aware and may need to include in the treatment and outcome.
In the case of male and female urologists who only employ female medical assistants it would seem to restrict only one gender if you consider all staff to be within the sphere, that bubble so to speak as the team effort, caregivers. It would seem from the patient perspective that what you are saying is not true since male patients will only see female medical assistants.
PT
I certainly didn't mean to imply that a male urologist specializing in male patients could never speak to a female :>). Any of the definitions of "patient" shown here ( https://www.medicinenet.com/script/main/art.asp?articlekey=39154 ) would work for the point i'm focused on: male patient only urology practices can find a future and may help to counter some of the trends that Biker identified. REL
Maybe the discussion is getting too academic for me. If I were unfortunate enough to have a female urologist, I would be bothered, but I would be comfortable with my wife talking to the female urologist. Do future MDs need to be trained on how to communicate with family members that are of the opposite sex of the patient? Am I missing the point?
Sorry for being dense, hopefully just today, but could you restate the following in the vernacular?
"In the case of male and female urologists who only employ female medical assistants it would seem to restrict only one gender if you consider all staff to be within the sphere, that bubble so to speak as the team effort, caregivers. It would seem from the patient perspective that what you are saying is not true since male patients will only see female medical assistants."
BJTNT
BJTNT
My point is this, physicians in most specialties are trained to see both male and female patients. Do some urologists see only male patients? In some cases yes. Case in point I once was a patient at a Urology clinic whereby the clinic was divided into 2 sections. One side was the prostate “side” and the other side saw other Urology cases of both genders, yet all the medical assistants were female.
The concern was that the physician should be able to treat both genders but shouldn’t the patient be able to be treated by both genders as well from the perspective of the medical assistants. It seems a lopsided argument, physicians yes are expected to treat both genders and the patient may see differing physician genders but, the gender of the medical assistant will always be fixed ( female).
Therefore the argument doesn’t seem to hold when you see the healthcare team as a non variable from the perspective of the medical assistant when you have to consider the patient sees the healthcare team as a whole and all parties should be variable if you expect the physician to be variable!
PT
Maurice
A local chiropractic clinic advertises that “ we here at XYZ chiropractic will treat men and women. Notice the word “we”, therefore that creates a bit of a quandary. I once knew an ER physician who was nicknamed the Candyman so named by his patients that he would quickly prescribe opioids just to get good patient ratings and get the patients out of the ER. So much so in fact that they would call the ER to see if Candyman was working.
We now have half a nation hooked on opioids to the point of knee jerk reactions that patients who need pain meds can’t get them. What a concept, if I were to call my Urology clinic and ask “ Hi, is the medical assistant Arthur working next Thursday. Good, he can prep me for my cysto, bye.” Now getting back to the word “ we” this is how physician offices advertise. We at so and so clinic will get you feeling better in no time. Yet the emphasis is on just the physician who treats male and female patients and we know that variable, but why disregard the rest of the staff? Why are their genders not relevant after all it’s advertised as a team. The patient may see several physicians within the office and maybe the gender of the physician changes but the gender of the medical staff does not.
In conclusion, it’s the perspective from the patients view that’s important and what counts. The patient may know you see male and female patients and that’s a variable but when the gender of the medical staff does not change the argument really does not hold up well that physicians should see both genders and therefore the patient should expect to see both genders in the medical staff as well when the word “WE” is used.
PT
I think PT and others will agree with this source's conclusion on the issue being discussed here now. "Medical Assistant Career Guide.Com which states pertinent to male medical assistants:
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Gender discrimination against male medical assistants
While the pay imbalance exists in the woman-dominated, medical assisting field, doesn’t mean that men have it easier in every way. Male medical assistants may not be taken seriously by patients, doctors and the general public. Men in these types of jobs often suffer from the perception that they are effeminate or otherwise inadequately masculine. Male medical assistants are also more likely to be scrutinized heavily as possible abusers, especially when they work with children. This may be due to the popular perception that men are not inherently able to care for others and must thus be looking for sexual gratification or other advantages when they seek medical assistant positions.
It can be hard for qualified male candidates to get jobs at all, even though they rise through the ranks more quickly than women once they have been hired. Many employers automatically assume that any medical assistants they hire will be women, either consciously or unconsciously discriminating against men.
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Could that be the issue? Males are considered by the public as the more "sexually aggressive" gender and weak on attempting to "care for others".
If this is true, imagine the work necessary to re-orient the public and employers. And who is promoting this concept or is it an ancient belief and we are all "born into a world" that accepts that notion. I think this stereotype must be defeated.
Don't you? ..Maurice. p.s.- Please excuse me taking sides as Moderator but I think this concept if truly the basis for the gender inequality currently written about here is a public ethical "wrong". ..Maurice.
My group of 6 first year medical students have just finished a discussion in their Professionalism course about the interaction between the various healthcare professionals involved in patient diagnosis but also care.
I am going to present them with that article I posted above of medical assistants and what their opinion is about the issue presented and what, if anything, should be done about it if the description of the male medical assistant issue is valid. I will let you know about their responses. ..Maurice.
Dr. Bernstein --
"Could that be the issue? Males are considered by the public as the more "sexually aggressive" gender and weak on attempting to "care for others".
If this is true, imagine the work necessary to re-orient the public and employers. And who is promoting this concept or is it an ancient belief and we are all "born into a world" that accepts that notion. I think this stereotype must be defeated."
I believe you have it right that this could be the real issue. But is there any factual basis for the stereotype? Unfortunately, some things just are whether fitting our prejudices or not. I wonder if there is data to suggest that the stereotype is false and therefore must be defeated.
REL
Maurice
It is a notion put forth by the medical industry itself. The public does not and never has any say on who gets hired from a gender perspective and that’s fair to say for any industry. Who is responsible for the tremendous imbalance? Physicians, nursing directors, office managers, HR directors etc. It is these people who do the hiring that’s who. In the last two years how many female teachers have been arrested for having a sexual relationship with their pupils. Is the public in an uproar over this and perhaps maybe more male teachers need to be hired? No.
PT
Good Evening All:
Teachers are getting away with molesting our young men PT because our brilliant prosecutors & judges are of the opinion that the young man, had the time of his life.
Why don't they feel the same when the rolls are reversed?
The problem for today’s modern man is that society long ago stereotyped all men as being strong, aggressive, and bold.
It’s wrong, that a man who’s only intention is looking out for the wellbeing of his fellow human beings will, because of society’s view on gender always get that label which in turn will cause him to fail more often than not, at getting hired for healthcare positions he is fully qualified for simply because employers are afraid he could show aggressive tendencies against fellow employees or patients.
Today’s employers must let go of the past if good, compassionate, intelligent men are going to have any chance of entering the healthcare field in positions other than MD’s.
Women for years have taken an aggressive approach to achieve their goal of equality in the business and medical world.
If men expect to have any chance at all of achieving equal footing in the healthcare field, they must be more aggressive than women were when they were challenged as it’s the only way to cut this noose.
We must seek out and change the mindset of healthcare industry employers and the general public itself.
Not an easy challenge but, a challenge none the less that I know, we can overcome if we set our minds to it.
We need to show them, what today’s man is all about. They need to see that yes, men today are just as empathic and caring as women. That we can hold our own no matter the task at hand.
If we don’t succeed in breaking this window, we will always be on the outside looking in on something we could have had if we just pushed a little harder when we had the chance.
It might be, that the only way to finally break this vicious cycle, is for men who want the jobs, who have put in the time, effort, and money to get their education and training, to shake the very core of the healthcare industry and shock them into reality, by filing discrimination lawsuits against any healthcare provider and/or their affiliates that discriminate against them while trying to secure a position.
We all know what needs to be done here. Now together, we have to get it done!
Call it the #Men4Men movement. 😊
I took a look online at that all-men’s clinic Misty referenced in her earlier post.
They are no longer just an all-men’s clinic. The have multiple locations in the San Antonio area and if you look at their staffing you will find, that they have at least one female urologist along with some female nurse practioners on staff now.
If by some chance the #MeeToo movement spreads through the healthcare industry as it did through the entertainment industry, maybe then, we will see more men only clinics going up around the country.
Regards,
NTT
Dr. Bernstein, for a very long time society was socialized to doctors are men, everyone else in healthcare are women. The occasional male nurse was often thought "wanted to be a doctor but wasn't smart enough" and the occasional female physician was seen as a curiosity. I can remember hearing these things said in my younger years.
