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 bet bter 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.
There will be no further Comments published on this Volume 86 as of May 6 2018. Continue the Comments on Volume 87,

181 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

 
At Friday, April 20, 2018 6:07:00 PM, Anonymous Medical Patient Modesty said...

I am female and I have a BSBA degree in Computer Information Systems. I have a web design business and I am the president / founder of Medical Patient Modesty. I developed the web site for MPM.

Misty

 
At Friday, April 20, 2018 7:43:00 PM, Blogger Maurice Bernstein, M.D. said...

Though my Bioethics Discussion Blog has currently 1006 "Posts" according to Blogger.com (I haven't actually counted them myself) and though some threads are slight followups of a previous thread or two and my visitor responses to any particular thread has been 0 to 40 or so, it has only been the "Patient Modesty" thread with its current 86 Volumes which has steadily and I mean steady had visitor comments running into the 160-190 for virtually all.

So, now I ask the question to our visitors here, after scanning the many many topics of related to the ethics mainly with regard to medical practice (but also a few other none-medical topics such as the ethics of "torturing" trees and other plants)--- WHAT IS IT ABOUT PATIENT MODESTY that has attracted so much interest by visitors and writers for this blog?
There are so many other life and death topics throughout this blog and yet with them the number of responses from visitors is relatively trivial (though, to me, they are also important and worthy of responding to) but WHY PATIENT MODESTY leads the way and continues to do so?

What lights the fire under this topic? Are all the others of minimal importance in the general consideration of bioethics?

Can anyone here philosophize in writing about my question? ..Maurice.

I would appreciate

 
At Friday, April 20, 2018 8:46:00 PM, Anonymous Anonymous said...

You have two men walk into a Starbucks and occupy a table without buying anything and suddenly the industry is turned upside down almost overnight. That company will lose millions of dollars as that loss will be passed along to the shareholders and loss of jobs. I on the other hand am a paying consumer, a patient that supports an industry whereby 1 in every 5 dollars goes into that revenue. An industry that posts fake core ethics that no one can recite, an industry that has some unimaginable acts of unprofessional behaviors reported in the news that even those working in the industry have a hard time believing it themselves.

Continually, it’s enough to make anyone want to puke. Not one facility that I’ve been in polices cell phone use, it’s just another day at the office. Run like hell when you read comments from so called health care providers that say “ well I can’t speak about other operating rooms but here we “. You know it’s bad when the police are called and even they don’t know what to do re: the Denver 5. There is no limit as to the potential comments that can be brought up on this site simply because the number of unprofessional idiots in the healthcare industry are continually increasing.

When the article hit Allnurses regarding Dr Twana Sparks the posts were “ Is this a joke “. When the article hit Allnurses regarding the Denver 5 the posts were “ Any truth to this “ . Yet, when those girls who swing from monkey bars for a living and then pose nude accused Dr Nassar had their day in court, you know we will never hear the end of it cause that crap will rain down from the heavens for years to come.

PT

 
At Friday, April 20, 2018 9:55:00 PM, Anonymous Anonymous said...

Hello Dr. Bernstein,

Modesty/ Dignity for some individuals involves both body and psyche (soul). It's a modality that reaches to the core of our being. It is an integral part of who we are. When our modesty/ dignity is violated, it's not just a physical affront. Our entire selfhood is traumatized. Our values, self-worth and emotions are shattered. Although, possibly, unaltered physically, our soul is pierced. That identity we call ourselves is somehow not the same. Moreover, the scars are not visible. They sometimes lie dormant until something triggers a flashback of the event. And we relive the agony again and again and again. Physical wounds heal; but, psychic/ emotional ones are masked with layers of self-doubt, feelings of inadequacy or outbursts of displaced rage. Our innocence has been wrenched from us, never to return. We feel less than we were before the incident, through absolutely no fault of our own.

We fault health care for modesty/ dignity violations because, medicine tends to bifurcate the physical and the mental/ emotional (with the exception of obvious mental health conditions). Forget modesty/ dignity concerns, the physical outweighs everything, even when life and death do not hang in the balance. The patient will overcome the emotional travesty once the physical is healed. Only recently has health care recognized that the patient heals more quickly, if his/ her emotional concerns (including modesty/ dignity) are also addressed. Neglecting, or even denying, this aspect of the person is one of the most serious deficits of modern medicine. Admittedly, treating the whole person (especially, in an emergency situation) is a tremendous undertaking. One cannot fault health care for not always succeeding at this task. Medical personnel, nevertheless, can (and should) be faulted for denying the existence of modesty/ dignity concerns by adopting a "leave your modesty/ dignity at the door" attitude. For some individuals, this is tantamount to saying, "leave a very important part of your being at the door". The travesty of trampled modesty/ dignity is not overcome by denying its existence. Please see me as a multi-faceted person and, not just a body to be fixed.

Reginald

 
At Friday, April 20, 2018 10:39:00 PM, Blogger 58flyer said...

Maurice, in response to your request for biographical info:

I am male, 61 years of age, spent 24 years in a large city police department with assignments in patrol, detective, evidence technician, and aviation, then retired. Began a second career with a statewide law enforcement resource protection agency focused on aviation, now 16 years into that career. Associate degree in law enforcement subjects and several technical certificates. Rated commercial pilot, fixed wing and helicopter.

Mike

 
At Friday, April 20, 2018 10:45:00 PM, Blogger 58flyer said...

Thanks for the kind responses everyone.

Reginald, the Doctor is Joseph Locker of the Orthopedic Institute in Ocala, Florida. The hospital is West Marion Community Hospital in Ocala.

Misty, thanks for the link.

Mike

 
At Saturday, April 21, 2018 4:52:00 AM, Blogger Biker in Vermont said...

Dr. Bernstein, I think this issue gets the lion share of discussion on your site because the medical world refuses to acknowledge it exists. So long as the defacto operating basis for healthcare is that men have no modesty and that medicine is gender neutral (at least for men), this topic is going to elicit strong feelings.

The other piece to this is the oft-repeated "patient dignity is respected" using a definition that amounts to "patient dignity is respected because we say it is" without ever looking at it from the patient perspective or if a given exposure was necessary and appropriate. Healthcare has made being polite synonymous with patient dignity being respected. One can be extremely polite while needlessly or inappropriately exposing patients. Also, "necessary and appropriate" is generally construed by healthcare staff to mean whatever is most convenient for them.

The medical world is great with the various buzz words (patient dignity is respected, necessary and appropriate, professional) but in practice there is no substance behind those words. This is why this topic gets so much discussion here.

There is a steady stream of articles on KevinMD and elsewhere written by female medical students/residents/physicians bemoaning various aspects of how women do not dominate surgery in particular or medical practice & education in general and of how tough they have it. Rarely are patients mentioned and if they are it is usually in the form of their presence finally giving women a choice or bemoaning sexist men who don't want them as their urologist for example. I have responded a number of times pointing out the vast gender imbalance below the physician level and its impact on male patients, and those female physicians or physicians in training never respond. Equality of the patient experience is not even on their radar, only increasing the feminization of healthcare. Yet another reason why this topic elicits such a prolonged discussion here.

 
At Saturday, April 21, 2018 12:46:00 PM, Anonymous Anonymous said...

Dr. Bernstein, I believe that the patient modesty thread has attracted so much interest because it deals with the fundamental issue of personal identity.
As far back as I can remember, my parent taught me to be modest in the presence of females; and I grew up in an American culture that places a high premium on modesty between the genders.
We have no same gender restrooms, locker rooms, or changing rooms at the beach. In addition, our legal system has deemed our genital areas to be indecent. If I were to expose myself to anyone other than my wife, I could be arrested and tried for indecent exposure.
Having grown up in this culture is it any surprise then that I internalized the idea of opposite gender modesty, that it became part of who I am?
Yet if I enter a doctor’s office, or am hospitalized, I am often asked to dissociate, that is to detach myself from my identity and emotions and become someone who I am not and this is something I simply cannot do. (Yes, there are individuals who can actually do this; but we label them as suffering from a psychological illness called dissociative identity disorder.)
Any person or institution that actually threatens our sense of who we are quite naturally arouses our anger and a feeling that we need to protect ourselves and I believe that so many people come to this blog to discuss strategies for how we might best do so.
Finally, I would like to thank Reginald and Biker in Vermont for their thoughtful comments on the subject.
MG


 
At Sunday, April 22, 2018 10:30:00 AM, Blogger NTT said...

Good Afternoon:

Dr. Bernstein, I agree with Biker.

This topic will continue to garner the most hits until the following happens.

1. The medical community stops fooling themselves and admit a mistake they made decades ago saying men have no modesty was the wrong thing to do. Let’s clear the slate & in an OPEN forum, start talking to each other about ways to bring more men in to balance the gender scales.

2. Our legal system and medical community must stop looking the other way when a female healthcare worker violates a male patient. He didn’t have the “time of his life” he was VIOLATED plain and simple. His case must be treated the same way a female patient’s case would by both the hospital and the legal system.

To society right now, patient modesty is a taboo subject that should only be talked about behind closed doors or out in cyberspace.

I liken the issue to the female predatory teacher issue that’s plaguing our country right now.

Female teachers are preying on our young male kids. They do so because in their minds they are in a position of power that the student won’t challenge. That subject was taboo to talk about until so many women were caught red-handed that it caused people to start asking what’s going on here. That in turn got the issue some much needed press coverage which in turn brought the issue out into the light of day.

By talking in the open about the issue, prosecutors and judges are now rethinking their idea of giving the women a pass that the kid had the time of their life. Instead, they are giving these predators prison time which is the way it should be.

Patient modesty needs to travel along that same roadway.

The medical community has been able to keep this issue in the shadows for so long for the one reason that they are banking on with continue to stay in their favor.

Men will be afraid to come forward and take their case to its conclusion through the courts of public opinion and the criminal justice system out of fear of seaming weak in front of the world and out of fear of retribution from caregivers against those men currently in treatment.

It is this weak man who will take a stand, and find he has the inner strength to stand up against a system that has done him wrong and at that point, he will want to see his case through to its conclusion if for no other reason but to send a message to the entire medical community that like it or not, change is coming.

Once men see more and more men are standing up for their rights, more will join the bandwagon. That in turn will cause the news media to take up the cause, whereby prosecutors and judges will have been served notice no more free passes for female predators regardless of their industry.

The healthcare community has no reason to bring this issue out into the light as it will in the end cost them more money.

If men want to end this nightmare, they are going to have to speak up when they are violated and ignore attempts by the community to settle quietly.

The more noise, the sooner the general public will pick up on there’s problem in our hospitals that needs everybody’s attention.

Then, the healthcare industry will have to bring this issue out of the shadows.

Once out & talked about in the public eye, your blog totals will start leveling off then go down Dr. Bernstein.

Regards,
NTT

Male
BA
Businessman

 
At Sunday, April 22, 2018 2:02:00 PM, Anonymous Anonymous said...

Female

First career: Professional vocalist/musician
Second career: Writing Consultant/Lecturer

BA English
MA English
Academy of American Poets
Marjorie Short Piano Studio
Theo Verlyn Vocal Studio

And, just so we're CRYSTAL clear: Member of NVIC (National Vaccine Information Center). I have inalienable rights as a human being to reject all "medicines/medical care." This especially applies to all "medicines" promoted/mandated by Big Pharma, their cronies in Federal and State governments, medical trade groups such as the AAP, ad nauseum...

EO

 
At Sunday, April 22, 2018 6:05:00 PM, Anonymous JF said...

NTT, I mostly agree with what you said but the male doctors are at fault also. (female doctors to ) If a male doctor working in urology requires female staff to assist him and either requires or permits other females in the room then HE IS AT FAULT.Paying a woman to hold a mans penis out of the way when he could pay a man to do it OR use a peice of tape? How is that saving money? He isn't Mr Innocent here, he either believes the guys are having the time of their lives, or he is secretly enjoying their humiliation/his power over them. When a male doctor or even a female doctor allow extra people to come and go when intimate care is going on, they don't care if that patient lives or dies, as a certain number won't seek care anymore. That doesn't matter to the provider though because they will still enough other patients.

