Bioethics Discussion Blog: Patient Modesty: Volume 86

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Tuesday, April 10, 2018

Patient Modesty: Volume 86



The above graphic for this Volume really shows distinctly a major discussion point which has continued on our blog thread, literally for years: the requirement for the patient undergoing surgery with general anesthesia to have his underwear removed, in this case for his arthroscopic knee surgery. The story is told by an onion farmer in his blog "Mucking It Up in Muckville"

I hope my visitors here go to the above link and first read the patient's story.  Then, come back and  continue, reading the experience and view of an anethesiologist-ethicist Dr. Alyssa Burgart.  I have been given her permission to reproduce her presentation here but besides writing your Comments to my blog thread, you should go re-read the text and write your comments directly on her own blog "Medicine, Ethics and More" and therefore to her own readers.  I am pleased to be able to get Dr. Burgart's experience and knowledge in both her areas of experience.
Her blog address: http://www.alyssaburgart.com/blog/2018/04/11/underwear-for-surgery/ and here is what she wrote:



Why was I asked to take off my underwear for surgery?







It can feel weird to be asked to take off your knickers… Underwear makes us feel proper, protected, clothed. Even though I get that those are concerns, there are several reasons why you may be asked to remove underwear:
Number One and Number Two
Under general anesthesia, patients sometimes pee and/or poop. It’s not pretty, it’s not always easy to know when this will happen, and we usually ask patients to use the restroom before surgery by means of prevention. If a surgery will be very short, the risk is lower. It is completely irrelevant which body part being operated on when the whole body is anesthetized and unfortunately, this can be a messy situation. The nice, clean skivvies the patient wore to the hospital are going to be peeled off and put in a biohazard bag. Patients do not necessarily bring extra underwear with them and don’t have any to wear home. Removing the garments before surgery means the patient can put those clean undies on when they wake up. We usually still have patients lie on an absorbent towel/pad, just in case. Undies or no, the nurses in the OR are going to make sure the skin is cleaned before the patient wakes up.
Time
If a surgery is long, a Foley catheter is typically placed to drain, collect, and measure urine. Placing the catheter requires sterile prep of the genital area and underwear are going to be in the way. They won’t fit properly and can apply unwanted pressure to the catheter once placed. This can even cause a pressure injury to the skin.
Spic and Span
Some people (not you, I’m sure) wear undies that are not very clean. It’s a gross over-generalization to apply that concern to everyone, but for practical reasons, it can be easier to just have everyone take them off.  If you’re having a belly surgery, your skin will usually need to be cleaned as low as your pubic bone. Knee surgery? To clean the whole knee, it has to be lifted up and the prep drips down the thigh. Those undies can get saturated with cleaning solution. They might get stained with the dye in the soap, which is rude on our part. They may not dry very quickly– and this can increase the risk of a fire during surgery (yeah – we have to worry about your pants on fire!). Realistically, the only procedures that underwear don’t get in the way are those on the chest and above.
While You Were Sleeping, We Got Back Pain
Is it more awkward to ask a patient to take off their panties or, if they absolutely have to come off, to take them off when they’re under anesthesia? Personally, I think it’s weird to wait until someone is anesthetized to take off their tighty whities. Then the patient wakes up having lost their underoos. If they need to come off for any number of reasons, I prefer the patient does it themselves. I think it’s weird to take them off in the operating room. Plus, it can take multiple people to get them off and we genuinely risk workplace injuries (back pain anyone?) to do so.
That’s nice, but maybe you still don’t want to ditch your briefs.
There may be hospital staff that get their panties in a bunch about your underpants. If you’re an adult, no one can MAKE YOU take off your clothes. If you refuse to do it, you can take your chances that your underwear will be on your body and be clean. But they may need to come off emergently (or because they interfere with the procedure you showed up to get) and that may mean they get cut off. There is dignity in controlling the removal of your own clothes, as I would personally find it more of an affront to emerge from anesthesia with clothing inexplicably missing. But that’s me. Maybe you don’t mind. There are perfectly uncomfortable mesh underwear that hospitals are likely to have on hand – meant to hold absorbent pads for post-partum or menstruating patients, or who have other reasons to need them. (To the above points, those will be promptly cut off if they are in the way, or of the patient urinates.)
When teens and adults are concerned about removing their underpants, I ask them why and offer to explain the reasons why it is called for in their particular case. Generally, I think the whole underwear things gets patients bend out of shape when they don’t feel they are being heard. Coming in for surgery is stressful, and maybe taking your tighty whities off based on the demands of a pre-op nurse is the last straw. When it comes down to it, patients are usually certain that they are just being asked to do something ridiculous, with not reasoning behind it. Secondly, they are concerned that their body will not be respected while they’re anesthetized and that it will be exposed for no good reason. By staff taking the question seriously, a dialog can form where the patient hears that they are respected, and staff have a chance to explain that this isn’t a thoughtless, nonsensical request to diminish inherent human dignity.
We have better things to do all day than play power mind games with our patients. I can’t speak for every operating room out there, but I have yet to be in an OR where patients were left exposed for no good reason. First and foremost, we respect patients’ dignity and modesty. We have lots of sheets and blankets and use them to cover whatever we can. On a practical matter, it’s really important to keep patients warm, and leaving them uncovered is super counter productive.
On the surface, most of these reasons might seem like they are solely for the benefit of the healthcare people involved, but I think they are rooted in an effort to prevent patient inconvenience from dirty, damaged, wet, stained undies and loss of dignity from being given a biohazard bag full of soiled unmentionables, and to ensure that, above all, the patient gets safe care. If you disagree and refuse to take em off, staff should listen to your concerns to find an acceptable solution.


62 Comments:

At Tuesday, April 10, 2018 1:23:00 PM, Anonymous Medical Patient Modesty said...

This is ridiculous that the man had to remove the underwear since the surgery was on his knee. It is time for us to abandon that policy completely. There is no reason that patients should not be able to wear 100% cotton underwear for surgeries.

Read this important article, Unnecessary Underwear Removal For Surgeries.

Misty

 
At Tuesday, April 10, 2018 3:38:00 PM, Blogger NTT said...

Misty:

The medical community isn't listening to the patient who are saying we want change and our elected officials aren't listening to their constituents who say they also want change so how, do you propose we get hospitals to abandon this policy?