Society has moved forward to acceptance of women as doctors and they are rapidly achieving numbers parity. That staffing is still 90% or so female below the physician level represents change happening at a glacial pace at those levels. Whereas girls growing up know they can be doctors, boys growing up are still socialized that non-physician roles are for women. Those boys who came of age a generation ago are now the ones acting on their prejudices and not hiring male medical assistants, and/or not directing their female office managers to hire males.
The other piece that has carried forward is that women are naturally modest and must be protected and that men have no modesty. We know that isn't true, but boys are still socialized to make believe they aren't modest, to "man up" so to speak.
I suppose all that you can do with your students is to build in an awareness of these hidden prejudices so that they might become change agents in how they treat their male patients and in how they staff their practices.
NTT,
It looks like some things have changed around for the urology clinic in San Antonio. It has been almost 4 years since I've confirmed that it was an all male clinic. They have added numerous locations and some of them do have female urologists as you researched.
I am going to get in touch with them to check to see if they still have that one location that only has the male staff.
Misty
The issue of same gender care is really a secondary issue. The primary issue is that of informed consent. That includes the necessity of exposure or performing certain exams/procedures, ALL the alternatives (think MRI as an alternative to the traditional prostate exam), who will be present, and how the procedure will occur.
This also means that research needs to be done to access the value of these procedures. We have seen that annual pelvic exams for women were more ritual than science, and the DRE in trauma added nothing to outcomes (despite the mantra of trauma surgeons: "Only 2 reasons not to perform a DRE, no rectum or no fingers...").
I sympathize with patients like Biker who have certain conditions that put them in the undesirable position of having to go through such procedures. Assuming that the science supports the procedures he endures, OR it is his choice to, obviously he has NOT been told HOW the procedures occur and WHO will be present.
AFTER all that is done, IF Biker still chooses to proceed, then same gender care MUST be an allowed option. It makes the procedure a little less UNDIGNIFIED. I believe that the advantage of same gender care is the ability to empathize that as a male nurse for Biker, one would realize what this means to another man and the male nurse can support him as only another male could. It would mean so much more, words of support, coming from someone who has a prostate than someone not born with one.
-- Banterings
Here is one of my students' response to my request for comment regarding the article extract on medical assistant gender
http://bioethicsdiscussion.blogspot.com/2018/02/patient-modesty-volume-84.html#c5034303851286909359
..Maurice.
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A quick read, but very interesting. Many of the points brought up by the article are facts that I have previously thought of as well. This all really boils down to the fact that society has defined what is deemed "masculine" or "feminine" based on heuristics of the two opposing sexes. For thousands of years women have naturally taken the role of caregivers, and have thus been perceived as being superior than men in this capacity. Unfortunately, these beliefs have carried over into modern day society, and they may be very difficult to separate from our minds. Therefore, men in medical assistant positions may always have a hard time, because society has defined them as being in an "unnatural" position. It is still interesting to see that men in these positions receive higher pay and benefits than women, which also stems from patriarchal societal roots. Again, this is a very broad issue that effects all aspects of society, and very well may not change in the field of medicine, until our perception of gender roles in society itself has changed.
Thank you for the interesting read.
Maurice
I have to disagree with the post by one of your students.
Your student said “ This all boils down to the fact that society has defined what is deemed masculine or feminine based on heuristics of the two opposing sexes.”
Not really, it’s economic equilibrium, secret hiring quotas and what about male physicians. If male medical assistants can’t be caring enough then how can male physicians.
Your student said “ For thousands of years women have naturally taken the role of caregivers.
Male orderlies dominated most intimate care to male patients up till the late 60’s.
Your student said “ It is interesting to see men in these positions receive higher pay and benefits than women.
No they do not. Male medical assistants are not paid more than female medical assistants and I can reference that from the Dept of Labor.
In conclusion, as I have said over and over and over society has nothing to do with who gets hired at XYZ hospital . Society has nothing to do with who gets hired at XYZ physician’s office or XYZ Urology.
PT
Maurice
I’ve a few more comments to make regarding your student’s post. You have to be careful about reading articles often published on the internet as they are often inaccurate and/or written by non-medical staff. Written by people who have never worked in a hospital and simply make assumptions. I have lost count but over the last 40 years I’ve worked at 25 hospitals or more and have been to hundreds of physicians offices, many nursing homes, etc.
During that time I have never met a male medical assistant and what I mean by that is a male that attended a medical assisting program. I’ve never seen one and quite honestly I doubt if there are any who have actually been hired after completing the program. I’m not talking about a male Cna, Rn, Lpn or ER tech. I’m talking about a male medical assistant and there is a difference.
PT
The point Banterings makes about patients not knowing how procedures will be done and who will do them is a big part of the problem. Patients are routinely taken by surprise which contributes to distrust. Even with the vast info available on the internet it is still hard to find out how most procedures are actually done or who will be there. Most written descriptions are fairly generic in nature and sometimes misleading. Videos are generally incomplete, if there is a video at all.
It would seem that if hospitals and medical practices are putting videos and literature on the internet that provides incomplete info that it is purposeful. Worse, they are often misleading patients as to what to expect. Better to give complete info and answer the ensuing questions ahead of time than to ambush patients the day of.
Here is a one small example that I just got in the very 1st site I opened doing a search on "cardiac cath prep". The site is for a very famous hospital that most of us have probably heard of.
"The catheter will be inserted into a small area on one or both legs. This area will be clipped of hair and cleaned with an antiseptic solution to prevent infection."
Might it come as a surprise to patients that the legs they refer to really means the genital area? That the hair being clipped is your pubic hair as opposed to leg hair? Sure a lawyer could prove they were technically correct, but the patient has been mislead nonetheless.
Here is the description from the 2nd site I went to, again a very well known hospital most of us have heard of:
"Just before the procedure, a nurse or technician may shave the hair from the site where the catheter will be inserted."
This one doesn't even tell you what part of the body will be prepped. I know that sometimes it is done via the wrist rather than the groin, but really, they can't be more specific than this? Again, they are technically correct, but the description is meaningless.
Here is another response by one of my first year medical student regarding the article on medical assistant gender: https://www.medicalassistantcareerguide.com/gender-discrimination/
This student as was the first student's response already published here are both males. ..Maurice.
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Sex segregation in the workplace is representative of power and privilege in this country. “Pink collar” jobs dominated by women – nursing, teaching, clerical – are far less prestigious than male-dominated field like finance, medicine, and engineering. This occurs despite comparable contributions to society by these types of jobs. The fact that men can get promoted even in pink collar environments is a testament to male privilege – as the opposite scenario (a woman breaking into a male-dominated field) presents numerous challenges. It also does not come as a surprise to me that men and women of color are often overlooked for promotion in these fields. Again, I believe this reflects the sad power dynamic in this country, and while change towards equality is occurring (albeit slowly), I agree with the sentiment in the article that supervisors (and doctors even) should be cognizant of the workplace barriers for minority groups.
And while it is easy to dismiss the problems of men by saying that “women have it worse,” it can still be a very challenging ordeal for men in pink collar jobs. The article brings up how male nurses may be perceived as effeminate or as sexually deviant. I spoke to a male OBGYN that shared a similar sentiment in regard to global practice. He said that there is a stigma for him to manage women’s health and obstetrics in socially-conservative countries like India and Pakistan.
Dr. Bernstein, thanks for sharing the responses from the two medical students and thanks to them for taking the time to respond. Both responses are somewhat disheartening though.
The first does not understand the "female as caregiver" for male intimate care in medical settings is a fairly recent phenomena as PT pointed out. Probably not his fault as I doubt historical gender roles in healthcare is taught.
The second is entirely focused on the barriers staff face and doesn't seem aware of the impact on male patients.
Hopefully both will come to realize that staffing patterns impact more than just staff career opportunities and in some cases can even be a barrier to entry for some patients in need of healthcare.
Biker, I await written comments from my female medical students. In any event, we plan to discuss as a group tomorrow morning questions such as: "would you, based on your gender,feel more comfortable working with a medical assistant of the same or opposite gender? How about with a nurse? or a physician? Would you, based on your gender, feel more comfortable as a patient being cared for by a scribe, technician, medical assistant, nurse or physician of the same or opposite gender? How about present in the room for genital as a male or pelvic exam or mammogram as a female patient?. If you would feel comfortable, how do you explain the discomfort of some patients in relation to exams which appear gender related? How would you as a professional respond to their concerns and discomfort?"