 
At Sunday, April 22, 2018 7:25:00 PM, Blogger Maurice Bernstein, M.D. said...

OK, believe it or not, I just got a concerned comment from a relative in my family. Recently, the male relative had a dermatology exam by a male dermatologist. But, to my relative's surprise, the physician was "shadowed" by a male, thought to be a doctor (but I wonder). However, in addition, the dermatologist also had a female scribe in the room via a video connection to apparently some distant service company. The scribe was visible to the patient and the dermatologist was talking to her. I don't know if the video was also transmitting pictures of my relative's skin exam to the scribe to add to the documentation. All of this was never told to my relative in advance. I got the impression that my male relative was not told in advance who would or could be "watching" the examination.

Googling "dermatology scribes", I see there are a host of companies providing this service via this remote video service.
This scribe activity was all new to me.
And I do think it is unethical for a physician to, without informing the patient in advance, suddenly present the patient (like my male relative) a "shadow" and a "remote visual scribe". What could possibly be the "defense" of the dermatologist?

What has become "routine" for the medical profession obviously and in the case of my relative is "unexpected and possibly unwanted" in the eyes of the patient. ..Maurice.

 
At Sunday, April 22, 2018 8:58:00 PM, Blogger Maurice Bernstein, M.D. said...

Here is a current article in JAMA Dermatology
which seemingly supports the value and acceptance of scribes in dermatology by patients... well, mostly female patients to only female scribes in the study. ..Maurice.

From JAMA Dermatology
Association of Patient Satisfaction With Medical Scribe Use in an Academic Dermatology Practice
Vinod E. Nambudiri, MD, MBA1,2; Alice J. Watson, MD, MPH1,2; Mitchell H. Rubenstein, MD1,2; et al


https://jamanetwork.com/journals/jamadermatology/fullarticle/2672394?result


Discussion
In an era of increasing administrative burden placed on physicians, medical scribes provide an important clinical adjunct for enhancing clinical care and reducing physician burnout in dermatology. One of the major concerns of scribe implementation by physicians is whether scribes would negatively impact the patient encounter. Our study suggests that patients are comfortable with and supportive of scribes, and most patients feel that the scribes actually enhanced the patient-doctor experience. Our department chose to work with only female scribes during implementation of this service. This may have impacted the female (vs male) preference we observed across our patient population.


Conclusions
Scribes were well received by patients of both sexes and all ages. Taken together with prior findings of the enhanced impact on clinical productivity and dermatologist satisfaction, patients’ strong support of the scribe experience provides valuable affirmation for this strategy of clinical care enhancement.

 
At Sunday, April 22, 2018 10:03:00 PM, Anonymous Anonymous said...

Maurice

I’ve read many many articles from JAMA and frankly their opinion means absolutely nothing to me!


PT

 
At Monday, April 23, 2018 3:48:00 AM, Blogger Biker in Vermont said...

This is just to comment on the "holding the penis" after inserting lidocaine in the urethra issue. The supposed purpose is to keep it upright so that the lidocaine doesn't come out and so that the lidocaine goes further down the urethra. I have had lidocaine inserted so many times I could teach the class.

There is NO reason for anyone to hold the penis AFTER the lidocaine is inserted. NONE. The person doing the prep, with just one motion A SINGLE TIME using two fingers applies a little pressure in a downward sliding motion to force the lidocaine in deeper. Then a clamp of sorts is put on the penis that stops any lidocaine from coming out. The clamp also serves to keep the penis from totally flopping over and laying flat.

They do hold the penis to apply an antiseptic wipe to the head of the penis and then to insert the lidocaine, but that is brief compared to the reports of the penis being held for several minutes after the lidocaine is inserted. Any urology office or hospital that has someone standing there holding the penis after the lidocaine is inserted is either ignorant of modern practice or are being purposely inappropriate.

On the "holding it out of the way" matter JF commented on, she is right. Either have the patient hold it out of the way or tape it down. There is no reason for a staff member to hold someone's penis to keep it out of the way. Again, ignorance at work or purposeful inappropriateness.

 
At Monday, April 23, 2018 3:50:00 AM, Blogger Dany said...

Doctor Bernstein,

I don't know that I can add anything of value to what has already been said, and far more eloquently in my opinion, by many here regarding patient modesty.

I suspect it has something to do with cultural biases. With some few exceptions, many activities enforce strict gender segregation rules (think bathroom, or lockers). I learned a few years ago, much to my amazement, that sexual education in many schools across the United States is still taught - or what passes as such anyway - in separate groups (that, to me, makes no sense at all).

Another reasons might be self-consciousness. Ask anyone and they'll readily agree that it's not "normal" to walk around naked. Also, we are very much defined by what what we wear (many professions have dress codes, some more rigid than others). When you take that away, it might leave someone feeling like they are loosing a part of themselves. It undermines their confidence, and sense of "self."

And yet, in many medical situations, we're told to put all that aside. That it doesn't matter, that everyone's a professional and they've seen it all. The medical healthcare community (trying to be as broad as possible here) makes tremendous effort to normalize certain behaviors, in order to gain and maintain compliance from their patients. This isn't to say that in some instances it isn't useful or even necessary.

There's also the sexual aspect to take into account. Let me be candid here; there are two occasions I might expose my genitals: either I'm about to have a really good time, or I'm about to jump in the shower.

But when it comes down to medical settings, again, patients are expected to put all that aside; to pretend that everything is normal (that word again). Obviously, there are times when it would be necessary. But I believe it creates some confusion. Many people finds themselves at a lost; not knowing precisely how to react, how to behave. If there wasn't a sexual component to this, there wouldn't be chaperonnes. And I'm not saying this is the case for everyone; it's there, and people know about it but, again, we're told to put that aside.

It doesn't help that, in my opinion, the sliding scale of what is considered "normal" in medical settings, is continuously pushed back, making it harder for patients to feel like human beings.

Perhaps what gets to me the most is the apparent trivialization of exposure, the banality of it. Sure they might get used to it, but we're not. A kinder approach, one that acknowledges the challenges patients face here might help smooth out some issues. Or at the very least, reassure patients that how they feel is perfectly normal. And not, as it seems to be the case, to deny that aspect, or pretend it doesn't exist.

Dany

 
At Monday, April 23, 2018 4:08:00 AM, Blogger Biker in Vermont said...

Dr. Bernstein, concerning your relative's dermatology exam, what he experienced is par for the course. This is modern medicine where convenience of the providers trumps all other considerations.

Hopefully your relative will follow-up with the dermatologist on this. It is understandable that he was too shocked that day to say anything at the time.

For me I'd rather a scribe in the room than a remote scribe via camera. Any dermatologist as clueless as the one your relative went to most likely has relied upon a sales rep to tell him that the video is secure. If the scribe wasn't watching the exam there would be no need for there to be an actual video connection. The connection would instead be voice only. This means she's still watching his genital exam and the video is subject to being hacked and put on the internet vs just a person in the room watching the exam. Clueless is as clueless does.

 
At Monday, April 23, 2018 10:45:00 AM, Anonymous Anonymous said...

I believe that the the JAMA study that concludes that the use of dermatology scribes receives strong patient support and provides valuable affirmation for this strategy of clinical care enhancement is flawed. This is due to the fact that only female scribes were used. For a truly objective study surely male scribes would have been included as well. However, if that had been done, it is quite likely that at least some women if not many would have had a less positive view of the experience, thereby weakening the conclusion about the positive patient perception of the presence of scribes.
Notice that the summary mentions that the “use of all female scribes may have impacted the female (vs male) preference we observed across our patient population.” (Ya Think!)
I believe this study is simply another example of the self-serving distortions so frequently used by the medical profession to push its own agenda. After all, if patients are so wonderfully happy with the current situation then there is certainly no need to put forth any effort or expense to train or hire more male scribes, nurses, and other medical providers.
MG

 
At Monday, April 23, 2018 1:21:00 PM, Blogger Dany said...

Biker,

Man I really wish you'd made that post before I went for my own cystoscopy a couple years ago. The nurse who prepared me - no, let's be honest here - the student nurse certainly held on to my penis after she inserted the anesthetic gel. All under the watchful eyes of her supervisor (another female nurse) without a comment. Now I wonder if that's not how all nurses are training in urology.

Not that I ever asked but I always thought it was to prevent the gel from being pushed out (isn't that how the urethra works?). As far as making sure it went all the way down, it sure did! The nurse used so much force to "squirt" it in that my bladder had a spasm.

Anyway, I'm not sure how long she held on to, but it would have been a few minutes (say 2-3 maybe), although it felt much longer for me. To the point where it got a little awkward. Not that I became aroused (I was way too nervous for that) but I was beginning to wonder what she was doing.

("You can let go of it, I'm not going to run away; I'm naked." Not that I said that, but I sure thought about it.)

Dany

 
At Monday, April 23, 2018 1:34:00 PM, Blogger Dany said...

Doctor Bernstein,

Regarding your relative's experience, I can only say what I've stated before: people don't realize how bad it is until they're faced with a situation like this (or know someone to whom it happened). This seems a typical case of ambush medicine (although the videoconferencing part is a bit of a new twist for me).

I can't say I have any experience with dermatology exams but now I am going to be more cautious if this is proposed by my care provider. I'm going to have to be more proactive(about what I want and, more importantly, what I don't want).

(My list of worrisome scenarios is getting longer by the day...)

Dany

 
At Monday, April 23, 2018 4:57:00 PM, Blogger Biker in Vermont said...

Dany, all I can say is that a clamp can and does accomplish the exact same thing as someone holding your penis, and it is far more humane and far less sexual in nature.

More and more I realize that different practices have very different protocols. Recall my recent abdominal ultrasound where all I had to do is pull up my shirt and unbuckle my jeans & scootch them down just a bit. My prior abdominal ultrasound at a different hospital had me remove pants & underwear, don a gown, and then the sonographer lifted the gown fully exposing me before she put a towel over my genitals. Same procedure, one with no exposure, the other with full exposure.

The nurse that did the prep for my most recent cystoscopy put a cloth over my penis after he inserted the lidocaine and put the clamp on. I had no exposure while we waited for the urologist. None of the other nurses ever covered me over like that. Why not?

Regretfully we often only learn of more respectful, more dignified protocols after the fact.

I was new to dermatology myself this past year, and it was only because I had learned from others here that preempted the female scribe/female LPN ambush before it happened. Note that not every dermatologist brings others into the room. A male friend of mine goes to a female dermatologist and says she never brings anyone else into the room. Ask ahead of time and just say no females in the room unless they are visually shielded from you. For example a scribe could work behind a screen and still hear the doctor dictating to her.

 
At Tuesday, April 24, 2018 10:06:00 AM, Blogger A. Banterings said...

Reginald,

That was the most eloquent description of why we are drawn to this topic.

Let me add this aspect as well, the trauma that we suffered was pushed upon us and we were bullied into compliance. Then the dawn of the internet, we find the reasons that we were given were wrong. We find these procedures are matters of ritual and not science.

We know that we knew (know) more than the provider did.


-- Banterings

 
At Tuesday, April 24, 2018 11:02:00 AM, Blogger A. Banterings said...

Here is another answer to the question why we get involved with this topic: SOCIAL JUSTICE."

Medicine has never apologized for the mistakes it has made. Patients have had to extract justice through civil and criminal means. Society has made the profession to conform to its expectations.

When medicine did not police itself, society required doctors to carry malpractice insurance, and rates for bad docs went up so high, they could not practice any more.

