Bioethics Discussion Blog: Patient Modesty: Volume 85

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Tuesday, March 06, 2018

Patient Modesty: Volume 85


I think this Volume's graphic really defines the basis for the ongoing modesty discussions which continues to focus on the behavior of some females in the healthcare profession with regard to their male patients but also importantly seemingly often the inability of male patients to express their distress or, in fact, change the system to male demands for the system to attend to their modesty as the system offers to female patients. The men seeming just have to stand for this inequality. Isn't this "the Problem"? ..Maurice.

Graphic: From Google Images and modified by me with ArtRage.

Beginning TODAY  April 10 2018, no further Comments will be posted on Volume 85 but the
discussion can continue on Volume 86.  



186 Comments:

At Wednesday, March 07, 2018 7:56:00 AM, Anonymous Anonymous said...

Let’s post a different picture. One with a male mammographer ( if there were one) looking inside a female patient’s bra through a magnifying glass, anyone see a problem here. Male patients have never had anyone on the inside to set professional, advocating standards like female patients have. Don’t get me wrong male and female patients alike have been groped, touched unprofessionally by medical staff, however, in this current system females set the standards in “their” industry for their female patients and “ themselves” yet cannot ensure it seems lately that male patients cannot be assured a professional environment so to speak in which case the entire system needs overhauling.

Let’s be transparent, the vast majority of unprofessional behavior towards female patients comes from male physicians. The vast majority of unprofessional behavior towards male patients comes from female nursing staff and by that I mean nurses, cna’s Etc. Is this a knee-jerk reaction by this feminine industry to protect females and if so it dosen’t explain why there are female nurses and medical assistants only at urologist’s offices. There obviously are several dynamics at play here which both tend to discriminate against male patients. Then there is the psychological carryover between physician-nurse bullying Negativity that always ends on the door step of the male patient I assure you.

It has always seemed apparent to me in many regards that male patients are an anomaly in the healthcare setting over the last 40 years or so. Like an after thought, there are facilities called family health care, women’s healthcare, pediatric health care yet none of these places really have included male patients in that picture. Is it because the industry is feminized and there never was any focus in that regard, that the mentality was “ well let’s just take care of us and the female patient and that benefits us too” . Let’s not put male patients in any of our advertising you know, young nurse holding an elderly female patients hand, let that be the extent of it. We don’t want to appear awkward if we have young men in there with all female nurses. People might talk and next thing you know we would have to change the format, hire male nurses. For now our game plan is put it out there that all male nurses are gay. Make it extremely difficult for males to enter healthcare, cut them down wherever you can. Make sure they fail, do not crosstrain males into mammography and whatever you do don’t let them come up and work in L&D.

Another tactic, if you have a male nurse in the Er or icu, promote them to some stupid desk job that way we get them out of patient care cause I don’t want a male nurse taking care of me. I would never have my baby at the same hospital where I work, but yet it ok to you that patients have to come here and be taken care of you, wouldn’t it be great if they could go someplace else like you can.i don’t want other female nurses I know seeing my nude body when I have my baby.,especially where I work.????? I don’t want to get my mammogram where I work, I see those female techs everyday.???

PT

 
At Wednesday, March 07, 2018 8:42:00 AM, Blogger Maurice Bernstein, M.D. said...

PT, thanks for the followup on my graphic. With regard to the last paragraph, I suspect that most female nursing staff get a VIP (very important person (provider) treatment such as the tendency given to male physicians when as a patient within the hospital where the female nurse works. Though, personally, I don't have such experience since I have not personally observed how specifically female nurses are treated in their own institution.
Oh! Maybe that is because: those female nurses go elsewhere!

I am all in favor of the need to balance the responses of the medical system to the needs but also the requests of "all" genders of patients. There must be a societal attempt to provide gender equality in the practice of medicine and prevent graphics like on this Volume from being needed to reflect this true PROBLEM of our medical system. ..Maurice.

 
At Wednesday, March 07, 2018 8:52:00 AM, Anonymous JF said...

A teenage girl gets an intimate exam and the chaperone enters the room at just the wrong moment and random people in the hall see her. A teenage boy- the same thing. Which one do you think will be crying in the car all the way home? When the parents of the kid coax the reason they are so upset, who's parents are going to return to the clinic and raise hell? Which kid knowing they might have to.be naked at the.doctors is more likely to lock themselves in their bedroom and make a real effort to not go? I still blame the doctors when there is all female staff when many of the patients are male. I can't help but think he is amused by the male patients embarrassment. I also have thought about female CNA's and nurses being neglectant regarding male patients dignity. Could they possibly be the female patients who get a sexual thrill when they get their pelvic exams? I know a lot of women hate those kind of check ups but I've also heard a lot of friends and coworkers admit to liking them.

 
At Wednesday, March 07, 2018 10:27:00 AM, Blogger NTT said...

Good afternoon Everyone:

Why do we currently have male gynecologists, male breast surgeons, and male radiologists but no male mammographers?

We all agree for the most part these gentlemen are all professionals in their fields.

So why no mammographers?

It’s because physicians and hospitals have labeled mammography as an intimate exam.

Wasn’t that kind of them?

By doing so, the can offer women more protection of the dignity and privacy by keeping men out of that area.

Why are male urological related events such as BPH related testing, prostate biopsy testing, and scrotal ultrasounds to name a few, not labeled as intimate by physicians and hospitals whereby affording men the same dignity and privacy protections they freely afford women?

It’s because on a daily basis, our wonderful American healthcare system discriminates against both male patients and male healthcare workers. They do it knowingly by not acknowledging and completely ignoring this real issue.

Think about it.

If women are willing going to see male breast surgeons, and male gynecologists, why can’t they see a male mammographer for their mammograms?

Hypocritical don’t ya think?

Women want equality BUT ONLY ON THEIR TERMS. While at the same time, males needs be damned.

If the American healthcare system is going to bend over backwards for one gender, then it MUST bend over for ALL genders.

It’s time people open their eyes and see just how discriminatory our healthcare system really is.

It’s time to use our true powers of influence. The powers of our voices and our votes to force change upon this broken system before it’s too late and we lose more people for no good reason.

Regards,
NTT

 
At Wednesday, March 07, 2018 11:07:00 AM, Blogger Biker in Vermont said...

JF, in your example, that boy who was inappropriately exposed has been socialized from a young age to "man up" and not complain. I did this myself for years. Most men do. The healthcare system knows this. It is partly how they can justify female-centric staffing models.

 
At Wednesday, March 07, 2018 12:41:00 PM, Blogger A. Banterings said...

Here is an interesting article n AllNurses: A Checklist for Patient Safety. These are all excuses for the trampling of patient dignity.

Notice that dignity/exposure is NOT mentioned anywhere in the article as a safety concern.

I would argue that psychological safety is just s important (to the PATIENT) as physical safety.


Of course, when you get right down to it, the purpose of the article is NOT about patient safety, but nurses getting fired.


-- Banterings


 
At Wednesday, March 07, 2018 6:11:00 PM, Anonymous Medical Patient Modesty said...

NTT,

It puzzles me that many women who are willing to go to male gynecologists, male breast surgeons, and male doctors for intimate procedures, but are unwilling to see male mammographer. Also, many of those women refuse to let male nurses do intimate procedures on them. I believe it is because many of those women are taught that doctors are different and that they can do anything in name of medicine. But the reality is you cannot take the “man” out of a male doctor. Also, for many years there were not many female gynecologists because medical school would not let women be doctors for many years.

Here’s some interesting insights from a man who asked his wife why she was okay with a male gynecologist, but not a male technician:


Many years ago when the issue of male gynecology became vital to me, I asked my wife about the question of male doctors versus male technicians. For example, I asked which made her feel worse - going to a male gynecologist for a pelvic exam or going for a mammogram with a male nurse/tech? She replied that she would rather go to a male gynecologist, because the male technician would be handling her breasts. I was astounded!! I replied, "But the male doctor is handling your genitals! Why isn't that more invasive and embarrassing?" After quite a bit of back and forth, I think we discovered that she felt less comfortable with the male tech because she had never experienced that before. In addition, the doctor held a vaunted position with years of training. The tech may have taken a few courses and was not occupying a prestigious position in society.


It’s sad that many people do not understand that men deserve the same privacy as women. Look at how many all-female ob/gyn practices there are in the US compared to all male urology clinics.

By the way, I found out that the men’s clinic in San Antonio is still an all-male urology clinic. They need to update their web site because one of the urologists, Dr. Case works at other locations now.

Misty

 
At Wednesday, March 07, 2018 7:12:00 PM, Anonymous Medical Patient Modesty said...

I wanted to share an interesting article that was published in Los Angeles Times about male doctors disappearing from gynecology.

The link is http://www.latimes.com/health/la-me-male-gynos-20180307-htmlstory.html.

It's encouraging there has been a big increase in female gynecologists for the past 10 years. I wish we could see a big increase in male nurses and assistants for male urologists.

Misty

 
At Wednesday, March 07, 2018 8:18:00 PM, Anonymous Anonymous said...

Misty

Would a female choose to see a male mammographer is not a valid question because there are no male mammographers. Little known secret is the medical feminine machine ensured that. I personally don’t have a problem with this at all but give male patients options too cause as it stands who can afford to go to San Antonio. That provider is NOT going to be on anyone’s plan.

When is healthcare going to truly become transparent and police itself? Recently a physician back east has been accused of raping female patients during colonoscopies. Upon investigation the physicians semen was found on the floor of the exam room, he stated he often masterbates in the exam room to relieve stress. He would give patients oral sedatives and stated in his defense that there would be a female medical assistant in the room.

However, the medical assistants countered with “ that’s not true, often we are so busy sometimes no one would be there in the room assisting the physician. REALLY, that never happens with us male patients. We never have a problem getting plenty of female assistants during our exams. It’s so refreshing to know that so many female staff worry about us that there is plenty of help during our exams. But then on that day there were no assistants for that physician, perhaps they were all assisting in the male patient exams.

PT

 
At Wednesday, March 07, 2018 10:59:00 PM, Blogger 58flyer said...

Banterings, thanks for the links in reference to the use of the ERC in prostate MRIs. Looks like that process is going to become extinct thanks to the image quality of 3T. A relief to me for sure.

PT, thanks for your advice and I always appreciate your input. While I have not had an MRI specifically for the prostate, I have had a pelvic MRI. It's been some years ago and I've forgotten what it was all about but I remember it was with contrast. I do wonder what effect my hip replacement would have on an MRI at this point in time.

My PCP called me today to advise that the issue of the MRI should be discussed with the urologist. Had I known what I know now I would have asked for an MRI BEFORE the uro referral. I plan to call my urologist tomorrow and ask his thoughts on the MRI prior to the biopsy. I'm getting into a time crunch with this whole uro thing and my upcoming hip replacement. The hip surgery is scheduled for April 18th and there are some pre op visits to be taken care of so I may just put off the uro issue until the hip surgery is done.

All that said, remember my dermatology visit a couple of weeks ago? I was all concerned about the full skin exam but since I was presenting for the sebaceous cyst removal that was all the doctor was going to deal with. On Tuesday I went in and the medical assistant (I presume since she had no name tag and didn't introduce herself any other way) began the prep for the cyst removal. The doc was a real speedy Gonzalez and breezed right in and went to work. I was face down on the table but I can read people's reactions to things and I heard a gasp and saw blood shoot over my head and hit the wall in front of me. The doc went to work cauterizing and cauterizing and said something about he couldn't stop the bleeding and left me wondering if I was about to get an ambulance ride to a hospital ER. Yes, he hit an artery. He finally got things under control and breezed out of the room and left the closing to the nurse practitioner (Amber). Amber did most of it and then asked "Brianna" to go get "Chelsea" so she could get some practice. I am face down and all this going on behind me. 'Chelsea" shows up and goes to work with the stitching with Amber critiquing. I asked, "are we teaching today?". "Yes" came the answer from Amber. While all that was going on Brianna was busy cleaning blood off of me and then the wall beside me and then the floor. As I got up the pillow I was resting on was covered in blood from what dripped over my shoulder. I remarked how it looked like a crime scene from the chainsaw massacre. That brought a few laughs and then some questions about my background in crime scenes. I revealed my 40 career in law enforcement which included some time in the homicide unit and the evidence technician unit in a large city police force. Then Amber commented that her husband is a pilot in the local Sheriff's aviation unit. I then revealed that I was active in state law enforcement aviation for the past 16 years and that I knew her husband and the other pilots he worked with, naming names. Yea, small world. So, Brianna finishes my dressing and I leave. Problem is the bleeding never stops so today I call in and asked if the dressing can be looked at and perhaps improved to where I am not leaking blood all over everything. They say to come on in and I am once again at the mercy of Brianna and Amber. This time Amber does the dressing and finally gets things under control and I am no longer bleeding. But, I had to call in sick from my job but it was so windy I didn't mind not flying today. It did bug me that Amber decided to teach on me without asking my permission. I was not exposed during this so maybe it's not a big deal but I do plan on mentioning this in my critique.

Mike (58flyer)

 
At Thursday, March 08, 2018 4:40:00 AM, Blogger NTT said...

Good Morning:

Misty I spoke to my wife last night & she like your reader prefers a male gynecologist & a male doctor over a female but she'd never use a male mammographer if they existed because she didn't want him touching her breasts.

Something else I found out from talking to her in depth. Not a lot of women really know or want to know what a man has to go through during a urological related event.

If they did things might be different.

Regards,
NTT

 
At Thursday, March 08, 2018 8:59:00 AM, Blogger Biker in Vermont said...

Colonoscopies have come up in discussion many times and there is something here that I'm not understanding. I've had 4 myself, the last 2 being w/o sedation. I am targeted to have it done every 2 years going forward due to multiple polyps including one that was precancerous. Also, a family history of colon cancer.

Our backsides are exposed. No avoiding that. In my last 2 I know for sure there was no front exposure at all. I had the gown plus a sheet covering me, and my legs aren't spread open or anything like that.

When patients are sedated are they treated differently in terms of exposure before, during, or after the procedure?

 
At Thursday, March 08, 2018 11:19:00 AM, Anonymous Anonymous said...

NTT

Just to be clear during mammography the mammo tech never touch the breasts of the patient.

Biker in Vermont

During colonoscopy the patient is on their side, however, any position is suitable for the procedure. Furthermore typically once the exam is completed the patient is turned back supine ( lying face up on your back) and it is during this time that frontal exposure is possible.


PT

 
At Thursday, March 08, 2018 12:00:00 PM, Blogger A. Banterings said...

Biker,

For colonoscopy, one can wear a pair of men's boxer shorts backwards (so as to enter the rectum through the fly).

There are also colonoscopy shorts that one can purchase themselves if the provider does not have them.



-- Banterings


 
At Thursday, March 08, 2018 12:57:00 PM, Blogger NTT said...

AB

Not many places let the guy wear the boxers backwards or the shorts.

Friend of mind bought the shorts then started calling around & the facilities (most all female staffed) all said no shorts no boxers so he just told his doc when colonguard gets covered by insurance, he'd do that as colonoscopy was out of the question anymore he told the doc because facilities aren't willing to work with him. He's not wasting anymore time or effort on the issue.

NTT

 
At Thursday, March 08, 2018 3:42:00 PM, Anonymous Anonymous said...

Risks to the physician and staff for not allowing male and female patients to wear boxers

Loss of revenue

Current cost of a colonoscopy $ 3400.00 to $ 4000.00

Cons. Up all night on the commode, loss of work for a day, medicated, loss of privacy and respectful care

Cost of a virtual colonoscopy cat scan. $ 3000.00. Cost of the contrast media. Free. drink 2 bottles of water 2 hours before exam.

PT

 
At Thursday, March 08, 2018 4:33:00 PM, Anonymous Medical Patient Modesty said...

PT is correct that the mammogram technician usually does not touch the women’s breasts. To be honest, gynecological exams are far more invasive than mammograms. Gynecologists have to handle woman’s genitals during a pelvic exam / pap smear.

I think that many women from the older generations are accustomed to male doctors and they have been desensitized that doctors can do anything because of their position in the society and their training. If those women had a choice of female doctors many years ago, most of them would have chosen a female doctor. Look at how many young women prefer a female gynecologist today.

Misty

 
At Thursday, March 08, 2018 5:04:00 PM, Blogger Maurice Bernstein, M.D. said...

58 Flyer, I apologize for the delay in your very detailed and rather startling posting from yesterday. Some how I missed publishing it and published it now dated yesterday evening. Anyway, for me and presumably for you, it was a startling occurrence you described. Let it not happen again. ..Maurice.

 
At Thursday, March 08, 2018 7:26:00 PM, Anonymous JF said...

Dr M, Do you really think a woman would get treated like a very important person just because she was a patient where she works? For the most part she wouldn't want to be there as a patient because she wouldn't want coworkers to see her nude. Also women can be VERY abusive and bullying towards other women. But if a person works in health care, finding a hospital where you don't know anybody is a major accomplishment. Where I came from I moved an hour away ( twice) There were still people working at the new jobs that I had worked with in the other cities. One time a doctors wife believed he was stepping out on her, so while he slept she superglued his genitalia all together. He wouldn't go to his hospital to get help but he still didn't go far enough. He probably should have gone 3 or more hours away to seek help.

 
At Thursday, March 08, 2018 10:53:00 PM, Blogger Maurice Bernstein, M.D. said...