Would I miss an important question to present?
Interaction of students when they become active physicians with both members of the healthcare team and their patients who may also be under the "hand" of these other healthcare providers is a situation that the students are certainly going to face.
Learning to "work together" with these medical supporters to accomplish satisfactorily a clinical goal is one thing but students should bear in mind the need to "work together" properly with their patients is just as important to accomplish the same beneficent goal.
Any suggestions today of points I have missed? ..Maurice.
Excellent questions Dr. Bernstein. For some who have little interaction with healthcare as patients the responses will be somewhat theoretical but others may speak from experience. In either event the answers will be interesting.
The medical student said “ The article brings up how male nurses may be perceived as effeminate or sexually deviant.”
The article is not talking about male nurses but rather male medical assistants. I challenge anyone to find a male medical assistant who completed a medical assisting program and subsequently was given a job.
Additionally, the article does state that female supervisors are more likely to engage in this type of discrimination against women in medical assistant positions.
AGAIN FOLKS, how can this be when their are no male medical assistants. This is why the article that’s being referred to as false and/or useless.
In 2016 the Dept of Labor posted that there were 634,000 medical assisting jobs. How many male medical assistants truly are there? That would be difficult to answer because that number is somewhat classified.
You see on US Navy submarines there are only male medical assistants because women are not allowed on submarines and the number of submarines in the US Navy is classified,
So there you have it. When you visit the hospital, physicians office, surgery center you may ask yourself where are all the male medical assistants.
Society has deemed that they are so effeminate and sexually deviant according to that false article that they have all been placed under the sea.
PT
Re the Staten Island case. It's so disheartening to read the comments by the morons who posted there: http://www.silive.com/news/2018/02/man_sues_nurse_for_alleged_sex.html. There were only several posters who had a accurate grasp of the situation that male clients (patients) often find themselves in. Of course the 67 FEMALE COW (NURSE) sexually abused him, and of course she's been getting away with it for her entire career! I applaud this gentleman who had the courage to go public with his abuse. American culture loves to ridicule males, especially in the medical arena - just look at the medical shows, evening "news" shows ridiculing men re prostate exams and so on, and so it goes in so many areas of American culture. Males are considered either evil, weak, lying, prejudicial, violent, etc. etc. ad nauseaum ad infinitum! THEY ARE ESPECIALLY RIDICULED/SILENCED WHEN THEY STAND UP TO THE FEMINAZIS IN THE MAKE'EMSICK INDUSTRY! Again, we are looking at widespread misandry that American culture IGNORES. Man are those medical students stupid! The first nurses were males, and when females were introduced, they were at first, gee, prostitutes! Now these female cows can earn an hugely over inflated salary for getting their sexual jollies at work, and they don't have to participate themselves, but still enjoy their peeping, feeling, and other nasty "work" habits! I find that, with the exception of this blog, I am silenced when I state the truth of the matter: MOST FEMALE "HEALTH" WORKERS THOROUGHLY ENJOY VIEWING NAKED MALES AND THIS STEMS FROM, YES, THIS STEMS FROM SEXUAL URGES. WHENEVER I BRING UP THE UNDERLYING MOTIVATION OF THESE FEMALE HAGS, I AM SILENCED! THIS CENSORSHIP SPEAKS VOLUMES!
Good Afternoon Friends.
In regards to patients not knowing how procedures will be done and who will do them.
I believe Biker that you and Banterings are correct.
We know they don’t tell men ahead of time. If they did, they might have to answer some tough questions they don’t want to answer because they know not all men will just ‘go with the flow’ and let them get on with the test or procedure.
Because most places wait until the ‘last minute’ to tell you anything, they would be taking a chance that you might not like the ‘accommodations’ they have arranged and request same gender care or, just call the test/procedure off and go somewhere else which could cost them $$$$.
If the time came and men did ask about these tests the majority of the time they are never told the whole story. Not even by their own personal physician. They are given enough sugar-coated information to get them into the facility on the day of the testing. The doctor that is sending you is hoping you will ‘go with the flow’. He/she is passing the headache on to the facility as far as telling the patient the whole story.
I am also totally befuddled and disgusted as to the complete lack of caring on the part of the medical community for men who are going through gender specific medical issues.
Where did the caring and compassion for the sick go people?
There is no logical or sane reason not to offer a man same gender care for any gender specific issue. For many men, just taking that one step for his comfort, would go a long way towards seeing that he gets the best possible outcome out of his situation.
I’m sure most institutions, would, without a doubt, make sure any woman going through a gender specific medical crisis had same gender care without ever even asking for it.
As Banterings said, if one hasn’t lived with the parts all of their life, they can never be on the same level with the patient that has no matter their gender, education, experience or how hard they try. It’s time for the medical community to try using some common sense. Something that seems to be in short supply these days within the medical community.
The United States healthcare community needs to be put on the national transplant list and get a new heart as the old one has long forgotten how to really care for and about our sick people.
Regards to all,
NTT
The response I got from a female medical student of my group of 6 was not related to the article about physician's assistants but to the questions I intend to discuss with the students tomorrow:
"would you, based on your gender,feel more comfortable working with a medical assistant of the same or opposite gender? How about with a nurse? or a physician? Would you, based on your gender, feel more comfortable as a patient being cared for by a scribe, technician, medical assistant, nurse or physician of the same or opposite gender? How about present in the room for genital as a male or pelvic exam or mammogram as a female patient?. If you would feel comfortable, how do you explain the discomfort of some patients in relation to exams which appear gender related? How would you as a professional respond to their concerns and discomfort?"
The first year female medical student's response was:
When it comes to working with others in a professional medical setting, I do not have a gender preference because their gender has no bearing on the level of competence that individual has. I am comfortable with working with any gender in any position that they hold because we have been all trained with the same information and therefore should be equally competent to deliver effective care for our patients. When I'm a patient, my same philosophy applies in most contexts. No matter the medical setting in which I'm being treated in (e.g. urgent care, outpatient, ER), have no preference with my provider's gender and it is not something I even think about. The only thing I care about as a patient is that the individual is good at their job. In a more intimate setting however, such as a pap smear, I would prefer to have a female provider examine me because I would find it less awkward, but even then, I would not ask for another provider because it is assumed that the male provider is a professional and is going to behave accordingly. If my patient voices his or her discomfort with the gender of the professionals around me or even with myself, I would state that I understand (especially given the climate of society today). People all have different experiences with their own triggers and I even though I am comfortable handling the opposite sex, I would not hold it against others for not having the same view. I would try to adjust the teams so that the patient is able to be more comfortable with their gender of preference.
..Maurice.
I stumbled across this news article today from a British-Columbia newspaper called the Times Colonist. The author, one Lawrie Mcfarlane (which I assume is a woman), addresses the issue of mixed (or opposite) gender care in healthcare and I thought this offered a small glimmer of hope.
Here is an exert from the article:
"This is a difficult column to write, because it raises a concern most folks don’t like talking about. Yet with the current attention directed at gender issues, I think it deserves an airing.
The topic is patient sensitivity when it comes to medical procedures involving what a Monty Python skit called the “naughty bits.” The treatments in question are generally diagnostic procedures such as pap smears, prostate ultrasounds and minor surgical investigations such as catheter insertions looking for bladder stones.
The reason this deserves a hearing is that reliable studies in both the U.S. and Canada suggest one-third of patients want these “sensitive” procedures carried out by a provider of the same gender."
The article in full can be found at this link: http://www.timescolonist.com/opinion/columnists/lawrie-mcfarlane-health-care-system-fails-on-gender-1.23184562
I thought it was really well written and dared to speak about the elephant in the room.
Dany
Even better question, would they allow medical students of either gender participate and for all or some procedures?
I believe that because of their special training (professionalism) AND the debt that they owe patients (whom they learned on), they owe it to the profession and to non-medical trained patients (meaning one less patient to be examined by med students) to be the patients that medical students learn on.
Facilities should search out medical professionals upon admission and they should be targeted for medical student participation.