NTT

 
At Tuesday, April 10, 2018 3:43:00 PM, Blogger Biker in Vermont said...

Misty, if you read the blog that Dr. Bernstein attached, he asked why he had to remove his underwear and was told it made it easier for the nurses if he soiled himself during the surgery. It is for their convenience. Assuming he has fasted since sometime the evening before, and had restricted fluid intake as is common before surgery, and emptied his bladder before surgery, I wonder what the frequency is for patients to soil themselves during a couple hour surgery? If the frequency was high I imagine it would be common knowledge. My guess is that it is far from the norm. The nurses apparently just prefer everyone be totally naked because it is more convenient for them.

 
At Tuesday, April 10, 2018 4:34:00 PM, Anonymous JF said...

No, it iz so they can tell who is the patient.

 
At Tuesday, April 10, 2018 7:15:00 PM, Anonymous Medical Patient Modesty said...

Biker in Vermont,

That is a ridiculous argument. The truth is if he soiled, it would be worse if he had no underwear because more would get on the operating table. You are right that many nurses are just concerned about their convenience. Of course, most gynecological and urological procedures require underwear off since the genitals are exposed.

Misty

 
At Tuesday, April 10, 2018 7:59:00 PM, Anonymous Anonymous said...

Let’s just see what is exactly sterile in the operating room.

The nurses underwear, No
The nurses scrubs, No
The nurses Bouffant hat, No
The nurses shoe covers, No
The nurses face mask, No

The surgeons underwear, No
The surgeons scrubs, No
The surgeons Bouffant hat, No
The surgeons shoe covers, No

The only thing sterile in the operating are the surgeons gloves and gown. Instruments and drapes.
Don’t always count on the instruments being properly disinfected.

Finally, who most likely has the cleanest underwear in the operating room?

The patient, because the operating room staff have been working in their underwear all day, provided they wear any.

PT

 
At Tuesday, April 10, 2018 8:28:00 PM, Anonymous Anonymous said...

Jolly nurse Jane Doe leaves the operating room in her scrubs, shoe covers and bouffant hat for one of many cigarette breaks. She returns to the operating room to circulate for an open Cholecystectomy and places her previously used face mask back on.

Little does Jolly nurse Jane Doe realize that there is something called “ Third hand smoke “ that is particulate that settles out after smoking which contains 69 cancer causing particulates. Once in the operating room the laminar flow will pick up these particulates that’s been deposited on her scrubs and redeposite them on the sterile surgical instruments as well as the open surgical site. These compounds all 69 separate chemicals will be absorbed into the open wound.

Realize these particulates are of an ultra fine size and become airborne quickly. With diameters of particulates ranging from .18 to .3 microns with mass in the neighborhood of .5 to 15 mg m^-1, they are toxic. Oftentimes protocols are not followed for the autoclaving of surgical instruments coupled with the unnecessary foot traffic and all other variables that predispose the patient to post-op infection before they leave the operating.

But those damn underwear are coming off no matter what!!


PT

 
At Tuesday, April 10, 2018 9:12:00 PM, Anonymous Anonymous said...

Biker in Vermont

The only time i’ve ever thought it convenient to be naked was for the benefit of at least one of the two parties having sex.

One of the prime anesthetics used in the operating room during surgery is Propofol. Now it’s known that Propofol impairs gastric contractile motility. Now, in all the years I’ve been involved in surgical procedures I’ve never ever known of any patient who soiled themselves during operative procedures. Now, at least in our universe feces and urine are not known to flow uphill. I can think of no position surgically that the patient would need to be in that might promote contamination should they void or have a bm. It makes common sense that underwear or even depends could be worn. I’m thinking that possibly the nurse responsible for requiring all patients to remove their underwear is the same one who instructed nursing students to strike patients erections with a spoon.

PT

 
At Wednesday, April 11, 2018 3:01:00 AM, Blogger Biker in Vermont said...

Very interesting PT. You confirmed what I suspected was the case, that there is little to no expectation that a patient will void or have a bm during surgery. It is certainly possible, but not likely. The underwear off protocol is just an old habit that the nursing staff wants to perpetuate.

A year or two ago my wife had foot surgery under general anesthesia. In the pre-op the doctor came by and without my wife asking or saying anything the doctor said she could leave her underwear on, so maybe some doctors are trying to reduce needless exposure?

 
At Wednesday, April 11, 2018 6:23:00 AM, Blogger A. Banterings said...

Dany,

As to your military experience, I have also worked with a number of private and government (I guess the best term being) "security forces" or LEOs (law enforcement officers). It is a universally accepted (psychological) protocol to break down before you build them up to follow orders blindly. This is even done in the medical education. I believe Maurice has a volume here on the practice of "pimping" (not what you think it is).

Nakedness is part of this process in the more extreme "indoctrination" process. This was used in Gitmo and Abu Gitmo and Abu Ghraib (see the Congressional report and Red Cross report).

Reference:
Report: Exams reveal abuse, torture of detainees
Abu Ghraib Tactics Were First Used at Guantanamo
Report Details Alleged Abuse of Guantanamo Bay, Abu Ghraib Detainees

The most egregious violations (torture) involve the violation of bodily integrity under the guise of a medical procedure.
See:
ZERO IMPUNITY - The US's "psychological" weapon against terrorism
Rectal feeding is rape – but don’t expect the CIA to admit it
Rectal rehydration and waterboarding: the CIA torture report's grisliest findings

During the Stanford Prison Experiment, without instruction to do so, the student volunteers who played the role of the guards, used nudity as a way to control and punish the ones who were prisoners.

Nudity was part of the most common punishments (along with hair shaving) that (civilian) communities imposed upon German sympathizers during WWII. The Nazis also used used nudity as a punishment. Part was for economic reasons and part was just an additional form of control and torture.

Warning: this links contain images of nudity as a punishment which may be disturbing or act as "triggers" for those with trauma.

Truth of Abuse
Pintrist
Abuse Historical Photos of women
Pintrist

What is particularly interesting is that the majority of nude punishments of German sympathizers occurred in France, a country know for its liberal attitude toward nudity and sexuality (as seen in their art, fashion, and nude beaches).