Here is the latest:

J. Marion Sims statue (5th Ave/103rd Street, Manhattan)
The City will relocate the statue to Green-Wood Cemetery and take several additional steps to inform the public of the origin of the statue and historical context, including the legacy of non-consensual medical experimentation on women of color broadly and Black women specifically that Sims has come to symbolize. These additional steps include: add informational plaques both to the relocated statue and existing pedestal to explain the origin of the statue, commission new artwork with public input that reflects issues raised by Sims legacy, and partner with a community organization to promote in-depth public dialogues on the history of non-consensual medical experimentation of people of color, particularly women.
Source: Mayor de Blasio Releases Monuments Commission's Report, Announces Decisions on Controversial Monuments

Just last week in Los Angeles I saw on the news: Patients With Medical Horror Stories Demand the California Medical Board Back Patient Bill of Rights Requiring Transparency, Accountability.


-- Banterngs






 
At Tuesday, April 24, 2018 12:46:00 PM, Anonymous Medical Patient Modesty said...

Mike (58Flyer),

I have submitted your testimony to our patient modesty friendly doctors database director.

It's always encouraging to see doctors honoring patients' wishes for modesty.

Misty

 
At Tuesday, April 24, 2018 6:13:00 PM, Anonymous Anonymous said...

The annual cost of healthcare in this country hit 4 trillion dollars. If you can wrap your mind around that number here are a few numbers that are not as near staggering, distance to the sun, 93 million miles, distance to Pluto, 4 billion miles. Distance to the next closest star, 3.6 light years. Just what kind of healthcare should we come to expect for this kind of money, 4 trillion dollars. How much trust can that kind of money buy you, apparently not enough as demonstrated by comments made by a female nurse on a Urology floor. After making fun of her patients level of pain ( calling him a wuss) after a prostatectomy and then making fun of the fact that he was a marine in front of a student nurse. Her comments as well as over 30 other commenting told the student nurse, get used to it , you will talk about your patients like that too.

PT

 
At Tuesday, April 24, 2018 7:36:00 PM, Anonymous Medical Patient Modesty said...

I encourage you all to read this article about common fears for anesthesia at http://allaboutanaesthesia.com.au/faqs/common-fears/.

I found the below sentence under Should I Have an Enema interesting.


Uncontrolled emptying of the bowel is uncommon during anaesthesia, except in infants. You do not need to have an enema, or medication to clear out the bowel, unless your surgeon specifically orders one. If so, it is because you are having an operation on or near your bowel.



It is pretty rare for a patient to soil their underwear. I bet that Dr. Alyssa had some patients who soiled their underwear because they ignored the instructions to not eat anything after midnight.

Misty

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

DJP wrote the following at 2:41pm today. An institution name was edited out in view of initial negative comments. Nevertheless DJP's entire presentation is of value. ..Maurice.

I can not even guess where anyone would think it is "protocol" for and abdominal ultrasound to pull up a shirt and lower pants and being exposed for this procedure--are you nuts to comply! In Dec./17 I got this same crap at the [name of medical institution deleted]-man did the s--t fly. I've have 2 abdominal ultrasounds before at the same facility and never ask to pull down pants and be exposed. I demanded to go up the chain of command and created a furor. The dumb asses in management never thought that there is a large number of adults, young adults,adolescents and children who have been sexually assaulted by same and opposite sex individuals only to encounter this trauma again under the guise of medical staff. A month latter I had another abdominal ultrasound for a complex situation at the same facility-boy what a difference. The receptionist told me how management had been shaken, prior protocol reinstated and thanked me for speaking up as they were like me a survivor of assault; in my case by female medical staff with a female doctor watching and doing nothing. For men ever having to go through this check on line and purchase a men's Japanese kimono which will will give discreet coverage. For any abdominal ultrasound and most others, underwear does not need to be removed. The concern is regarding clothing that may have metal such as a zipper,etc. Anyone who tells you to follow the nutty procedure as described in a prior posting about abdominal ultrasound clothing procedure needs to be verbally castrated and have the common sense to demand the manager or dept. head. I am always amazed at the laziness and stupidity of men to stand up for themselves. You are the paying customer in a service supplying industry. The first premise in a service business is to kiss the client's a-s, not the other way around. If there is a problem call your insurance company file a complaint and contest the bill. Wake up guys and take control of you life and stop sitting on your duff waiting for someone else to do it for you and never take no for an answer. I've been told that I am a demanding "patient", to which I say I am paying for a service not a half ass snow job from ignorant self absorbed undereducated and socially inept medical staff.

 
At Wednesday, April 25, 2018 3:40:00 AM, Blogger Dany said...

Biker,

I'm thinking you might be right. There seems to be a wide margin between facilities about what's considered "standard protocol." And, of course, we patients have no way to know before hand.

Misty, I came across that same website earlier when replying to Dr. Burgart. There doesn't seem to be a whole lot of research data on the topic that originates from North America. Of it there is, it's not well published. Which leads me to believe it's not a common occurrence.

To the poster "DJP," let me welcome you to Dr. Bernstein's blog. I see you've come across, much like us, a situation where you weren't exactly treated with dignity. Unfortunate, but it happens. You spoke up, and that's the right approach.

With regard to abdominal ultrasounds, I have found that asking specific questions to your doctor well before the appointment helps ironing out any issues. Make sure to ask exactly what organs he/she wants an image of. Ask about protocol (be specific - if you're concerned about having to undress, even partially, ask about that).

When I had a KUB ultrasound test, I sought to confirm with the urologist what was going to happen, how, and I made it clear (once I had the answers I was looking for), that I wasn't going to remove any piece of clothing. All I had to do was unzip the fly of my pants and lower my underwear a little bit. A towel was placed to protect them. Considering how low the bladder sits, if I didn't have to remove anything, neither should anyone else.

Dany

 
At Wednesday, April 25, 2018 4:58:00 AM, Blogger Biker in Vermont said...

I don't know if DJP is referring to my posts or not but if so I think he misread my comments.

I have had two abdominal ultrasounds. I recently commented on the stark difference between them. I was asked to pull my shirt up, unbuckle my jeans, and scootch them down a bit. Perhaps he misunderstood my "scootch them down a bit". That was just an inch or two. There was no exposure at all (which I stated) and I was very pleased with the protocol. I had called ahead to inquire as to their protocol because if there was to be exposure I was going to ask for a male sonographer.

My first ultrasound that I contrasted it to was 13 years prior, long before I found my voice, and at a time when I didn't even know what an ultrasound was. All I knew was my PCP said he made me an appt. for an abdominal ultrasound on account he found microscopic blood in my urine. That time I was handed a gown and told pants and underpants off. She lifted the gown fully exposing me and then covered me over with a towel. Now I know that exposure was totally unnecessary.

Given the extreme differences from facility to facility in the protocols they use, we really do need to ask questions ahead of time for scheduled tests and procedures.

 
At Wednesday, April 25, 2018 10:40:00 AM, Blogger NTT said...

Good Afternoon:

DJP, men aren’t speaking up for themselves out of fear of being seen as weak and out of fear of retribution from caregivers for those men currently under treatment.

What staggers the mind is across this country in every doctor’s office, imaging center, and hospital there is a set of standard tests for all patients.

These tests all have “standard protocols”. Part of the protocol is maintaining the patient’s dignity and protecting their privacy at all times.

How one place can take the test and run it one way and another location run the same test yet a different way tells me they are either lazy, don’t give a hoot if they embarrass the patient at all, or both.

If it’s not already in place somewhere, here’s what is needed. If it is in place it needs replacing fast.

There needs to be a governing body consisting of medical and civilian personnel that set the protocols for standard tests. These people would serve a 6 month to a year term on the board.

Protocols are finalized by this board and then sent out to all the medical offices and facilities in the country. Offices and facilities are given a one-month grace period to get the protocols up and running.

After a patient has a visit to their doctor of a medical facility they receive that questionnaire.

Part of this questionnaire should state if it doesn’t, recently you went to abc facility and had an abdominal ultrasound. Then it asks, were you treated in a dignified manner by facility personnel before, during, and after your test? Yes __ No__. If no, please elaborate as to why you feel you were not treated in a dignified manner.

For all questionnaires received back with a no answer that have a valid reason, the facility is told about the infraction and they are monetarily penalized for not following established protocols. Each time they are penalized for the same infraction, the cost of the penalty rises.

Hit them in the pocketbook enough times and management will make sure protocols are followed or people will be let go.

It’s amazing how blind the general public is as to the real depth of how bad our healthcare system really is right now.

They say we have a patient-centered system. That is a total lie on their part.

We will never have a truly patient-centered healthcare system in this country until a man, presenting to a facility with a gender specific intimate illness, can walk in, request same gender caregivers every time and get them no questions asked by the facility.

Show me that, and I’ll say we truly are patient-centered.

Regards,
NTT

 
At Thursday, April 26, 2018 8:06:00 AM, Blogger Maurice Bernstein, M.D. said...

NTT, I apologize, I pushed the DO NOT PUBLISH button this morning by accident, So below is what you wrote and to which I fully agree. "Informed Consent" means exactly what is stated in those two words. ..Maurice.


Good Morning:

Biker, I agree with you on the differences from facility to facility and yes, we really do need to ask questions ahead of time for scheduled tests and procedures.

I don't allow my PCP's office to schedule any test where I don't know the who, what and where.

I make them wait until I've done my own research as most of the time all the PCP says about a test is it's done by professionals that know what they are doing.

I told them that answer is unacceptable. So I make them wait. They don't like it but I just tell them I won't be ambushed by a male unfriendly system again.

Regards,
NTT

 
At Thursday, April 26, 2018 12:13:00 PM, Anonymous Anonymous said...

Dr. B. Sorry I’m slow in responding to your query of 2/6/18. After I submitted a message that day then I had an elderly relative fall and go through an ED trip, Hospital Admission, Skilled Nursing Facility and to a higher level of Assisted Living in succession the past couple months. Very interesting experiences having been out of health care for a couple years.

On 2/6 you asked “do you think the basis for the problems is that others in administration are just sitting and observing but ‘too high’ to see injustices? Or does it have anything to do with the fact that there are too many ‘non-physician’ administrators who have never experienced a medical school education and never have had direct intimate medical profession interaction and attention to the sick?”

Its true, many of the CEOs, COOs and of course the CFOs have no direct medical experience. A growing (but still small) number of CEOs and COOs are nurses and physicians. But at the highest level the job is PR, budgets, and making a profit. Healthcare is a business first for CEOs - they don’t survive if they don’t meet their financial obligations. For them there is little value and little time to spend on lower level issues even if they were passionate healthcare providers. Once they reach the C-suite level it is about business survival. Most senior Administrative types never learn of issues at the unit/patient level - that is triaged to the responsible lower administrators, including perhaps the Chief Nurse Exec. Most C-suite administrators only learn of general or specific patient issues in a handful of ways - 1) during a Joint Commission survey or Joint Commission complaint investigation, 2) during a unannounced CMS survey (important because the organization can lose certification in 90 days if something is seriously wrong) and 3) during legal action or regulatory enforcement (the former being more common because of constant med/mal lawsuits). All of these have the opportunity to cost the organization $ and/or harm its reputation (which costs it $).

Can you change an organization without directly involving the CEO? Yes! If you complain about your rights being violated, being abused, etc. and threaten than a whole host of people may be involved. The unit Administrator, the Risk Manager, the Chief Nurse Exec, a Patient Relations person, perhaps the Legal Department and the Compliance Departments, etc. If there is legitimate indefensible behavior by the medical center and you possibly could expose that and if they are reputable center they will work to change their behavior. In past years I’ve provided some regulations that are applicable for this blog. In a second post shortly I’ll post info relevant to inappropriate exposures, draping, etc.