-- Banterings
Banterings, I've noted here a number of times, that at our school 2nd year medical students learn to perform male genitalia exam and pelvic exams on real teacher-subjects. From then on to graduation, they are performing patient-benefit exams as experience. And even as residents there is more learning going on. Tomorrow, at my school, second year students will be learning female breast examination on live female model-teachers with instructors also present. Otherwise, all learning of the techniques of physical examination of all the other systems are performed on each other prior to performing the exam on hospitalized patients.
..Maurice.
OK so what do we know
1) All male medical assistants live and work in the deep ocean
2) Male mammographers are as rare as a white unicorn
3) 95% of all nurses are female
4) female nurses who are caught peeping at the genitals of male patients alive and deceased get 3 weeks of paid vacation.
5) Physicians offices not not hire males for any position
6) Male patients undergoing surgery for genital injuries will have tons of people taking cell phone pics and showing them to everyone.
So why would I care what some female medical student’s opinion are why she certainly will say whatever is contrary to her admitting that she is a hypocrit. I don’t!
PT
Hello,
I work at a University and received the following e-mail:
"My daughter is a high school senior at ... High School and we're looking for a tutor to help her with AP Calculus once a week. She's easily able to meet a tutor on campus there - no problem. We'd prefer a female, but need a tutor." I presume that the parent thinks that her daughter would be more comfortable working with a person of concordant gender. If this is true for something as simple as tutoring, why would one NOT suspect that same-gender medical care is something that one (male or female) might also prefer?
Reginald
From another male student of my first year medical student group. ..Maurice.
In regards to the gender discrimination within the field of medical assistants, I found the article very interesting to consider in the context of our roles as physicians. I find it unfortunate to hear that gender discrimination extends into this field as well, and it appears to manifest in a similar fashion compared to other fields. Discrimination against women, in the form of lower pay and slower promotion, exists in almost every field without fail and speaks to a larger societal bias against this gender. As stated in this article, a large reason for this discrepancy deals with the perception of women as less competent and more appropriate in care-giving roles. I think the most interesting issue to consider on Tuesday will be the reason why female supervisors share and exacerbate this discrimination. Wouldn't a women, who had already dealt with the same problematic workplace, try harder to adjust the stereotypes? On another note, I also think it is interesting to consider the perceptions of patients against both men and women; I generally would prefer a caregiver that shares my gender, but apparently others do not share this feeling.
I like the idea of having informed consent about exposure for procedures. I also think patients should be informed of alternative procedures that could protect their modesty best. For example, a woman should be able to make a decision between an abdominal ultrasound or transvaginal ultrasound if it is suspected she has an ovarian cyst. Many modest patients do not mind medical care from opposite sex medical professionals if no private parts are exposed. For example, most men on this blog who only want male doctors or nurses for urological procedures would not mind having a female for a knee problem as long as no genitals are exposed.
I really think that history of intimate procedures should be addressed in medical schools. Male orderlies and doctors used to do intimate procedures on male patients up to late 1960s. Also, men (including doctors) were not allowed to examine women’s private parts before 1800s. Look at an article about the historical progression of pelvic exams that includes facts.
I have read some articles about male orderlies. If any of you have some articles about history of male patients, please include links. I’d like to use them for a project I’m looking at starting to raise awareness about the importance of medical facilities accommodating male patients’ wishes for modesty.
Misty
I would caution those who "spank" a student for their comments or views. I find that "spanking" is never productive in education of facts or methods. Education, especially in professions upon which others are dependent upon to maintain their health requires understandable educational corrections. "Spanking" may be easier but does not truly provide the essential technical and decisions including professional behavior that is necessary. ..Maurice.
Maurice
I dont think it’s ever fashionable to exert ones sexist views on one gender group, particularly when entering a profession that should be advocating for both genders, student or not.
PT
I don't see any reason at all for optimism in the student responses. Strike me as almost desperate attempts to put together text that will fit into a narrative but one which is largely divorced from issues being discussed here. In short, none seem to recognize the issues being discussed here. Presumably, this will be the only passing glance paid to this type of material during their training. Perhaps doesn't suggest much promise for an educational role in curing medicine's faux blindness. REL
REL, I doubt any of my students whose comments were reproduced here had even came to this Volume before writing their piece. I provided this link only after they had submitted their comment to me and I was asking them for permission to publish it here. All the issues were written for class discussion tomorrow but I thought it would be of value for our discussion on this thread to try to get the comments reproduced here. I will find out tomorrow whether any came afterward to read the responses and, if so, their reactions.
Constructive and therapeutic professional interaction with patients both by communication with empathetic understanding and by examination is what they are to be learning. Since they are learning, their own past personal experiences, knowledge and feelings are naturally going to be in the education mix but the goal for us instructors is professional considerations and actions. ..Maurice.
Was I wrong in terms of providing views from a different population but pertinent to the discussions here? ..
Maurice
Any med student, resident really should learn very quickly to differentiate between a medical assistant, lpn,rn,cna, er tech from the standpoint of the scope of practice, otherwise they can find themselves in legal hot water. I just found it disturbing that one of your students referred to a medical assistant as a nurse, maybe she dosent know the difference but she should.
Secondly, I’m very saddened and disappointed that such junk is placed on the internet as that article was and that readers are referencing it in order to offer up an opinion. Recent posts from your students only demonstrate the short sightedness by people who really should know better. There is just no excuse.
PT
PT, my first year student group has just been in the process in their professionalism course learning about their "colleagues to be" and how to interact with them.
Before they came to medical school, all students have had different degrees of experience in the practice and practices of medicine and their own medical personal experiences. There is more complex personal issues of each medical student to consider in the education process than if they were engineering students being taught engineering. ..Maurice.
Maurice
That’s a good thing, that they should know among these credentials, rn,lpn,cna,medical assistant, er tech, who can take a verbal order.
PT
Dr. Bernstein, I do appreciate the students offering their opinions. I like understanding where others are coming from on these issues and their being receptive to discussing it. In my own life journey it took me time and experience to come to terms with my own feelings and to find my voice. If by the discussions you have with them they can come to understand that staffing gender is a real issue for many people perhaps some good can eventually come of it.
Was I wrong in terms of providing views from a different population but pertinent to the discussions here? ..
In my opinion "no" -- mutation is a key parameter in successful genetic search and that principle may apply here if the goal is to reach some kind of coherent strategy. I've long favored a loosening of the moderation reins here to stimulate progress. However, responses to essay questions by students that don't know what's going on often give the appearance of having tried to put down something that they think the teacher will agree with. I detect that element in the student responses here. REL
Good Morning Fellow Bloggers:
I read the article Dany referenced above about the Health-care system fails on gender.
Afterwards, I sent the author an email thanking her for her efforts and sent her the link to this site.
Maybe someone down here will see it & roll with it.
Regards,
NTT
Here are a couple interesting articles.
The first asks the question Why Are My Favorite Journals Obsessed With Sex?
Yet, there is no answer to the question. I believe that the answer is the same as why the incidents occurred in Denver and Pittsburg, and why Twana Sparks gave genital exams: simply because we can... Getting to the root cause of why one does something that they can do but is not necessary to do; All power tends to corrupt; absolute power corrupts absolutely. Not the linked article states:
Please do not misunderstand me. These persons who are corrupted by the process of ruling over their fellow men are not innately evil. They begin as honest men. Their motives for wanting to direct the actions of others may be purely patriotic and altruistic. Indeed, they may wish only "to do good for the people." But, apparently, the only way they can think of to do this "good" is to impose more restrictive laws.
Now, obviously, there is no point in passing a law which requires people to do something they would do anyhow; or which prevents them from doing what they are not going to do anyhow. Therefore, the possessor of the political power could very well decide to leave every person free to do as he pleases so long as he does not infringe upon the same right of every other person to do as he pleases. However, that concept appears to be utterly without reason to a person who wants to exercise political power over his fellow man, for he asks himself: "How can I do good for the people if I just leave them alone?"
PATERNALISM!!!
The second article is Deeply entrenched gender bias in academic medicine is treatable
Wait, have we not been handed all this BS that gender does NOT matter and physicians, nurses, etc. are trained professionally this way???
Just like with being naked, gender does NOT matter when it relates to the PATIENT. Soon as a female is passed over for a promotion, NOW gender matters.
As per a Supreme Court ruling, gender of the provider is one of the most important issues for patients, especially those subject to intimate procedures. I would argue that patients undergoing intimate procedures have a right to know the gender of their providers. I would guarantee that patients would be treated much more differently if they did not just simply take the word of the provider about their gender...