-- Banterings

 
At Wednesday, April 11, 2018 8:42:00 AM, Blogger Maurice Bernstein, M.D. said...

To followup on a reference to my blog thread on "pimping" in medical education:
http://bioethicsdiscussion.blogspot.com/2015/12/pimping-not-about-sex-about-medical.html
I feel that this behavior used in medical education is essentially for the "pimper's" (attending physician) "best" (self) interest and for intimidation toward the student. One could argue (e.g. Banterings) that the professional behavior toward patients in the current area of discussion here is nothing but for the professionals "best self interest" or frank intimidation applied to the surgical patient. Interesting argument if the behavior of surgical staff represents not applicable science but following tradition. ..Maurice.

 
At Wednesday, April 11, 2018 9:58:00 AM, Blogger Biker in Vermont said...

Wasn't there a discussion many volumes back about nurse training including having patients undress being part of a strategy to garner compliance? Something to do with the power imbalance created as soon as the patient has undressed?

 
At Wednesday, April 11, 2018 2:24:00 PM, Blogger Dany said...

Banterings,

I do not doubt that nudity was, and sadly still is, used to psychologically destabilize individuals. Thankfully, I was never subjected to such treatment. I mean sure, boot camp (basic training) was tough, but not to that extend.

I don't think this was the intentions of the PA who assessed me that time. Sure there was some level of intimidation at play, mostly due to the rank difference (I wasn't that high up in the pecking order back then) and I'm sure she used that to her advantage to coax reluctant patients.

But... Playing the Devil's advocate here, I'm also honest enough to admit that, hey, maybe - just maybe - she felt she was doing her job. For all I know maybe she believed we (her patients) just had to get those tests done, for our own good. And our feelings on the matter did not factor in.

It does not justify her behavior, as it directly violates the rules regarding medical consent (she was deliberately trying to coerce me). My hackles went up pretty quick and this physical was pretty much over from that point on. I thought I'd get in trouble for this but no, nothing came out of it.

With regard to nudity applied in medical settings, I will only say that it's pretty darn hard to keep your composure and self-confidence when you're not wearing any clothes. There is a reason for the saying "stripped of all dignity." And while there might be other logical and reasonable reasons for it (I can even agree with some of them), the effects it has on the persons subject to it are well known.

Many healthcare professionals will try to mitigate this (appropriate draping comes to mind) but far too many will use this to their advantage. I'm tempted to point the finger at nurses but, frankly, they're not the only one doing it.

Dany

 
At Thursday, April 12, 2018 1:42:00 PM, Anonymous Medical Patient Modesty said...

I wanted to let everyone here know that I put up a new article that I wrote, Why You Should Have a Personal Advocate For Surgery?.

I am sure that some people here would make excellent advocates. I know some patients would gladly pay for a personal advocate. I think PT would be an excellent advocate for male patients.

Misty

 
At Thursday, April 12, 2018 3:36:00 PM, Anonymous Anonymous said...

Misty

I do believe everyone should have an advocate during surgery. This could be the choosing of a family member or it could be someone the hospital could provide. Appreciate that no hospital or surgery center anywhere in the United States provides such a service. I believe that hospitals should allow a family member or someone of the patients choosing provided that the person should require to attend a brief in service.

This person is not going to be able to determine if the surgery was done correctly or not so what are the gains. I’ll tell you and I’m being truthfully honest. I have heard enough nasty disgusting comments directed towards the anesthesized patient to last me a lifetime. An anesthiologist commented about a female patients breast size during surgery, she was not completely under. After the surgery she told the Dr what he had said, he was stunned. She sued and won. Two nurses made comments to each other about the patients small penis size during surgery. He too was not completely out and heard them.

A general surgeon during a male patients surgery commented about how large the male patient’s penis size was during the duration of the surgery and the odd occupation he had, which was some kind of an oil field worker. A surgical nurse during surgery told the surgeon that the patient is an attorney. The surgeon said “ ok he won’t get any pain meds when he wakes up.” Do these kinds of comments benefit or hurt the patient? Can they effect a negative outcome and promote the bully mentality?

Everyone is aware of the female anesthiologist who berated the male patient during his colonoscopy, telling everyone falsely that he had a veneral disease. The patient had recorded the conversation with his cell phone, sued and was awarded $ 500,0000. The female anesthiologist was fired and reprimanded by the medical board. Would a surgical advocate be beneficial and promote a more positive environment for the patient undergoing a procedure, I believe so.

PT

 
At Thursday, April 12, 2018 4:29:00 PM, Blogger NTT said...

Good Evening:

Misty, it's been my experience that surgical centers will only allow the patient in the OR. No family members or advocates. They are allowed as far as pre-op & AFTER they get the patient settled in PACU they let family & advocates see the patient.

They don't want anyone seeing or hearing what goes on in the OR unless you are an employee, or sales rep.

Regards,
NTT

 
At Thursday, April 12, 2018 5:26:00 PM, Blogger Maurice Bernstein, M.D. said...

I just UPDATED the INTRODUCTION to this VOLUME Patient Modesty with a copy of a posting by a professional anesthesiologist and ethicist and I hope that you read her explanation of what is the hot topic here. But as I wrote above, I left a link to her ow blog and topic and hope you go there and express your opinions for her readers beyond those from my blog can read.

I am pleased that my readers can have an opportunity to read and have access to this physician's blog. I understand she did read our blog here before starting her own presentation. ..Maurice.

 
At Thursday, April 12, 2018 5:46:00 PM, Anonymous Anonymous said...

Maurice

Garbage in Garbage out. That’s what I think of her comments.


PT

 
At Thursday, April 12, 2018 5:54:00 PM, Anonymous Anonymous said...

What I find amusing at most is that these days they end it with “ While I can’t speak for every operating room out there “ Double speak for self righteousness. I wonder though if Dr Twana Sparks would have given the same response “ We have better things to do all day than play power mind games with our patients” we just want your under wear off so our nurses can peek and we can grope you. So much easier.

PT

 
At Thursday, April 12, 2018 6:20:00 PM, Blogger Biker in Vermont said...

Dr. Bernstein, I read Dr.Burgart's article and went to her site but I didn't see a comments section. If she reads this, thank you Dr. Burgart for joining our discussion here. I appreciate hearing your perspective.