Also send complaints to the institutions accrediting organization, if they use one. The most common is the Joint Commission. Each complaint the Joint Commission receives requires the health care organization to provide a satisfactory answer back. It also means the healthcare organization may have this topic scrutinized at their next survey (within every three years). You may not get immediate satisfaction, but you may start the wheels of change.

As appropriate complaints to local medical boards (for MDs & Medical Assistants under MD supervision), licensing boards (for personnel like Ultrasound techs), and the facility licensing Agency adds even more pressure (please see my next post). - AB in NW

(formerly “AB”, but “AB” gets confused with Banterings. Also, credentials - PhD, Medical Imaging/Radiation Scientist 35 yrs, Compliance Officer 20 years, Regulatory/Licensing matters 20+ years at very large Medical Centers).

 
At Thursday, April 26, 2018 2:50:00 PM, Blogger Maurice Bernstein, M.D. said...

AB, you can continue to use AB as your pseudonym and your style (and content) of writing is different than Bantering's.
Ideally, everyone should obtain a permanent acronym through the Blogger as NTT and Biker, as examples. ..Maurice.

 
At Thursday, April 26, 2018 3:25:00 PM, Blogger Maurice Bernstein, M.D. said...

Does anyone here think that the medical profession is involved in "nudging" the average patient in accepting what is felt to be "unacceptable" behavior on the part of the caregivers by those expressing their opinions on this "Patient Modesty" thread?

To learn more about "nudging" in medicine, just click on
http://bioethicsdiscussion.blogspot.com/2013/06/nudging-informed-consent-toward-one.html

I would be interested in your opinion.
..Maurice.

p.s.-If you want to write something in general about the nudging behavior, write it at that site but if you are writing for application in this "Patient Modesty" topic, write your response here.

p.s.-Have you noticed that I am attempting to nudge you to say something on this topic?

..Maurice.

 
At Thursday, April 26, 2018 4:36:00 PM, Anonymous Anonymous said...

Tried to post this earlier but it failed. As stated previously in this blog there are CMS, Joint Commission and Licensing regs that one can cite when complaining/threatening about inappropriate or discriminatory behavior by a medical facility. But reading in this blog about the number inappropriate “abdominal” ultrasound exams (probably a “KUB” exam - Kidney, Ureter, Bladder exams) and Cystoscopies (not draping the patient after injection of the anesthetic, no privacy while exposed, etc) it is time, in the “MeToo” movement era, that male patients also start calling out inappropriate behaviors they experience.

The Federation of State Medical Boards (which administers board exams for physicians and creates model policies for State medical boards to adopt) has long issued a document that is applicable. http://www.fsmb.org/globalassets/advocacy/policies/grpol_sexual-boundaries.pdf

Here is a condensed version.
“Sexual misconduct by physicians and other health care practitioners is a form of behavior that adversely affects the public welfare and harms patients individually and collectively.”

“Sexual impropriety may comprise behavior, gestures, or expressions that are seductive, sexually suggestive, disrespectful of patient privacy, or sexually demeaning to a patient, that may include, but are not limited to:
-neglecting to employ disrobing or draping practices respecting the patient’s privacy, or deliberately watching a patient dress or undress;
-subjecting a patient to an intimate examination in the presence of medical students or other parties without the patient’s informed consent or in the event such informed consent has been withdrawn;
-performing an intimate examination or consultation without clinical justification;
-performing an intimate examination or consultation without explaining to the patient the need for such examination or consultation even when the examination or consultation is pertinent to the issue of sexual function or dysfunction; and/or”

And in the state I live in now physician abuse is defined as:
“As stated in the rules, a practitioner abuses a patient when he or she:
(a) Makes statements regarding the patient's body, appearance, sexual history, or sexual orientation that have no legitimate medical or therapeutic purpose;
(b) Removes a patient's clothing or gown without consent;
(c) Fails to treat an unconscious or deceased patient's body or property respectfully; or
(d) Engages in any conduct, whether verbal or physical, which unreasonably demeans,
humiliates, embarrasses, threatens, or harms a patient.”

Remember Medical Assistants are under Physician supervision so the above includes them too. Taken together I see no reason why male (or female) patients who are unnecessarily exposed, left exposed, poorly draped, inappropriately draped, etc. should not be filing sexual misconduct and abuse complaints to the respective local boards. Having to expose your genitals for a KUB ultrasound exam is absurd and an example of abuse and sexual impropriety. Leaving you exposed prior to a cystoscopy is absurd (the field isn’t sterile, it can be covered after injection). These could be construed as examples of abuse/sexual impropriety. Asserting his would force changes in process & policy quickly. - AB (in NW)

 
At Thursday, April 26, 2018 10:15:00 PM, Blogger 58flyer said...

Misty, thanks for submitting my information to the patient modesty database. I would have done it sooner but the last few days have been kind of a rough road. Getting better.

Dr. Bernstein, I submitted my bio information on or about the 20th of April. I do not see that it has been published. Did it get lost? I can submit another if needed.

Mike

 
At Thursday, April 26, 2018 10:44:00 PM, Anonymous Anonymous said...

AB

Everything you have said in your last post is true, to the t, but who enforces it. The medical facilities don’t. I’ve never seen anything regarding these issues enforced.

PT

 
At Friday, April 27, 2018 10:49:00 AM, Blogger Maurice Bernstein, M.D. said...

Mike, I found your biographical input and must have missed publishing it at the time but I did now and it is now located at April 20.
However, I will also publish here your very interesting biography.

By the way, I found Mike's first posting of many, many which followed on this "Patient Modesty" thread (Volume 13 dated April 3 2009) http://bioethicsdiscussion.blogspot.com/2009/04/patient-modesty-volume-13.html
and he described his own personal urology office experience with the physician's "nurse". He ended with " I realize it's just easier to say nurse with one syllable as opposed to medical assistant with 6 syllables. Too many folks don't know the difference."


What progression toward an ethical "good" has occurred in the topic being discussed on this Volume 86 9 years later? I would say "not much, if at all." ...Maurice.



Maurice, in response to your request for biographical info:

I am male, 61 years of age, spent 24 years in a large city police department with assignments in patrol, detective, evidence technician, and aviation, then retired. Began a second career with a statewide law enforcement resource protection agency focused on aviation, now 16 years into that career. Associate degree in law enforcement subjects and several technical certificates. Rated commercial pilot, fixed wing and helicopter.

Mike

 
At Friday, April 27, 2018 11:37:00 AM, Anonymous Anonymous said...

PT,

As you know (better than most on this blog) a majority of patients aren’t aware they can complain places *external* to the medical organization, about inappropriate/abusive/discriminatory treatment. The rank order of complaints I found were to the medical center > to the medical center licensing agency > to other state/Federal agencies > Joint Commission. Very few complaints to the Joint Commission, lots to the Medical Center (yes, many of which sort of “disappear” with the unit Administrator unless someone higher up is involved in oversight) and a fair number to the licensing Agency. For every complaint to the Joint Commission we probably got 25 to the licensing agency of the medical center. Complaints by patients to their State Medical Board (about physicians and medical assistants) and to other provider State licensing boards (e.g., Nursing, etc.) were really few (we turned in far more nurses & staff than our patient population). Patients think mostly about holding the medical center responsible and are often not aware of other avenues to address their inappropriate experiences.

Some states have passed regulations requiring detailed reporting and investigations of any patient complaints of sexual assault and abuse in healthcare. Complaints of this nature, now, by patients, will get everyone’s attention - especially the Risk Manager at the facility where the complaints are happening. In addition, a complaint to the State Medical Board is a serious matter for the physician. In some cases they have to hire an attorney to defend themselves. Again, a legitimate complaint to the State Medical Board about a physician or their medical assistants is something a physician will not want to deal with a second time. Most will adjust their practice to avoid the headaches & expense. As for a medical center - at my old facility any complaint about sexual assault/abuse involved a group (security, HR, Risk, Compliance, Nurse Executive). The legal implications and potential bad PR should insure serious attention is given to these matters unless the institution is totally disorganized.

The rules, regs, and laws apply equally to males and females. Historically males have not complained about their inappropriate treatment. No point in speculating why males don’t complain and instead tolerate the abuse. I simply want them aware they can complain, they can complain to many entities external to the medical center or physician’s office, and in many instances those complaints will drive change. Silence will not. - AB in NW.

 
At Friday, April 27, 2018 12:23:00 PM, Blogger Maurice Bernstein, M.D. said...

AB in NW, with your medical administration background and its associated organizational and procedural experience and your awareness of the issues of gender inequality in the development and current practice of the medical system, to me you would be one of the most excellent individuals to write an article to the New York Times. That could start something big and constructive. I suspect an argument against that action would be that you would have to expose your identity to all your previous employers and others with unknown personal consequences. (For example, all those named psychiatrists who came together with a diagnosis of President Trumps psych pathology had received some negative feedback from the psychiatric association and who knows from other colleagues.)
But I think it requires some nation-wide initiation by you (as an example) to make good and ethical things happen in the medical system. What is your opinion about this? ..Maurice.

 
At Friday, April 27, 2018 2:45:00 PM, Anonymous Anonymous said...

Dr. B,

I might write an article later for some other venue, probably not the NY Times, but I’ll have to think about it. There are so MANY issues at play in our unbalanced health care system…

On another note - this is one of my pet peeves, the chaperoning of male U/S techs or male urology medical assistants and how it affects their hiring. Often male U/S techs are required to have a female chaperone when they perform a vaginal U/S exam on a female patient and often male urology MAs are required to have a chaperone present when they prep a female patient for a cystoscopy, for example.

I fully understand the origin of this practice, Risk Management knows females have a appreciable probability of complaining of sexual impropriety/assault. The arrangement is deemed to protect the medical center or physician office that has the male provider and secondarily “protect” the female patient. But the converse is rarely seen, where a female tech or MA is chaperoned by a male when a male patient is examined or prepped by the female provider.

Risk issues aside, this is blatant discrimination of the male employee. To my knowledge no male U/S or urology MA employee has filed a discrimination lawsuit about this in the US. About 10 years ago a male tech in the UK did file such a claim and won (different legal system but no doubt this would be the decision in the US too). But without a male tech or MA speaking up and challenging their employer and filing a discrimination lawsuit the biased health care system rolls along. (And yes, the cost and personal risk of pursuing a lawsuit severely inhibits this action undoubtedly).

Aside from the issues to the patient, the real problem with institutions and physicians feeling this practice is appropriate is it leads to preferential hiring of females, since they are *deemed* to be able to serve both sexes, whereas the male must be chaperoned and thus is deemed an extra cost. They may not admit it but most physicians who need such MAs to perform intimate exams/test preferentially will hire female MAs for their office for this very reason.

An important reason to push back on such biased practices by healthcare. - AB in NW.

 
At Friday, April 27, 2018 4:35:00 PM, Blogger NTT said...

Good Evening:

What Every time a female healthcare worker came to do something intimate related to a male patient and she was not accompanied by a male chaperone the gentleman patient turned the tables on the system so to speak and said "You're not going forward without a male escort"?

What's good for the goose is good for the gander.

So no females allowed to do any type of intimate related male prep, or catheters without a male escort.

Give them a taste of their own medicine!

Regards,
NTT

 
At Friday, April 27, 2018 4:56:00 PM, Anonymous JF said...

Modesty violations aren't considered sexual abuse, even if 50 people were to see a patient and 49 of them unnecessary and without consent.

 
At Saturday, April 28, 2018 5:36:00 AM, Blogger Dany said...

Doctor Bernstein,

You asked if anyone here thought that the medical profession was involved in “nudging” patients in accepting unacceptable behaviours from caregivers. I believe they do. Maybe not every providers, or not in every situations but yes, I get the feeling that this sort of manipulation tactics are used. And it could be that this sort of things happens more often than people realize, or fully understand.