-- Banterings
The folks coming to this thread here and writing here clearly express strong feelings and I wonder if they are also coming to my blog thread about Trump and the Goldwater Rule that Banterings and myself are currently exchanging views. This posting is to invite those here to consider going to the other thread and express their own views on the Trump-Goldwater Rules issue. I am sure both Banterings, myself and others would be interested to read your views of the matter. ..Maurice.
I do agree with Maurice. The Goldwater Rule does have implications in the overall ethics and rules that govern the profession. I have attempted to show that they also have the same shortcomings as well.
-- Banterings
Maybe this is what we need in medical education and professional results to solve the main issue presented on this thread.
Read:
https://www.nytimes.com/2018/02/24/opinion/sunday/doctors-revolt-bernard-lown.html
..Maurice.
I agree Maurice.
If physicians are made to go through the system (NOT as VIPs) at the hands of trainees, the system will change quickly...
-- Banterings
Interesting article Dr. Bernstein. If the humanity of the patient actually mattered then the issues we discuss here might be addressed.
I liked the part about inpatients being measured in various ways every 4 hours interfering with the patient being able to heal. One could draw a parallel with the gender issue that if the forced intimate care by females leaves the male patient embarrassed or stressed or reluctant to seek future treatment, does that also interfere with healing.
Here and on the next posting are the positions of the final two of my six medical students who permitted me to publish their responses. ..Maurice.
FEMALE STUDENT:
Gender discrimination is pervasive in society even today, and has come to the forefront of national conversation as of late. It is a complicated problem that has no simple solution. I believe that gender discrimination is so integrated into society, given the historical dominance of men over women in the workforce, that until recently, not many were aware of its existence. An interesting point the article made, which surprised me, is that women in positions of power also discriminate against other women working in a relatively lower status role, and most of this bias is implicit. In my mind, I believe several steps must be taken to level the playing field between men and women in the workforce (especially in healthcare) for the future.
- More women should be placed in positions of power. With respect to the medical field, this can come in the form of hospital administration, female surgeons, or basically any role that is not seen as “stereotypically” female.
- This next point is much easier said than done. I think it is important to remove any negative associations with certain job titles. For example, it is my hope that a nursing role in the future would not be seen as a “feminine” career choice. Not only does this undermine the female nurses that work daily to care for their patients, but it also places unnecessary stress on male nurses performing a job that is already difficult emotionally and physically as it is. Additionally, it is important that we as future physicians treat nurses (and other hospital staff) as our equals, rather than the physician-nurse relationship that was more prevalent in the say the 1960s. As the physician class becomes younger (with recent graduates), I hope that this will be realized sooner than later.
- It is difficult to rid of bias entirely from job selection, as like the article stated, often times the offender is not aware of any bias existing. Additionally, if a business is meeting a demand (in the article, female medical assistants were preferred by patients over male), it would be difficult to suggest to the business to go against its consumers’ best interest. I believe a more permanent solution would be at first to remove the negative associations between male and medical assistant and perhaps this problem would be non-existent. Of course, again this is all a very complicated situation requiring a multifaceted response.
And finally from a MALE student. ..Maurice.
This article definitely takes on some points which I have observed in the healthcare settings and other points that I have not really experienced. I do think that there is a wage-gap between male and female workers (which exists for most occupations). Also, although it's not as prevalent as in previous times, I can definitely see male medical assistant/nurses being mistaken for doctors, while female medical assistants/nurses may not get that same perception. It is even likely that female doctors be mistaken as nurses. Nevertheless, there are other points that I haven't really seen. For instance, the article discusses how male medical assistants are seen by patients as effeminate, and this something that I have not observed in my experiences in the medical setting. I have also never heard of any patients thinking that the reason males go into the medical assisting field because of sexual gratification. In fact, my father is a nurse and in no way has he ever perceived himself nor has patients perceived him as inadequately masculine, nor has he ever had encounters with patients who thought of him as an abuser or seeks sexual gratification from his occupation.
With regards to my personal professional interactions with other health providers, I can't foresee any instance where gender would play a role in how I could work with nurses, doctors, medical assistants, etc. On the other hand, I can understand when patients prefer a specific gender to perform the various physical exams. If an instance like this occurs when I am a practicing physician, I would try to explain the circumstance to the patient and regardless of gender, every person in the medical team will be professional and mindful of the patient's modesty. But at the end of the day, if the patient would still prefer a specific gender, I can respect that decision and I will try my best to accommodate her request.
Thank you Br. Bernstein, and also to your students, for sharing their responses. Hearing the perspectives of others is always helpful.
I do want to comment on the last one who said "I will try my best to accommodate her request". Not his or her request, but rather her request, and even then after trying to convince her that all the staff are professionals that are mindful of the patient's modesty. I know that through your efforts he is aware that men have gender concerns too but what I assume was a slip of the tongue so to speak is indicative of how deeply entrenched the female-centric mindset is.
I also hope that he learns how to have those conversations. While it may not be their intent, the "we're all professionals" type response to gender based requests more often comes across as attempts to shut down the conversation rather than acknowledge the patient's concern and speak to it.
My last comment concerns the "mindful of the patient's modesty" statement. Training literature and hospital policies frequently use that kind of language. In training literature for medical staff it generally boils down to pulling the curtain and being polite to patients maintains the patient's modesty and dignity. From my perspective those things constitute behaving in a professional manner rather than maintaining modesty or dignity. For some patients that may be all they need but for others the latter does not automatically flow from the former. For example, no matter how polite a CNA may be or how careful she may be to shut the door, her helping me take a shower in the hospital would not maintain my modesty or dignity in the least. Her presence violates my modesty and strips me of my dignity. The very polite chaperone who carefully maintains a professional demeanor about her does not maintain my modesty or dignity by virtue of that professional demeanor. Her presence violates both.
This is what the medical world does not seem to grasp.
I had my visit with my urologist today. With an elevated PSA he confirmed what I already knew. Protocol calls for a prostate biopsy.
After carefully listening to his discussion about why this is necessary, I guess he sensed something was on my mind. He asked "I think you have some concerns, want to talk about it?" Very perceptive of him. So, I explained the abuse past and how I found the involvement of females in my care to be essentially intolerable. He seemed to be very understanding and took time to listen, even though it was a busy time of day with lots of other patients to be seen. I reminded him of the cystoscope he performed on me 10 years ago and that he did it without an assistant, and I told him how much that mattered to me. I was of course concerned about the presence of female staff for the biopsy. He said that he really has to have help with the biopsy, but that he would do all the prep himself, that I would be fully draped and that he would be the only person touching me. He also added that there would be no genital exposure. When I asked about the qualifications of the assistant, he said she is an actual RN and not a medical assistant, and they are both very attentive and respectful of the modest patient. He apologized for my past abuse even though it obviously wasn't his doing. He said this was something he was concerned about as he felt some abnormality during the DRE. He stressed the importance of early detection and treatment, if necessary, something I very much agree with.
The biopsy is scheduled about 3 weeks from now. Hopefully I can give a good report back here.
I brought up the subject of male assistant staff at urology clinics. He said he absolutely supported that idea, and he has had male medical assistants in the past but they are very rare to start with and then how few go into the urology field. He said the problem is that they tend to be transient, that is, they are usually still in school and working their way towards something better. He said the other problem he encountered is that the perception is that the guys can only work with men whereas women are allowed to work with both men and women patients. That is something he said was "rubbed in" from time to time by the female staff. The real justification is that the more men the male assistant worked with, the less the embarrassment for male patients. He did say that there were times when doing procedures on female patients that when a third assistant was needed, he would often call upon the male assistant, depending upon the acceptance of the patient. That tended to shut up some of the "rubbing in." Asked about who makes the hiring decisions and he said he does, and personally reviews all applications and sits in on all interviews. I quit probing at this point feeling that he had given more time than I should have expected considering the workload at the moment, and he is a one doctor operation, no one else but him and his staff. I thanked him profusely.