I have to admit here and probably repeat my professional experience in the many many years of my medical practice, I haven't seen all the sexual misbehavior by healthcare providers.. in fact, I have seen NONE (of course I've read the occasional newspaper articles about "bad" doctors) and that is over 30 years of active practice. however in the more modern times with hospitalists present, my "in hospital" hours were much less than previously. If I am a statistical outlier myself then that is the explanation. But I never hear gossip by other professionals and neither my patients regarding their observation of true sexual misbehavior or gross inattention, without remedy, of the patient requests regarding nursing or physician management. It could be that patients were experiencing all that but just didn't moan or groan about it to me. But what I write here is my true experience. That's why from the beginning of this thread almost 12 years ago, I have been learning from those who write here. This blog thread represents my education of realism regarding my profession. And I am concerned about what I read and I have discussed the views. presented here with my first year medical students. So, again, let's do something about it. Why are there celebrated "women marching" to accomplish a social goals.. where are the "men" marching for remedy of their dignity goals? ..Maurice. p.s.-How do you start a march?

 
At Friday, March 09, 2018 6:35:00 AM, Blogger A. Banterings said...

Maurice,

I am not gloating, please don't misconstrue this post as such.

When I stopped lurking and started posting, I was seen as an outlier. Now that you have looked in the mirror (and see that mirrors reverse the images), it appears that you are the outlier. That statement from you is a sort of affirmation of our experiences.

If I was in that situation, I would be going crazy trying to figure out why I have never experienced even a single situation. I would wonder if I was not trained to notice such discomfort or to suppress it as "patient silliness."

Even more troubling for me (if I were in your shoes), am I training the next generation of physicians to not notice such discomfort or to suppress it?

The fact that it has taken you so long to acknowledge it as being real and as prolific as all who have posted on this blog say, let alone you holding that you may be the outlier, may be the result of how you were trained as a physician. I am not saying that you are NOT a statistical anomaly, I am just saying that it is very unlikely.

In light of the previous 2 comments (by you and JF), I hope that you do not find the following questions too personal.

For your own health care including intimate care), do you seek treatment at your own facility/organization/local where there are providers that you know, or do you travel someplace else where people probably do not know you?

May I suggest that next time you need care that involves an intimate procedure, that to see what you are missing, you travel to a different facility. I am not suggesting that you be abused, obviously you would withdraw consent before you can be abused. I am simply saying see if your physician comes walking in with students, nurses, or others unannounced.

See if nurses make assumptions that it is no big deal because that is how things are done here... Make requests for same gender care, see how those requests are treated.

You also stated:

But I never hear gossip by other professionals and neither my patients regarding their observation of true sexual misbehavior or gross inattention, without remedy...

Again I hope this is not too personal, and I am not asking you to violate HIPAA, but what gossip do you hear?

The incident at the U of Pitt hospital was attributed to something as having educational value (another BS excuse IMHO). I have to imagine that you must have heard of things that you consider acceptable that patients would consider a violation of their person (like at U of Pitt).

The incidents that required remedy, what was the remedy? (A stern talking to?)

I ask these questions to stimulate productive discussion, critical thinking and attempt an ad hoc root cause analysis.

You ask what are we doing? First we need to find the root cause. My research (that and the opinion of others) has pointed to medical training as the culprit. That is what I am exploring here.

Again, I make these comments out of my commitment to making the profession what it should be, what patients and society want it to be by stimulating ongoing debate. I apologize that I must ask you these questions, but being one of the very few here that has Identified themselves as a physician or having received that particular training, there are no others I can pose this to.

If there are any physicians LURKING here, PLEASE participate.



-- Banterings



 
At Friday, March 09, 2018 6:47:00 AM, Anonymous JF said...

Dr Maurice, You are a doctor and staff isn't gonna misbehave in front of you.They also aren't gonna talk about patients in a sexual way in front of you. If you were to hide a tape recorder in the break room though, you would hear something, I bet.

 
At Friday, March 09, 2018 6:48:00 AM, Anonymous Anonymous said...

Maurice

I’m very surprised you say you’ve never seen sexual misbehavior. I have read the newspaper in my city over the last 30 years and have read about it frequently. I know of it happening in all of the hospitals I’ve worked at as well as what has been posted on this site and Dr Sherman’s site. I read about it frequently on the internet as it’s presented, however, I don’t go looking for it on the internet. I did so yesterday and typed in a variety of phrases and basically I would be reading about all of them well into next week, something I dont have time to do.

Now, I’ll mention that I additionally frequent state medical boards to look at board actions as I know personally many physicians in my state and one of the lesser evils is physicians having mutual sex with their patients which results in a reprimand. I see it on the psychology board of examiners as well. It is so prevalent on the nursing board with nurses having having sexual realations with their patients which can result in revocation that the Director of nursing for my state has blocked from the public all reasons for reprimand or revocation.

I suppose they are so embarrassed since a large number of nurses are reprimanded for the following, drug diversion, felony conviction,
Dual relationship ( sex with patients) and sexual misconduct. So much for the most trusted profession. This stuff goes on al every single facility and yet you say you have never seen any of it. I’m a little flabbergasted by that.

PT

 
At Friday, March 09, 2018 7:03:00 AM, Anonymous JF said...

That's good that the medical assistance contradicted him when he said they witnessed the examinations, but they hadn't. Some of us have serious doubts about if they would endanger their jobs to speak up for a patient.

 
At Friday, March 09, 2018 12:39:00 PM, Blogger Biker in Vermont said...

First I think the two most common issues that we as patients face are as follows. One is the widespread lack of gender choice for healthcare involving intimate exposure. The other is lack of professionalism, primarily with non-physician staff. I include in lack of professionalism the "it doesn't matter for men" casual approach to male patient intimate exposure. I also include the less than empathetic responses to requests for same gender intimate care. Both of these issues can be fixed and it is what I think the focus should be on.

Actual sexual assault or sexually inappropriate behavior is not what most patients deal with on a day to day basis. It is a lower probability event for most of us than is lack of gender choice and lack of professionalism. These bad actors just need to be weeded out as fast as they are caught. Bad actors will find their way into every profession. It is only an indictment of the medical profession when there is no meaningful punishment.

To the extent that few patients speak up on gender choice issues or lack of professionalism I understand completely that Dr. Bernstein hasn't experienced it. It could be that some of his male patients were embarrassed if he brought in a female asst. for an intimate exam or procedure, but prior to this blog picking up on that embarrassment wasn't on his radar. I was pretty good at hiding my embarrassment in years past and suspect most men are. JF is right that staff are not going to overtly misbehave in front of him.

 
At Friday, March 09, 2018 2:41:00 PM, Anonymous Anonymous said...

Re: colonoscopy attire. Rather than try to find those special shorts, I simply asked my (female) ENT if I could wear a jockstrap. She was fine with that, and also wrote detailed instructions to her staff to keep me as covered as possible during the procedure.

RG

 
At Friday, March 09, 2018 4:20:00 PM, Blogger Biker in Vermont said...

Sorry for not getting it on the colonoscopy stuff. Wearing colonoscopy shorts or boxer shorts backwards or jockstraps infers to me the expectation that there is frontal exposure. Are they removing the gown during the procedure or otherwise lifting the gown at some point? This is not an issue for me any more being I don't allow sedation. I'm just trying to understand what people are trying to protect themselves from.

 
At Friday, March 09, 2018 4:54:00 PM, Anonymous Anonymous said...

"p.s.-How do you start a march?"

I don't know but don't think a march will be helpful. Perhaps I'm wrong but did civil rights marches really have an impact or was it riots in Watts, Detroit, Washington, and other cities that really precipitated change? I still feel that until medicine perceives the issues raised here as business opportunities, fear is the best weapon whether it be fear of a lawsuit or simply fear of a male patient causing a very memorable, unpleasant scene at an ambush. REL

 
At Friday, March 09, 2018 10:46:00 PM, Anonymous Medical Patient Modesty said...

Biker in Vermont,

They often have to lift your gown to do colonoscopy so there is a potential for at least partial exposure of genitals. The colonoscopy shorts only expose your rear.

Misty

 
At Saturday, March 10, 2018 6:02:00 AM, Anonymous Anonymous said...

Biker --

In answer to your question about colonoscopies: for me, the issue was simply the possibility of genital exposure. I'd never had a colonoscopy before, and was under general anesthesia per my own request, so I can't speak to the specifics of what happens or can happen. My previous "chaperone" ambush encounter taught me that I have a low (or zero) tolerance for non-essential intimate exposure, and the jockstrap seemed like the most efficient way to address that. Which it was. Staff had access to the parts of me they needed access to, and nothing they didn't need to see was exposed.

RG

 
At Saturday, March 10, 2018 8:40:00 AM, Blogger NTT said...

Hello:

I agree with Biker. Supporting staff is where the problem is. As he stated, they will not act out with hire-ups in the area. When no hire-ups around men pay the price.

The medical community has created a condition that male patients find totally intolerable and are now pushing back against.

They’ve completely destroyed the patient/provider trust with male patient’s that must exist for the system to work properly.

They have nobody to blame for this situation but themselves.

Their complete lack of oversight of supporting staff coupled with their lack of meaningful remedies when violations occur, has created an environment where patient’s no longer feel safe or are willing to trust healthcare workers anymore.

The healthcare community has what they term “gold standards” for certain medical procedures. For instance, TURP currently is considered the “gold standard” for PCa.

What needs to be developed and then implemented system wide is a “gold standard” of care for intimate perineal and gender specific medical conditions. No medical facility or doctor’s office can be excluded from these rules.

In conjunction with public input, the Dept. of Health and Human Svcs., maybe the Joint Commission, and even the congress if need be must for the well-being of the public put this protocol together and get it implemented.

It’s time for the people to take a stand.

Whether one’s personal preference is for either same-gender or opposite-gender medical care, their choice should not only be respected by all, but also accommodated by every healthcare provider and their affiliates.

Regards,
NTT

 
At Saturday, March 10, 2018 3:49:00 PM, Blogger Maurice Bernstein, M.D. said...

I do agree with NTT's last summarizing posting.

What is being described here is a system problem. And unfortunately, from the position of teaching first and second year medical students, I don't see that simply our educational support of NTT and the others who provided similar conclusions is going to make changes anytime soon in a system that is, unfortunately, in many respects income oriented rather than income secondary and truly patient directed. (It is terrible that I have to speak out this analysis but if what I am reading here is true regarding the patient, particularly male patient experience, I find no other conclusion). Do you think that this system ignorance with regard to the personal concerns of male patients is totally unknown by those in medicine who have the potential to remedy the situation or just remedy abandoned because of some eons old but now erroneous philosophy which has been passed on to them? ..Maurice
-------------------
p.s.-
On the topic of the patient remaining conscious during a TURP, here is some facts from MENSCAPE:

From Medscape:
Anesthesia for TURP
Spinal anesthesia is generally preferred for transurethral resections for a number of reasons, not the least of which is the ability to converse with the patient and to evaluate him for symptoms of an early dilutional hyponatremia (ie, transurethral resection [TUR] syndrome) during surgery.
Spinal anesthesia may make recovery a little easier with better pulmonary toilet. Patients recovering from a general anesthetic often cough heavily, which tends to increase hematuria. Laryngeal mask anesthesia (LMA) tends to minimize many of the negative aspects of general anesthetic and is now used for many TURP cases.
A large national survey and cooperative study of 13 institutions by Mebust et al confirmed that up to 79% of transurethral prostate resections are performed with the patient under spinal or epidural anesthesia.
A 1998 study by Fredman et al compared general versus spinal anesthesia in patients older than 60 years undergoing short transurethral prostate surgery. The study demonstrated that general anesthesia with propofol and desflurane facilitated shorter induction and recovery times without adversely affecting patient comfort. In this study, these general anesthetic agents appeared to be preferable to spinal anesthesia for TURP, at least in this particular age group.

Several studies have failed to show any significant differences in complication rates, operative mortality and morbidity, or blood loss between regional and general anesthesia. Transurethral resections have even been performed with local anesthesia and sedation, although these have only been performed on relatively small prostates averaging just 11 g of resected tissue.
The obturator nerve runs near the prostate and can be electrically stimulated during transurethral prostate surgery, causing a violent thrusting of the leg, which is called the obturator nerve reflex. This reflex can possibly lead to inadvertent intraoperative surgical complications. The problem of unintentional obturator nerve stimulation can be corrected under general anesthesia by paralyzing the patient.
The obturator reflex most often occurs while resecting bladder tumors on the lateral walls of the bladder. In these cases, the reflex may be prevented by injecting a local anesthetic into the sensitive area through a special needle passed through the resectoscope.

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

 
At Sunday, March 11, 2018 5:08:00 AM, Blogger Biker in Vermont said...

To answer your question Dr. Bernstein, I think some know that the current system is problematic for many men, but they know few will speak out and it is thus easy to make believe that the issue is very limited in scope. My guess is that many, perhaps the majority, have never given it a second thought. They just defer to the societal norm that men have no modesty, and that any man who does has a problem.

You make a concerted effort to make your students aware of these issues. As good as that is, it is still theoretical in that they are not dealing with real patients that express modesty concerns. As they progress in their training and start dealing with paid patient-teachers, the scripts for those simulations aren't including the patient expressing modesty concerns. When dealing with real patients odds are modest patients aren't agreeing to be seen by students, and if they are, how many of those patients are going to raise an objection?

What I am getting at here is that the students aren't likely to be exposed to modesty objections during their training with real or simulated patients. The system as it stands reinforces the mantra that men have no modesty. They may know in theory that modesty is a concern, but they haven't been exposed to it in formative training stages.

As I understand it, nursing and other non-physician staff training takes the stance that being polite and maintaining a professional gameface is all that is necessary. Nothing more is needed when it comes to male patients.

 
At Sunday, March 11, 2018 12:54:00 PM, Anonymous Anonymous said...

It’s no secret when you want to know the female teachers who have been arrested and reprimanded for sleeping with their students. This is the list up till 2014. www.wnd.com/2014/08/39783. Yes the list keeps growing. You can also know which physicians, psychologists were reprimanded as well for sleeping with their patients simply by going on to the medical board for each state. Now typically most state medical boards will only go back two years. Beyond that you have to make a written request to the state medical board.

Over the last 4 years or so medical facilities have tried to use big fancy words like being transparent, self report etc. just a big continual lie as nothing really has changed. If you want to know who the nurses are in each state who have been reprimanded for having sex with their patients then you are out of luck. Boards of nursing are keeping this away from the eyes of the public, why? They admit it’s a chronic problem but isn’t that taking a step back from being transparent. Are they just so embarrassed by this, how would this affect their rating.

As a patient you should have a right to know about provider and as far as that goes anyone who provides care in any manner to you. You are paying for the service and it’s your right. If I want to know the background of any physician I can do so and learn as well where the physician practices, yet why are the directors at boards of nursing keeping this a secret?

PT

 
At Sunday, March 11, 2018 5:15:00 PM, Anonymous Medical Patient Modesty said...

I wanted to let everyone on this blog know that Medical Patient Modesty is planning on giving out flyers to some teenagers and parents about unnecessary breast / genital exams for sports physicals. It will be based on this article, Are Breast / Genital Exams Necessary For Sports Physicals?

I also developed a sample petition parents can use for their school system in word and you can find it at this link.

We need to fight for teenage guys. There is no reason for genital exams for sports physicals. Would any of you be interested in participating in this project in your local community? If so, please email Medical Patient Modesty through this link.

Misty

 
At Sunday, March 11, 2018 10:34:00 PM, Blogger 58flyer said...

In response to NTTs comments on 3/10, I agree we have a system wide problem. Even if men were willing to speak up more and more and demand gender choice in ancillary staff, and those demands were slowly agreed to by the medical community, none of us would live long enough to see any real change. Something has to be done at the national level and applicable to all 50 states. I've said before, I think the answer is legislation.

I agree that it is sad that common sense and respect for others has to be legislated, but time and time again that has proven to be the case. I wish we didn't have to make new laws to correct what should have been done in the first place but there are times when such laws have been beneficial.

Where to start? I'm not sure but let's take a look at HIPAA. I have yet to do research but there has to have been some advocates at work to make that happen. Was it a patient rights group? As we all know, HIPAA is a big deal, applicable to all 50 states. I propose that we expand the scope of HIPAA to go beyond the privacy of just information, but also include physical privacy of the patient. After all, I would MUCH rather my information be compromised than my body. Definitions could be formulated to define what exactly patient modesty, patient dignity, and respectful care really is and how it fits into the big picture.

In my little world I wish that any person having intimate access to any patient should at the very least fall into a licensed category. That would eliminate the MAs and PCTs or would force them to become licensed by their state. I agree that a license is no guarantee of professionalism, but it is a good start. I believe that under an expended HIPAA, any medical facility should be required by law to assure gender choice in ancillary staff. Also, any staff present in any examination or procedure or operation ought to be required to be identified with their full name, medical qualifications, and reason to be present and that information be a permanent part of the patient records. After all, you cannot have professionalism without accountability, and you cannot have accountability without identification. Any patient should have the right to refuse the presence of non-essential personnel, or to be used for training purposes. All the above could be made a part of an expanded HIPAA. Also, a chaperone would be defined as a healthcare professional of the same sex as the patient, no exceptions.

No doubt medical practices, clinics, and hospitals would cry foul that they are unable to meet such regulations or it would cost big bucks to do so. The medical industry is big business, they would have to step up even if it meant sponsoring prospective employees training and education. They will do what they have to do to stay in the game. More men would go into healthcare if they felt they were welcome.

Mike

 
At Monday, March 12, 2018 3:20:00 PM, Anonymous Anonymous said...

58Flyer


I’ve had this opinion for over 20 years, that Hipaa should have been expanded. Many years ago before Hipaa medical offices were simply throwing their medical records in the dumpsters. Insurance companies were using this information against you the employee and the patient and yes we have come a long way since then but not enough. All anyone needs to do is look at the gender of medical staffing at every single facility, they know the situation.

PT

 
At Monday, March 12, 2018 4:37:00 PM, Blogger Dany said...

Here's a very interesting bit medical news that might be of interest to some of you (I know I perked up when I found it!). While it might not directly relate to male dignity, I think it is worth bringing up here. A Canadian doctor named Jason Profetto (out of McMaster University, in Hamilton, Ontario) is going public with the idea that Digital Rectal Exams as routine screening test for prostate cancer might not be as useful as they were once thought of.