I told of a disturbing (maybe “upsetting” would better describe how I felt) encounter I had with a military PA quite a few years ago. In my opinion, her approach was a nudge – one on the more extreme end of the scale – to ensure my cooperation (to do exactly what she wanted me to). Biker in Vermont's “everything off” experience is another example of nudging. Patients who are told to remove all clothing for certain types of imagery tests not related to genitalia is also, in a way, a form of nudging. Or the seemingly direct link between sedation and complete nudity (which still puzzles me, but that is a side issue).

At the core, the issue is one of “compliance.” What can a health care provider (and I'm including everyone here from the CNAs all the way to specialized surgeons) do, to convince a patient to agree to a procedure, a test, or what have you. This is driven, I think, by the perceived “duty to act” many health care professionals adopt. A more cynical way to word this would be the “I know better” syndrome. And just to be clear, in perhaps many cases, they actually do “know better.” But that is not relevant, not when it comes to consent.

On one side of the scale, the accepted approach (from the public point of view) is that care is offered (perhaps strongly recommended), along with an explanation of the risks and benefits. Then the patient makes his or her decision (I assume here that all relevant information was given). And either care is provided, or not. The other end of that scale would be when coercive measures are used. That, obviously, is a no-no and should never happen, right? Right.

What some people may not realize is that there is a wide, very wide, margin between these two and I believe many health care providers consider it fair game to use any means available to them to convince, or “nudge” a patient to accept care (or the version of care they believe is more appropriate). It could be a lengthy conversation (I would consider this more of an argument) where the provider attempts to “knock down” or refute objections. Or by withholding information that might lead a patient to refuse care (the sometimes very vague way a procedure or test is described, but not in too many details). Or by over emphasizing the risks of not accepting the care. These, in my opinion, are rather mild, all things considered. Still inappropriate but mild.

But what of badgering? Peer pressure? Outright lying? Forcing a patient's hand by presenting the care as an “all-or-nothing” situation (if you don't want to accept X, you can leave AMA)? Manipulating a patient by presenting a false sense of choice (if you won't give a urine sample, we'll have to use a urinary catheter)? Those, in my opinion, raises some serious ethical concerns. I have read far too many posts in various forums (All Nurses being a prime example, but other sources as well), heard too many first or second hand account experiences to dismiss these as impossible, or even improbable. They do happen.

Dany

 
At Sunday, April 29, 2018 11:50:00 AM, Anonymous Anonymous said...

All this grief, is it a bargain for 4 trillion dollars?

PT

 
At Sunday, April 29, 2018 9:44:00 PM, Blogger Maurice Bernstein, M.D. said...

If you want to get a bit academic with regard as to what component of the "nudge" you experienced, you may want to read the thesis of one of the creators of MINDSPACE which is the acronym mnemonic for each of the components which can be used to "nudge": Messenger, Incentive, Norms, Defaults, Salience, Priming, Affect, Commitments and finally Ego.


https://spiral.imperial.ac.uk/bitstream/10044/1/28411/3/King-D-2015-PhD-Thesis.pdf



These are the "toolkit" tools physicians can use to provide that "nudge".


MINDSPACE and Effects on our Behavior:

Messenger- we are heavily influenced by who communicates information to us

Incentives- our responses to incentives are shaped by predictable mental shortcuts
such as strongly avoiding losses

Norms- we are strongly influenced by what others do

Defaults- we ‘go with the flow’ of pre-set options

Salience- our attention is drawn to what is novel and seems relevant to us

Priming our acts are often influenced by sub-conscious cues

Affect- our emotional associations can powerfully shape our actions

Commitments- we seek to be consistent with our public promises, and reciprocate acts

Ego- we act in ways that make us feel better about ourselves

Which element or elements are your healthcare providers using to "nudge" you into accepting an action? ..Maurice.

 
At Monday, April 30, 2018 5:46:00 AM, Blogger Biker in Vermont said...

Dr. Bernstein, I think the norms and defaults are the ever present nudges. Patients are basically told “this is how it is done” so as to get them to go along with whatever is most convenient or the staff and/or which generates the most billing.

The example I will use is the virtually automatic sedating of patients for simple procedures for which non-sedation should be an option. In the past year I have had a colonoscopy, an upper endoscopy, and a transesophageal echocardiogram without sedation. In each case sedation was presented as the way it is done without non-sedation even being mentioned as an option. I imagine the same occurs for other routine procedures such as cardiac caths.

Beyond the “sedated patients are more compliant” convenience aspect of this, there was a billing piece to it too. It took multiple rounds but I succeeded in getting a $600 recovery room charge removed for the T.E.E. procedure that is included as part of the sedation billing.

Another norm and defaults nudging example would be the female scribe and LPN in the room for dermatology full skin exams. The nudge towards norms and defaults is so strong there as to portray the male patient as having a problem if he is not comfortable with the presence of those “professionals”. Males are routinely nudged with the medicine is gender neutral, there is nothing sexual with opposite gender exposure meme.

 
At Monday, April 30, 2018 7:43:00 AM, Blogger Maurice Bernstein, M.D. said...

Biker, I would say the "nudge" you describe,
the nudge for the patient expected to be selecting the procedure with sedation meets and utilizes the MINDSPACE NUDGE of "Defaults :we 'go with the flow' of pre-set options". It is folks like you, Biker, who challenge the "defaults" expressed, in decision-making, by their physician. ..Maurice.

 
At Monday, April 30, 2018 7:08:00 PM, Anonymous JF said...

Don't take my word for it,I've never had a colonoscopy, but one of my Facebook friends posted an article about them saying they are a scam and do more harm than good. For one thing they can cause a person to become incontinent. I just thought I'd put that out there.

 
At Tuesday, May 01, 2018 9:40:00 AM, Anonymous Anonymous said...

Hello,

Excuse me if I'm not adept at using euphemisms. After fully explaining to the adult patient the benefits, possible complications, alternatives, etc. of the procedure, isn't a "nudge" the same as medical paternalism - "I know what's best for you"?

Reginald

 
At Tuesday, May 01, 2018 1:23:00 PM, Blogger A. Banterings said...

Biker et al,

One area that I caution physicians offices on is not fully discussing alternatives that may have a financial cost (i.e.: not as profitable) to patients. This is essentially mail fraud (not telling patients a less costly alternative). What qualifies as mail fraud, is that some aspect of the procedure (billing, scheduling, legal notices, EOBs, etc.) are sent by mail.

What that means is that this claim is made to the (local) postal inspector's office. If you will excuse the metaphor, this is more intrusive than an anal probe. There is one thing that is more intrusive, more humiliating, scary as hell, and no anesthesia is allowed, it being the target of a postal investigation.

Even if you are completely innocent (just an innocent bystander), you will be spending $25K to defend yourself. If you might be possibly guilty (such as the described by Biker of not being offered the cheaper alternative), $100K.

A situation such as that, there may NOT be intent to commit (mail) fraud , but technically if there is a pattern of doing the procedure without offering the cheaper alternative, that IS fraud.

Unfortunately, most people think that a postal investigation is like a malpractice claim. Just let insurance hire an attorney and it goes away.

I also advise patients who have been wronged as Biker has been, to first approach the physician (and/or their office) about changing policy, then file a mail fraud claim with the postal inspector.


-- Banterings




 
At Tuesday, May 01, 2018 6:01:00 PM, Anonymous Medical Patient Modesty said...

I encourage everyone here to read the case of Don who successfully stood up and refused a body exam by female nurses when he was in the hospital recently. You can go to this link. I think those female nurses had a strange excuse to examine him from head to toe.

Misty

 
At Tuesday, May 01, 2018 6:30:00 PM, Anonymous Anonymous said...

Misty

Just to let everyone know there is something called a head to toe nursing assessment. I’m not going to go into it in detail but essentially it’s worthless. Most don’t do it and I know some who do when parts of it are absolutely unnecessary.

PT

 
At Wednesday, May 02, 2018 5:20:00 AM, Blogger Biker in Vermont said...

Misty, call me cynical, but I'd guess the guy Don you wrote about was a good looking/fit guy deemed worthy of a thorough look over by the nursing staff. I would add that it does not take 2 nurses to do such an exam. I'd also guess that standard protocol would not include such a thorough exam for an alert patient capable of pointing out sores or other issues. It would be good if he did a follow-up with the hospital explaining the incident. Just another reminder that there is a sexual component to medical care for some staff members directed at some patients.

 
At Wednesday, May 02, 2018 8:39:00 AM, Blogger Maurice Bernstein, M.D. said...

My impression is that nursing behavior in terms of their sexual stimulation is a rare behavior and this is not part of nursing activity. What may appear as excessive sexual interest during an interaction between nurse and patient is misleading and may be misinterpreted because of the patient's own physical modesty issues. I have never read that lack of or excessive sexual stimulation in nurses interaction with patients was a factor in well-established "nurses burnout".

I would advise a male patient being attended by a female nurse and the patient senses behavior which appears not appropriate for the situation and actually appears to the patient as sexual misbehavior, the nurse should be notified by the patient and challenged to explain the nurses present behavior.

Patient autonomy means more than the patient making their own medical decisions. It also means the ethical right to "speak up". ..Maurice.

 
At Wednesday, May 02, 2018 8:55:00 AM, Blogger A. Banterings said...

Maurice,

The MINDSPACE thesis is interesting. My first concern was that this manipulation is an affront to personal autonomy. The author covers this issue in chapter 10. First off this focuses on government interventions on the macro level, patient-physician interaction is on the micro level.

One of the most misleading examples used is that of getting people to quit smoking. If smoking is so bad, why not outlaw it all together?

Answer: billions of dollars $$$$$ in tax revenue.

The other problem is this was written in May of 2015.

Perceptions have changed due to Facebook and the Presidential election and potential "nudging" done on FB.

I personally think that Donald Trump was a much better choice than Hillary Clinton. The (so called) nudging (allegedly) by the Russians simply highlighted Hillary's shortcomings. It nudged voters to make an informed decision.

So you can see how nudging is now viewed as a bad thing in our society and the arguments of 2015 will not stand the muster of 2018.


-- Banterings


 
At Wednesday, May 02, 2018 9:09:00 AM, Anonymous JF said...

PT, If you had your way women would give birth fully dressed and the babies would come out wearing a diaper.

 
At Wednesday, May 02, 2018 11:40:00 AM, Blogger A. Banterings said...

Let me add this to the discussion of MINDSPACE and nudging:

One nudge discussed in MINDSPACE was opt-in vs. opt-out. We know that the consent section is opt-out for students, but others are assumed to have consent. That is changing.

Society is making medicine conform to the norms and expectations of society, not to those of the industry.

Read the article, "Warner Chilcott's marketing probe snared a doctor, and now she could go to prison."

Even though medicine thinks it is OK to have manufacturers' reps part of the procedures, records, etc. Yet, society, and its members (us on this blog for example), do NOT give carte blanche access to our bodies or medical records.

Although this is because the physician lied, she would not have had to lie if manufacturer was acceptable to society.


-- Banterings


 
At Wednesday, May 02, 2018 11:50:00 AM, Blogger Maurice Bernstein, M.D. said...

Banterings, I don't want to get into a presidential political discussion on this thread..though Trump does face a personal lack of modesty issue with regard to his Tweets and his alleged history with women.
..Maurice.

 
At Wednesday, May 02, 2018 11:51:00 AM, Blogger Biker in Vermont said...

Dr. Bernstein, you are correct of course that the best time to speak up is when it is happening. The person Don that Misty wrote about could have said "the reason you are giving me for why I should have a head to toe exam does not make sense to me and is leaving me with the sense that you just want to see me exposed". That would be pretty difficult for most men to do when taken by surprise by the nurses in that fashion, but it could be done.

I would suggest that the nurses could have acknowledged his distress and said something to the effect of "I sense you are uncomfortable with this. Would it put you at ease at all if only one of us did the exam or if I found a male nurse to do it?". She could also have said "how about if we at least do your upper torso and your legs, thus skipping your genital area". If the exam is as important as they maintained, doing 90% of his body is better than doing 0% as it ended up being. The fact that they didn't do any of this is what makes me think they just wanted to see what's under the covers.

