Bioethics Discussion Blog: Patient Modesty: Volume 84

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Sunday, February 04, 2018

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.  



97 Comments:

At Sunday, February 04, 2018 10:24:00 AM, Blogger Maurice Bernstein, M.D. said...

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.

 
At Sunday, February 04, 2018 12:50:00 PM, Anonymous Anonymous said...

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



 
At Sunday, February 04, 2018 3:15:00 PM, Blogger Biker in Vermont said...

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.

 
At Sunday, February 04, 2018 5:36:00 PM, Anonymous Anonymous said...

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

 
At Sunday, February 04, 2018 8:32:00 PM, Anonymous Anonymous said...

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

 
At Sunday, February 04, 2018 10:06:00 PM, Blogger Maurice Bernstein, M.D. said...

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.

 
At Sunday, February 04, 2018 10:19:00 PM, Blogger 58flyer said...

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

 
At Monday, February 05, 2018 5:08:00 AM, Anonymous Anonymous said...

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

 
At Monday, February 05, 2018 5:49:00 AM, Blogger Biker in Vermont said...

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.


 
At Monday, February 05, 2018 6:42:00 AM, Anonymous Anonymous said...

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

 
At Monday, February 05, 2018 7:39:00 AM, Blogger Maurice Bernstein, M.D. said...

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.

 
At Monday, February 05, 2018 8:38:00 AM, Blogger Maurice Bernstein, M.D. said...

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.

 
At Monday, February 05, 2018 9:40:00 AM, Blogger Maurice Bernstein, M.D. said...

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.

 
At Monday, February 05, 2018 11:34:00 AM, Blogger Biker in Vermont said...

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.

 
At Monday, February 05, 2018 12:07:00 PM, Anonymous Anonymous said...

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

 
At Monday, February 05, 2018 1:58:00 PM, Blogger Maurice Bernstein, M.D. said...

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.

 
At Monday, February 05, 2018 2:02:00 PM, Anonymous Anonymous said...

"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

 
At Monday, February 05, 2018 3:20:00 PM, Blogger Maurice Bernstein, M.D. said...

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


 
At Monday, February 05, 2018 3:26:00 PM, Anonymous Anonymous said...

Thanks for the offer but no need; I already know he's an idiot LOL!

Ed

 
At Monday, February 05, 2018 3:34:00 PM, Blogger Biker in Vermont said...

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.

 
At Monday, February 05, 2018 4:04:00 PM, Blogger Maurice Bernstein, M.D. said...

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.

 
At Monday, February 05, 2018 4:21:00 PM, Anonymous Anonymous said...

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

 
At Monday, February 05, 2018 5:58:00 PM, Blogger Maurice Bernstein, M.D. said...

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.

 
At Monday, February 05, 2018 6:58:00 PM, Anonymous JF said...

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.

 
At Tuesday, February 06, 2018 5:54:00 AM, Anonymous Anonymous said...

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

 
At Tuesday, February 06, 2018 11:11:00 AM, Anonymous Medical Patient Modesty said...

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

 
At Tuesday, February 06, 2018 4:31:00 PM, Anonymous Anonymous said...

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

 
At Tuesday, February 06, 2018 6:26:00 PM, Anonymous Anonymous said...

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

 
At Tuesday, February 06, 2018 9:18:00 PM, Blogger Maurice Bernstein, M.D. said...

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.

 
At Wednesday, February 07, 2018 4:55:00 AM, Anonymous Anonymous said...

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

 
At Wednesday, February 07, 2018 5:56:00 AM, Blogger Biker in Vermont said...

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.

 
At Wednesday, February 07, 2018 9:06:00 AM, Anonymous Anonymous said...

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

 
At Wednesday, February 07, 2018 10:00:00 AM, Anonymous Anonymous said...

PT and others,
Thanks and please keep educating us.
BJTNT

 
At Wednesday, February 07, 2018 11:08:00 AM, Blogger Maurice Bernstein, M.D. said...

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.

 
At Wednesday, February 07, 2018 11:14:00 AM, Anonymous Anonymous said...

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

 
At Wednesday, February 07, 2018 12:30:00 PM, Blogger Biker in Vermont said...

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.

 
At Wednesday, February 07, 2018 1:46:00 PM, Anonymous Anonymous said...

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

 
At Wednesday, February 07, 2018 2:35:00 PM, Blogger Maurice Bernstein, M.D. said...

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.

 
At Wednesday, February 07, 2018 6:33:00 PM, Anonymous Anonymous said...

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

 
At Wednesday, February 07, 2018 7:05:00 PM, Blogger Biker in Vermont said...

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.

 
At Thursday, February 08, 2018 10:57:00 PM, Blogger 58flyer said...

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

 
At Friday, February 09, 2018 7:55:00 AM, Anonymous Anonymous said...

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

 
At Saturday, February 10, 2018 11:26:00 AM, Anonymous JF said...

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.

 
At Saturday, February 10, 2018 5:47:00 PM, Anonymous Anonymous said...

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

 
At Saturday, February 10, 2018 7:03:00 PM, Anonymous Anonymous said...

Sorry about that. Tigerhawk.blogspot.com/2005/05/nurses-secret-weapon.html

PT

 
At Sunday, February 11, 2018 6:20:00 AM, Blogger Biker in Vermont said...

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.

 
At Sunday, February 11, 2018 10:54:00 AM, Blogger A. Banterings said...