The news article appears on the CBC News website, under Health (http://www.cbc.ca/news/health/prostate-digital-rectal-exam-1.4570631) but he also published his findings in the Annals of Family Medicine (our version of JAMA, I suppose).

We'll see if this sticks or not (some doctors aren't exactly pleases with Dr. Profetto's findings) but I'm definitely keeping this handy for my next doctor appointment.

Dany

 
At Monday, March 12, 2018 6:13:00 PM, Anonymous JF said...

I think a video camera that staff is unable to access would be the way to go. That would make protecting Healthcare worker and protecting patients equally important. Supporting staff wouldn't be lying to protect their own jobs. I know that wasn't an option in the past but why couldn't it happen now? Nobody should have the ability to get the videos unless an accusation occurred, then a judges order and then the person authorized to unlock and access. The judge or the cops shouldn't see the videos either. It should be a female Healthcare worker when a female makes a complaint and a male Healthcare worker when a male makes a complaint.

 
At Tuesday, March 13, 2018 7:54:00 AM, Blogger NTT said...

Good Morning All:

JF, I suspect video recording in common areas is already being done industry wide. However, recording in exam rooms in my opinion would be a BIG no no and maybe even a HIPPA violation as the patient has an expectation of privacy in the patient treatment rooms.

Regards,
NTT

 
At Tuesday, March 13, 2018 1:30:00 PM, Anonymous Anonymous said...

Well over twenty years ago I was working at a major level 1 trauma center and they recorded every trauma that came in. We will never know where the recordings went. Furthermore, someone was breaking into the women’s lockers and they put a camera “ outside” of the door leading to the locker room to secretly record who was going in there.

At that same facility someone started breaking into the men’s lockers so the hospital put a camera “ inside” the men’s locker room to secretly record. I am against any recording of any kind in any patient areas and that includes employees changing areas. It is a tremendous privacy violation.

PT

 
At Tuesday, March 13, 2018 1:54:00 PM, Blogger Biker in Vermont said...

I agree with NTT, videos of undressed patients is an open invitation for abuse. Staff are not going to adhere to any rules, nor will such films be well protected from hacking. The extent of privacy we have now would all but disappear.

 
At Tuesday, March 13, 2018 2:20:00 PM, Blogger Biker in Vermont said...

It occurred to me today that while most hospitals and other medical facilities are by default going to be overwhelmingly staffed by women below the physician level given the available pool of applicants is overwhelmingly female, those facilities do have a lot of discretion in matters that are discussed here.

I had an abdominal ultrasound today. It was only the 2nd one I have ever had. The first one I had was 13 years ago at a small local hospital. A female sonographer instructed me to remove my pants and underwear (in private) and don a gown. Once on the table without asking she lifted the gown exposing me, covered my genitals with a towel, and then proceeded with the ultrasound. There was no medical reason to expose me, but yet her training and/or the hospital's protocol allowed her to.

Today without me saying anything, the sonographer says being it is only my kidneys and bladder (same as was done the 1st time) all I needed to do was lift up my shirt and unbuckle my bluejeans, scrunching them down just a tad.

Same ultrasound done very very differently. Two hospitals, two different cultures.

I also had what must have been my 20th (or thereabouts) cystoscopy today, but only my 2nd at this hospital. As occurred last year I asked for a male nurse, and was given one without any hassle whatsoever. The prior hospital never once had any male staff other than the physicians. As evidenced by my new hospital, there are male RN's who will take urology jobs if the practice is willing to hire them. Also, this hospital makes clear that the women who make appts can be trained to handle gender based requests from patients in a professional manner, something else that is far from the norm.

What especially surprised me with today's cystoscopy prep was that when the nurse was done with the prep, he covered over my penis with a cloth while we waited for the doctor to come in. Clearly that is an option all those women at the other hospital (and the male nurse I had last year) could have done, but not one ever did. Again, different hospitals, different training & protocols for the exact same procedure.

 
At Tuesday, March 13, 2018 3:07:00 PM, Anonymous Anonymous said...

Biker in Vermont

Just to be clear, training has nothing to do with it, beyond the protocol it’s what they want to do,

PT

 
At Tuesday, March 13, 2018 6:15:00 PM, Anonymous JF said...

Chaperones are modesty violations all by themselves, if they see everything. EVEN if they are same sex.

 
At Tuesday, March 13, 2018 7:49:00 PM, Blogger A. Banterings said...

NTT & PT,

If the patient is recorded by video, then it MUST be made a part of the medical record, hence accessible by the patient upon request and anyone else who has records to EMR.

Can you imagine the uproar that come about that if a patient disputing charges requests the complete medical record and gets the video of them under anesthesia?

JF,

The first time that a patient claims to be abused in a place where there are no cameras, the staff locker rooms, showers, bathrooms, sleeping dorms, etc. will all have cameras. When a complaint is made, they will follow that person for the entire day: their morning shower from working 3 back to back 12 on/8 off shifts in the dorms, their day including their "liaison" with the male nurse veteran, all patient interactions, all bathroom breaks, and back to undressing for bed.



-- Banterings


 
At Tuesday, March 13, 2018 8:14:00 PM, Anonymous Anonymous said...

A. Banterings

The recording of trauma patients was used for training purposes for residents at that facility and I know for a fact was never put in their medical records. I personally think it’s very unethical to record any patient without their knowledge under any circumstances and not only would a civil suit be appropriate but the people who agreed to install these cameras should be charged with a crime.

PT

 
At Wednesday, March 14, 2018 12:18:00 AM, Anonymous JF said...

Why would it be the entire DAY? If Jane Doe alleges that Doctor x abuses her, look up her appointment time and when she was seen. But it could be that hacking could occur. I never thought of that as a possibility. If it IS a possibility, then the video option is the WRONG option. If it could be made hack proof, and medical staff UNABLE to access the videos, that's the only way it could work. I actually think medical staff should be unaware because if they would have sinister motives they would just take victim/ patient to a room where there isn't a video. I don't share the opinion that medical workers couldn't or wouldn't take advantage of a patient just because a chaperone or assistant was present because it would probably be subtle. The assistant or chaperone wouldn't necessarily know that Jane Doe or John Doe had 2 or more intimate exams already this year or that he/she was getting intimately examined for a sprained ankle.

 
At Wednesday, March 14, 2018 1:32:00 AM, Anonymous JF said...

Maybe sometimes PT. But sometimes they just don't give it any thought. As a CNA I've protective of my residents privacy. I've also made coworkers aware when they were absent mindedly getting ready to violate a residents privacy.

 
At Wednesday, March 14, 2018 10:35:00 AM, Blogger A. Banterings said...

JF,

All of a sudden it is wrong when the provider is on video? As you stated:

...If it IS a possibility, then the video option is the WRONG option...


It should not be a problem for providers who have that special training (that makes them comfortable with patients being video recorded) being video recorded themselves.

When the tables are turned, providers object to the their loss of dignity that they routinely expect patients to give up.


Bolsheviks!!!!

One set of rules for them, another set for everyone else



Now, more to the legal point.

The exact time may be called in to question by the patient because of anesthesia, medications, pain, etc. If the provider defends one's self by saying they did not abuse the patient, then the best proof would be following the provider for the entire day showing:

1.) interactions with the patient (being non-abusive)
2.) all other activities of the day (showing no other interactions with the patient in question)


If there is ANY DOUBT, the provider has the potential of being found guilty whether it be a civil or criminal trial.

Look at the bright side, all that footage of providers can be used for research and teaching purposes.

Notice how this nurse does not shower completely, potentially causing the spread of infection...

...or the sexual liaison these two residents are enjoying instead of sleeping their 8 hours between shifts...


I am sure all are familiar with the problems that New York Presbyterian Hospital had allowing the filming of the ABC television show "NY Med". Yet all the staff at NYP were made to sign consent forms acknowledging that they were aware they may be filmed.

Anytime that patients sign a consent form that they may be filmed, staff (employees, contractors, students, etc.) also sign forms consenting to being filmed as well. That is just good employment law.


-- Banterings

 
At Wednesday, March 14, 2018 10:53:00 AM, Blogger A. Banterings said...

As to video as part of the medical record, here is the issue with video that telehealth created:

Telehealth creates unique health information management challenges for various reasons, including: aggregating large data sets (i.e. remote monitoring); using and storing numerous file formats (video, audio, text, digital images, film); establishing safeguards for sharing data with virtual providers and distant sites; determining the appropriate location for data storage (if more than one provider or entity is involved); and more. All of these challenges create issues relating to medical record management, maintenance, ownership, and storage.

In the past, it was easier to define what was and was not considered the “medical record” for a patient. Typically, the medical record was the patient’s paper file and/or a basic electronic medical record (EMR). With the addition of the internet, telehealth, and other electronic means of data transmission, the question remains:

What new mediums must be included in a patient’s medical record?

Must it include…

Digital images?
Emails?
Phone conversations?
Video recordings?
Live stream videos?
Remote monitoring data streams?


It is important to understand the definition and scope of the term “medical record” because under the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule, an individual has the right to access and/or amend his or her protected health (medical record) information that is contained in a “designated record set,” or DRS. Thus, healthcare providers must understand what they are required to include in the patient’s medical record and provide for the patient upon request.

The term “medical record” generally refers to the collection of information regarding a patient and his/her health care. The term “designated record set” is defined within the Privacy Rule to include medical and billing records, and any other records used by the provider to make decisions about an individual. Each healthcare organization is required to define the data or documents that meet this definition.

In addition to HIPAA, some organizations are subject to state laws that provide specific definitions relating to telehealth and medical record documentation/retention. For example, in Colorado, Colo. Rev. Stat. § 25-1-802(5) states that “medical information transmitted during the delivery of health care via telemedicine… is part of the patient’s medical record maintained by a health care provider.”

Another common theme in many state statutes and codes is that telehealth documentation retained in the medical record must be comparable to an in-person office visit. For example, Texas Administrative Code states that in order to be reimbursed for telemedicine services “documentation in the patient’s medical record for a telemedicine medical service or a telehealth service must be the same as for a comparable in-person evaluation”...
Source


Here is guidance from the Texas Medical Association

In some fields of practice, such as dermatology, photographs are a common way to document a patient's condition and response to treatment. These records are no different from narrative records — the photo is meant to document what is necessary to achieve an adequate medical record and should be considered part of that record.



-- Banterings

 
At Wednesday, March 14, 2018 4:50:00 PM, Blogger A. Banterings said...

PT,

In regards to the recording, not including it in the medical record may be ILLEGAL.


-- Banterings


 
At Wednesday, March 14, 2018 6:38:00 PM, Anonymous Anonymous said...

A. Banterings

I can tell you with great certainty there are many instances whereby reports never end up in the patients chart. Particularly so before there was such a thing as EMR. Even now electronic charting is never a guarantee and as an example your typical level 1 trauma center that I worked at might see well over 2500 trauma patients a year. With some trauma patients being recorded for an hour or more who is going to sit there and via the video recording, separate out each recording, edit and make a copy for that patients chart, never happened. The recordings made of trauma patients were I’m told strictly for training for the general surgery residents who attended level 1 trauma patients.

Those trauma patients were never told they were recorded. Who had access to those recordings honestly I don’t know. Do I think it was appropriate, absolutely not. Do they still record trauma patients at any level 1 facility I don’t know. I only became aware of it at one facility I worked at in the mid 90’s. Furthermore as far as say, medical imaging reports, lab reports and biopsy reports yes it’s possible many of those reports may not end up in the patients chart, however, they would become available if say through a subpoena from an attorney.

PT

 
At Wednesday, March 14, 2018 10:18:00 PM, Anonymous JF said...

What I was suggesting would be completely worthless if the Healthcare staff could get their hands on it. It would be best if they weren't even aware of it. That way they couldn't just use a different room. Generally speaking I think doctors and nurses are very much needed.We'd be in trouble without them. But I have heard that when allegations of sexual abuse by a provider occurs, the investigation process favors the provider through every step of the process. Sexual abuse by medical staff might be rare, but if and when it happens, it needs to be CAUGHT.Not just sexual abuse either. If through carelessness, a provider shows a patients naked body to people in the hallway or in the waiting room or if another patient or staff members just walks in, all that needs confronted.

 
At Thursday, March 15, 2018 6:44:00 AM, Anonymous Anonymous said...

Just wanted to recognize and thank JF for her comment a few days back:

"Chaperones are modesty violations all by themselves, if they see everything. EVEN if they are same sex."

I agree with every word of this. I was ambushed by a female nurse, brought in unannounced by my female NP, but I believe it would have been just as traumatizing for me if the "chaperone" were male, or if both were male. Being intimately exposed in front of an official, non-participating witness was degrading and humiliating, at least to me.

JF, I hope you will be able to spread this understanding among your medical colleagues.

RG

 
At Friday, March 16, 2018 2:40:00 PM, Anonymous JF said...

I think I might tell my story on the hospital review. But it's gotta be from a different device because it's gonna be done anonymously.

 
At Saturday, March 17, 2018 4:20:00 AM, Blogger Biker in Vermont said...

Here's some interesting stats. For National Nurses Day the local paper took out a big ad thanking their RN's, and listing them by dept. This is the 2nd largest hospital in the State. There are 143 RN's, 12 (8.4%) of which are male. That's likely par for the course, but the interesting part is that 7 of the 12 males work in the ER. One each work in Endoscopy, the ICU, Medical Oncology, the OR, and Diagnostic Imaging.

In response to a letter I sent the President of the hospital they told me that they do not consider gender when hiring and that they respect the privacy and dignity of all patients. They also told me that they are not a BFOQ employer and cannot take gender into consideration.

 
At Saturday, March 17, 2018 9:44:00 AM, Blogger Maurice Bernstein, M.D. said...

Here is a philosophy and an action which is currently taking place and should be further developed as part of the entire medical system.Read all about it at
https://www.pcpcc.org/about/medical-home
and here is the Introduction:

The medical home is best described as a model or philosophy of primary care that is patient-centered, comprehensive, team-based, coordinated, accessible, and focused on quality and safety. It has become a widely accepted model for how primary care should be organized and delivered throughout the health care system, and is a philosophy of health care delivery that encourages providers and care teams to meet patients where they are, from the most simple to the most complex conditions. It is a place where patients are treated with respect, dignity, and compassion, and enable strong and trusting relationships with providers and staff. Above all, the medical home is not a final destination instead, it is a model for achieving primary care excellence so that care is received in the right place, at the right time, and in the manner that best suits a patient's needs: Patient-Centered Medical Home.

In 2007, the major primary care physician associations developed and endorsed the Joint Principles of the Patient-Centered Medical Home. The model has since evolved, and today the PCPCC actively promotes the medical home as defined by the Agency for Healthcare Research and Quality (AHRQ).


Maybe our visitors here who want change should work through and with this organization.

By the way, my first year medical student group in a couple of weeks will be having a focus experience session where they will learn about this organization and be introduced into the activities and responsibilities of community medicine.
(by the way, this experience is required in our school for the first year students.)

Go to the site and return with your comments. ..Maurice.

 
At Saturday, March 17, 2018 4:36:00 PM, Blogger NTT said...

Good Evening:

Providing care that is respectful of, and responsive to, individual patient preferences, needs and values, and ensuring that patient values guide all clinical decisions.

It's a nice concept however, when a male patient presents with a male specific issue & requests same-gender care, 98% of the time they won't be able to meet the patient's preference therefore the concept fails.

I like the concept but I don't see it working for men that present with gender specific issues or those already in as patient's & they need perineal care & want same gender care.

Regards,
NTT

 
At Saturday, March 17, 2018 9:14:00 PM, Anonymous Anonymous said...

Biker in Vermont


Reading those comments makes me want to vomit, what a load of crap. “He says, they respect the privacy and dignity of all patients”

What he really should say is we cannot guarantee the privacy and dignity of all patients. Every single hospital that’s ever been built has failed in that fake core value.

Overall dissatisfaction with the quality of healthcare in the United States is increasing.....Fact

One in every five dollars in the United States economy is going towards healthcare spending....Fact

Then they make false claims that Equitable: Provider care that does not vary in quality because of personal characteristics such as gender, ethnicity, geographical location and socioeconomic status.

Lies and more Lies


PT

 
At Saturday, March 17, 2018 9:25:00 PM, Anonymous Anonymous said...

Biker in Vermont

One more comment while my nausea subsides.

He is the President of the hospital.? Therefore, in that case there must be several hospitals otherwise he would be the CEO. Do they provide mammography and L&D and if so then NO they are not a BFOQ employer. I would look into that and respond back, I doubt they know the difference.

Pt

 
At Sunday, March 18, 2018 4:09:00 AM, Blogger Biker in Vermont said...

PT, he is President & CEO, and he delegated one of his underlings to write the response on his behalf. This hospital does do mammography and L&D. There are some things that they will send patients to either Univ. of VT Medical Center in Burlington, VT or Dartmouth-Hitchcock in NH for but this local regional hospital otherwise provides a fairly full array of services. It is not part of a larger system. The guy I wrote to is retiring. It came as a surprise to me that they hired a man to replace him. I was sure it would be a woman in the current politically correct climate. The large hospital I have most of my stuff at in NH recently replaced their retiring President & CEO and in their case they hired a woman.

 
At Sunday, March 18, 2018 9:12:00 AM, Anonymous Anonymous said...

Biker in Vermont

There is your answer, they are a BFOQ employer if they provide mammography services, they lied to you.

PT

 
At Sunday, March 18, 2018 11:04:00 AM, Blogger Maurice Bernstein, M.D. said...

Should Giftbearer's approach to change (as currently written to my thread:
http://bioethicsdiscussion.blogspot.com/2006/06/dark-side-of-medicine-writing-lies.html) be of help here? ..Maurice.