 
At Wednesday, May 02, 2018 12:26:00 PM, Blogger A. Banterings said...

Maurice,

Perhaps I might have to disagree with you. At that point, Donald Trump was (is) a professional entertainer (celebrity), this is perfectly acceptable in that industry (standards set by the industry themselves).

Perhaps the women are being too modest...

Please note this post is a satire.



-- Banterings


 
At Wednesday, May 02, 2018 12:50:00 PM, Anonymous JF said...

Biker, the second nurse was a chaperone and there to make him more comfortable. The exam that he turned down would have extended his life by 5 or 6 years.

 
At Wednesday, May 02, 2018 1:14:00 PM, Anonymous Anonymous said...

QUOTE: My impression is that nursing behavior in terms of their sexual stimulation is a rare behavior and this is not part of nursing activity. What may appear as excessive sexual interest during an interaction between nurse and patient is misleading and may be misinterpreted because of the patient's own physical modesty issues. I have never read that lack of or excessive sexual stimulation in nurses interaction with patients was a factor in well-established "nurses burnout". UNQUOTE

I tend to agree with the about. If a male violates a female's modesty, he's probably a pervert. If a female violates a male's modesty, it's probably about control, control, control. Violations are common in the medical community because female "professionals" know that they have the power to control patients with impunity.
BJTNT

 
At Wednesday, May 02, 2018 2:28:00 PM, Anonymous Anonymous said...

JF

Only female nurses work in L&D so how they prefer to have their patients dressed is up to the patient, I wouldn’t know.

Regarding the patient Don and the two nurses wanting to do a skin exam, really, I doubt they would know the difference
between actinic keratosis , rosacea and a mosquito bite. That’s how pointless the exam would be.


PT

 
At Wednesday, May 02, 2018 2:44:00 PM, Anonymous Anonymous said...

JF

I’m impressed that you are able to make a differential diagnosis over the internet regarding Don the patient, that two nurses would have came up with the same conclusion. Tell me, how did you arrive at his life being cut short by 5 to 6 years? How many nurses does it take to change a light bulb, yet how is it that it takes only one nurse to eat a large pizza.

PT

 
At Wednesday, May 02, 2018 3:25:00 PM, Anonymous JF said...

Dr Maurice, How do you explain what was done to Marjory Star when she was brought in the ER? It was in an earlier volume. 20 I believe. She told of being 15 years old and being franic, because the nurse was cutting off her clothes in the ER as the police and the EMT's stayed around and watched. PT then said that he had witnessed the exact same scenario, only on male patients. If that stupid nurse really didn't realize that poor girls reason for distress because nakedness was just like seeing elbows then she's just too used to seeing nudity. Maybe she was working to many hours. But I hope she lost her job over it. I hope the cops and EMT's got some kind of substantial trouble out of it also.

 
At Wednesday, May 02, 2018 3:52:00 PM, Blogger Dany said...

I have to admit... What "Don" did was a pretty brazen thing to say to a nurse. Bet they never saw that one coming. I'm surprised the Charge Nurse didn't come barging in the room, wanting to "sort him out."(as I have heard sometimes happen) Of course, I fully realize the author only gave a summary of the incident, and that perhaps we are missing some information. I'd be curious to know what led up to his final "challenge." Were the nurses insisting? Did he stated his refusal to consent more than once, only to use that line as a last resort (when realizing the nurses wouldn't take no for an answer)?

My experience with some providers, is that sometimes saying a polite "no" is misunderstood as "I'm not too sure, but maybe if you insist I'll change my mind." That's why I tend to get a lot less polite the more often I have to repeat myself.

I find myself agreeing with Biker on many of the points he made. I do wonder if such a skin integrity check was absolutely necessary in his situation (this was a short hospital stay, no information provided about restricted mobility or being bedridden). And yes, the nurses could have shown a little more tact in handling this, acknowledging the awkwardness of the situation (okay, let's be honest here; there's about zero chances they'll offer to find a male nurse but one can always hope). And I also agree that an incomplete assessment is better than no assessment at all.

(On a side note, it's a time-tested and well known nudging technique to claim an assessment must be completed because it's what they have to do - it's on the form.)

JF, while I agree with you that the second nurse was a chaperone, I can definitely say that it wasn't for his comfort (if anything, adding a second female nurse probably increased this patient's discomfort). This was to cover the hospital/nurses' back side in case of any alleged inappropriate behavior, and nothing more. I'm not sure I understand how accepting such an assessment would extend someone's life, though.

Dany

 
At Wednesday, May 02, 2018 4:47:00 PM, Anonymous JF said...

What I said about the 5 or 6 years was sarcasm. The chaperone being there for patient comfort was sarcasm also. If patient comfort had anything to do with it, we would be ASKED! I've never been asked, have you? They cover their butts while requiring us to uncover ours.

 
At Wednesday, May 02, 2018 7:51:00 PM, Anonymous Anonymous said...

I’d like to offer a very effective suggestion to anyone who may feel nursing staff may try to push something on you that you may not want or feel uncomfortable about or if they bring their charge nurse in to further push or persuade you. You simply say “ I want everyone to stop trying to bully me “. Verbally abusing or bullying a patient are considered reportable to state nursing boards and is considered unprofessional.

PT

 
At Wednesday, May 02, 2018 8:53:00 PM, Anonymous Anonymous said...

JF, the colonoscopy "save lives" BS is yet another medical fake news SCAM, as your friend on Facebook noted. There has been some discussion of the term "nudging" on this blog and how medical providers use it to influence clients to adhere to what they think is best. I call it bullying, which it really is, as most providers re colonoscopies only highlight the so called positives of this invasive test and hardly ever relay the negatives associated with it. Though there is debate on who first coined the reference, Mark Twain made it popular: "There are three kinds of lies: lies, damned lies, and statistics." If you're willing to research it, a person undergoing a colonoscopy may be THREE TIMES more likely to die from the procedure itself than from colon cancer. Perforation of the colon and infections from poorly disinfected scopes are two of the worst outcomes, and all told, we can expect 30 deaths per 100,000 colonoscopies performed, meaning that the death rate from colonoscopy is roughly equal to the number of cancer deaths supposedly averted through early detection!!! This is the dirty secret that the American Cancer Society never informs one of when it advises that everybody undergo a screening colonoscopy starting at age 50.

I'll never have one, and I'm a boomer! Also, to make more money, about 80% of facilities use Cidex (glutaraldehyde solution) rather than peracetic acid which is much superior in its disinfecting value. Endoscopes cannot be autoclaved, that is they cannot be sterilized, only disinfected. There are sterile sheaths for esophagoscopes and bronchoscopes. These sterile sheaths contain sterile, disposable air-water and biopsy channels. However, sterile sheaths are NOT available for colon cancer screening devices.

"The big problem with these scopes is that the channel where the air and water flow through, which also gets contaminated with tissue, blood, feces, and all kinds of things, is not fully accessible in most flexible endoscopes. You can't get a brush all the way through it... You can't cook [autoclave] these things between patients like you do in normal surgical devices"(D. Lewis).

One is more likely to be harmed by a colonoscopy then one is to have a cancer diagnosed by it. (R. Clare M.D.). Gee, sign me up, doc!

Readers, doesn't this remind you of something else - the PSA hype? Nudging people to get these kinds of dangerous tests is unethical. Complications are ten times more likely in colonoscopies than in any other commonly used cancer-screening test, according to the Annals of Internal Medicine. So, if one in every 250 to 350 colonoscopies results in serious complications, with 15,000 deaths per year, why is the US make'emsick industry hyping it to clients when developed countries without kickbacks use the FOBT?

"And here’s how the math works out: screen 100,000 asymptomatic people to find between 40 to 45 cancers, most of which will be early-stage with a decent chance for cure. That’s the good news. Now here’s the bad news; to save those 30 to 35 people (not every person diagnosed will survive), the test will harm upwards of 250 people, meaning that for every 1 patient who benefits, between 7 and 8 will be harmed. What kind of harm am I talking about? Diarrhea and dehydration from the bowel prep before; colon perforation, anesthesia reactions, and the occasional heart attack during; and GI bleeding and pain afterward. Of the people suffering these complications, a few will have heart attacks and die, a couple will suffer fatal anesthesia reactions, some will develop congestive heart failure, a couple will die from hemorrhage, and a few more from peritonitis complicating a perforated colon. In fact, you are more likely to have your colon perforated from the test than you are to have cancer detected!"(R.Clare M.D.)

Continued due to word length. EO

 
At Wednesday, May 02, 2018 10:21:00 PM, Anonymous Anonymous said...

EO

Excellent comment on colonoscopies! I’d like to add that two methods used to clean endoscopic scopes are manual and automatic machine of which neither are truly effective. If you recall about 7 years ago at a VA center in the south, 10,000 patients were infected with HIV from poorly cleaned scopes. Virtual colonoscopy is an equally effective means of evaluating the colon utilizing a Cat scan.

I’ve never came outright on this blog regarding endoscopy at least regarding colonoscopy from my personal perspective. I’ve refused the procedure not from a loss of privacy but the risks associated from this routine test being acquired infection and perforation. There are other comparable tests utilizing endoscopes at the other end being your esophagus, stomach and duodenum called an EGD or esophagogastroduodenoscopy. This test has the same risks as a colonoscopy and again the anatomy can be evaluated equally utilizing imaging tests.

I will say though that if you ever produce stones in your biliary ducts an ERCP is inevitable. This entails an EGD as mentioned and currently there are no other suitable methods to date.

PT

 
At Wednesday, May 02, 2018 11:28:00 PM, Blogger Maurice Bernstein, M.D. said...

EO, if you continued your lengthy narrative on another submission, I can't as yet find it. If you did send it, please send it again.

Now to my experience: in my medical career, I had only one patient that I know of with a complication from the colonoscopy procedure. It was an elderly lady with the study performed by a gastroenterologist and she suffered a distal perforation of colon which as I recall was satisfactorily managed. I don't recall that this was a screening study but was a followup procedure.

Finally, about "nudging", I spent a half hour yesterday with my 6 medical students , before they went to the hospital wards, discussing "nudging" which they were first learning from me. Though I didn't use the word "bullying", I wanted them to know that "nudging" was a form of presenting alternatives for consideration in the decision making by the patient but had to be used cautiously with the benefit of the patient's by following the "nudge" only going to the patient and no one else.
To me, for some patients and some decisions, proper and ethical use of a "nudge" is a benefit for the patient, particularly the patient who "needs assistance" in making a decision. But all attempts at "nudging" has to be performed carefully, thoughtfully and ethically with only a benefit to the patient, based on the physician's education and understanding.
The physician has to be prepared to take seriously and accept the patient's decision contrary to the one "nudged". But the physician must accept the response even when the "nudge" is "ineffective".

..Maurice.

 
At Wednesday, May 02, 2018 11:40:00 PM, Anonymous Medical Patient Modesty said...

Biker in Vermont,

Don is actually in his 80s. I think he should complain to the hospital about the nurses. I'll tell him. He is one of MPM's supporters.

Misty

 
At Thursday, May 03, 2018 10:06:00 AM, Anonymous Medical Patient Modesty said...

I wanted to encourage you all to read this article in Outpatient Surgery Magazine about a nurse who was fired for reporting safety concerns at a hospital. This is why many nurses feel intimidated to report wrongdoing.

Misty

 
At Thursday, May 03, 2018 1:02:00 PM, Anonymous Anonymous said...

Misty

There is more to this story than you see. The job of Chief nursing officer is to resolve safety issues and the issues with the physician should have been brought up In the medical staff review which is the job of the CEO and or the COO. Nurses actually spend more time complaining about their job, backstabbing each other, bullying patients, bullying new young nurses, nurse to physician bullying rather than working as a coherent team. You want examples, I’ve got plenty.