I think she did a good job explaining why the medical community thinks it is necessary, though she grossly over estimates the value people might put on saving the underwear they wore to the hospital the day of their surgery. Most of us would gladly sacrifice a pair if it came to that in exchange for maintaining a bit of dignity. Bringing an extra pair or going home commando is not a big deal.

She advocates for staff to discuss the respect and dignity aspect of this with patients, and that's a good thing, but realistically what are the odds the doctors/nurses would do that in pre-op vs just demanding the underwear comes off? Pre-ops tend to be pretty busy places.

Assuming that discussion does occur, what the doctors and nurses see as necessary and appropriate exposure may differ from what the patient sees it as. Though not a surgical example, I point to my dermatologist practice thinking a female scribe and female LPN being present for my full skin exam is necessary and appropriate. I suspect they think that as long as the scribe and LPN are polite and maintain the proper gameface that my dignity is maintained. It is not.

Similar kinds of examples where patient perspective is significantly different than provider perspective abound throughout healthcare, thus why would the OR be any different? One simple OR example would be the presence of students, vendors, and other observers. She says that they respect patients' dignity and modesty, but how is that possible if they allow these various observers in while we're naked on the table? It speaks to very different perspectives.

 
At Thursday, April 12, 2018 6:34:00 PM, Anonymous Anonymous said...

Maurice

By introducing The commentary by Dr Alyssa Burgart I believe you’ve opened up a big can of worms. You see over the years that Dr Twana Sparks groped her male patients they all had their underwear on during their surgical procedures. Therefore, those underwear didn’t stop the good Doctor from groping them. Here is the legal commentary from court records.

Dr. Sparks threw back the covers on the patient, reached into the fly of his boxer shorts, pulled out his penis and held it in her ungloved hand toward the ceiling. Dr Sparks noticed fluid filled vesicles indicative of a sexually transmitted disease on the right side of the shaft and yelled, Oh gross. She then slapped the head of the penis 3 times and yelled Bad Boy Bad Boy Bad Boy. The all female team laughed.

So this is the dilemma, one female ethicist says no underwear, one female ENT surgeon who groped her patients didn’t care if they wore underwear or not. Now Dr Burgart is correct on her one point. “ She says she can’t speak for all operating rooms. “ Should I reach out to both of them to see if we can come to a consensus as to what is best for the patient?

PT

 
At Thursday, April 12, 2018 7:25:00 PM, Blogger Maurice Bernstein, M.D. said...

Let's all be a little civil within a discussion of an important subject. The link was to a beginning blog started today by Dr. Burgart and the first topic was based on what she had read on my blog and what I had previously entered for discussion on a bioethics listserv to which we both subscribe. When I recently looked at her blog today there were no comments but I am sure that there will be readers beyond those from my blog. So, my personal suggestion, on writing to Dr. Burgart's blog thread be informative but civil. ..Maurice.

 
At Thursday, April 12, 2018 8:39:00 PM, Anonymous Anonymous said...

If they're so concerned about you soiling your underwear why don't they have you wear a pair of adult depends . You put them on , you take them off . AL

 
At Friday, April 13, 2018 3:45:00 AM, Blogger Dany said...

Much like Biker said in his comment, I want to express my thanks to Dr. Burgart for taking the time to visit this blog - however briefly - and providing her explanations on this topic.

As to making comments on her blog, a little bit of tinkering revealed that you need to click on the title of the post, which seems to reload the actual post but with a comment section at the bottom. I will be heading over there this the weekend myself (after I do my homework).

A brief search on the topic of bowel movements and/or bladder voiding while under general anesthesia make me believe that it doesn't happen very often (one Australian site - I know, not US - stated that it was uncommon, except with infant patients). I will diligently keep looking for more data on this.

A somewhat clunky analogy here would be to say that there's a chance you'll get hit by a car leaving your house, so you shouldn't leave your house (just to be safe, you know).

And I'm with Biker as well on the idea that I'd rather stain a pair of underwear than having a complete stranger - someone I may never meet face to face - clean me after an "accident." Obviously, this would be different if the surgical site was the genitals or near it.

As for the possibility of having to use urinary catheters for "long" surgeries, that is also misleading. What is define as "long?" I know what the CDC says but a few inquiries indicates that it's more a suggestion than a hard and fast rule. So it seems to be up to the facility or the surgeon. It is a known fact that catheters are used much more often than strictly necessary (I will point to the Ann Harbor convention).

I will not address her remaining two reasons, as I do not believe they merit a comment beyond this: don't complain about a problem of your own creation.

Dany

 
At Friday, April 13, 2018 5:33:00 AM, Blogger NTT said...

Good Morning:

The end goal of any hospital stay is for the patient to leave the facility with the best possible outcome.

When the underwear issue comes into play maybe it's time the medical community enacts a shift on policy so that the paying patient has the best possible outcome from their experience.

Maybe the time has come for same gender surgical and PACU teams.

The patient wants to keep their dignity intact as best as possible.

The medical community wants to minimize the chance of the patient being infected during surgery.

By assigning same gender surgical teams you allow the patient to keep their dignity as best as possible by not being exposed in front of the opposite sex while under general anesthesia and you keep the possibility of infection down to a minimum as they don't have the underwear on in the OR.

Both sides are going to have to come together and find a middle ground that everyone can live with. Even if that means hiring more men.

People already are and with continue to forego needed surgeries to protect their dignity and privacy.

It's called being human.

A concept the medical community wants to strip away from all patients.

It's up to people like you and me to start putting unrelenting pressure on our policymakers to work with the paying public and mandate changes to our healthcare system and make it a patient friendly system that everyone will use.

Have a great day all.

Regards,
NTT

 
At Friday, April 13, 2018 8:23:00 AM, Blogger Maurice Bernstein, M.D. said...

With regard to Dr.Burgart's blog thread, please write her as I have already done last evening though its publication is yet to be moderated. However, realize that she may be professionally more active than myself with regard to attending to the blog.

The point regarding improving the overall issue of the medical system... providing those attending to the patient the gender desired by the patient in the OR or x-ray or patient's hospital room or clinic or office front desk, behind doctor's desk or the exam room ...is to, in the current discussed gender, get more males into these positions. There is not much, if any, talk here on how to move ahead on this obvious solution to the issue.