At Friday, March 16, 2018 3:43:00 PM, Blogger Giftbearer said...
So that I don’t run out of space I’m going to add my comments in several separate parts. This abusive charting practice is a rampant problem in the medical system and none of the so-called "regulatory agencies" really regulate corrupt doctors and corporations they work for. I proved this in December 2015 when I was abused by an on-call neurologist in the ER because of an incomplete medical record from a previous hospitalization (at a different hospital) for severe near syncope and systemic weakness.

The man interrogated me in a very accusatory manner (as his resident and the ER doctor looked on), was overly rough during his "neuro exam" which ended up as a beating, posited that there was "nothing neurologically wrong" and that it must be "psychological", then had his resident come back into the room by herself afterwards and plop her butt hard on my left foot to see if I was faking. I'd told him he was wrong and not to jump to conclusions, and that he must not write any such thing in my chart as I had long-term positive doctor/patient relationships there and what does he do but write worse than what he'd said to my face, painting me pretty much as though I were either a nut or a criminal.


At Friday, March 16, 2018 3:45:00 PM, Blogger Giftbearer said...
Part 2.
Not only did I file an internal complaint with the healthcare system itself, but also a police report, Medical Board grievance, and one with every regulatory agency with jurisdiction all the way up to the Office of Civil Rights! (The GA. Medical Board claimed it lacked jurisdiction over the on-call neurologist who was licensed in this state because he worked for this medical care corporation). Sorry, but in what universe is a doctor not under the jurisdiction of the state that licenses him? I called BS on the guy who told me this but regardless, he stated “the board’s decision” was “final”.

What I was subjected to was in the true sense of the word a hate crime, (because I was a patient, and because it was assumed I was somehow hysterical; a judgment disproportionately meted out onto women) yet the response from every agency was that they base investigations "solely on what's written in the medical record", (by the perpetrator(s), so my grievances, all filed through proper channels, were summarily dismissed with no consequences imposed upon those who committed and colluded to legitimize these acts and proceeded to cover them up.

The healthcare system that went after me as a corporation to cover up the malfeasances of their employees is the largest in Georgia and pretty much controls the entire field of medicine in this state. Almost every "independent" medical practice outside of there either uses their labs, radiology, has done residency there, and/or refer patients back and forth, so I was screwed once they kicked me out as their Chief Medical Officer put in writing "because we are unable to meet your expectations." Yeah, patients don't expect that kind of cruel treatment when they go for medical care, and if being treated humanely is "unreasonable" then what kind of world is this?



 
At Sunday, March 18, 2018 11:06:00 AM, Blogger Maurice Bernstein, M.D. said...

Giftbearer's comments concluded. ..Maurice.

At Friday, March 16, 2018 3:48:00 PM, Blogger Giftbearer said...
Part 3.
Though legal action was not my first choice in how to get these lies removed from my medical record nobody would force them to amend nor remove the libelous statements, so I did look into that. What I ran into was that attorneys either had conflicts-of-interest because they represented them on other issues, or that they felt this was biting off more than they could chew, as the violations span several subspecialties of law and attorneys shied away from such a case because of the lack of (or scarcity of) precedents.

I do have provable damages in that it has caused years of delay in diagnosis and thus treatment for my condition(s) and as a result I am way sicker now, it destroyed previously good doctor patient relationships within that system, the corporation sabotaged the efforts of the last two doctors there who were trying to get me independent evaluations out of state, and then after I went elsewhere it even biased my next GP and a neurologist (after both insisted on my releasing the poisoned records).

A paper trail has been sent to Secretary of Health and Human Services Sylvia Burwell, and another patient and I are now working on getting Congress to provide added protections to patients under the law via this petition; https://www.change.org/p/stop-power-hungry-doctors-from-bullying-gaslighting-and-blacklisting-their-patients

I and others would greatly appreciate if you would share this with all who have been impacted by mistreatment in the medical system. Feel free to add your signatures, and your personal accounts where it says “reason for signing”, and be as specific as possible so that the incidence of various types of abuses can be documented and statistics compiled.

My story is the example featured in the petition. For a more detailed account you can also read the first 8 or so entries in my blog at www.PatientsRightsAdvocate.com

 
At Sunday, March 18, 2018 11:11:00 AM, Blogger Maurice Bernstein, M.D. said...

I have invited Giftbearer to visit our Patien Modesty blog here to more directly describe her approach for medical system change. ..Maurice.

 
At Sunday, March 18, 2018 2:29:00 PM, Anonymous JF said...

If only that had been on a video recording, with the medical staff having no ability to get to it or delete it. As far as the ER doctors looking on? Many people are cowards when that kind of bullying goes on. I'm not excluding myself from that either because I've been guilty as hell also. Could you possibly contact a prosecutor directly? One time a coworker of mine was badly assaulted by a new boyfriend. She had to get surgery because of a head injury. She/her family reported it to the police, but the police just didn't fill out the paperwork. They then contacted the prosecutor and he responded. And it turned out the guy was wanted in FOUR STATES.

 
At Tuesday, March 20, 2018 4:15:00 PM, Anonymous JF said...

Dr Maurice, Thanks for sharing this with us and giving us the opportunity to try to help this lady out. Too many people don't think something like this can happen to them, until it does. This woman's story shocked me. I shared her story on Facebook and will post it every few days for a time.

 
At Wednesday, March 21, 2018 10:06:00 AM, Blogger A. Banterings said...

I am going to change direction a bit here. I am going to revisit the harms that the exams themselves bring. The first is a 2017 article in The Journal of Pediatric Psychology; Disorders of Sex Development: Pediatric Psychology and the Genital Exam. While this article does a good job of pointing out the psychological harms these exams bring upon patients, paternalistic medicine still infects the article with the following (my comments in bold):

...Given that careful genital examinations are often an essential component for establishing an accurate diagnosis, omitting them is not an option.WRONG, WRONG, WRONG!!! OMITTING is always an option. If a condition is documented when younger, there is no need for constant re-examination. Here is an excellent article about this point: Genital examination: when and how? (What I Learned from Jodie)

Objective To provide suggestions for clinical care of youth with disorders of sex development (DSD) and their families... Only a suggestion. If one is told that the extra, inconvenient work is NOT necessary, then it will NOT be done, especially in healthcare.

Youth with DSD and atypical genitalia may undergo extensive and/or recurrent genital exams throughout infancy, childhood, and adolescence, with the potential to enhance feelings of embarrassment, and highlight anxieties. Like being too modest, "feelings of embarrassment" imply that this is somehow the patient's fault.

...with little research attention or clinical discussion thus far involves the subjective perceptions and experiences of youth who have frequent medical and genital exams. They are probably wrong in their feelings, after all, they are not trained professionals.

Interdisciplinary treatment teams are often found in teaching institutions, where patients may be examined by several trainees and/or mid-level providers before seeing the Attending Physician (Crissman et al., 2011). Does this fact really need a citation? Yes, the study was done because providers said this did not happen.

However, this practice can also leave patients vulnerable to feeling dehumanized or even mortified in more extreme scenarios.
Again, the patient's fault for feeling this way. Nothing about the treatment ACTUALLY BEING DEHUMANIZING...


(4) youth can be given control of various aspects of the exam to the extent possible, and encouraged to communicate with providers; (5) children should not be forced to participate in an exam if acute distress is too high; These statements contradict each other. Patients should ALWAYS HAVE CONTROL.

(6) efforts should be made to reduce the possibility of stigma and shame, which may entail asking permission for trainees to be present in a context that encourages a child and parent to deny consent if that is more comfortable, and reducing the number of specialists in the room to only essential participants; That word, "should" again.


HERE ARE GOOD POINTS:

Horner et al. (2009)...The authors conclude that children have a wide variability in anxiety, and that physician report cannot substitute for a child’s self-report. The patient's experience is the only correct answer!

The harms are spot on!


-- Banterings


 
At Wednesday, March 21, 2018 10:25:00 AM, Blogger A. Banterings said...

Next I am going to look at how the issue of genital exams is an issue of Human Rights violation, from the UN addressdelivered via Charles Radcliffe, Chief of the Global Issues Section of the UN High Commissioner of Human Rights.

First let us note:

For example, many intersex children and adults have suffered symptoms of PTSD related to repeated genital exams throughout childhood.

Yet the American Academy of Pediatrics (AAP) is advocating for multiple genital exams for children annually. Source


This paper looks at trauma in healthcare settings as a result of loss of control over one's body: Minimizing pediatric healthcare-induced anxiety and trauma


This paper does not insist that a genital exam must be performed, instead is says that one should be offered... Updated Guidelines for the Medical Assessment and Care of
Children Who May Have Been Sexually Abused



-- Banterings


 
At Wednesday, March 21, 2018 10:42:00 AM, Blogger A. Banterings said...

...and finally, the end of the DRE for CA preventative screening.

Another case of ritual over science.

Digital Rectal Examination for Prostate Cancer Screening in Primary Care: A Systematic Review and Meta-Analysis


CONCLUSION Given the considerable lack of evidence supporting its efficacy, we recommend against routine performance of DRE to screen for prostate cancer in the primary care setting.


-- Banterings


 
At Wednesday, March 21, 2018 10:58:00 AM, Blogger Maurice Bernstein, M.D. said...

Excellent, Banterings. There are so many clinical issues is medicine where those performing the "examination, analysis and treatment" have never themselves experienced so that while some statistics of physical or mental outcomes may be available, those who recommend and those who perform, have never themselves personally experienced and this leads to "routines" of recommendations and actions but no way for those to perform their clinical work with the knowledge from TRUE EMPATHY and all that this lacking personal experience provides. ..Maurice.

 
At Wednesday, March 21, 2018 5:09:00 PM, Anonymous Medical Patient Modesty said...

I wanted to share a recent article about a neurosurgeon in Alaska who took pictures of a male spine surgery patient’s genitals while he was under anesthesia at
http://www.outpatientsurgery.net/newsletter/eweekly/2018/03/20#1
.

This is sad, but the outcome would have been different if the below things had happened:

1.) If he had been put under only local or regional anesthesia and fully awake, I doubt that the surgeon would have taken the pictures if he knew the patient was awake and watching. This is why I advise patients against general anesthesia as much as possible.

2.) This patient should have worn an underwear or a special garment to cover his genitals. The no underwear policy for many surgeries should be abandoned.

3.) If this patient had an advocate such as his wife who was not employed by the hospital present, it is likely the surgeon would not have taken pictures since he would know the advocate was watching him.


I agree with the patient’s lawyer’s comments in this article: “There's no excuse for this kind of behavior," says Mr. Henderson. "When patients are under general anesthesia, they're at their most vulnerable. They have to have confidence that doctors are going to act honorably, professionally and free of any immoral, perverted, or depraved motives or impulses.

Numerous patients under anesthesia have no idea how exposed their private parts might be and what kind of horrible things could happen. I am sure that most medical professionals who misbehave are never caught.

Misty

 
At Wednesday, March 21, 2018 6:36:00 PM, Blogger Biker in Vermont said...

Misty, I am left to wonder is how many times he did this without getting caught, or with the tacit consent of the OR staff that saw him do it.

 
At Wednesday, March 21, 2018 8:46:00 PM, Anonymous Anonymous said...

What’s equally disturbing below that article is the nurse stealing drugs and the plastic surgeon watching porn and violent movies while performing surgery. I’m not surprised, crap like this all happens every day at every medical facility.Ask me how I know.

PT

 
At Thursday, March 22, 2018 4:07:00 AM, Blogger Biker in Vermont said...

The interesting part PT is that other than direct Dr. Kralick to destroy the evidence so as to make any legal proceedings more difficult to prove, the hospital has taken no action against him. He's still in there operating on patients. After the lawsuit is settled I wonder if the hospital will retaliate against the OR staff member that reported him. Their "we take patient privacy seriously" statements are meaningless if no action is taken against offenders.

 
At Thursday, March 22, 2018 2:07:00 PM, Blogger A. Banterings said...

Mr. Henderson released a letter he says his client received from Dr. Kralick on Jan. 5. "Please consider this a letter of apology for inappropriate conduct on my part in the operating room," it reads. "While I did not intend my actions to be disrespectful, I can understand why some members of the operating room staff might have thought otherwise, and as a result I sincerely apologize."

Basically saying"I did nothing wrong," (I am a professional surgeon, I can do nothing wrong...) and :it is the fault of the other people and how they perceived what I did...


-- Banterings


 
At Thursday, March 22, 2018 2:18:00 PM, Anonymous Medical Patient Modesty said...

I agree with your Biker in Vermont’s insights. I bet that he has done this numerous times before and simply was not reported. I also doubt he would do this in front of administrators or medical school professors (if there were any). Many people (including medical professionals) only misbehave under certain circumstances. For example, I still remember how some students in a college class started cheating on their tests as soon as the professor went out of the classroom for a while.

I wonder who reported the surgeon. It would not surprise me if she/he is given a hard time. This is exactly why patients must take precautions to protect themselves. Patients under anesthesia are most vulnerable since they cannot see what things happen.

Misty

 
At Thursday, March 22, 2018 4:04:00 PM, Anonymous Anonymous said...

Not to hijack the modesty part of this but it’s truly staggering the amount of drug diversion that goes on and the cost is passed on to you the patient. Consider that every hospital will have an average of 20-35 Pyxis machines at a cost of 15-20 thousand dollars EACH. That multiply that by the 5000 hospitals in the US. They do not stop nurses from stealing your pain meds. Imagine going to the emergency room for a kidney stone, necrotic bowel, gall bladder attack. You think you have experienced pain, no you have not. Imagine this and not getting pain meds but rather just saline while the nurse pockets your pain meds, happens every day at every facility.

PT

 
At Thursday, March 22, 2018 8:47:00 PM, Blogger Maurice Bernstein, M.D. said...

OK PT, I will take you up on your previous offer: How do you know? ..Maurice.

 
At Thursday, March 22, 2018 10:42:00 PM, Anonymous Anonymous said...

I personally investigated this case


www.cnn.com/2013/12/02/health/new-Hampshire

www.cbsnews.com/news/David-kwiatkowski-traveling

He was sentenced to 39 years in prison. He was just one cog of many cogs who do this every day!

PT

 
At Friday, March 23, 2018 4:40:00 AM, Anonymous JF said...

That would be a good time to have a staff meeting and after the meeting, lie detectors. I know you guys probably think I'm over dramatic but this issue is important to me.

 
At Friday, March 23, 2018 7:13:00 AM, Anonymous Anonymous said...

"OK PT, I will take you up on your previous offer: How do you know? ..Maurice."

Not answering for PT and sharing his desire to not hijack the modesty discussion. It seems that reports like that of the dealing/thieving nurse at the link provided by Misty are too numerous, frequent, and widespread to suffer much from sample selection bias. A formal study may not be needed. Perhaps some medical staff would prefer to steal celebrity medical records but there may not always be a celebrity around. I heard somewhere that a UCLA staffer received a very good bonus from a tabloid publication for a cellphone photo of a deceased Michael Jackson. That may have been a more convenient theft that trying leave the UCLA facility with stolen drugs. REL

 
At Friday, March 23, 2018 9:48:00 AM, Anonymous Anonymous said...

To be employed as a CNA many states only require that you complete the 8th grade. The minimum age is 16 with CNA training being less than 2 months. Any criminal record that you may have won’t matter because juvenile records are sealed and do not show up on background checks. Now, you know boys won’t be hired for such sensitive jobs considering all boys are viewed as juvenile offenders.

For medical assisting positions this can simply be on the job training. Medical assisting certificates can be obtained in as little 3 months. This will allow young women to wear any color scrubs with a stethoscope to visit the popular local coffee shop. Everyone will assume you are a nurse because this is the position you relay yourself as.

At this point you could be on the fast track to an RN position in 10 to 15 years. Provided you get past basic algebra that you missed while obtaining your GED. You will really get attention with that “Have you hugged a nurse today” on the back bumper of your Kia at that point but sadly your “ I’m a sexy nurse scrubs” don’t fit you any more.

PT

 
At Friday, March 23, 2018 10:10:00 AM, Anonymous Medical Patient Modesty said...

PT: Those two links you provided did not work. Can you please recheck and post the right links? Like you, I am not surprised at ways medical professionals misbehave. Frankly, it surprises me more when they are caught because medical professionals often get away with unethical things.

Banterings: Good observations about the letter that Dr. Kralick. I think he is sorry that he was caught.

Misty

 
At Friday, March 23, 2018 12:20:00 PM, Blogger NTT said...

Good Afternoon:

Misty, here's a CNN link to PT's story.

https://www.cnn.com/2013/12/02/health/new-hampshire-hospital-worker-hepatitis-c/index.html

Regards,
NTT

 
At Friday, March 23, 2018 12:28:00 PM, Blogger NTT said...

Hello:

We need more public oversight of the healthcare system.

Not congressional because all they'll do is what the insurance and drug companies tell them to do.

The general public needs to see what these people are doing so they see it's time to put an end to it.

When you have episodes like the Denver 5 & Pittsburgh you call in a panel of non-medical people.

Let everyone present their case. Then let the panel decide the fate of the perpetrators.

It's the only way to get the public involved & let them see for themselves what these so-called professionals are doing.

Regards,
Raffie

 
At Friday, March 23, 2018 1:36:00 PM, Anonymous Anonymous said...

Misty

Just yahoo David Kwiatkowski, traveling tech. There are countless cases on the web like this and we had to call back every patient he came in contact with while he worked in Arizona and offer them HIV testing as well as hep testing as well.

PT

 
At Friday, March 23, 2018 1:47:00 PM, Blogger Biker in Vermont said...

Concerning PT's comments on CNA licensure, in VT and NH you can be licensed as an LNA (Licensed Nursing Assts, our version of CNA's) at age 16. My understanding is hospitals won't hire you until you are 18 but at 16 you can find jobs at nursing homes and the like, so that girl giving Dad a bath that looks like she's 16 may in fact be 16. Not to worry though, she's a professional.