PT

 
At Thursday, May 03, 2018 3:16:00 PM, Anonymous JF said...

PT, The bullying abusive behavior you talked about does happen. I've worked at places like that. But I've also worked at more places that that kind of behavior is minimal. If you were to say The hens will cluck, I will tell you Not this hen. Why couldn't the story we just read be true? It's true that we don't know for sure. It can be a very dangerous thing to go against the flow. Everything isn't always puppies and kittens.

 
At Thursday, May 03, 2018 5:49:00 PM, Blogger A. Banterings said...

JF,

Your response to PT seems luke warm, it lacks the condemnation necessary to right these wrongs.

We all need to remember:

"For evil men to accomplish their purpose, it is only necessary that good men do nothing, -- Rev. Charles F. Aked.


-- Banterings


 
At Thursday, May 03, 2018 8:14:00 PM, Anonymous JF said...

I just see no reason why the story we just read couldn't be true. I know women can be witches. It doesn't mean ALL are, or even most. But it's a really common thing for people to wimp out when stepping up to the plate could endanger your job. People depend on their jobs, even if its a low income job.

 
At Thursday, May 03, 2018 9:18:00 PM, Blogger A. Banterings said...

JF,

I am sorry, but all you are doing is giving abhorrent behavior a pass. History has shown us that in the worst cases (such as with genocide), people have stood there and said what can I do?

In incidents of hazing, people have stood there and said what can I do?

During the lynchings (prior to the civil rights movement), people have stood there and said what can I do?

To look away makes one just as guilty as those who commit the act.


And the King will answer them, 'Truly, I say to you, as you did it to one of the least of these my brothers, you did it to me.' Matthew 25:40


-- Banterings


 
At Friday, May 04, 2018 12:56:00 AM, Anonymous JF said...

Banterings. Did you read the story? The nurse in the story did the right thing. Look what happened to her! That's why people don't want to rock the boat because people want to protect their own jobs. I know she did the right thing. Most people wouldn't though. Do you remember Gift bearers story? One super grouchy doctor decided she was a drug seeker/hypochondriac and wrote sabotaging things in her chart and basically threw her under a bus. His coworkers just let him do it. The story was on this blog last month. The regulators refused to investigate. And said their decision was final. The story was here last month but its years later. Everything it takes for the hholocaust to happen is in place already. PT, is the one that put it back on the nurse, not me. He said there had to be more to the story. Problem behaviors in high places brings out the cowardice in people. Am I different? I have fallen down that way at times. I don't see how I'm giving anybody a pass. Read the story and listen to Mr Woman haters response.

 
At Friday, May 04, 2018 3:52:00 AM, Blogger Dany said...

Doctor Bernstein,

I wonder if I haven't been using the term "nudging" inappropriately. Perhaps coaxing would be more accurate, although I can certainly see where some of the examples I have talked about would be a lot closer to bullying. It all seems to come down to manipulation, in order to get someone to do something he/she might not be wiling to do.

My sister told me of an experience her husband had a few years ago. He had to have surgery to repair some hernia-related injury. I do not recall exactly what the issue was, other than it was very painful (so I am told), and that my brother-in-law had to stay at the hospital for a few days.

At some point during hospitalization, a nurse came to his room and told him that she needed to do a rectal swab (I believe to screen for C. Diff). My brother-in-law immediately objected to this, in a very vocal way. The nurse took it all, then looked at him and said well if you won't let me do it, then it will be the security guard. It just so happened that, curious about the commotion, a security guard, got closer to the room and was standing by the doorway. My brother-in-law relented and agreed to let the nurse do the rectal swab.

To me, this is a classic example of presenting care as a "false choice." The nurse's approach was that the swab was going to happen (like it or not). But she presented him with a screwy choice: her or the guard. And my brother-in-law, like most people I would assume, completely swallowed that tale. Faced with this unpleasant choice, the thought of saying no probably never occurred to him.

And the nurse was perfectly aware of that fact. This was a deliberate attempt at manipulating her patient. The sad part, and a little scary, is that I get the feeling that this is not an isolated incident.

So I have to ask, was this a "nudge?" I know how I would call it.

Dany

 
At Friday, May 04, 2018 7:29:00 AM, Anonymous JF said...

O Wow Dany. I wonder if that was allowed or if she could have gotten in trouble for it! I'm AFRAID. that she might be congratulated on what she did, being he couldn't prove she said any such thing ( unless he would be taping the confrontation with his cellphone )

 
At Friday, May 04, 2018 8:10:00 AM, Blogger Maurice Bernstein, M.D. said...

Dany, a "nudge" is NOT a threat. A "nudge" represents an education but aimed in a direction set by the educator most people would tend to accept. ..Maurice.

 
At Friday, May 04, 2018 9:22:00 AM, Blogger A. Banterings said...

JF,

I know the nurse did the right thing. Good for her. I refer to the "other people" who do not want to rock the boat. They are just as guilty as the perpetrator.

To say that they fear for their jobs slaps the face of dignity of very person and their profession. If healthcare providers are so compassionate and all the other marketing fluff we hear about them, then they would sand up and do the right thing.

What you are saying is that most healthcare professionals would rather turn a blind eye than do the right thing.

How can anybody respect that?


Dany,

Hospitals find creative ways to use security guards. Patients need a way to fight back. Here in Pennsylvania we have laws that specifically protect institutionalized individuals. Although this was enacted to protect mainly the elderly and mentally challenged, this can be applied to hospitalized patients.

One could also apply tort law that if the security guard intervened, he could be sued for practicing healthcare without appropriate licensure or training.

I personally would have told the guard that this nurse is threatening me with sexual assault with a foreign object, I do NOT feel SAFE, and to please remover her.

This has just created a legal duty for him to protect, notify the proper personnel so that an investigation can begin.

In healthcare today, the magic words that a patient can say are: I do NOT feel SAFE.


--Banterings


 
At Friday, May 04, 2018 10:11:00 AM, Blogger Biker in Vermont said...

So we have two great phrases that can be used as appropriate:

From PT: “ I want everyone to stop trying to bully me “

From Bantering: "I do NOT feel SAFE"

It does seem that either will likely stop whatever is happening in its tracks.

 
At Friday, May 04, 2018 10:35:00 AM, Anonymous Anonymous said...

Anyway, there's tons of great info on the cons of this con game! And, it would be great if some of the male contributors to this blog emailed Jimmy Kimmel and educated him as to the REAL FACTS re colon cancer. ( Re video of Katie Couric with Kimmel having a col.) Another aspect to the video clip which really pissed me off was the three attending/medical females - he's really doing some damage to the male modesty movement here, as well as scaring sheeples into thinking that this dangerous test will "save lives"! Let’s recall – the phony “war on cancer” is lost!
Even the American Cancer Society (just another trade organization!) states that "Unfortunately, reliable statistics on deaths from colon and rectal cancers separately are not available because almost 40% of deaths from rectal cancer are misclassified as colon cancer on death certificates. The high level of misclassification is partly attributed to confusion between the terms colon cancer and colorectal cancer because of widespread use of 'colon cancer' to refer to both colon and rectal cancers in educational messaging."

Educational messaging = nudging = bullying = propanganda! Conduct your due diligence!

Oh heck, let’s just say it for what it is – the ACS and its minions ARE LYING TO THE PUBLIC ABOUT THE RATES OF COLON CANCER, DELIBERATLEY MIXING IN DEATHS FROM RECTAL CANCER, FOR WHICH A COLONOSCOPY WOULD DO JACK! Deaths from rectal cancer are “misclassified”? Just how stupid are the physicians filling out the death certificates? Or, is it like the nursing hags – can’t tell a penis from an elbow! Can't distinguish an anus from a colon!

EO

 
At Friday, May 04, 2018 10:55:00 AM, Anonymous JF said...

Cowardice and not unifying is exactly way our rights are so easily trampled on. But we're not unified. What about Gift bearer? The woman whose doctors branded a drug seeker and a hypochondriac? Did you ( or would you if you haven't already ) post for her on your Facebook page? I've been posting for her but I only get responses when I tag people. Some of them have shared the post but I don't think they are tagging. Also I think a more attention getting picture should be used.

 
At Friday, May 04, 2018 1:59:00 PM, Anonymous Anonymous said...

JF

First, I need to say that really I don’t care anymore what people say about me on this blog. Many of us have many years of experience in this game, we know the rules and can contribute to the subject enormously. What I’ve noticed over the years is that healthcare workers I believe are tremendously insecure, they bully, they backstab, they whine, they complain. When all else fails find someone to blame, throw somebody under the bus, anybody, The drama is so thick you can cut it with a knife.

I greatly respect Banterings for all he has contributed to this blog and will continue to do so. I just had to bring up your comment JF when you responded back to Banterings and you said “ PT is the one who put it back on the nurse, not me” You see, this is what healthcare workers do, find someone, anyone to blame. I think the phrase throw someone under the bus was invented in healthcare. Over the years I believe this mentality hurts only one person, the patient. Crap flows downhill and eventually pools around the ankles of the patient rather then everyone try to be in a coherent team for the patient.

Frankly, I’ve just too many examples to list to describe this behavior and I don’t need to regurgitate it cause we all know ALL nurses hate their jobs. You don’t have to look far to find it on the web, just type “ nurses hate their jobs”. In some way I think this mentality is partly responsible for the very negative manner in which patients privacy are violated. It’s attributable to what I call the hate factor, devoid of caring, devoid of advocating.

PT

 
At Friday, May 04, 2018 3:42:00 PM, Blogger NTT said...

Good Evening:

First a link or two to articles you might be interested in reading.

The importance of a patient experience officer.

http://www.physicianspractice.com/staff/importance-patient-experience-officer?rememberme=1&elq_mid=1319&elq_cid=121070

And for those dealing with ED issues, here’s an article about who’s going generic this year you’ll be interested in.

http://www.patientcareonline.com/diabetes/rx-shorts-ed-drugs-go-generic-2018?elq_cid=121070&elq_mid=1329&rememberme=1

Now for today’s story.

I recently had the joyous occasion of getting my annual physical. I’ve used the same office now for many years. For this joyous occasion and any other occasion where testing might come into play, I wear a pair of men’s boxers modified especially for these types of occasions. The boxers are tight to the leg & have the fly sewed shut to keep prying eyes at bay (even though I have nothing anyone would want to look much less gawk over).

Physicals are no-brainers.

In the first stage, the PA (who of course are females in this office), brings the patient back to an exam room. Their job is to check patient’s blood oxygenation, bp, weight, and medical & drug history.

After the first stage is done, next comes the EKG which entails leads on each arm, leg, and chest all linked back to a laptop to run the test. All I do was pull up each pant leg & shirt & they are ready to attach the leads.

That’s been the routine that was followed since I started with this office.

This year they (the PA & her trainee), changed the routine on me.

First stage went without a hitch.

Before the EKG was started I was handed a gown & told to strip down to my socks & put the gown on front open then they left.

Okay, we know where this is headed. They were going to get the surprise today not me.

So, I changed & waited.

They come back in, ask me to lay back so they can attach the EKG leads. Next, she opens the gown wide leaving nothing to the imagination except my special pair of boxers. LOL. I never saw two more dejected women.

After they got over not seeing anything things moved along.

After the EKG I never saw them again.

The rest of the physical is with the PCP. Shortest physical I ever had. Check the ears, tap the knees, touch my finger to the tip of my nose and that was it. The DRE has been a necessary evil up to now but this year, No DRE, no PSA test. Doc said internists are being advised to drop the DRE & PSA tests.

So, I asked how are they going to detect PCa at an early stage or are they just going to let men die from it? I was told it’s a slow growing cancer. Yeah unless you get the aggressive strain. Silence came over the room then the doc changed the subject.