What are the real issues involved in student interest, med education admission administration interest, employer interest and overall patient population interest to get more males into all aspects of medical care? Have we discussed this issue in as much detail as, for example, "underwear in the operating room"?

Yes, it is terrible to consider the gross misbehavior or even frank criminality of those participating in medical care that could be occurring at any time to potentially any patient but let's also be truthfully realistic--this really is a rare behavior and it is up to governmental agencies and patient's legal actions to get rid of these type of people who call themselves medical professionals. But, I am sure, all the rest of us humane and ethical folks in medicine are looking to do the best for all their patients.. I know I do too both in the medical clinic where I attend and the classroom-hospital wards where I participate by teaching this principle to my students.

So now, how do we equalize the medical care population by encouraging more males to enter all aspects of the profession to participate and be fully accepted by their employers and patients? This is what we should be talking about and not just the "bad apples" of either gender described in the news. ..Maurice.

 
At Friday, April 13, 2018 9:49:00 AM, Anonymous Anonymous said...

"If you’re an adult, no one can MAKE YOU take off your clothes."

-- Dr. Alyssa Burgart

Nice to have that reinforced. Worthwhile to remember.

RG

 
At Friday, April 13, 2018 11:01:00 AM, Anonymous JF said...

Regarding your clunky analogy, my best friends former boyfriend once lost control of his vehicle and crashed into the side of a house. The floor couldn't hold him.up and he and his car fell into the basement. Another friend's son crashed into somebody's porch.

 
At Friday, April 13, 2018 11:03:00 AM, Anonymous JF said...

I think she should still have to account.

 
At Friday, April 13, 2018 2:46:00 PM, Blogger Maurice Bernstein, M.D. said...

JF, can you elaborate a bit about your last posts and its analogy to what has previously been written? ..Maurice.

 
At Friday, April 13, 2018 2:51:00 PM, Blogger Maurice Bernstein, M.D. said...


The direct link to Dr. Burgart's thread and Comments section is:

http://www.alyssaburgart.com/blog/2018/04/11/underwear-for-surgery/

I updated the link also in the Introduction.
..Maurice.

 
At Friday, April 13, 2018 4:13:00 PM, Anonymous JF said...

I was kidding about Dany comparing people not seeking medical care to people not leaving the house because they might get hit by a car, because cars could hit you even as you lay in your bed. Sorry, it wasn't a good joke, and the issue discussed on this blog IS important to me. I'll try not to go off issue.

 
At Friday, April 13, 2018 5:36:00 PM, Blogger Dany said...

Well JF, I guess that'll teach me to try to make semi-intelligent posts in the wee hours of the morning, when I haven't had at least a cup of coffee into me.

My analogy was a comparison of the reason given to a patient to remove his or her underwear for surgery (they might have an uncontrolled bladder or bowel voiding) and staying home, because they might be hit by a car if they don't.

Going off topic shouldn't be that big a deal (within reasons), but then again, I'm not the one moderating the blog. I do notice the odd posts not making it to the page now and then, but I'm sure there's a perfectly reasonable reason for that.

Dany

 
At Friday, April 13, 2018 8:29:00 PM, Blogger Maurice Bernstein, M.D. said...

My posting on Dr. Burgart's thread has now been published there.

I encourage my readers and writers here to go to her thread and write your views, expectations and approaches to change but also in terms of the general issue of gender inequality within the medical profession.

Dr. Burgart is not only involved in the surgical aspect of medicine, she is also a studied ethicist. That means that her potential audience of her blog may involve a composition of potential visitors quite different than those who come here or go to Misty's blog or go to AllNurses. Having such a different audience may be helpful for consideration, suggestions and even actions by others. Am I being overly optimistic? ..Maurice.

 
At Sunday, April 15, 2018 6:18:00 AM, Blogger Biker in Vermont said...

Dr. Bernstein, responding to your question from a couple days back about encouraging more males to go into nursing and related fields, it has to just be the old cultural norm that non-physician fields are for women.

About a year and a half ago I contacted the nursing program at the local college and the LNA program at the local tech school about their lack of males in their programs and asking about outreach. I also noted their websites only featuring females as reinforcing the programs only being for females. I got polite responses but having just checked their sites, nothing has changed.

Rural America is aging as most of the young people leave for urban areas with modern economies. With fewer young people, there are fewer children and the population of most rural areas is in slow decline. Given the relative lack of modern economy opportunities, cultural norms of "nurses are women" is the only plausible explanation for why so few guys that might like to stay in their hometowns aren't pursing nursing & related careers. We don't have much in the way of high tech or other modern economy career opportunities here, except for the medical field. Despite our slow population decline, medical jobs are abundant due to the aging population. Guys should be pursing these careers, but they are not.

 
At Sunday, April 15, 2018 6:27:00 AM, Blogger Biker in Vermont said...

Dr. Bernstein, concerning Dr. Burgart's blog, yes it would be wonderful to have a different audience hearing part of this discussion. I presume people interested in medical ethics might be a tad more sensitive to the topic, and the medical world is more likely to hear their voices than ours.

Before the comments section being opened, I thought the only way to reach her was via private email and so I sent one two days ago I think, but then yesterday I submitted a post in the comments section. It isn't up but perhaps she doesn't plan to administer her site with the frequency that you do. Nothing ventured, nothing gained. We'll see.

 
At Sunday, April 15, 2018 2:54:00 PM, Anonymous Anonymous said...

When we read about unprofessional behavior such as Dr Twana Sparks or the Denver 5, we fall into this trap I call the news media mentality. We assume that this never occurred until now or that it’s a rare occurrence. I’m deeply troubled by the referencing that these are rare events, they are not. It’s only rare that the news media gets this information of unprofessional behavior in healthcare.

We all know when there are plane crashes because they are reported in the news or in the newspaper. Thus we know everytime one crashes and thus considering the number of safe travel passages we assign them as rare events. Not the case in healthcare since not all events make it to the news and that is the job of risk management in hospitals. We only hear about a few of the bizarre events which typically have an even better chance of making it to the news when law enforcement becomes involved.