As to the practice, I observed that the place had recently been remodeled and was very clean and modern in appearance. The staff was exceptionally polite and respectful. The only thing that irked me was that the front clerical office staff wore exactly the same purple scrub outfit as did the clinical staff. Maybe they just trade off on those duties, one day they work directly with patients, and the next they are working the front desk. But I do wish they had separate crews for that. Speaking of the receptionist, she was quite unattractive and very overweight. When I paid my copay, she had to get up and go to the printer to get my copy and I got a unwelcome view of her, um, how do I say it, coin slot, or plumbers butt. I didn't need that! The only reasonably attractive female had tattoos up both arms. But she was nice.
Sounds like you've got the right urologist for you 58Flyer. Good luck on the upcoming test.
I was scheduled for this next week for an ultrasound and cystoscopy but got a call rescheduling me for the week after. After settling on the day/time I reminded her that I wanted a male nurse for the cystoscopy prep, and she said they already had me down for one and that I would have a male nurse for this rescheduled appt. What I really liked was that there was no tension in that conversation. My request was not a big deal to her at all vs the women in most places not reacting well to such requests.
Blogger Biker in Vermont said...
I do want to comment on the last one who said "I will try my best to accommodate her request". Not his or her request, but rather her request, and even then after trying to convince her that all the staff are professionals that are mindful of the patient's modesty. I know that through your efforts he is aware that men have gender concerns too but what I assume was a slip of the tongue so to speak is indicative of how deeply entrenched the female-centric mindset is.
I picked up on that too Biker. I read it as though the concerns of the female patient is the one and only concern. Maybe he didn't mean it that way, but that's how it read to me.
Good Luck on your upcoming procedure.
Mike (58flyer)
58flyer
You do have options. I disagree with most of what the urologist said, he’s justifying why he doesn’t hire males. My first question to you is have you had an MRI. If not, you should. I recommend a pelvic MRI with prostate protocol and before you choose the facility ask if their MRI scanner is at least a 1.5 or More Tesla. A 1 Tesla just does not provide the image quality.
Secondly, a prostate biopsy is invasive and unnecessary. First you could request the biopsy be performed at a hospital under anesthesia and in doing so request a male. You would have much more leverage at a hospital. If you do decide to have the biopsy there are risks as well as the possibility of no real information coming from it, (indeterminate). Usually, it takes prostate cancer a while to take you out and something else by then usually gets you first.
The biopsy is achieved by first piercing the colon and often involves from 10-14 samples. Piercin* the colon is never a good thing and neither is piercing the prostate which is no no longer an encapsulated organ, but that’s just my opinion. As you know the PSA is no longer considered an accurate indicator. Many problems of the prostate simply boil down to not drinking enough water. Prostatitis can elevate a PSA score. The MRI can determine if there are masses within the prostate and in some cases determine if the mass is maglinant or benign.
PT
PT,
I am sure that you will agree with me that both healthcare and the media have created a hysteria over cancer. There is even speculation that healthcare does not want cures for disease because it’s far more profitable to chronically maintain patients. This is driven by factual stories such as a pharmaceutical giant plotted to destroy cancer drugs to drive prices up 4,000%.
Most of the intimate preventative care are for detecting cancer. (See: Stop The Fearmongering Over Cancer and
Sack the hysteria: Men’s shorts aren’t filled with cancer time bombs. )
If we look at the history of cancer we see that it is a disease that created the most horrible, debilitating, and painful way to die. The modern hysteria with CA screening started in 1971, when President Richard Nixon did in fact declare war on cancer.
When science is applied to all this CA screening hysteria, we find that it is unnecessary. Previous protocols that have been proven false or seriously questioned because there is no clear benefit or risk include annual pelvic exams, testicular exams, PSA tests, CA screening in seniors, and genital melanoma screenings (to name a few).
Indeed there are billions in the cancer industry (both in diagnosis and treatment). Historically, CA screening has been forced upon patients. It is also a case of how we have always done things.
Thankfully patients are standing up th medicine and bending it to the expectations of society.
-- Banterings
PT,
It is interesting about the alternative procedure, a pelvic MRI you mentioned that could replace the prostate biopsy. I’ve never heard of that before.
As for you recommendation that the prostate biopsy be done under anesthesia, do you actually mean local or regional anesthesia? In my experience with helping patients to stand up for their rights to modesty, I do not recommend general anesthesia because once you are under anesthesia, it is easy for them to disregard your wishes for modesty since you are asleep. I strongly recommend that patients have local or regional anesthesia for most surgeries so they can be alert and awake to make sure their wishes are not being ignored.
Misty
Might I, as Moderator, toss in another community which really has never been entered into the discussion here about patient modesty and the gender requests and the response to the gender of the healthcare physicians and employees. And that is the large LGBTQ community as patients and I suspect also as healthcare providers.
Does this community with ambiguity to one degree or another in their own biologic gender or sexual interests present other factors that we all should consider as attempts are suggested and actually, described here, as being begun to make changes in the medical system?
I just don't remember in all these Volumes that the LGBTQ community has been entered into the discussion. ..Maurice.
Misty
An MRI could not replace a prostate biopsy, but it could give a much more clear picture regarding where the masses are located within the prostate and could even negate the need for a biopsy. A prostate MRI is simply an MRI of the pelvis with additional images of the prostate.
Thus the patient would simply lie on the table for images. To be effective, an MRI with and without contrast would be required. That is a contrast injected intravenously. And as I mentioned be sure to choose an MRI scanner of 1.5 Tesla otherwise it’s a waste of time. I always tell patients that the Urologist never asks for an MRI before a biopsy. You need to ask for it yourself. Now, before your insurance will approve an MRI you will have to show evidence of an increasing PSA score.
PT
Misty
Regardless of what people say a prostate biopsy is painful with risks. I would never myself consider getting such a procedure without general anesthesia, Period!
PT
A. Banterings
I know very well the cost of cancer treatments regarding the taxol, cisplatinums etc, immunotherapy etc. The costs of these compounds would boggle your mind and yet what happens when a very lost cost effective treatment becomes available. How do you dismantle the giant that the industry has become. Honestly, I don’t know but I don’t think we are no where near there yet. I do believe there is hysteria to create revenues within the industry.
In fairness, the discovery of taxol from the pacific yew tree is worth a read. Basically, this compound is extracted from the bark of this tree. Sounds simple enough but when you are a pharmaceutical company and in a legal battle with environmentalists over some trees that grow only in the Pacific Northwest the costs quickly become Hugh. I know firsthand the hype in countless unnecessary tests on young patients in this country. I could actually post countless comments about the subject and go on and on but that is another place and another time.
PT
Dr. Bernstein, concerning the LGBT community I would think the primary issue for patients is the same as the rest of us, wanting to be comfortable as patients with those who are providing their care. Transgenders have certain medical considerations that are unique to them (hormone treatments as part of their transition for example) that requires providers who understand those issues, but otherwise it would seem that the LGBT community has the same health issues as everyone else. It is just the comfort and acceptance issue that might pose an issue for some of them. Those who work in healthcare are human and bring their own prejudices to bear and I can imagine that some in the LGBT community have had bad experiences as a result.
Last year when I was looking for a new internist for my primary care and couldn't find one taking new patients, I grudgingly ended up with a young PA only a year out of school. Much to my surprise that first visit with him turned out to be the only wow experience I ever had in a medical setting, he was that impressive. Since then he has come out professionally as a gay man and now lists serving the LGBT community as a specialty focus. He is no longer taking new patients, perhaps because word spread within the regional LGBT community and he was quickly booked solid.
As for me I plan on sticking with him. I don't care if he is gay. Mandatory gang showers starting in 6th grade, mandatory swimming in the buff my 1st year in college, and a lifetime of locker rooms since then has made me totally comfortable being exposed to other men, and I'm not so naive to think there haven't been many gay men in those locker room settings. This PA is good at what he does. He figured out the source of dizzy spells that for 13 months nobody else had figured out despite a number of expensive tests and he explained a couple important things about my health history that nobody else ever did. He asked good questions and carefully listened to my answers. I don't care about his sexual orientation and am glad I got on his patient roster before he came out and got fully booked.