 
At Friday, March 23, 2018 2:40:00 PM, Blogger Maurice Bernstein, M.D. said...

Biker et al: How should the descriptive term "professional" be fully defined? ..Maurice.

 
At Friday, March 23, 2018 3:50:00 PM, Blogger BJTNT said...

The definition of "professional" in the medical community is "employee".
BJTNT

 
At Friday, March 23, 2018 4:12:00 PM, Anonymous Anonymous said...

Maurice

Generally, I’d say a person whose competence can be measured against an established set of standards, perhaps having completed a course study. But then it dosen’t explain why every medical assistant I’ve encountered at Urology clinics don’t know how to take a proper blood pressure.

PT

 
At Friday, March 23, 2018 4:51:00 PM, Blogger Biker in Vermont said...

Dr. Bernstein, there is a vast difference between being a professional and acting in a professional manner. Any and all healthcare workers should be trained to act in a professional manner but only the top tier of healthcare workers who have significant post-grad education are professionals. My beef is that the healthcare system uses the word professional very loosely. I would prefer they be honest and say that the Medical Asst has been trained to act in a professional manner rather than tell me the Medical Asst is a professional.

I have no doubt but that if a patient raised a concern about that 16 year old LNA/CNA giving him a bath that he would be told that she is a professional and as such he should not have any concerns.

 
At Friday, March 23, 2018 7:20:00 PM, Blogger A. Banterings said...

My wife is a MA. She wend back to school for that later in life for a change of careers. She did not work in a setting where patients were exposed, but she was very hands on assisting the doctors.

She often mentioned the immaturity of the other students 15+ years younger than her.She would never assume she has the right, she is one who would ask permission.


-- Banterings


 
At Friday, March 23, 2018 9:09:00 PM, Blogger Maurice Bernstein, M.D. said...

At my medical school we try to teach in the professionalism course the full meaning of what being a "professional" means. Here is an excerpt from the internet description written by the school:

Four ICM groups (24 students) are combined in Year I for the professionalism and practice of medicine component of the course. These students form a learning community in which students participate in a core curriculum guided by two clinical faculty members. Coursework is designed to help students gain skills and competence in the areas of communication, the social and community context of health care, ethical judgment, self-awareness and reflection, self-care and personal growth, professionalism, cultural competence, and lifelong learning. The course emphasizes interactive small-group learning experiences which may include community leaders, faculty-mentored small-group discussions, student presentations and student-led sessions.


Fortunately but also for our school reputation unfortunately two deans of the medical school, one following the other in sequences had to be fired because of their unprofessional behavior.

Yes, it does require an individual who considers themselves a professional to be aware and not ignore unprofessional behavior of others in their profession and do something about it. This is what students are taught. But what happens to this teaching when later this teaching must be applied but in a totally different environment when self-interest is more dominant in a different way than what is experienced by a first year medical student. ..Maurice.

 
At Saturday, March 24, 2018 12:56:00 AM, Anonymous Anonymous said...

My experience with drug diversion cases in hospitals is this, like airplane crashes they tend to come in threes. They seem to occur in different floors of the hospitals at the same time, different nurses and techs. Once a male nurse in scrubs showed up at the hospital and said, “ I’m here from the traveling nurse agency”. Everyone said “ great, we have help”. At the end of his shift he was confronted by security because he would disappear and spend considerable time in the restroom. His pockets were full of syringes, pain meds he never gave the patient. Turns out he was never sent from any agency, he was just a drug seeker off the street with an elaborate plan to steal drugs intended for patients.

My point is this, hospitals are supposed to be considered a safe place but are they? It’s an industry that is supposed to advocate and safeguard the patient and yet year after year the nursing industry claims to be the most trusted profession. You don’t know about all the drug diversion cases that really occur, only the ones that make the news and only the ones that get caught. At a time when you are ill, very ill which is the lowest point in your life cause if you don’t have your health you have nothing, those that you are supposed to trust to help you and advocate for you. To give you the medicine that the physician prescribed to ease your pain, to offer and respect your privacy. We should have the finest healthcare in the world when one in every five dollars in our economy goes to healthcare. Sad!

PT

 
At Saturday, March 24, 2018 4:13:00 AM, Blogger Biker in Vermont said...

Dr. Bernstein, simply being a physician gives one professional status in our society. What you describe is teaching students what the behavioral expectations are that come with that status. Certainly there are physicians and other healthcare professionals who do not act in a professional manner, but the expectations in this regard for those with professional status are rather high.

Though the lower ranks (which represent the majority of staffing) are not professionals by status, they too receive some degree of training in how to act in a professional manner. That training is certainly not as extensive as with your students because the expectations for their behavior is not as high.

Please know that I am not being snobbish here in my thinking as who is a professional and who isn't. I have an MBA and retired as Executive Vice President and Chief Financial Officer where I worked but I don't consider myself to have had professional status in that my role did not require extensive education post-grad nor was I licensed or credentialed in any manner. However I did act in a professional manner as was expected of someone in my position.

My point is that the medical world needs to stop telling us that everyone who works in healthcare is a professional and by virtue of that status patients are expected to be comfortable being exposed to them, even if those so-called professionals aren't providing any actual care.

 
At Saturday, March 24, 2018 9:25:00 AM, Blogger NTT said...

Good Afternoon:

Part of our discussions here have been on how the medical community never really gives us the patient the entire picture when it comes to exams, tests, or procedures.

In my travels around the web, I found this pdf book. Pocket Guide to the Operating Room 3rd edition. Here's the link.

www.bmsu.ac.ir/UserFiles/Pocket%20Guide%20to%20the%20Operating%20Room,%203rd%20Ed.pdf

At least it gives us more info than we get sometimes from some physicians.

Regards,
NTT

 
At Saturday, March 24, 2018 11:15:00 AM, Blogger Maurice Bernstein, M.D. said...

NTT, I haven't read the entire document but I was impressed with this expression in the Preface:
"The reader is encouraged in Chapter
1, and throughout conduction of the surgical procedures in Part 4, to
assess individual needs unique to the surgical patient". I have a feeling that those writing to this thread would want to have the expressed twisted a bit to:
"..to access the needs of the individual unique to their specific surgical patient."

Was my "feeling" valid? ..Maurice.

 
At Sunday, March 25, 2018 4:42:00 AM, Blogger Biker in Vermont said...

Well Dr. Bernstein, that might be how it plays out in reality, but these texts can't really say that.

I did read some of the pre-op/post-op stuff and was glad to see the careful checklists and double checking. What I would have loved to see, but of course didn't, would have been some commentary on the patient's dignity and privacy still being protected after the patient is sedated or anesthesized.

 
At Sunday, March 25, 2018 4:06:00 PM, Anonymous JF said...

I guess I'm kind of different than some of us. I didn't care about my modesty when I was under. I gave consent for med students to be in the room and didn't give any thought to whether they were men or women. Awake I'm conserned about one extra person, under I'm not. There could have been 20 people in the room and I wouldn't care or even know.

 
At Sunday, March 25, 2018 9:06:00 PM, Anonymous Medical Patient Modesty said...

I wanted to share an email I received from a woman who was violated during lung cancer surgery:

I had a lung cancer surgery a year ago. I was totally intimidated by the surgeon and hospital about asking any questions and particularly about no males in the OR. No one cared. I never felt safe and have had nightmares and PTSD since from the trauma I endured. I trusted these people. They did whatever they wanted. I didn't want any males in the OR. I was totally naked. I "took the punishment" because a limited amount of info about the lung cancer was actually explained no matter what I asked and didn't know what to actually do--leave, reschedule, seek other surgeons--for a robotic procedure that few doctors/hospitals perform. I've been in therapy but kick myself to this day that I let them treat me like this. Thank you for listening. Hopefully I'll never have this cancer again and reading your website I NOW know I can ask for what I want without being intimidated. Cindy


This is so sad, but it does not surprise me. It is very common for your wishes to be ignored once you are under anesthesia unless you have a personal advocate that is not employed by the hospital present for your surgery. It is also best to opt for local or regional anesthesia.

I wanted to encourage you all to read this article about the dangers of general anesthesia at https://www.scientificamerican.com/article/hidden-dangers-of-going-under/.

Misty

 
At Sunday, March 25, 2018 9:11:00 PM, Anonymous Medical Patient Modesty said...

Also, check out this article about effects of anesthesia at https://www.asahq.org/whensecondscount/anesthesia-101/effects-of-anesthesia/.

It is actually safer to use local anesthesia and it is also a good way to protect your modesty. Medical professionals will protect your modesty better if you are awake.

Misty

 
At Monday, March 26, 2018 9:14:00 PM, Anonymous JF said...

I just Googled Patient Harm: Why cant I get an attorney. The article talks about, that 9 times out of 10 a patient cant get an attorney to take their case because $50,000 to $150,000 has to be paid first. Do any of you know anything about this? What is that money for? Who gets it and why? Its a deterrent to people getting justice. Is there a real reason for it?

 
At Tuesday, March 27, 2018 1:42:00 AM, Anonymous Anonymous said...

JF

In cases of medical malpractice attorneys work on a contengency fee structure similar to personal injury. Unlike personal injury cases a law office may expend considerable resources investigating a potential malpractice case. The are often many attempts by patients to file frivolous lawsuits against hospitals and physicians and the truth is it is very few real malpractice cases are accepted by law offices on contingency fee. Of all existing tort claims only about 4% are medical malpractice cases, which are a direct result of efforts regarding patient safety etc by medical institutions. Currently, over 75% of all medical malpractice cases result in no win to the patient. Now don’t get me wrong if forceps or a surgical sponge are left in you then yes you have a case and yes I’ve seen a few of those but I think if an attorney asks for a retainer up front then most likely you don’t have a very strong case.

PT

 
At Thursday, March 29, 2018 9:27:00 AM, Blogger Maurice Bernstein, M.D. said...

Returning to the ongoing topic of sexual misbehavior of healthcare providers, I want to bring up (which I am sure I have brought up here previously) of sexual "misbehavior" of patients, both male and female towards their male or female physicians. In August 2007, I put up the topic of "Sexually Seductive Patient: How Should Doctors React?"
Wouldn't you think that most professionals following the American Medical Association's Code of Ethics would be "troubled" by the patient's behavior.

We talk on "Patient Modesty" regarding the unprofessional behavior of professionals or other participants as healthcare providers, but fail to mention that, indeed, possibly as rare as professional misbehavior, patients themselves sexually misbehave toward their physician and this has posed a teaching issue to present to medical students as to how to react to this type of patient behavior. Here is a link to a Medscape article on the subject: https://www.medscape.com/viewarticle/870522(Hopefully, you can read the article, if you desire, without registering to Medscape.) ..Maurice.

 
At Thursday, March 29, 2018 11:43:00 AM, Blogger Biker in Vermont said...

Certainly being sexually inappropriate goes both ways. Patients can be the offenders too.

In the current #metoo era in which the bar for what constitutes harassment continues to fall, we may have lost sight of what harassment or sexually inappropriate behavior is. There is a steady stream of articles written by female medical students, residents, and physicians that use as examples of the sexual harassment they face what are likely to instead be nervous reactions from embarrassed male patients.

One of the primary ways in which men try to hide their embarrassment is by making jokes about their exposure. Female medical students should be taught this is something they will experience and to take it as a sign of embarrassment rather than harassment, and hopefully do whatever they can do to alleviate that embarrassment. While these young doctors and doctors-to-be celebrate women no longer having to see male physicians for intimate matters, many become indignant at suggestions that men might be uncomfortable with them. They don't want to acknowledge some of their patients are deeply embarrassed and uncomfortable, let alone that their inappropriate comments are poor attempts at humor to hide the embarrassment.

 
At Friday, March 30, 2018 3:04:00 PM, Anonymous JF said...

I know of two incidences of patients being inappropriate with their doctors. One friend talked about when her doctor needed to listen to her heart with a stethoscope, she wouldn't wear a bra. The other friend, when she was pregnant and her doctor was doing a pelvic on her and had his finger in her, she bore down. He hadn't asked her to do it. I haven't heard anybody say they were sexually abused by a doctor or a nurse. That being said I have experienced having modesty violations and have heard other friends and family members tell of those kinds of violations. Medical staff make many false assumptions. One false assumption is it's ok to do intimidate care in front of patients family and friends. Another BIG false assumption is since he/she is doing an intimate exam and the patients most private are on display for him/ her, that the patient will think it no big deal if her most private parts are on display for the assistant to, and its ok for the door to be unlocked and no kind of screen or curtain blocking the veiw from people in the hallway. My best friend, when she was pregnant with her first child. Her doctor brought in a group of med students without asking. He did the exam and then said "Next". She said "No!" I guess it doesn't seem like a big deal to medical staff but she could never again go to one of those types of exams again without her boyfriend/husband with her. There are other violations but this is all I want to say right now.

 
At Saturday, March 31, 2018 10:31:00 AM, Blogger Maurice Bernstein, M.D. said...

JF, there is nothing "sexual" in itself with the female patient not wearing a bra during examination of heart or lungs. The absence of a bra is worthy for percussion of the left heart border and for auscultation of the heart sounds (as well as the lung sounds) and ideally each breast should be sequentially uncovered for proper and complete evaluation of both the heart and lungs. A bra in place diminishes the ability to best make these determinations.

With regard to the patient "bearing down" during the pelvic exam, that is the way the examiner can detect by palpation or inspection the prolapse or tendency for prolapse of the bladder, the uterus or rectum.

Thus neither of these actions need be considered sexual with regard to either party but would depend on the parties words or other behavior. ..Maurice.

 
At Saturday, March 31, 2018 6:10:00 PM, Anonymous Medical Patient Modesty said...

It is sad about how surgery patients under anesthesia are so vulnerable to patient modesty violations. Look at this video of a man undergoing a lobectomy at https://www.youtube.com/watch?v=UCOkT_EgJTI. You cannot see his genitals in this video, but it is pretty obvious he is not wearing underwear. Look at the comments from SJ about modesty and underwear at the bottom of the video.

Misty

 
At Saturday, March 31, 2018 9:25:00 PM, Blogger Maurice Bernstein, M.D. said...

Misty, I don't think that link works or the video was taken down.
In any event, I have observed many surgeries in my medical career including those being observed by my medical students and as I may have noted on this thread in the past I have never seen frank disregard for unnecessary genital exposure. What I have seen was genitalia quickly covered if exposed.

There is also perhaps a philosophic or even a realistic definition of patient modesty. I am sure this will raise a few responses here BUT isn't physical modesty a conscious
expression by the individual and if that person is under general anesthesia and unconscious for a period of time and thus unaware, does modesty still exist during that period? Will anyone agree with my functional definition of physical modesty?? ..Maurice.

 
At Saturday, March 31, 2018 9:54:00 PM, Blogger Maurice Bernstein, M.D. said...

Here is a link to a recently published meta-analysis in the Annals of Family Medicine regarding the value of prostate cancer screening of digital rectal examination in primary care:

http://www.annfammed.org/content/16/2/149.full

"CONCLUSION Given the considerable lack of evidence supporting its efficacy, we recommend against routine performance of DRE to screen for prostate cancer in the primary care setting."

..Maurice.

 
At Sunday, April 01, 2018 7:27:00 AM, Blogger BJTNT said...

Cut and paste of the following works.
https://www.youtube.com/watch?v=UCOkT_EgJTI

"There is also perhaps a philosophic or even a realistic definition of patient modesty. I am sure this will raise a few responses here BUT isn't physical modesty a conscious
expression by the individual and if that person is under general anesthesia and unconscious for a period of time and thus unaware, does modesty still exist during that period?"

With the above definition, the number of general anesthesias for dental procedures will greatly increase. Use your imagination for all the other procedures that will require general anesthesia.
BJTNT

 
At Sunday, April 01, 2018 9:23:00 AM, Blogger Maurice Bernstein, M.D. said...

Biker, resubmit your last posting. I received a stream of ??? interposed with numerous random letter text. I never have seen such display previously. ..Maurice.

 
At Sunday, April 01, 2018 9:32:00 AM, Anonymous Anonymous said...

"CONCLUSION Given the considerable lack of evidence supporting its efficacy, we recommend against routine performance of DRE to screen for prostate cancer in the primary care setting."

Gee, is there anything else going on in primary care for which there is limited data for support?

(1) Why wasn't the efficacy of this primary care procedure researched decades ago before it was implemented?

(2) I'd be willing to bet that the conclusion won't change practice. Physicians will justify continuing on by saying that "in my experience . . ." which is another way of saying we don't need medical research.

REL

 
At Sunday, April 01, 2018 9:56:00 AM, Anonymous Medical Patient Modesty said...

Dr. Bernstein,

Let me respond to the below comments:

I am sure this will raise a few responses here BUT isn't physical modesty a conscious expression by the individual and if that person is under general anesthesia and unconscious for a period of time and thus unaware, does modesty still exist during that period?



Even if the genitals are exposed for a minute, it still matters to many people especially those who do not want the person of the opposite sex to see their private parts briefly. Many patients care about their modesty even when they are under anesthesia. What about this other scenario: How would a man who was sleeping feel about multiple people coming in to see him naked while he was asleep? How is that different from medical settings?

Also, the argument that nothing matters when you are under anesthesia would mean that all crimes committed while someone is attacked while unconscious such as with date rape drugs, would not matter either because the victim was unaware of what happened. The arguments are, if carried out to their logical conclusions, ridiculous.

Misty

 
At Sunday, April 01, 2018 10:44:00 AM, Blogger Biker in Vermont said...

Dr. Bernstein, my internet connection was acting up earlier. Life in the countryside.

Certainly many people don't care about their exposure once they are unconscious or sedated. Some do because that is when they can't advocate for or otherwise protect themselves. If a patient has had a prior bad experience they may go into such an encounter apprehensive about what might happen once they are out.