It’s even more troubling that since these events are labeled as rare, the number of outliers are rare hence the label. I’ll venture to say that if every person who had deep feelings about their privacy violations as a patient were to find this blog and post, it would be overwhelming. I’m never surprised to read newer articles that say “ well I don’t know about other operating rooms “ or well this is how I’ve always done it or this or that. “ I think people are adjusting their language because they too are seeing the unprofessional behaviors @nd in those regards the implication is it’s not so rare anymore.

PT

 
At Monday, April 16, 2018 8:42:00 AM, Blogger NTT said...

Good Morning:

PT I agree with you that this board would be overwhelmed. I talk to guys on different boards all the time.

Many won't speak up because of the stereotype issue & many others (especially those currently in PCa or BPH treatment), won't speak up out of fear of retribution from their caregivers.

Guys just don't realize how strong they really are and that by standing up & saying you want things changed not only makes the healthcare community wake up & take notice but you make it that much easier for the next guy when it's his turn.

Have a great day all.

Regards,
NTT

 
At Monday, April 16, 2018 1:08:00 PM, Blogger A. Banterings said...

PT and NTT,

That was our original challenge with Maurice, trying to show it was not just an outlier thing...

Now Maurice is only one physician and look how long and how many of us it took to convince just him. Hopefully the seeds he sows in his students will change the perception that it happens too often and is NOT acceptable!


-- Banterings


 
At Monday, April 16, 2018 3:42:00 PM, Blogger NTT said...

Good Evening:

How do we equalize the system Dr. Bernstein asked?

Let go of all the ideas and methods that have failed over the years to produce the correct outcomes. Stuff like gender neutral, and the old male stereotype they’ve been using for decades.

The first and biggest problem that must be solved is the healthcare gender scale.

So how do we go about balancing the scales?

For starters, every accredited medical school program in the country must freely accept and encourage any male applicants that want to apply for a nursing or technician program to apply. It’s time to accept men with open arms into traditionally female positions as a man’s dignity and privacy is just as important as a woman’s.

No more telling men not to waste their time and money as we don’t hire male nurses and sonographers.

To help curb the current shortage of male sonographers, male radiologists could be cross-trained in sonography and in the short-term step in when a man asks for a male sonographer.

Urology is the one area of a hospital where the majority of the patients are males yet the majority of the staff caring for the patients is female.

Hospitals must be required to balance the gender scale here so that on any shift, any male patient that chooses to have same gender caregivers has them. If that means moving some current female staff out of that section into other areas of the hospital and at the same time offering male nurses incentives to go into that dept., you do it.

At the national level, The Dept. of Health & Human Services, must create a taskforce consisting of healthcare & civilian people.

The purpose of this taskforce will be to come up with a viable and sustainable long-term plan to bring more male personnel into the healthcare areas where they are needed the most and help balance out the gender scale.

After we get the personnel we need in place so the system functions in a fair manner for all patients, the next step for the taskforce would be to examine employee working conditions.

What can be done systemwide, to lighten employee loads, make their shifts more pleasant, and prevent worker burnout?

Don’t kid yourself, these problems will not be resolved overnight. It’s going to take hard work and perseverance on everyone’s part.

At the local level, find out if there are male support groups in your area. Sometimes the local hospital sponsors a monthly meeting.

Talk to the support group leader & ask if the guys all know they have the right to same gender care especially if intimate exams, tests, or procedures are involved. Tell the leader about Dr. B’s site & ask that he tell his group. Offer to even speak to the group if the leader will let you. Don’t be surprised if you are shot down. I have been 4 times so far.

If you know someone who say is receiving treatment for PCa or BPH, try talking to them. See it they know their right to choose. Have them spread the word to others they know. Once we get the ball rolling, there will be no way to stop it until change comes about.

We have some of the brightest minds in the world, right here in our own backyard.

Working together there is no problem that is insurmountable.

Regards,
NTT

 
At Monday, April 16, 2018 6:07:00 PM, Blogger Dany said...

NTT, PT, et al,

I think the biggest hurdle in attempting to achieve gender parity in healthcare will be the various unions representing the workers, if not the workers themselves.

This idea has come up before on AA and it became quickly evident that, with the exception of a very few nurses, many weren't interested to change the status co. After all, preferential treatment might mean they'll be forced to move out of their job. I am not sure if the members of other working group have similar opinions about this.

One way to help push things along is to offer bursary or education grants to male students. Another way would be to have selective hiring policies and have "male only" positions (or at least preferential hiring selection). Of course, if a position cannot be filled after a reasonable amount of time, than look at whoever else is available.

But it's going to make some people unhappy, no matter what.

Dany

 
At Monday, April 16, 2018 7:22:00 PM, Anonymous EO said...

Dany,

The recommendations against the DRE are stated by many organizations, and some of these were stated as early as 2012/2013! The Choosing Wisely campaign and the American Academy of Family Physicians (AAFP) have included not only PSA testing, but also digital rectal exams as procedures that are usually unnecessary. In 2013 The American Academy Of Family Physicians stated thusly: "Don’t routinely screen for prostate cancer using a prostate-specific antigen (PSA) test or digital rectal exam. There is convincing evidence that PSA-based screening leads to substantial over-diagnosis of prostate tumors. Many tumors will not harm patients, while the risks of treatment are significant. Physicians should not offer or order PSA screening unless they are prepared to engage in shared decision making that enables an informed choice by patients."
As of 2018 the Preventative Services Task Force recommends against both the DRE and PSA. I won't get into the PSA fiasco as it's lengthy and doesn't immediately apply to male modesty (not taking into account the terrible road many men endure via opposite gender care for exams, procedures, etc.) but suffice it to say the Richard Albin, who discovered P.S.A in 1970, stated in 2010 that "the test is hardly more effective than a coin toss." Here's the link: https://www.nytimes.com/2010/03/10/opinion/10Ablin.html]
Back to the DRE. Since both previous and recent studies, including those in Australia and Europe, recommend against the DRE, why are Primary Care Physicians still using it? In much of the anecdotal accounts I have read it seems that FEMALE providers, especially NPs and PAs, still regularly perform the DRE. And these providers only relay the now useless and erroneous version that DREs "save lives" but never inform the client of the possible harms, such as ED and incontinence, that many men will endure who had false positives and were railroaded into dangerous avenues via surgery and/or radiological procedures.
In a lit. review current through March 2018, it was found "that for an American male, the lifetime risk of developing prostate cancer is 16 percent, but the risk of dying of prostate cancer is only 2.9 percent. Many more cases of prostate cancer do not become clinically evident, as indicated in autopsy series, where prostate cancer is detected in approximately 30 percent of men age 55 and approximately 60 percent of men by age 80. These data suggest that prostate cancer often grows so slowly that most men die of other causes before the disease becomes clinically advanced."
So, I guess what I'm trying to convey here is that mainly FEMALE providers will often routinely perform the DRE as part of a general physical exam. Why is this? If so many respected organizations and studies recommend against the DRE (and I'm not including Urologists who are consulted by men because they have significant issues or concerns) why are these female providers still performing the DRE? I know my friend who was bullied into multiple DREs witnessed by 3 females, was given no information or informed choice or shared decision making. That NP hag did just what she wanted, turning him into a guinea pig. (It took years for the physician to finally fire her as her gossiping/trash talking of clients was being noted on line!)
Again I ask: Why are mainly FEMALE providers still subjecting male clients to this useless and embarrassing exam, almost always with other females in the room?
PT, at least you and I know why!