Banterings — Of course you are correct. There are many writeups like this one https://blogs.scientificamerican.com/cross-check/sorry-but-so-far-war-on-cancer-has-been-a-bust/ which correlate with your point. And I believe the pretense of expertise is at the root of the issues being discussed here. I can’t recall asking a medical doctor a question that was answered and, of course, if someone is an authority on nearly everything, it becomes fairly easy to brush a patient’s concerns away. "Ask your doctor” that we hear so often seems to imply that your doctor knows what’s best for you and you can be sure that the invasive test being recommended is in your best interest. However, if they will permit you to draw them out far enough without getting mad (unlikely), the defense of an invasive test often comes down to an experience they had with a patient, maybe 20 years ago, when the test didn’t detect the target of the investigation but some other malady was found. So that’s why they do the test : > ). I’ve been unable to locate the research foundation for skin cancer excision margins currently in use so I think I’ll pass on the genital skin exam. REL
Biker, it appears that, in summary, your view is that the issue that concerns you is not the gender of the healthcare provider or that provider's own gender self-selection or interest in the gender of a sexual partner but the willingness to accept as his or her patient your gender desires and requests for a provider who will give you the most comfort in the medical interaction. The provider's sexual bias is not your concern, it is the attention and compliance with your concerns relative to gender that is at issue. ..Maurice.
Dr. Bernstein, I may not be totally understanding what you are saying and so will paraphrase this somewhat. I don't care what the sexual orientation is of the healthcare staff that I interact with. I do care if healthcare staff sexualizes my care in any fashion. A gay male doctor is no more likely to sexualize a male patient encounter than is a straight female doctor with a male patient. It is highly unlikely in either case.
That said I do care about the gender of my caregivers if intimate exposure is part of the care. A lifetime of locker room experience has made me totally comfortable with males. In my mind there is no sexual content to healthcare encounters with male staff.
I am not automatically comfortable with female caregivers, in part perhaps because I see sexual content in exposing myself to females, and in part because I know from experience that some of the non-physician female staff see sexual content in their dealings with male patients. Been there.
Intellectually I know that it is highly unlikely a female physician is ever going to behave inappropriately with me but to date I haven't ever chosen one for anything that might lead to intimate exposure. Why? Because I find it highly unlikely that even if I were comfortable with her that a female physician is ever going to understand my not being comfortable with her female staff.
PT,
I understand your concerns about prostate biopsy being very painful. However, general anesthesia has a lot of risks. There are some nerve blocks that can help with the pain.
If a man who cares about his modesty has to be under general anesthesia, I strongly recommend that he demand that his wife or a male friend or family member be present as a personal advocate during the procedure to make sure that his wishes that no females be present is honored. Patients under general anesthesia are very vulnerable to modesty violations. Medical professionals can do anything to you once you are under anesthesia unless you have someone not employed by the medical facility present. Many patients have been deceived that their wishes for an all same gender team would be honored and it mostly happen to patients who are under general anesthesia.
I have researched prostate biopsy and nerve blocks. I wanted to include some links you can check out.
1.) Is periprostatic nerve block a gold standard in case of transrectal ultrasound-guided prostate biopsy?
2.) Techniques of Local Anesthesia for Prostate Procedures and Biopsies
3.) Three different anesthesia techniques for a comfortable prostate biopsy
4.) Is nerve block anesthesia better for surgery?
5.) Sedation Before Nerve Block Increases Risks, Not Pain Relief
Misty
Following up on my post regarding a LGBTQ healthcare provider and Biker's encouraging followup post about his view of a gay male physician, I want to let my visitors here aware of a 2010 thread titled "Would You Accept a Gay or Lesbian Physician as Your Doctor" started in 2010 and currently has 26 Comments. Go take a look. It is pertinent to what I and Biker have written here.
However, I do want to reproduce a Comment on that tread written July 19, 2014 by a lesbian GP to develop the topic here a bit more. ..Maurice.
I am a lesbian G.P. I have acknowledged my sexuality when patients have asked,.
I would like to say that when I was young I had to go to a male heterosexual doctor because there weren't any women docs around. it was a very painful experience with a condescending male that made me realize we needed women in medicine it. All women were expected to just accept that doctors were male. I have trained with male doctors who are pigs and can say from experience that people should be concerned with them more than any lesbian doctor who doesn't have to control testosterone and the brain of a penis.
Secondly, I have treated gay and straight patients and have only ever been concerned with their health and being the best doctor I could be for them.
I have observed through the years that there is a great deal of sexual abuse with so many of the women I have treated ,especially lesbians.. 99 % of the time that abuse was by a male
It is also very often heterosexual men who are sex offenders and pedophiles even religious leaders.
You should really pick a doctor based on how you connect to them and if you feel like you are being heard , respected and that you can trust their knowledge and care. You must also maintain sexual boundaries with any doctor. If you get any kind of vibes that make you uncomfortable find another doctor.
Just my thoughts. DR. L
Oh, I forgot to mention that our PT posted a brief warning on that thread in 2014. PT have you changed your view? ..Maurice.
Good Morning Everyone.
Biker, I completely understand where you are coming from and absolutely 100% agree with your view.
It’s not the female MD by herself that kills the interaction with the male patient.
The problem comes in when she doesn’t take the time beforehand to understand her male patient and his boundaries so she knows ahead of time he’s not comfortable with female support staff in intimate situations. If she did take the time, it would give him the chance to walk away no-harm-no-foul if he was uncomfortable.
There isn't enough sensitivity training in the world women can get that will help men trying to protect their privacy & dignity feel comfortable with female caregivers.
There's too much painful history there that cannot be undone by the healthcare community.
It's time the medical community accepts that fact and work with men & come up with answers.
Regards,
NTT
Murice et al,
what patients want is to trust their providers and feel comfortable with them. To do this, providers must
-- NOT assume simply because they are comfortable with exposure or a procedure that the patient is,
-- that only this procedure is needed and there no other alternatives,
-- that the doctor told the patients who would be present and got permission,
-- that the patient will do the RECOMMEND procedure,
-- never use the words "MUST", "NEED", "HAVE TO," etc. but rather "like to," "want to," "allow me to," etc.,
-- ASK what the patient wants,
-- that being thorough makes the patient feel as comfortable as the provider,
-- because you have a magic stethoscope you are right,
-- NOT ASSUME that simply because you have a magic stethoscope that people SHOULD or WILL trust you,
-- AND never assume that you do not continue to have to earn trust.
Saying "this is how we have always done things" or "you don't have anything I haven't seen" does NOT earn trust.
Sensitivity first must be complete and present, then applied to all patients.
-- Banterings
And Banterings, that is exactly what we teach our first and second year medical students. Also, I must say that they are NOT taught that the stethoscope is "magic" but is only as effective as it's proper use by the student.
I would advise patients to avoid staring at the stethoscope around the physician's neck and instead be attentive to the responses of physicians after being spoken to by the patient. It will be the response of the doctor which will be a comforting "magic" of the physician or simply a failure within the doctor-patient relationship. ..Maurice.
Maurice,
By "magic stethoscope" I mean the assumption that simply because one is a physician, nurse, etc., they are right, it is OK to view/expose a patient, are trusted, etc.
Providers seem to think that people simply put aside all human emotions and common sense.
I forget where I heard it, but a really good litmus test is to take the experience out of the hospital/doctor's office and put it in a motel room.
I know that you will be bringing up the therapeutic aspect, but simply have the exact same actions performed in a motel room and it seems like sexual assault. My point being that to the patient it feels like it is taking place in a motel room.
As to what medical students are taught, they were NOT always taught in that manner. We also know that the hidden curriculum may undo all or part of what you you teach.
-- Banterings
Banterings, and yet in all my years within the medical community (beyond teaching students but treating patients as an internal medicine physician and my contact with them and dozens and dozens of different physicians, I just didn't hear or observe sheer ignorance of gender needs or talking about sexual misconduct until started reading this blog thread or with respect to physician or other caregiver sexual misconduct my reading the news. With regard to the latter, revelations have been brought to light only in recent decades.
Another and a different issue, consensual doctor-patient sexual relation (as "lovers"} and its misconduct by professional standards criteria has been a much longer ethical and professional publicized misbehavior.
--------
By the way we are already in just 1 month at 179 postings on this Volume and I will be creating a new Volume (85) shortly. ..Maurice.
A key piece of this for me is simply being afforded the respect of having a concern or request that I express be acknowledged and spoken to even if the ultimate answer is no. The standard "we're all professionals" or "we don't have any male staff" type responses are not acknowledging a concern nor is it speaking to the concern.