Last year I had a procedure for which patients are always sedated, except I refused sedation. One of the nurses commented that I was so cute, that she wished I was sedated. The only difference between sedated and non-sedated was I'd of been naked under the gown if I was sedated. Not sedated I had only removed my shirt. I can only think of one reason why she'd of preferred her "cute" patient was sedated.

Back when I had my initial bladder cancer surgery, just seconds before she put me under to begin the prep, the OR nurse tells me in a decidedly sexual manner that she was going to get to know me very well. This surgery is done via the penis so the prep is very up close and personal as as the clean up afterwards and inserting a catheter after the surgery. I still wonder what she may have done or said once I was out and she could remove my gown.

I am not saying those two represent the norm. I'm sure they don't but the fact that I encountered nurses like that twice when sedation was an issue will forever more make me nervous when being put under. I would like to think that others in the room would protect me but my guess is that nobody would because I'm unconscious and will never know.



 
At Sunday, April 01, 2018 11:11:00 AM, Blogger Biker in Vermont said...

I looked at the YouTube and didn't see anything wrong with the manner in which the patient was handled. He was covered while they were working on his head. The subsequent positioning and strapping down of his body can't be done while keeping him covered up. They were moving quickly to get him ready and then he was draped once the positioning and strapping was complete. Nobody was focusing on his genitals or otherwise being inappropriate.

I accept that with surgery comes some exposure. My concern only comes from knowing that sometimes there may be staff that are enjoying their job for all the wrong reasons. That I am unconscious does not make it easier to accept.


 
At Sunday, April 01, 2018 2:38:00 PM, Blogger Maurice Bernstein, M.D. said...

I agree with Biker's evaluation of the video. I saw no behavior suggesting sexual intent, behavior or interest in any part of the body except the respiratory system and maintaining cardio-vascular function.

If anyone assigned to provide care to a patient behaves or implies some sexual interest in any way that is unprofessional, inappropriate or just plain upsetting to the patient should be notified at once and ordered by the patient to leave and the patient should yell for help. I would say, beyond "speaking up", I would advise to "yell up". Inappropriate sexual behavior within a professional setting is potentially a crime until proven otherwise.
And, yes, there is no place, no role for a physician, nurse or other healthcare provider to speak or act in a sexual manner. Patients do not come to a physician or undergo procedures or surgery for a sexual experience for themselves or for any others. ..Maurice.

 
At Monday, April 02, 2018 7:27:00 AM, Anonymous Anonymous said...

Biker in Vermont

For a nurse to tell her patient he is cute and/or telling a patient in a decidedly sexual manner she is going to get to know you very well is considered by Boards of nursing sexual misconduct. What could have transpired was that you call a time out, ask to speak with the director and let the director know what the nurse said. This is exactly what you say to the director “ I want a nurse who is going to treat and speak to me in a professional manner and if you as a director cannot ensure that, then I will complain to the state nursing board and I will give them your name and the name of the nurse who spoke to me in an unprofessional manner. I will then let administration know how I was treated.”

I can assure you if you were a male nurse and spoke like that to a female patient your job as a nurse would end that day and your nursing license would be revoked or suspended within a week. I think any nurse male or female is a super duper idiot to refer to their patients as anything other than ma’m , sir or by their first name. Furthermore, when you let them refer to you like that don’t expect any sympathy from me on this blog.

PT

 
At Monday, April 02, 2018 12:24:00 PM, Anonymous Medical Patient Modesty said...

Even if there is a 100 percent guarantee that there is no sexual misconduct in the cases of unconscious patients being naked for surgery, there is another issue that is important. It is ridiculous for patients under anesthesia to not be able to wear 100 percent underwear or disposable underwear for surgeries that do not involve their genitals. This man’s genitals should have never been exposed even for a few seconds since they only needed to operate on his chest where the lungs are. We need to end Operating Room traditions such as underwear removal for surgeries that do not involve genitals. Urinary catheters should not be inserted in most surgery patients unless the surgeries take longer than a few hours. Also, if an urinary catheter has to be inserted, the patient should be given the option of being awake for this urinary catheter insertion so she/he can make sure that a medical professional of the same gender does it. Also, a patient who requires an urinary catheter can wear depends or disposable underwear to cover her/his private parts.

The truth is it is harder for a medical professional to sexually abuse a patient if he/she has their genitals completely covered. For example, I think Dr. Sparks would have had a harder time abusing those male patients if they had been wearing shorts and/or underwear. There is no reason for ENT surgery patients to not be able to wear underwear and/or shorts for ENT surgeries.

Check out this great article about OR traditions that need to be abandoned. Especially look at Patient Personal Clothing section.

I agree with this bold statement in the article:


Brown12 describes the ritual of making patients coming to the operating theatre remove their underwear as the “most illogical of rituals”. It is still practised in many surgical units and should be stopped for the good reason that it causes embarrassment to the patient and serves no useful purpose.


Misty

 
At Monday, April 02, 2018 3:50:00 PM, Anonymous Anonymous said...

Referring to your response to Misty on 3/ 31-"I have never seen frank disregard for unnecessary genital exposure. What I have seen was genitalia quickly covered if exposed." I am a board-certified OB/Gyn and have performed many surgeries and procedures where patients were sedated or under general anesthesia. They were all treated with great respect, uncovered just long enough to prep them, and immediately covered. So I would agree with your statement quoted above in my PROFESSIONAL experience. However, one personal experience was significantly different. The endoscopy tech left me uncovered with the foot of the stretcher close to and in direct line with the open doorway, yelled at me when I tried to cover myself despite the fact that I was having an endoscopy first. Made me stay like that even when a male tech walked into the room able to see my exposed bottom and genitalia, while they continued to talk standing next to my exposed bottom. I rolled partly to my right just a little to try to obscure the view, so as not to further incur the tech's wrath, to try to obscure the view, knowing this was not acceptable standard of care. Finally she let me be covered. I wrote to and met with the head nurse, explaining my concern that if she treated me this way knowing I am an MD, then she likely would treat others similarly. She and my doctor assured me they would make changes and this would not happen in the future. This last experience at the same hospital was completely different and was treated kindly with great preservation of my privacy. I wrote all of the nurses involved in my care and my doctor letting them know what a positive experience I had this time. So since there were multiple changes from my other experience, I like to think perhaps I made a difference for other patients too. Most of us in medicine take great care to preserve the dignity and privacy of our patients. DB

 
At Monday, April 02, 2018 4:10:00 PM, Blogger NTT said...

Good Evening:

Misty,

In a perfect world, men & women would be allowed to wear a pair of boxer shorts backwards and get their colonoscopy whereby the AMA could reach their goals of getting more people tested.

In a perfect world, men & women would be allowed to keep their underwear on during short surgeries where the genital area is not involved whereby the AMA would see more people taking better care of themselves.

In a perfect world, when gender specific intimate issues are present, same gender teams would automatically be assigned to the patient from the start until discharge whereby the AMA would see people not putting off needed tests & surgeries.

In a perfect world, a man who needed gender specific intimate care for issues like PCa or BPH could walk into any medical institution then request and get same gender care without any hassle from anyone at the facility whereby the AMA would see a sharp uptick in men taking better care of their health & living longer.

Problem is we don't have a perfect world.

The American Medical Association is so into itself that it has it's head buried so deep down in the sand that a 10.0 earthquake wouldn't shake the cobwebs loose enough for them to start seeing the light.

Until someone with power decides it's time for the AMA to change & start listening to the people it is supposed to be serving, NOTHING WILL CHANGE.

We are and will continue to chip at the wall but we need an earthquake to help shake the wall enough that it comes tumbling down and the AMA head is dug out of the sand & they work with the public they are supposed to be serving.

Regards,
NTT

 
At Monday, April 02, 2018 4:58:00 PM, Blogger Biker in Vermont said...

Dr. DB, thank you for sharing your experience and for speaking up as you did. It is how incremental changes get made one hospital at a time. Many other patients have benefited from it.

 
At Monday, April 02, 2018 7:25:00 PM, Anonymous Anonymous said...

DB

I have to say of the 25 hospitals that I have ever worked at The L&D suite has their own surgical suite, separate from the main OR. Thus
any exposure is irrelevant since the all female team in L&D also assists in the L&D surgical suite. Additionally, most surgical procedures in those suites are C-sections, therefore appropriate draping is always done so absolutely, all patients in those suites receive respectful care.

The patients are female as is the surgical nursing staff. Now in your case you stepped out of your comfort zone, welcome to our world where no one it seemed to provide you respectful care, how does that make you feel? Does it change your perspective? Now what I will tell you is that from a privacy perspective L&D patients do receive that indeed.

But don’t be fooled by that professional propaganda, L&D nurses can be very judgmental particularly when their L&D patients are very obese and comments range from “ Asian women drop those babies and are back to work the next day, but those Hispanic women are here for weeks after they drop those kids.” And don’t ya know most nurses working in the hospital prefer to have their deliveries elsewhere just to avoid the personal gossip.

PT

 
At Monday, April 02, 2018 10:28:00 PM, Anonymous Anonymous said...

DB

Wait a minute..Wait a minute. Are you telling us that you were trying to cover, obscure your exposed bottom from staff, do you not think for a moment that maybe, just maybe it’s a body part just like an elbow, that’s how your bottom is viewed, like an elbow. They are after all professionals and would never think anything different. Have you digressed to the point of being just one of us “outliers”.

What has happened to you, did you read all 85 volumes and when you went for your endoscopy did you choose a hospital or clinic that you work at or like most nurses decide to go somewhere that no one knows you, Why?

PT

 
At Monday, April 02, 2018 11:26:00 PM, Anonymous Medical Patient Modesty said...

DB,

Are you female or male? What state do you practice in?

Misty

 
At Tuesday, April 03, 2018 8:17:00 AM, Blogger Maurice Bernstein, M.D. said...

Not much humor on this blog thread. Here is a humorous snippet I received yesterday which I think discloses a rational explanation for the patient not to be wearing his underwear in the operating room. Enjoy. ..Maurice.

An old man goes to the doctor for his yearly physical, his wife tagging along. When the doctor enters the examination room, he tells the old man, “I need a urine sample, a stool sample and a sperm sample.”

The old man, being hard of hearing, looks at his wife and yells: “WHAT?”

“What did he say? What’s he want?”

His wife yells back, “He needs your underwear.”

 
At Tuesday, April 03, 2018 11:15:00 AM, Blogger Biker in Vermont said...

I liked that one Dr. Bernstein. Sometimes laughter is the best medicine.

 
At Tuesday, April 03, 2018 3:45:00 PM, Blogger Maurice Bernstein, M.D. said...

Biker, yes it is amusing but I included the story in this discussion because it is a valid explanation of the basis of not allowing the patient's underwear to be part of the surgical coverings: potential surgical dirt. ..Maurice.

 
At Tuesday, April 03, 2018 5:50:00 PM, Anonymous JF said...

The solution to that would be to wear a disposable pull up.

 
At Tuesday, April 03, 2018 5:53:00 PM, Anonymous Anonymous said...

Hello,

Covr Medical (covrmedical.com) is offering a garment to cover the genital area during surgery. Medical personnel posters, would you please comment on the potential for leaving this garment on during hip arthroplasty. Is there a sterile field consideration?

Reginald

 
At Tuesday, April 03, 2018 6:03:00 PM, Blogger Dany said...

I want to express my thanks and interest to the poster "DB" for taking the time to make his/her post here. It's not every day we see actual doctor (let's assume the credentials are true) visiting this little corner of the web.

DB, if you haven't done so already, take some times to familiarize yourself with some of the previous volumes. You will find quite a lot of harrowing experiences - sometimes traumatizing - and witness accounts of unprofessional conducts. It has left many here with a deep sense of distrust and, in some cases, anger directed at many healthcare professionals.

The personal experience you related might have been an eye opener for you; but I can assure you, this stuff happens a lot more than you would be inclined to believe.

I hope you will continue to participate in this blog; I think you may have some valuable insights to provide.

Dany

 
At Tuesday, April 03, 2018 7:04:00 PM, Blogger Dany said...

Dr. Bernstein,

Regarding the wearing of underwear for surgery, I am not sure I am buying the idea that it is solely for sterile/clean requirements. Admittedly, this would apply if some situations, say emergency surgeries, but scheduled ones? Unless the operating area is right next to the groin, I fail to see how removing the underwear decreases the risk of contamination.

(And if someone is going to tell me that germs/bacteria/microbes are going travel from the groin all the way up to, say, the upper torso or the head, I want to hire these germs! They'll go places.)

Another reason I often heard to justify this is because modern surgeries involves the use of self-cauterizing scalpels. This necessitate the use of a grounding pad attached to the body (you don't see that; it's done after they put you to sleep). If the underwear are made of synthetic material, this might become a safety issue (Melting? Fire??). But this is why we have all natural fibers such as cotton.

Part of my upbringing is an ingrained habit drilled by my mother of making sure I am "squeaky clean" before going to the hospital or when going to see a doctor, any doctor. I feel a bit silly to state this but it also includes clean underwear. It's a habit I still follow to this day for all scheduled medical appointments.

I recall a minor injury I suffered when I was a teenager. The exact circumstances aren't that important but I ended up with a shallow cut just above one knee that needed having to go to the hospital to get sutures. Despite having a bleeding wound (not profusely, I wasn't bleeding out or anything), my mother still insisted I jump in the shower and get clean (admittedly I was filthy for having been outside most of the day) before we left for the hospital. She did get a scolding from the doctor about that, but she wasn't about to let her son show up in the ED all dirty.

This incident also brought me face to face with a modesty/dignity struggle as the nurse who received(?) me after the triage insisted I removed my shorts to allow the doctor to work on the wound. But I was having none of that, much to the exasperation and growing anger of said nurse. I was adamant about not removing them. When the doctor came in, she said that I could keep them on, that it was fine, she had enough room to work with (or something to that effect). I felt instantly better about the whole ordeal but if the look the nurse gave me could have killed, I would have flat lined right then and there.

It goes to show it pays off to be stubborn at times...

Dany

 
At Tuesday, April 03, 2018 7:05:00 PM, Anonymous Anonymous said...

Regarding medical jokes, ever notice it’s always the male patient that is the brunt of the joke. If it’s not the penis joke it’s the prostate joke or the happy nurses week joke “ I’ve seen more penis than a prostitute” . The medical jokes are countless but they always include the male patient.

I once knew a physician who gave a seminar on pripraism. A persistent and painful long lasting erection. Among the crowd were physicians and nurses. Laughter came from the crowd when pripriasm was announced as the subject matter. Those that laughed perhaps don’t realize that the condition can be fatal, but who cares right since it only involves male patients.

This blog involves a subject matter that is deep rooted in discrimination, misandry, sexual impropriety and unethical behavior. If any of you are ever at a medical seminar and the condition involves a female disease, laugh out loud when the subject matter is mentioned. I assure you they will probably show you the door.

PT

 
At Tuesday, April 03, 2018 8:00:00 PM, Anonymous Anonymous said...

"valid explanation" Really?
There's a study showing that male patients in for shoulder surgery experienced more complications if they were wearing underwear pants? Please share a link. REL

 
At Tuesday, April 03, 2018 10:39:00 PM, Anonymous JF said...

PT, Why do you want to say something like that to DB? He/she said that they protected their patients modesty. Genitalia and bottom facing the door? REALLY? Somebody needs fired, for starters. Private parts being like elbows doesn't fly with me.

 
At Wednesday, April 04, 2018 4:08:00 AM, Blogger Biker in Vermont said...

Dany, considering the fact that most patients are older and/or not prime examples of humanity, healthy teenage boys are going to be a treat for some staff. That is likely why the nurse was so insistent.

A couple years ago, my PCP sent me to the ER to get a head scan. I just ignored the "everything off" instructions and left my underwear on. Nobody said anything, but then again I'm way past my prime. A couple days later I got a courtesy call to see how I was doing. I politely pointed out that a patient should be told why they're being told to undress when it isn't otherwise obvious (why undress for a head scan?) and that it was rude for the doctor to walk in with a scribe without introducing her. I pointed out that had I been undressed it would have been uncomfortable having her just walk in the room unannounced.

My mother must have known yours. Her checks as to whether my brothers and I had showered and put on clean underwear always included the admonition "what if you're in an accident and go to the hospital". As a little kid I thought they wouldn't let you in the hospital if you hadn't put on clean underwear that morning.

 
At Wednesday, April 04, 2018 10:47:00 AM, Blogger NTT said...

Good Afternoon Everyone:

Reginald, Covr Medical has the right idea. The founder is a surgeon at Mayo Clinic in MN.

He has an uphill battle on his hands to get the product into the facilities due to the fact that the majority of his colleagues don't believe in patient modesty. Even when payments from the gov. are involved.

The nice thing about that garment is once it's on, if it isn't soiled it can stay on for up to 24 hours. So if you are going in for say day surgery, you could conceivably put it on when you change into their frilly gown then take it off when you get home since its disposable.

Regards
NTT

 
At Wednesday, April 04, 2018 4:51:00 PM, Anonymous Anonymous said...

JF

I’ve gathered that DB is female, but it’s irrelevant actually. In L&D protecting those patients privacy/modesty is not a priority after all what is there to protect. If you read my comments you would understand that. Now it seems that no one in healthcare ever is really keen or intent on ensuring their patient’s privacy but I find it amusing that when their privacy/modesty is affected then there is concern. But, you’ve heard or read the comments, a penis or breast is just like looking at an elbow! So why should she be concerned, a bottom or her genitalia is just like looking at an elbow, or is it.

So here is the experiment, when you get out of the shower in the morning flex your arms in front of your chest. Adduct both elbows toward the center of your body or more technically the mid-sagittal plane. Do this in front of the mirror, now compare the elbows with your genitals, do they look the same?

PT

 
At Friday, April 06, 2018 9:03:00 AM, Anonymous JF said...