 
At Monday, April 16, 2018 9:16:00 PM, Blogger Maurice Bernstein, M.D. said...

You know, I don't recall ever suggesting what I am about to write previously on this Patient Modesty thread but I think it would be helpful to all of us if those participating here might follow my suggestion. With that, here is what I suggest:
Could each writer identify themselves in a very limited way which will help us all better understand at least some of the views and suggestions of the writer.

May I suggest that each writer provide to us all on one posting the following:
gender (we might have assumed but verify), specific occupation or former occupation but without identifying workplace or location. You can detail the occupation and your role but keep the rest anonymous.
Letting us know about your educational background without naming names would also be part of my suggestion. I would say that this degree of information for us all to know would be of value in better understanding the views and information on the text being written. I am not calling for any further identification and do want to maintain other anonymity. It is my opinion that gender can contribute to our image of the writer and what is written a bit more "three dimensional". Write us, if you think that other elements of identification would be appropriate but still maintaining full anonymity.

As for myself, male, bachelor degree, master of science degree, doctor of medicine degree, continuing for 50 years to practice internal medicine and 30 years teaching first and second year medical students the basis of interaction with patients, history taking and physical examination.

Again, this is just a suggestion. ..Maurice.


 
At Tuesday, April 17, 2018 3:31:00 AM, Blogger Biker in Vermont said...

DR. Bernstein, in response to your request, I am a male with a BS and an MBA and am a retired corporate executive.

 
At Tuesday, April 17, 2018 6:48:00 AM, Anonymous Anonymous said...

In her post, Why was I asked to take off my underwear for surgery, Dr. Burgart writes that, “If you’re an adult, no one can MAKE YOU take off your clothes. If you refuse to do it” However, she does imply that they may be removed during surgery in any case if it is deemed necessary by the medical team. She goes on to suggest “If you disagree and refuse to take em off, staff should listen to your concerns to find an acceptable solution." Really? How difficult can it be for providers to figure out that they should simply offer disposable surgical shorts to any patients whose surgery is not in the genital area. This would prevent the “horrible” possibility that the patient’s own underwear might become stained in some way and since paper shorts could easily be cut off if necessary it would prevent back problems for the “multiple people” it takes to remove patient underwear. (It is really that difficult to yank down a pair of boxers?)
My question for Dr. Bernstein and other readers is that although Dr. Burgart suggests that “Staff should listen to your concerns to find an acceptable solution.” What if they won’t? Can they simply refuse to perform the surgery unless you remove your underwear? Similarly, If a patient were to refuse a genital check during a physical exam, can the practitioner simply discharge her/him as a patient for being non-compliant?

MG (Male with a BA and MA and a retired high school teacher.)

 
At Tuesday, April 17, 2018 3:02:00 PM, Blogger Dany said...

EO,

Thank you for taking the time to collect such an impressive collection of information on routine screening for prostate cancer. I only started looking into this myself a few years ago, out of self-interest, as it is something I thought I might come face to face eventually.

Given my rather unpleasant introduction to the DRE, I've always had issues with this test and getting close to the age where it used to be routinely done didn't help at all.

When I had my 40 yo Periodic Health Assessment (or PHA), the doctor sort of hinted at a DRE, but said that I wasn't quite old enough for that (I wonder if that wasn't a sort of mental primer?). And then two years ago, the doctor I went to point blank offered it to me. I recall him saying something like I know Health Canada doesn't recommend it for someone your age but some guys like to have it done anyway. Some do?!? Not I!

[Health Canada revised their guideline on routine prostate cancer screening. And much like the source you provided, the DRE seemed to have been abandoned all together and PSA test only in certain circumstances.]

The information you provided, along with what I have found on my own pretty much confirm that it's a test I probably will never have to do, that is until I become symptomatic.

This is why I was happy when I came across the article Doctor Profetto (see my post on that topic in the previous volume). Any reasons I can use that makes me sound more intelligent than "Nah-an! You ain't doin' that to me!" is worth looking into.

Dany

 
At Tuesday, April 17, 2018 4:03:00 PM, Blogger Dany said...

MG,

If you read between the lines, it is simple to imagine what would happen if a patient refuses to remove their underwear. Could the hospital/surgeon refuse to perform the surgery? I suppose they could (unless perhaps it was a life-saving surgery) but, then again, why bother?

As far as doctors severing (what's the proper term here? Terminating? Breaking?) their professional relationship with their patient for refusing a genital examination? I will politely defer to our local expert on this. Unless I am mistaken, "non-compliance" is usually invoked in relation to care plans (treatments), not assessments.

[I'm assuming you're referring to a visit to the doctor's office or health clinic, and not during an hospital stay.]

As a patient, you have the right to refuse to consent to any tests or assessments you do not agree with. I can say with complete honesty that I have refused - on multiple occasions - to submit to genitourinary exams and I've never had a care provider show me the door (so to speak). Sure I've had the odd looks, the mild arguments / discussions (in an attempt to persuade me) but that was it.

Dany

 
At Tuesday, April 17, 2018 9:30:00 PM, Anonymous JF said...

JF Female. Mother and grandmother ( non biological ) Long time CNA.