In almost every case the person that such a concern is being expressed to is not the one responsible for the staffing mix. It isn't their fault and they are just doing the job they are paid to do. I understand that but I still want my concern or question acknowledged and spoken to. They can show some empathy along the lines of "I know that this procedure can be embarrassing and appreciate that you'd be more comfortable with male staff" (acknowledgement). "We don't have any male staff but please know that we .............." (speaking to the concern). "I will pass along to my supervisor that you expressed this concern so that she is aware."
The answer is still no in that example but I feel a whole lot better about the interaction in that I have at least been talked to in a respectful manner. The other benefit is that the staff have been signaled that they have a patient who is concerned about his exposure and that could result in them being extra careful to adhere to proper protocols.
Maurice
As I recall my comment was that “ you may not know if your physician is gay”. Personally, I dont have a problem with a male gay physician, nurse, cna,tech etc, as long as I’m treated respectfully. I can say for a fact that 25-30 years ago when the HIV virus was frequently in the news I know of gay male patients who were shunned by female nursing staff regarding standards of care. That several gay male patients were found expired in intensive care units from tension pneumothorax, that these patients had been expired for hours unbeknownst to nursing staff. I also know of several patients who were hermaphrodites and were gawked at by ambulance crews and nurses.
PT
Maurice,
It should be troubling that you were unaware of such things.
Personally, I would ask myself what deficiencies I had to miss such blatant misdeeds.
How many physicians, nurses, etc. are still unaware? How many chalk up such requests or complaints as difficult patients?
How can members of the profession be trusted with such abject failures in its past?
When does medicine apologize for its past transgressions and shortcomings?
What will they do to make amends?
You seem in disbelief that it exists. Have you sounded the alarm to the profession or accept that you are just a cog in a big machine?
This is the problem that patients have historically faced, and we are changing the face of healthcare. Patients are not going to stop at just getting their dignity respected, there is the issue of the profession making amends and doing penance for its transgressions.
It would be arrogant for one to think that they can commit transgressions on the scale that medicine has and not be held accountable.
-- Banterings
Banterings. You'll wait a long time, if you want an acknowledgment from them. Some of the intimate care was out right deliberate sexual abuse. That doesn't mean every doctor and nurse or medical worker is getting anything sexual from it. Some are just following guidelines somebody else came up with.
PT asks,
My first question to you is have you had an MRI. If not, you should. I recommend a pelvic MRI with prostate protocol and before you choose the facility ask if their MRI scanner is at least a 1.5 or More Tesla. A 1 Tesla just does not provide the image quality.
PT,
I have not had a prostate MRI. Your question and Misty's subsequent comments got me to researching. When I Googled "Prostate MRI" there were lots of hits. I focused on those from the American Cancer Society, Inside Radiology, and Harvard Medical School. What I learned is basically that high quality MRI, such as 3T, can confirm the existence of cancers after biopsy and can also be a valuable tool in assessing if the cancer has spread to other nearby organs and tissues. I saw an image of an actual MRI that shows cancer being confirmed by a radiologist. So what comes first, the biopsy or the MRI? Like the old argument about the chicken or the egg being first. PT, I think you have a valid point. If the current image quality of MRI can confirm if cancer is present, then why not use it BEFORE the biopsy? Seriously, why would one resort to an INVASIVE procedure when a NON INVASIVE procedure is more accurate and in fact is used to confirm the INVASIVE diagnosis?
Maybe it's an insurance issue. A biopsy might be cheaper than the expensive MRI with the need to pay for the big machine and pay the salaries of the operators. But with the biopsy there is the chance of a false negative, taking the dozen or so samples in hopes that they hit the actual cancerous tissue.
In thinking about it, my urologist does not have an MRI at his office, so he will make no money from referring me to a radiology practice that has one. But he will make money on my biopsy. That is what he will resort to first. If the biopsy reveals cancerous or suspicious tissues, then he might refer me to radiology for confirmation as to the extent of cancer or its spread to other tissues.
As to the MRI prostate procedure itself, there is the placement of the endorectal coil, who places that? Yes, for me that would have to be a male. Then there is the need for an enema before placing the endorectal coil, again, who does that? So those issues have to be considered and addressed.
PT, you have given me much to think about. Misty, thanks for your response and the links, especially the periprostatic nerve block links. If I go with the biopsy I will be asking about my urologists experience with that.
I put in a call Monday to my PCPs office. I specifically asked about the MRI. The practice does have an MRI and I have used it in the past for other issues. The question is if the equipment is of the current technology and is able to achieve the desired image quality. Insurance is another issue. I will have to sort this out and take the desired path. Thanks to all who have contributed.
Mike (58flyer)
Good Afternoon:
Everyone on this board gives us all a huge amount to think about. So much so I have a headache right now. :)
Still waiting on that discrimination lawsuit or act of congress to see a same-gender protocol be put into place at all medical facilities that deal in any way with intimate gender specific issues.
There's no reason not to have it. Time for healthcare industry to stop ignoring the issue and get out in front of it.
Regards,
NTT
Mike (58flyer),
An ERC is NOT always necessary. The use of the endorectal coil is still prevalent in many academic institutions. Maybe in 2005 an ERC was necessary with the technology available to make an MRI a viable alternative, but that is NOT the case today.
Here are some links:
Is an ERC necessary?
Impact of the use of an endorectal coil for 3 T prostate MRI on image quality and cancer detection rate
Non-Invasive 3T MRI Scan Could Be a Game-Changer in Prostate Health
-- Banterings
58Flyer
No Urologist anywhere in the world is going to have an MRI scanner in their office. Those machine weigh in at over 40+ tons and have to be brought in with a special flatbed and crane. The cost of a typical MRI scan is about $5000 depending if you get contrast or not. No there is no coil placed in your rectum and I don’t know where you read that, NOT TRUE.
You should have an MRI before a prostate biopsy, why? First, you cannot have a pacemaker or other implanted devices such as a stimulator in your body. The MRI will show a mass within the prostate, wether the mass is malignant or benign can be only determined most of the time by a biopsy. Remember, an MRI of the prostate also includes the entire pelvis, therefore any active disease process can be seen. An MRI of the prostate should be performed BEFORE a prostate biopsy and the reason is primarily to help the Urologist determine where the mass is within the prostate thus making the biopsy successful.
Appreciate that during a prostate biopsy biopsy samples are taken in various areas of the prostate via ultrasound, therefore it’s not an exact science and by that the biopsy is not being performed with 3D space. An MRI performs an image in true 3D space, furthermore an MRI will demonstrate if there are renal calculi with the bladder, tumors within the bladder and most importantly if there is cancer that has spread. That certainly would make a prostate biopsy unnecessary wouldn’t you agree and if the biopsy comes back indeterminant then what. Get another one! Ridiculous! What if the MRI shows no mass within the prostate, you getting a biopsy just because you have BHP,
I question any Urologist who performs a prostate biopsy without first ordering an MRI. An MRI excels in soft tissue demonstration and is the gold standard in evaluating cancer anywhere in the body. Why put yourself through all that, to satisfy the insurance company all you need is a history of increasing Psa scores otherwise the insurance company will deny the approval.
PT
58Flyer
Every hospital that I know of has an MRI scanner. The contrast agent they will give to you is called Magnevist, you will be required to get a lab draw that will determine your kidney function called BUN and creatinine. You can choose an outpatient facility as well but I recommend you do two things. First, avoid an MRI scanner called an open MRI, they are designed for people who have claustrophobia but don’t have great image quality because a lot of the energy is lost and in MRI energy (magnetic power)= image quality
Secondly, choose at least a 1.5 or greater Tesla. If you are claustrophobic you can ask your ordering physician for a mild sedative to be given to you such as Ativan. The exam takes about 30 minutes and try your best not to move during the scan.
PT
In no way am I attempting to give medical advice on this blog, I’m only saying what I would do. I realize that perhaps many of you probably have never worked in healthcare and thus you are on the outside looking in. I’m someone on the inside looking out so to speak and with over 40 years working in the healthcare industry. Thus I’m just giving options and mentioning some alternatives that might help this path that we are on. There are substantial risks to any biopsy of the retroperitoneal area, but more information is always helpful. Why have I posted on this blog for over 10 years, because I do not like what I’ve seen.
PT
It is time to change Volumes. THERE WILL BE NO FURTHER POSTINGS ON VOLUME 84. POSTING OF COMMENTS WILL CONTINUE ON VOLUME 85.
..Maurice.
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