PT, That's funny. But I don't think ALL medical staff is guilty of violating patients modesty. According to DB, they quickly covered up patients after they did what they needed to do. Where any doors opened at wrong moments? Was their any person present who didn't need to be there, or did any person see something they didn't need to see? Your anger seems to be at ALL female Healthcare workers, but we're not all guilty.

 
At Friday, April 06, 2018 9:18:00 AM, Blogger Maurice Bernstein, M.D. said...

Considering all the terrible behavior of healthcare providers described on this blog thread, could there be an explanation for some cases that there is drug or alcohol use and addiction which releases this behavior?

I requested my current 6 first year medical students to read my 2014 blog thread "Drug Screening of Physicians..." and then write about the issue both in terms of physicians themselves but also the role of drug use by medical students.

You might want to contribute to the discussion on that thread or enter your comments here about the role of drug use by healthcare providers as an "excuse" for their described misbehavior. ..Maurice.

 
At Friday, April 06, 2018 9:23:00 AM, Blogger Maurice Bernstein, M.D. said...

I thought all those responses by my students was appropriate for that blog thread and so I published them there. Reading them might give you a little insight about the way current students evaluate the issue both regard to physicians and some comments about themselves. ..Maurice.

 
At Friday, April 06, 2018 12:50:00 PM, Blogger NTT said...

Dr. Bernstein drugs and alcohol might be a small percentage of the problem.

The nursing field has two big problems.

First problem is you have people going into the field that aren’t really going into it because they care about the sick or want to help advance the human condition.

They entered the field for the paycheck and the perception that as nurses and/or nurses assistants they’d have power over their patient.

These are the individuals telling their patient to strip that there’s no modesty here while they stay around & peak. These are the people that leave patients unnecessarily exposed for no reason. These are the people with the cell phones taking illegal pictures of patient’s privates.

So, you have this dark side of the field that nobody in the medical community wants to put an end to and try restoring the reputation of the nurse to what it should be. By not addressing the issue, the patient in the one that suffers for it.

Then you have the second problem which is you have people that joined the field because they truly care about people, want to advance the human condition, and want to really try and make a difference during their career.

The pressures for these people come from their senior management where they work and their colleagues. These individuals signed up for the right reasons and have dedicated their careers to advancing the field and caring for the sick. They are usually about 35 or older.

They have to compete with today’s generation of medical people. They’re the gime gime generation. What can you do for me, not what can I do for you. They just got their degree and they already know it all’s.

In-fighting between nurses and the pressures put on them from senior management to do more with less is causing such a stressful environment at work that they have begun taking their frustrations out on the patients although in their case it’s not done in malice.

The nursing field has their heads buried deep in the sand or they’d realize they have a resource that see’s the pressures they are under and if this resource were to be treated with respect and a little kindness, they would have an ally that would go to bat for them if asked and speak their mind to management about the way they treat their employees.

Treating people with respect & a little kindness no matter how bad a day you’re having always pays dividends.

The industry needs to create civilian oversight boards. Board members would be from the local community and would serve a 6 month to a year term. The sole purpose of these boards would be to make a final decision as to what happens when an employee violates a patient.

We’ve seen from experience when you leave these decisions in the hands of the medical community more times than not, the offender gets paid time off and a slap on the wrist.

The ship is sinking and patients are drowning.

It’s time to plug the holes & right the ship again.

Regards,
NTT

 
At Friday, April 06, 2018 1:40:00 PM, Anonymous Anonymous said...

JF

There is nothing within the medical literature either for nursing, medical assisting, cna etc. that says male patients are not modest. Yet, all male patients are treated as if they are not modest, their physical privacy is not respected. It is stated withinn the parameters of the state boards of nursing that such behavior is considered unethical and falls under sexual misconduct. So, you are suggesting that not all female medical staff are guilty of this. I’m suggesting that all female medical staff are guilty of this by not following the literature in their coursework and training ( for those who did go to school) but rather just assuming male patients are not afforded privacy for whatever reasons be it perverted or just sheer ignorance.

PT

 
At Friday, April 06, 2018 2:19:00 PM, Anonymous Anonymous said...

Maurice

I believe the biggest threat to patient safety, well being and recovery involves drug diversion and abuse by nursing staff. I’ve never known a physician to steal the patient’s meds. a) they just don’t have access b) they could write their own script. That’s not to say physicians don’t become impaired as I’ve known many who were in that alcohol tends to be their biggest downfall.

PT

 
At Friday, April 06, 2018 4:03:00 PM, Blogger Biker in Vermont said...

PT, concerning your response to JF, what is it in the literature that female staff aren't doing? The majority behave in a respectful and professional manner and are simply doing the job they were hired to do. That many men would prefer male staff for certain procedures is a totally separate matter. It is not reasonable to expect female staff to quit their jobs rather than do the tasks they have been trained and hired to do.

Yes we can fault that minority of female staff that behave inappropriately or that needlessly expose us, but we can't fault the majority who do their job in a respectful and professional manner simply because we're uncomfortable or embarrassed. The people who should be faulted for the lack of male staff are those who make the hiring decisions, the schools for their lack of recruitment efforts to bring men into the field, and the regulators who turn a blind eye to gender equity for men. Those are the ones to blame.

 
At Friday, April 06, 2018 5:19:00 PM, Anonymous JF said...

I don't think drug and alcohol abuse has anything to do with it. I think that possibly some of it was and is done with pure motives. The teenage boy who had a gash under his knee, MAYBE hospital staff want patients to depants to see if their is other evidence of ABUSE! Do I think that that's the motives are always pure? No, absolutely not. But even when the motives are pure, the Healthcare workers are not taking into account that patients may avoid care in the future because of it.

 
At Friday, April 06, 2018 7:20:00 PM, Anonymous Anonymous said...

Biker in Vermont

Over these 85 volumes I have categorically listed the vast shortcomings of nursing in regards to male patient privacy. I should say unprofessional conduct. No, the majority do not behave in a professional manner, I’m going to say with absolute certainty that every female nurse is guilty of unprofessional behavior which I’ve seen played out for 40 years. What more do I need to say regarding this? I guess after 85 volumes many on this blog just don’t get it and for the most part if you’ve never worked in healthcare you can’t get a full grasp on the problem.

PT

 
At Saturday, April 07, 2018 4:25:00 AM, Blogger Biker in Vermont said...

PT, no I haven't worked in healthcare but I've been an intimately exposed patient far more than most people. With a few exceptions that have caused me to now avoid female staff and physicians where and as I can, there is nothing I can point to that most of them did wrong. That I'd of been more comfortable with male staff doesn't mean that the females were inappropriate in how they went about their job.

What I don't know and will cede to you and others who work in healthcare is whether behind the scenes any of those females who were totally appropriate in my presence chose to then gossip about me or if they enjoyed their interaction with me in ways they shouldn't have.

I have been frequently hit on since was I was 15 years old in social and work settings and a couple times in healthcare settings too, so maybe I've been the guy being talked about. In social and work settings I mastered at a young age the art of gentle deflection, but the power imbalance in medical settings makes it a bit tougher there. That power imbalance is a piece of why I avoid female staff if I can.

 
At Saturday, April 07, 2018 4:34:00 AM, Anonymous JF said...

So PT. EVERY female doctor, PA,nurse and CNA is guilty of not pulling curtains, leaving doors open, or just opening them at wrong moments ( there should also be curtains blocking doors ) It isn't true! It's true that many are, some who even seem good and likable otherwise. In my opinion, one person seeing a patient naked, that doesn't need to see patient naked is one person too many. Or just seeing more of that patients body, that's bad to. What about the male staff PT? If you have all male staff, is it then gonna be OK that they expose your naked body to your daughter/ son who happens to be in the room? Or your sister or niece? If one leaves the room and there's no curtain blocking the door, are you OK that the 16 year old patient visitor and her brother get a veiw of your nude body? How about if your buddy and his wife are visiting? And NO! Im not saying all female staff will do all those things to you because we wont. Im just saying same sex care is just a partial solution. As long as they claim to viewing our private parts like viewing elbows it CONTINUES!

 
At Saturday, April 07, 2018 8:16:00 AM, Anonymous Anonymous said...

JF

Yes, that’s correct, every Physician, male or female , nurse, cna,tech, respiratory tech,x-ray, lab etc all and I mean all at one time or frequently will in some way violate the privacy of patients. They may be their patients or not, so yes that’s what I said!

PT

 
At Saturday, April 07, 2018 12:06:00 PM, Anonymous Medical Patient Modesty said...

I wanted to let everyone know that I just put up a new article, Unnecessary Underwear Removal for Surgeries on Medical Patient Modesty's web site.

There is a sample petition at the bottom of the article that you can download in Word. I think it would be nice if some people could start a petition at their local hospital to abandon this ridiculous no underwear policy.

Misty

 
At Sunday, April 08, 2018 12:17:00 AM, Anonymous Anonymous said...

Misty

Did you know that according to the 1964 General Surgeons report on smoking that there are 7000 chemicals in a cigarette of which 69 of those chemicals are known to cause cancer. Now those women who work in surgery need to take their cigarette breaks and so therefore numerous times a day they will go outside in those scrubs and return to surgery bringing in all kinds of debris and particulates of which many will land in your open wound. But, no those underwear must come off and it’s not a hospital policy at all, it’s their policy. They make the rules, it’s not about you it’s all about them. Now there was only one case I recall regarding an illegal immigrant who had not had a shower for so long that his underwear basically was literally in pieces. The surgery nurses were so grossed out that they decided to just let him keep them on. So there you have it, that’s one way to keep your underwear on.

PT

 
At Sunday, April 08, 2018 4:37:00 AM, Anonymous Anonymous said...

Misty

I’m going to give you reason why hospitals make everyone remove their underwear, but first a little bit of history is required. Every department in a hospital has policy books. That’s the first thing the Joint Commission looks at when they inspect a hospital. The policies must be dated, reviewed and signed off by the department head. For example, radiology will have a policy on how a finger is to be x-rayed or how a Nuclear Medicine Brain death exam is to be performed.

Visit the security department and there is a policy on what to do for a code grey ( combative person) what to do in a code silver ( person with a gun). Visit the EVS department ( housekeeping) there you will find policies on which disenfectant is to be used in restrooms. Visit the lab and you will find policies on how biopsy samples are to be handled or how a bmp ( basic metabolic panel) is to be performed.

Visit the surgery department and there you will find their policy books and there is NO POLICY that says specifically that all patients must have their underwear removed. Now, I have to say that many patients are just non-compliant. You can give them instructions 10 times and many still can’t follow them. Historically, for patients that were having their gall bladder removed or a hysterectomy or a urological procedure these stupid patients would be wheeled back to surgery and low and behold, they were told to remove their underclothing and they did not.

Therefore to resolve this issue nursing just said OK, let’s do a KNEE-JERK reaction and tell everybody to remove their underwear. So there you have it. Surgery departments make everyone remove their underwear because of all the past STUPID PATIENTS WHO CANT FOLLOW SIMPLE INSTRUCTIONS, AND NURSING MAKING STUPID KNEE-JERK REACTIONS.

THERE IS NO POLICY AT ANY HOSPITAL THAT SAYS IN SURGERY ALL PATIENTS MUST REMOVE THEIR UNDERWEAR!!!

FURTHERMORE UNDERWEAR DOES NOT POSE A THREAT TO POST-OP SURGICAL INFECTION RATE. WHY? Because the patient is wearing a gown over their underwear and thus debris and particulates cannot travel via airborne.

Post-op surgical infection rates are a result of nursing not washing their hands, surgical instruments not fully disinfected, excessive foot travel in the OR, surgical staff not changing scrubs each time they leave the department and a bevy of other reasons.


PT

 
At Sunday, April 08, 2018 1:31:00 PM, Blogger NTT said...

Good Afternoon:

PT,AB would it be to our benefit to start a letter writing campaign to the JC on how they must change the way the medical community handles male intimate care needs? If so, who do we write to?

We're just chipping at a door that needs a hole blown through it so we can get our foot in and get people to talk to us about the issue and work on answers that both sides can agree on.

Talking & writing to congress hasn't produced any results so far.

We must find a way to get them to come to the table and talk about this. Too many guys are walking away from needed healthcare because of their pigheadedness.

Thanks guys.

Regards,
NTT

 
At Sunday, April 08, 2018 2:04:00 PM, Blogger BJTNT said...

PT
Thanks so much for your postings. I know why I discard most of my draft responses - it's because yours are so much better. There are many attributes to describe the medical community including greed, integrity [lack thereof], violation of modesty, etc., but the one that bothers me most is "sanitation is perfunctory" because it could be addressed with continuous training and an administration that would insist supervisors enforce sanitation. The administration will never address integrity, modesty, etc. other than with pretense in their marketing campaigns, but sanitation - why not?

It's a strange world. It's national news when several customers become sick due to poor sanitation in the fast food industry, but thousands of patients die each year because of poor sanitation in the medical community and it only occasionally rates a ripple in the mass media.
BJTNT

 
At Sunday, April 08, 2018 2:11:00 PM, Anonymous Anonymous said...

NTT

As I’ve mentioned in the past the Joint Commission is not a regulatory agency. Hospitals pay them many thousands of dollars a year to have their seal of approval. It’s like owning a restaurant and having on the window Martha Stewart ate here and loves the food. The only thing the Joint Commission cares about are donuts and lots of them or other small enticing little treats. They couldn’t care less about the privacy of the patients. I have spent hundreds and hundreds of hours preparing for their stupid little inspections, horsey and pony show. Many of them are clueless about anything. Try making a complaint with them, you will be given a 20 digit number that goes into a black hole.

PT

 
At Sunday, April 08, 2018 2:14:00 PM, Blogger Maurice Bernstein, M.D. said...

I fully agree with NTT. The Joint Commission bearing down on this issue is probably the only way to get attention and action by the medical institutions involved. Once they are challenged by the JC, I think the corrected attention and behavior of the healthcare providers will filter down to clinics and doctor's offices. I disagree that the JC is simply some money making organization. I know that hospitals keep putting pressure on their physicians and staff regarding actions and behaviors with regard to patient issues after (or even before) a JC survey visit.

..Maurice.

 
At Sunday, April 08, 2018 3:40:00 PM, Anonymous Medical Student said...

I've observed 6 surgeries (all male patients of varying ages). In every case, the patient was treated with great modesty - properly draped, only briefly exposed if need be, and immediately covered thereafter. No comments or jokes about the patient were made. While this is a small sample size, I feel that it is largely representative (considering the fact that professionalism is drilled into our medical education).

This may come across as rather callous, but I believe this thread (and the 84 preceding) is taking a rare problem and demonizing and catastrophizing it into something of great urgency and consequence. Medical professionals are simply trying to do their job. They aren't staring at your junk. They aren't cracking jokes about your penis. If you suspect that they are - file a complaint and the hospital will take it very seriously and issue a punishment upon investigation.

What I find especially ironic is the post complaining about many nurses belonging to a "gimme gimme generation." Nursing is a profession that is largely thankless and under-compensated. These posts are portraying nurses as gaggles of mean girls that poke fun and act indecently - when in reality they act as the heartbeat of patient care. If you don't believe me, talk to any patient that's spent a long period of time in a hospital, and I guarantee you they'll have anecdotes of nurses demonstrating compassion. What strikes me as "gimme gimme" is pointing fingers at medical professionals that (as I repeat) are simply trying to do their job.

There's a simple solution to this molehill of a problem: state at the beginning of your hospital visit that "Modesty is important to me, please do not expose me in front of others if possible." If something indecent still happens, report it (as one of the previous posters did), and 10 times out of 10, swift action will occur to apprehend the .

I seriously doubt the Joint Commission will ever look into this issue, as they have innumerable other (more important) things to worry about. I apologize if this post hurts anyone's feelings, but I've read through about a 100 comments (many of little substance) and I felt like this needed to be said (and Dr. Bernstein is too level-headed and friendly to say such a thing). The fact that this is the most popular thread (by a huge margin) on a blog about the expansive issue of bioethics is somewhat ridiculous.

-A Medical Student

 
At Sunday, April 08, 2018 4:05:00 PM, Blogger Maurice Bernstein, M.D. said...

Read this from the JC website:
https://www.jointcommission.org/dateline_tjc/the_back_story_on_how_the_joint_commission_handles_complaints/

Maybe contacting Ana Pujols-McKee MD who is Executive Vice President and Chief Medical Officer of the Joint Commission would be a good beginning. I found a contact source outside of JC where she maybe still in practice in internal medicine:
PENN CARE MACKEE SHEPARD AND GRISKA MEDICAL ASSOCIATES in Philadelphia, PA (3801 Filbert St. Suite 212) zip code 19104
Phone: (215) 662-8978.

Somehow I think direct communication regarding the issue of this thread with an official of JC would be of help in understanding the interest of JC with regard to modesty and dignity BEYOND a general concern for "Patient Safety". Though, it would seem from the comments here that has been concern about patient safety. True? ..Maurice.

 
At Sunday, April 08, 2018 4:28:00 PM, Blogger Maurice Bernstein, M.D. said...

By the way, I do accept the view of the Medical Student and I have no idea of whether the student is one of my six first year students.

You may ask, if I accept the view of the student and which has always been my general view, yet I admit I am concerned about the issues of certain gender inequality with regard to dignity and modesty in aspects of the medical care system for males and why the JC should investigate, I agree with the student's advice which I have always stated: "speak up". ..Maurice.

 
At Sunday, April 08, 2018 5:29:00 PM, Blogger Biker in Vermont said...

Medical student, I agree that most medical staff are just doing their job and that most act in a professional manner. Most of us here have experienced staff that needlessly exposed us or that were otherwise unprofessional, but based on my experience those are the exceptions.

The piece you aren't grasping is that some of us just do not want opposite gender staff for certain intimate care. That is a much larger issue than the occasional unprofessional staff member.