 
At Wednesday, April 18, 2018 9:15:00 AM, Blogger Maurice Bernstein, M.D. said...

Attempting to devise a possible explanation for healthcare providers' various misbehaviors described here or inattention to the requests of the patients, could this be explained as a reaction to the intense stress at work and there is a whole lot of stres upon the providers within the medical profession which leads to the so-called "burnout". I am not defending the validity of this explanation but just offering it out for dissection. Can anyone find evidence that all this "misbehavior or worse" was rare generations or more ago?
Again, just tossing this out for discussion since stress and subsequent :burnout: in medicine was a recent topic discussed in the professionalism course for first year medical students at our school and, in fact, discussed yesterday at our course faculty meeting. However, misbehaviors or worse was, of course, not described nor even mentioned) as a mechanism to provide resilience nor to prevent "burnout" in the medical profession.

We have to do a pathological examination, a dissection of the misbehaviors of those in the medical profession in order to devise a cure. ..Maurice.

 
At Wednesday, April 18, 2018 10:05:00 AM, Blogger Biker in Vermont said...

Dr. Bernstein, my guess is that inappropriate or unprofessional behavior was worse in past generations. My parents never questioned authority, nor did most people of their era. Doctors were not to be questioned and people generally did as they were told by authority figures in all facets of life.

As a society things like sexual assault or other forms of abuse were more hidden than talked about or prosecuted. Perpetrators knew the chances of being caught/prosecuted were slim.

As has been discussed here before, men were raised to have no expectation of privacy. For male patients that meant little concern over keeping them covered or otherwise protecting their privacy. Female nursing staff surely knew boundaries could be crossed with impunity. I can certainly attest to the vast improvement in privacy-related protocols now vs when I was younger.

 
At Wednesday, April 18, 2018 2:17:00 PM, Anonymous JF said...

I don't know it for sure but my thoughts are that the cost of going to Med school is too high. Possibly a number of med students have to work and study in the same time period. Sleep deprived people are not generally easy people to be around. I know my work has suffered when I have worked too many hours and my personal life gets neglected. Some places where I have worked,the nurses automatically did 12 hour shifts. The CNA's who work 2 jobs, the quality of work suffers and they are hard to work with.

 
At Wednesday, April 18, 2018 10:19:00 PM, Blogger 58flyer said...

Sorry to change the subject here but I can happily report a success.

I am sitting up in my hospital bed recovering from total joint replacement of my left hip. As the days approached for my surgery, I reminded my doctor of the past abuse history I encountered as an adolescent. This surgery went even better than the last one. I asked for as much of a male team as was possible. My doctor and his staff stepped up and scored a homerun for me. The hospital responded to my request for an all male team which is exactly what I got.

As I was in the prep bay the OR charge nurse came in and reported to me that all members of my team were male, and that there were to be no students or observers. There were something like 7 people involved, and the manufacturers rep was male and also a licensed RN. As I was being prepped for the spinal epidural, I told everyone in earshot of my appreciation of their efforts. Their response was heartwarming to say the least. Everyone understood my situation completely. About that time the anesthesia took effect and I was out. I had 2 male nurses in PACU, and now on the floor both nurses are male. I had trouble peeing at first and the nurse helped me to a standing position which was successful. That couldn't have happened with a female nurse or tech. I might have had to take a catheter.

Anyway, I just wanted to report to friends here a success story. Much of the inspiration to speak up and ask for accommodation was gained here and for that I thank you all.

Mike (58flyer)

 
At Thursday, April 19, 2018 9:11:00 AM, Blogger BJTNT said...

BJTNT, male, math degree, retired manager, software development

 
At Thursday, April 19, 2018 11:01:00 AM, Anonymous Anonymous said...

Hello 58 flyer,

Would you like to tell us the doctor's name and the name of the hospital that assisted you. They certainly deserve acknowledgement and patronage.

Reginald

 
At Thursday, April 19, 2018 1:45:00 PM, Anonymous JF said...

I wonder if possibly, it was just never brought in front of a judge. A certain ratio would retaliate in a criminal kind of way but if the victims got apprehended THEY would be in the trouble, not anybody else. From what I have heard, sex crimes often get swept under the rug even now. People often say "What comes around, goes around! " but I don't see that happening. On Judgment Day it will, but not a minute before!

 
At Thursday, April 19, 2018 2:02:00 PM, Blogger Dany said...

That's amazing, Mike! I'm very glad that your doctor listened - really listened - to you and did so much to help accommodate you. I imagine it couldn't have been that easy.

I wish you a prompt recovery. Hopefully you'll be back with your family soon.

Misty, if you are reading this, perhaps it would be worth engaging Mike and see if you couldn't get a more detailed testimony for your own website. Positive outcomes like this are worth promoting.

Dany

 
At Thursday, April 19, 2018 2:30:00 PM, Blogger Biker in Vermont said...

Good for you 58Flyer., Well done. My guess is that the staff learned something very valuable from your experience. It'll be easier for the next guy that comes along with a similar request thanks to you.

 
At Thursday, April 19, 2018 7:09:00 PM, Anonymous Anonymous said...

Male

First career US Army honorable discharge
Second career BS Chemical engineering, Purdue University
Third Career health care. I won’t disclose other than I’m a consultant, an activist and
the health care industry does not like people like me because I tell the truth.

PT

 
At Thursday, April 19, 2018 10:25:00 PM, Anonymous Medical Patient Modesty said...

58Flyer,

I was pleased to hear about your excellent experience. I'd love for you to submit your case to the patient modesty friendly doctors directory.

Misty

 
At Friday, April 20, 2018 5:41:00 AM, Anonymous Anonymous said...

I tried posting this before, but it seems to have gone missing.

I'm male, have a PhD, and work in higher education.

RG

 
At Friday, April 20, 2018 12:51:00 PM, Blogger Maurice Bernstein, M.D. said...

Thanks to RG and the others for their response to my request for a super-brief identification biography. It is of value in helping to understand a bit more fully the writer's previous and future postings. Again, thanks. ..Maurice.

 
At Friday, April 20, 2018 1:35:00 PM, Blogger Dany said...

Dang it...

I'm male, have a High School diplomat, and currently serving in the Canadian Armed Forces. I prefer to remain vague on my exact employment, for personal reasons.

Dany

 

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