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


 
At Sunday, February 11, 2018 12:19:00 PM, Anonymous Medical Patient Modesty said...

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

 
At Sunday, February 11, 2018 12:35:00 PM, Blogger Biker in Vermont said...

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.

 
At Sunday, February 11, 2018 3:04:00 PM, Blogger Still Standing said...

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

 
At Sunday, February 11, 2018 3:20:00 PM, Blogger A. Banterings said...

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


 
At Sunday, February 11, 2018 3:22:00 PM, Blogger A. Banterings said...

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

 
At Sunday, February 11, 2018 3:22:00 PM, Blogger A. Banterings said...

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



 
At Sunday, February 11, 2018 5:55:00 PM, Blogger Biker in Vermont said...

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

 
At Sunday, February 11, 2018 6:29:00 PM, Blogger Maurice Bernstein, M.D. said...

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.

 
At Sunday, February 11, 2018 10:31:00 PM, Anonymous Anonymous said...

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

 
At Sunday, February 11, 2018 10:33:00 PM, Blogger 58flyer said...

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

 
At Monday, February 12, 2018 8:57:00 AM, Anonymous Anonymous said...

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

 
At Monday, February 12, 2018 9:44:00 AM, Blogger Biker in Vermont said...

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.

 
At Monday, February 12, 2018 12:36:00 PM, Blogger A. Banterings said...

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


 
At Monday, February 12, 2018 3:42:00 PM, Anonymous JF said...

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.

 
At Monday, February 12, 2018 4:41:00 PM, Blogger Dany said...

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

 
At Monday, February 12, 2018 4:52:00 PM, Anonymous Anonymous said...

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

 
At Monday, February 12, 2018 4:59:00 PM, Blogger Biker in Vermont said...

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.

 
At Monday, February 12, 2018 5:11:00 PM, Blogger Dany said...

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

 
At Monday, February 12, 2018 6:15:00 PM, Blogger Biker in Vermont said...

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.

 
At Monday, February 12, 2018 7:30:00 PM, Anonymous Anonymous said...

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

 
At Monday, February 12, 2018 10:13:00 PM, Blogger 58flyer said...

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

 
At Tuesday, February 13, 2018 4:00:00 AM, Blogger Dany said...

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

 
At Tuesday, February 13, 2018 8:28:00 AM, Blogger A. Banterings said...

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




 
At Tuesday, February 13, 2018 1:45:00 PM, Blogger A. Banterings said...

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...


 
At Tuesday, February 13, 2018 1:45:00 PM, Blogger A. Banterings said...

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


 
At Tuesday, February 13, 2018 2:44:00 PM, Blogger Maurice Bernstein, M.D. said...

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.

 
At Wednesday, February 14, 2018 7:53:00 AM, Anonymous Anonymous said...

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

 
At Wednesday, February 14, 2018 8:39:00 AM, Anonymous Anonymous said...

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

 
At Wednesday, February 14, 2018 2:21:00 PM, Blogger Biker in Vermont said...

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.

 
At Wednesday, February 14, 2018 11:18:00 PM, Blogger 58flyer said...

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

 
At Thursday, February 15, 2018 2:41:00 AM, Blogger Biker in Vermont said...

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.

 
At Thursday, February 15, 2018 12:19:00 PM, Blogger Maurice Bernstein, M.D. said...

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


 
At Thursday, February 15, 2018 9:50:00 PM, Blogger 58flyer said...

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

 
At Friday, February 16, 2018 4:01:00 AM, Anonymous Anonymous said...

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

 
At Friday, February 16, 2018 7:35:00 AM, Blogger Maurice Bernstein, M.D. said...

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.

 
At Friday, February 16, 2018 7:44:00 AM, Blogger Biker in Vermont said...

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.

 
At Friday, February 16, 2018 3:16:00 PM, Blogger Still Standing said...

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.

 
At Friday, February 16, 2018 4:04:00 PM, Blogger Still Standing said...

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

 
At Friday, February 16, 2018 9:46:00 PM, Blogger 58flyer said...

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

 
At Saturday, February 17, 2018 7:03:00 AM, Anonymous Anonymous said...

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

 
At Saturday, February 17, 2018 7:49:00 AM, Blogger Biker in Vermont said...

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.

 
At Saturday, February 17, 2018 8:46:00 AM, Blogger Maurice Bernstein, M.D. said...

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.

 
At Saturday, February 17, 2018 8:51:00 AM, Blogger Maurice Bernstein, M.D. said...

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.

 
At Monday, February 19, 2018 10:26:00 AM, Blogger A. Banterings said...

Still Standing,

Have you looked at my blog where I explore this very issue.


-- Banterings


 
At Tuesday, February 20, 2018 8:58:00 AM, Blogger Biker in Vermont said...

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?

 
At Tuesday, February 20, 2018 9:26:00 PM, Blogger Maurice Bernstein, M.D. said...

I am all for gender equality both inside and outside of medicine. ..Maurice.

 
At Tuesday, February 20, 2018 10:04:00 PM, Blogger 58flyer said...

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

 
At Wednesday, February 21, 2018 4:21:00 AM, Blogger Biker in Vermont said...

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.

 
At Wednesday, February 21, 2018 6:15:00 AM, Blogger NTT said...

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

 
At Wednesday, February 21, 2018 1:57:00 PM, Blogger Biker in Vermont said...

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.

 

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