When I had a testicular ultrasound, the female sonographer did not do anything wrong but it was very embarrassing nonetheless. I much would of preferred a male sonographer, but many places only hire females. All we ask is that facilities with multiple sonographers hire at least one male. It would make a big difference.

Having had 20 or so cystoscopies, while I know odds are the person doing the prep will be totally professional, I have been uncomfortable every time it was a female doing the prep. The 1st 18 times were at a very large hospital-based practice that only hires female staff, and so I had no choice in the matter. I switched to a different hospital that has a male nurse, and it was the first time I have ever been comfortable having the procedure done. Again, we're asking urology practices have even one male nurse for those of us uncomfortable exposing ourselves to female staff.

Same with dermatology. I understand most dermatologists want a scribe and/or nurse present, but if their protocol is to only hire female staff, then set up the room so that the male patient has some visual privacy for the genital/rectal part of the exam at least. It isn't asking much, but based on my experience this past year they sometimes don't understand why a man would care if he has an audience for his genital exam.

I would add that when there isn't any male staff, it would be nice to at least get an empathetic response along the lines of "I'm sorry but we don't have any male staff, but please know...." and then assure us our privacy will be respected and our exposure minimized. The more typical response however is dismissive along the lines of "We're all professionals here". Being dismissed like that rather than acknowledged just makes it worse.

Men have a very different reality than do women in healthcare settings given the extreme female-centric nature of healthcare staffing.

 
At Sunday, April 08, 2018 6:35:00 PM, Anonymous JF said...

Medical student. Your mindset is the typical mindset. But it is a PROBLEM mindset. Patients sometimes avoid/delay care because of it. The only thing your comment proves is that YOU don't have modesty. Good for you, but I hate to break it to you, plenty of people do and are harmed by the non options. You seem like a troll to me.

 
At Sunday, April 08, 2018 6:56:00 PM, Anonymous Anonymous said...

Medical student

I’m not sure where or when you have made an analysis, determination about this issue when you are still a “ medical student” . When you have worked in this business after 40 years then you come talk to me.

PT

 
At Sunday, April 08, 2018 6:59:00 PM, Anonymous Anonymous said...

Maurice

Just to clarify with you physicians offices are not Joint Commission accredited. If you are not a member then they will investigate nothing.

PT

 
At Sunday, April 08, 2018 7:26:00 PM, Blogger Maurice Bernstein, M.D. said...

JF, remember that contradiction is all part of discussion and Discussion in within the title of this blog. Ad hominem identification if that is the intent of using "troll" is not in the best interest of promoting a constructive and fair discussion.

I just want to remind my readers that in all the 85 Volumes we have truly rarely (any help on when last?) and I mean rarely have had a physician present here their views of these patient modesty issues..oh, except me! I appreciate input from others in the medical profession, including students (who are, by my experience, to be more aware of what is demanded by the term "professional" with their recent studies on the subject than a physician who has faced the "hot winds" of some years of trying to be professional under stress and without much in the way of structured tutorial help (if you get what I am trying to express).

I have to be honest in my reply (as I have tried to be since this thread started in 2005) that in all my years of medical practice, never,never, even currently has the modesty issues presented on this thread come to my professional work in internal medicine. No complaints--nothing! That is why I felt that what was written on this thread was an issue that represented statistical outliers. However, I have kept this thread going because even if not supported as common by statistics, ANY disregard for any patient's dignity and request for modesty is a professional wrong.
And something needs to be done to prevent that. I am all in favor of equalizing opportunities for patients of either gender to have a chance to acquire attendance of a healthcare provider of their desired gender who will give them the best in physical and emotional care as part of treating the underling disease. So I agree with attempts to improve the medical system to provide that equality of choice. But I do disagree that most doctors, nurses and techs are out there to embarrass the patient or more. ..Maurice.

 
At Sunday, April 08, 2018 8:17:00 PM, Blogger Maurice Bernstein, M.D. said...

PT, I understand what you say about JC and the private medical/surgical office. But, a change in the requirements and behavior of the institutions to which virtually all physicians are affiliated will be implanted in the professional behavior of the physician in his or her office..knowing now that "gender" and modesty issues may count for some patients. ..Maurice.

 
At Sunday, April 08, 2018 10:54:00 PM, Anonymous JF said...

Maybe the number of doctors, nurses,techs,CNA's,scribes and others not trying to embarrass is somewhat larger than the ones who do enjoy embarrassing, but don't kid yourself into thinking it doesn't happen or that it rare. Mostly the ones allowing the embarrassment, just don't care. I have a question for you. How did you finally become aware that certain of the patients were having problems with embarrassment?

 
At Sunday, April 08, 2018 10:55:00 PM, Anonymous Anonymous said...

Medical student

I’ve some final thoughts about your comments. You said “ state at the beginning of your hospital visit that modesty is important to me, please do not expose me in front of others.”

Really, I mean really! Is this something that should be put in the chart. What about please do not kill me while I’m in the hospital. Your suggestion is just plain STUPID! You’ve just suggested that this is what they will do and the fact that it happens. Exposing a patient unnecessarily to others from a nursing standpoint is considered unprofessional conduct and falls under sexual misconduct. I can give you that link to the state boards of nursing if you want to see it.

You go on to say that if something indecent happens report it. 10 times out of 10 swift action will occur. Ummm, I don’t think so. If you read the incident about the Denver 5 it took months and then they got 3 weeks of paid vacation. I could go on and on about your comments but you know it’s been a long day and I’ve made enough posts on this blog. Goodnight everybody.

BTW, are you sure you are a medical student?

PT

 
At Sunday, April 08, 2018 11:21:00 PM, Anonymous Anonymous said...

BJTNT

Thank you for the kind words and I absolutely agree with you that sanitation is paramount. I can never say enough positive things about hospital housekeeping for they do a tremendous job in keeping the hospital clean. But when nurses don’t wash their hands or change their PPE from one patient room to another you can expect cemeteries to be busting at the seams as 98,000 unnecessary deaths each year from hospital acquired infections.

I once worked at the largest pediatric hospital in the Southwest United States. Each year one child would be admitted the the hospital with RSV and within a week or so later all the children on that floor would have it. It was the nurses not washing their hands and wearing proper isolation gear, thus they were spreading it from room to room. I saw a lot of kids die unnecessarily.

PT

 
At Monday, April 09, 2018 3:39:00 AM, Blogger NTT said...

Good morning:

I agree with Dr. Bernstein about how making changes in the mindset and requirements in the hospitals would have a trickle-down effect thru the entire medical community.

I also agree with Biker in that our medical student doesn't understand that no matter what any healthcare provider thinks or says, there are and always will be men and women who don't want to be intimately exposed in a medical setting while the opposite gender is in the area.

Intimate exposure for those individuals remains the sole right of their special someone and nobody else.

The entire medical establishment needs to do more to hire more male staff & encourage them to go into areas where men are intimately exposed more often than not aka urology, radiology.

There needs to be a national effort on the part of the healthcare industry to entice men to enter the healthcare field.

Regards,
NTT

 
At Monday, April 09, 2018 3:40:00 AM, Blogger Dany said...

To the poster "Medical student",

I sincerely hope your comment won't turn into a drive-by posting. I would like to read more of your thoughts, and not only a single contribution. You've read some of the comments made here, and I am grateful for that; despite your dismissive attitude, perhaps you will come to realize the issues presented here aren't trivial. Not to the people who have experienced them.

It isn't about some healthcare workers misbehaving (although there are numerous examples available - hell, I've mentioned a few myself), it's about the discomfort many patients experience regarding exposure (of genitals, mostly) to opposite gender staff when such isn't absolutely necessary. It is even more damning, in my opinion, when these occurs for no other reasons then because it is a matter of convenience, tradition or for financial considerations.

Good healthcare encompass more than the body. Any reasons that makes a patient hesitate to seek care or refuse - any reasons at all - is worth looking into. And the onus aught not to be on the patients to "get on with it." Accommodation can be made and certainly should be considered in many situations. That is, if the aim is to provide compassionate, respectful care.

Dany

 
At Monday, April 09, 2018 8:14:00 AM, Anonymous Anonymous said...

I would like everyone to go back and read NTT’s comments on Apr 6 , at 12:50pm. I could not have said it better. He perfectly describes the entire nursing industry, particularly the “ gimme gimme’ all about me attitude.

PT

 
At Monday, April 09, 2018 10:31:00 AM, Blogger A. Banterings said...

PT,

I reread NTT's post. It was excellent (as you stated).

Part of this "gimme gimme" and "know-it-all" attitude which is missed, is the fact that some people don't like being exposed to any gender.

The next issue is that what is deemed "absolutely necessary," which in very, few, rare instances.


As (I believe it was you that) stated previously, unless there is surgery being done on the genitals, there is no reason for genital exposure. Even if there is a genital complaint, there are very, few, rare instances where genital exposure is necessary.

Sure, a visual exam for STIs helps the Dx, but guess what the physician will say if visually it appears to be an STI?

We need to run a blood test to be sure...

As Dany said:

It isn't about some healthcare workers misbehaving (although there are numerous examples available - hell, I've mentioned a few myself), it's about the discomfort many patients experience regarding exposure (of genitals, mostly) to opposite gender staff when such isn't absolutely necessary. It is even more damning, in my opinion, when these occurs for no other reasons then because it is a matter of convenience, tradition or for financial considerations.

The "absolutely necessary" that Dany is referring to is in the ED, I would say specifically trauma where exposure MAY be a matter of life or death. In this instance, the patient may choose to forego dignity and embarrassment to live.

A point that I have made in the past, has been that some patients may choose dignity over life. My example are religious martyrs. Even today, there are Christians in the Middle East who rather risk (and experience) death rather than denounce their beliefs. I am sure that many physicians would say strictly from a scientific view, this is not necessary.

I am not saying to what extent it happens, but it does occur, that people avoid healthcare for dignity reasons until it is too late and they are brought in by ambulance. That has bee discussed in other volumes of this blog, the most famous being a gentleman who refused treatment the 3rd time (???) for prostate cancer specifically for the indignities of the treatment.

PT, NTT, and others here with industry knowledge have talked about exposure for convenience. Medicare/Medicaid has refused to pay for infections for unnecessary catheterization. (Catheterization has been associated with convenience for the nursing staff.) See the study: Medicare Non-Payment of Hospital-Acquired Infections: Infection Rates Three Years Post Implementation

The problem with this whole exposure debate is we have the (mythical) exception of "where absolutely necessary." The same goes of informed consent (with the exception being an emergency). If we allow ANY exception, then every situation will be the exception.

The way we need to approach this is that exposure is NEVER necessary, it is up t the physician to earn the trust of the patient, convince them they should be exposed (never force or bully the issue), ask the patient the most comfortable way to do it, and CONTINUE to earn the trust of the patient, if they can't do this, then they need to figure out a different way.



-- Banterings


 
At Monday, April 09, 2018 11:34:00 AM, Blogger A. Banterings said...

Note the recent article The Disappearing Doctor: How Mega-Mergers Are Changing the Business of Medical Care. This is how society is shaping medicine to conform with the expectations of society. Look at the following statement made in the article:

But more traditional doctors like Dr. Purifoy stress the importance of continuity of care. “It takes a long time to gain the trust of the patient,” he said. He is working with Aledade, another company focused on reinventing primary care, to make his practice more competitive...

...Those relationships take time and follow-up. “It’s not something I can do in a minute,” Dr. Purifoy said. “You’re never going to get that at a MedExpress.”


So, in desperation, TRUST suddenly becomes important???

As I stated before, patients are winning. Physicians are becoming Walmart employees; LITERALLY!

There is a solution. Read my comments on: Physicians have had it. What do we do now?


Unions and strikes do not work. Look at what happens with nurses when they strike: staffing companies bring in nurses to fill the gap. These nurses come from home and abroad. These staffing companies already have contingency plans for physicians.

Ever heard of locum tenens?

The author is on the right track with the Gandhi example, but physicians must serve patients like Gandhi served the people of India or like Christ served the people. Physicians must elect to hand all power to patients. There are many more patients than physicians, lobbyists, insurance execs, and law makers COMBINED.

Physicians can then live better as a free people in their democratic republic of medicine rather than that of a subjugated people ruled by governors and viceroys with MBAs of big healthcare corporations or insurance companies.

Ever since the advent of paternalism in healthcare, physicians have feared the loss of power and have been unwilling to give up any bit of power. The most powerful move that physicians can make is to elect to hand their power to patients.

Gandhi, Christ, Mother Theresa, Pope Francis, and many others have achieved great power by humility, serving others, and giving their power away.

I know what is going to happen: I am going to receive negative comments about the one true solution, physicians will continue to complain, and their power will continue to be eroded away.


They do not get it! I was unable to respond because (as usual) as soon as physicians were being proved wrong, comments are shut down by the moderators.

They will keep living in denial as the leash gets shorter and tighter.


-- Banterings

 
At Monday, April 09, 2018 2:04:00 PM, Anonymous Medical Patient Modesty said...

PT,

You have so many great insights about the medical industry. You are correct about the “no underwear” policy. I am pretty sure that this was invented by some nurses because I’ve noticed that surgeons are more likely to be open to patients wearing underwear. In fact, it’s often a nurse who demands that your underwear comes off. Look at what one man shared with me after he read my underwear article:

Many years ago I had to have esophageal polyps removed. That required GA. I got the usual underwear/sterility nonsense argument. The compromise was that I was given a set of pajama bottom shorts to wear under the obligatory gown and which the hospital routinely stocks. I worked all this out with the Doctor before hand. When I was being transferred from the bed to the gurney a nurse noticed this and questioned it. I told her it was doctor approved and ask her how she would like it if I had looked up her skirt.


He also shared this insight which is true:

As for indwelling catheters, these are rarely ordered by doctors and are routinely placed by nurses for their convenience. UTI rates can run as high as 50%. Many doctors don’t even know their patients have been catheterized.

Nurses are the ones who have caused most infections as you have said. I think it is very odd that some nurses smoke. Smoking is very dangerous for your health. Why would a medical professional do an activity that is very hazardous? I personally think medical professionals who smoke should not be allowed to work in the medical profession at all. Patients have to stand up.

Misty

 
At Monday, April 09, 2018 4:34:00 PM, Anonymous Anonymous said...

Misty

Many hospitals now as a condition for new employment require a mouth swab for nicotine. If you test positive you don’t get hired. These same hospitals have a no smoking policy on the hospital campus as well. There is much to be said about unnecessary urethral catherizations and it’s very disturbing what I could comment. There have been deaths associated with the procedure, severe injuries particularly when a female cath kit is used on a male patient. High infection rates that require extended hospitalization.

PT

 
At Monday, April 09, 2018 6:31:00 PM, Blogger Biker in Vermont said...

A question or clarification here for future reference. Are people saying that when a surgery is being planned we should speak to the doctor about whether he/she says a catheter is necessary or not and also whether underwear must be removed or not? That we can then tell the nurses what the doctor has approved so as to overrule the nurse's standard protocol of underwear off, catheter in?

 
At Monday, April 09, 2018 7:00:00 PM, Anonymous Anonymous said...

The medical student wrote

“ The fact that this is the most popular thread ( by a Hugh margin) on a blog about the expansive issue of bioethics is somewhat ridiculous.

Maybe if all physicians followed the Hippocratic oath, I will respect the privacy of my patients.

Maybe if all nurses actually took the time to read the nurse practice act, adhere to the rules set forth by the state boards of nursing.

Maybe if hospital administrators, Ceo’s, Cno’s and Coo’s actually cared about the manner in which their patients are cared for.

Maybe if all the employees actually could recite verbatim the core values set forth.

Maybe just maybe this blog would have never existed.

PT

 
At Monday, April 09, 2018 7:03:00 PM, Blogger Dany said...

Bantering,

Your reference to STIs testing reminded me of a similar scenario which happened to me in my mid twenties. I wasn't presenting with any S&S, but because I was military, they often want to do these (unnecessary, in my opinion) tests, when you go for a physical.

(Despite many tales to the contrary, military members are not that promiscuous, take my word for it)

The impression I got was that it wasn't optional (a little "nudge" to encourage compliance, I would guess) and the PA (a woman) expected me to not only let her assess my genitals but she also had every intentions to swab me. I most sternly disagreed with her plan.

This was one of the very few "bad" interactions I had with a female PCP. Unfortunately, this experience also reinforced my determination not to allow anyone to assess my reproductive system unless I, you know... The patient, deems it necessary. And definitely not if I'm dealing with a woman. I will go to great lengths of effort, and trouble, to avoid this.

Dany

 
At Monday, April 09, 2018 9:24:00 PM, Blogger Maurice Bernstein, M.D. said...

For clarity, in PT's last post, quoting the Medical Student, a quotation mark was left out at the end of the first sentence and I was unable to correct the error. ..Maurice.

 
At Monday, April 09, 2018 9:37:00 PM, Blogger Maurice Bernstein, M.D. said...

We have hit over 180 postings on Volume 85 over a period of 1 month. Expect a transition to Volume 86 soon. ..Maurice.

 
At Tuesday, April 10, 2018 9:17:00 AM, Anonymous Anonymous said...

The medical student said

“ These posts are portraying nurses as gaggles of mean girls that poke fun and act indecently, when in fact they act as the heartbeat of patient care. “

There is an article on Allnurses under general nursing column titled Older student, unprofessional nurse during clinical.

This article pretty much tells the whole story with the responses.

PT

 
At Tuesday, April 10, 2018 9:25:00 AM, Anonymous Anonymous said...

Medical student

Make sure you read the part where the female nurse calls the patient a Fuc*ing P**y for having pain after his prostatectomy and then made fun of his military service as a marine. This is on a Urology floor in a hospital!

PT

 
At Tuesday, April 10, 2018 1:18:00 PM, Blogger Maurice Bernstein, M.D. said...

Beginning TODAY April 10 2018, NO FURTHER Comments will be posted on Volume 85 but the
discussion can continue on Volume 86. ..Maurice.

 

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