It was mentioned they have an all-new staff. The hospital they bow to, keeps shifting people in and out of the office so they cannot get a set routine down.

Given the opening, I mentioned that I ran into this inexperience today and explained what went down earlier. Doc apologized for staff & said it will never happen again.

With that I got my annual over with and left the office, but the story didn’t end there.

I had a funky feeling that morning before I left for the appointment. So, when I got to their office, I turned on the recorder app on my smartphone. It was recording from the moment I entered their building until I left. It was quietly sitting in my coat pocket where it picked up everything said by anyone that entered that room.

The last week I spent notifying the hospital that oversees the office, state medical boards, & the JC about their indiscretion.

As I expected, after the office got word I filed a formal complaint, they sent me a formal letter dropping me as a patient.

I expected that, especially when they found out it was all recorded.

I’m going to make it my business to make sure that PA is booted out for life.

Her antics have no place in medicine.

This story isn’t over by a long shot.

That’s it for now.

Regards to all,
NTT

 
At Friday, May 04, 2018 4:51:00 PM, Blogger Biker in Vermont said...

Wow NTT, when I read the "strip down to my socks & put the gown on front open", I thought you must have missed saying "underwear and socks" given there is no reason to remove underwear for an EKG. But you had it right. She has no place in medicine, and to think she was training someone new too.

I realize these things move slow but do update us as your complaint works its way through the system.

 
At Friday, May 04, 2018 6:57:00 PM, Anonymous JF said...

PT, I read your posts all the time and you have lots of value to say. This blog is made better by your contributions. Much of your anger is justified and I share that anger. But your anger towards ALL women is irrational. Medical staff AND female patients. You're angry at us because we did what you should have done also. Men, not just you personally. PART of why men don't get enough accommodation is the guys who love being on display. I'm not a spring chick either and we don't go around bullying and abusing each other. Yeah SOME do. I've been accused of liking all our patients/ residents. I do care about most of them.

 
At Friday, May 04, 2018 7:59:00 PM, Anonymous Anonymous said...

NTT

I make a point not to be seen by PA ( Physician Actors), NP( Nurse Quacktitioners). They don’t have the bio-physiology backgrounds that physicians have, they follow if-this, then-that mentality. They tend to order a lot of unnecessary expensive tests to arrive at a diagnosis which is why health care costs are spiraling out of control.

If in fact this PA did what you said and I find it disturbing I would look into who decided to drop you as a patient. Are there MD’s or DO’s at that office? If so then it’s not her call, complain to your health insurance company. One very important point I want to make and that is for you to review the bill. An NP or a PA cannot charge the same for an office visit as an MD or DO. The office visit for an NP or PA is considered a lower tier provider cost. If they charged you what a Physician would charge then report that facility to Medicare, Hugh fine.

Same goes if you were to be seen at a hospital emergency room by a PA versus MD or DO, different charges apply. You have a right to review and get a copy of the bill. Look at the bill very carefully, are there discrepancies with the services provided. If so report then to Medicare, you don’t have to be a Medicare patient to complain about billing fraud. For the uninitiated the title DO stands for Doctor of osteopathic medicine. Finally, a physician’s office has the right to dismiss you as a patient, however, there are guidelines applicable depending what state you live in. I would look into the laws, you might be able to claim gender discrimination. Just how far you want to cause that PA headaches is up to you.

PT

 
At Friday, May 04, 2018 8:28:00 PM, Blogger Maurice Bernstein, M.D. said...

Believe it or not, I am pleased with this rather "heated" discussion, "heated" NOT necessarily meaning one discussant antagonizing another commentator but the "heat" is providing the needed "ventilation" of feelings.

But more importantly, mixed in with all the "heat" is the distribution of methods of attacking the "fire" that should be acknowledged and, as necessary, attempted.

I have never entered medical practice with the idea that physicians or their "helpers" are some sort of "god" hovering over and manipulating their patients. And certainly this mistaken view is also what I am not teaching my first year medical students.

My students and everybody should be aware that the physicians, nurses and all the rest of the medical system do need the patient to accomplish whatever the medical system's goals may be. And that need requires not only "treating" the patient in their various ways but also being aware of how the patient wants to be "treated". This necessity must be known and acted upon by both the system and the patient. ..Maurice.

 
At Saturday, May 05, 2018 6:47:00 AM, Blogger Biker in Vermont said...

PT, PA's and NP's are not my first choice either, but the reality for at least the rural parts of the country is that they increasingly are the only choice people have for primary care.

Last year when I needed to find a new PCP, I could not find a primary care doctor (male or female) within 1.5 hours of where I live that was taking new patients. There were a couple female NP's but given their ability to practice without physician oversight and the fact that NP's are increasingly being churned out of online and fast track programs without any prior bedside nursing experience I would not even remotely consider an NP as my PCP.

I ended up with what turned out to be a very impressive PA at the large teaching hospital about 1.75 hours from here that I have now moved all of my care to. Sadly, I just learned yesterday that he has left that practice and that I need to see a female PA in order to get my high blood pressure prescription renewed. I will follow through with that appt. so as to get my prescription and then figure out how I proceed going forward.

I have no idea how easily people can find primary care physicians in urban/suburban areas, but rural America is increasingly being left to NP's and PA's for their care. And there aren't even enough of them. In my search last year, none of the PA's in that 1.5 hour circle were taking new patients and only a couple NP's were.

I would add that VT offers a very high quality of life amidst it's natural beauty. This is not some forsaken place nobody wants to live in, yet we have physician shortages here, and not just in primary care. The local hospital has been trying to find a new urologist. There is only one in this area and he is at retirement age. The local hospital where my son lives near in a different part of the State went for a year or more without a dermatologist when the one they had left. And his small town is a beautiful and historic college town.

 
At Saturday, May 05, 2018 8:27:00 AM, Blogger Dany said...

JF,

I don't think the issue is whether or not what the nurse did to my brother-in-law is allowed (it obviously is, if only tacitly). Recall what I said about the difference between seeking compliance and coercive measures. There's plenty of wiggle room there and, it would appear, quite a few nurses seems to think it's fair game to use some "creative thinking", so long as the patients comply. The end, it would seem, justifies the mean.

I suspect many in this profession "learn" how to deal with unwilling or uncooperative patients that way. And why not? It works (compliance), and has a fairly low risk of negative consequences to them (unless someone decides to make an issue of it and complain). Not many people do that (and I think it's because they don't even know they can). Which also works in encouraging that sorts of behaviors.

I have no doubt my brother-in-law realizes he's been manipulated. His slightly annoyed and defensive attitude when I talked with him ("What was I supposed to do?") points that way.

Banterings,

I appreciate the helpful tips. I think if I had been in this situation, I would have called the nurse's bluff, just to see the look on the guard's face. I will mention that I do not think the rectal swab was the problem (for all I know, maybe the hospital had a standing order to screen for C. Diff for all new admits). The issue I have is how the nurse went about getting my brother-in-law to comply, after he initially said no.

(I don't know if it's even possible but I wonder if doing a similar test on a stool sample wouldn't have worked just as well. It sure would be less embarrassing for the patients.)

NTT,

I have to say your latest experience is quite surprising. I've only had one ECG (so far) and I was only required to remove my shirt. Knowing myself, I'm pretty sure I would have spoken up right then and there if something similar had happened to me (well, at least I'd like to think so).

This may not be helpful to anyone else here, but I have learned (the hard way) that what works best for me is to head off these situations as early as possible. If I can't think of a good reason to be naked, it just won't happen. When told to "take everything off" my default answer is "No! I will keep my underwear on" in a firm voice while making eye contact with whoever gave the instructions.

On the other hand, if told to undress but can keep them on, then I'll say something like "Good, because I wasn't planning on taking them off anyway!" Again, eye contact and a firm voice. This is usually enough to send a strong message about my expectations. As a patient, I am the one drawing the line and I expect the providers (or ancillary staff) to respect that.

Obviously, it would be different if I was consulting for a urology issue. But even in this case, I'd make sure certain situations wouldn't happen. Or I should say won't happen again.

Dany

 
At Saturday, May 05, 2018 10:49:00 AM, Anonymous JF said...

With a swab, why couldn't an adult patient of average intellect be allowed to go in the bathroom and swab themselves? Maybe even a teenager should be allowed to self swab.

 
At Saturday, May 05, 2018 11:52:00 AM, Anonymous Anonymous said...

NTT,

That nasty PA and her trainee should both be booted out of the make'emsick industry!
The problem is that the physicians who oversee these female PAs couldn't give a crap about their male patients' modesty! Like my friend who was abused by the NP and made a spectacle of in front of 2 other PA "trainees" (and there may very well have been a female scribe to witness his humiliation as well) this female NP was fired only after on line reviews for her trash talking of (apparently EVERY client who had the misfortune to see her) clients! She worked there for many years, and the physician had no idea she was revealing intimate details of clients to other females in the office? I say bull pucky! Like you, my friend was sent a notice of being dropped as a client and the a%$#@(*#s referred him to a crappy free clinic! This was AFTER my YELP review. What a coinkidink!
Here's the worst of the rot in these all too familiar scenarios: the MD or DO won't report these unethical critters to the appropriate state board, but hope to sweep client abuse under the rug by simply firing them! Of course they're trying to cover their own asses! So, these female providers continue to abuse male clients without impunity, much like the nursing hags. If a physician is permitting lower level providers to abuse clients, then he/she too is equally guilty of said abuse!
Like you, I have made it a mission to get a certain abusive female out of the make'emsick industry. Let me paraphrase one of my favorite Vin Diesel lines in one of his sci-fi films: You know not who you *&^% with! I'm not letting her off the hook; I have a plan in place!
An especially alarming trend is occurring that has just several MDs or DOs opening multiple offices, stocking them with an almost exclusive staff of female PAs and NPs (much of their training is just on line), and willy nilly assigning male patients to these females for all types of intimate exams/care. And these kinds of scimmer-scammers (as I term them) are racking in the dough as these poorly trained mid-level providers are under orders to prescribe as many tests and Big Pharma prescriptions as possible! THIS IS OUR CURRENT REALITY! Lit reviews show that PAs/NPs order significantly more, often dangerous tests and of course they only mention the often false "positives" of certain tests but never the dangers. Just look at the colonoscopy scam - how many providers mention or are even aware of its incredible (I'm being kind here) negatives, such as falsified data! We increasingly see that they have no real foundations to work from, just the propaganda they memorized on line, and then passed college tests and the state boards by filling in the "right" circle! That's not a true education. Like I said in a certain review, a monkey can memorize also - they sent some on a space missions!
I've got some great info on the PSA scam, and how it applies to nudging - much, much worse than the colonoscopy scam! A universe of difference. I'll post it in a few.

EO

 
At Saturday, May 05, 2018 12:10:00 PM, Anonymous Anonymous said...

BTW, some hospitals are now requiring clients to have nasal and peri-rectal swabs upon admittance - for MSRA, C. Diff. and VRE. Now, seeing as how 95% of patients can do their own, I'm sure many nursing hags are telling the younger male clients that they, the "nurse" have to perform the swabs! Another little titillation to get them through their days of client abuse!
Here's a typical attitude from a female nurse: "My first swab was on a young, attractive male transfer from another hospital. Boy that was fun! LOL"

EO

 
At Saturday, May 05, 2018 2:49:00 PM, Blogger Dany said...

JF,

Don't be silly! Didn't you know patients are all a bunch of idiots who couldn't tell the difference between their big toes and their ears?? Let patients do their own swabbing? What a preposterous idea! God forbid, you wouldn't want anyone to confuse their navel with something else.

Most facilities won't even let their patients take their own temperature. Can this be any less infantilizing?

(All sarcasm aside, I do understand - to a point anyway - the necessity of not contaminating a specimen sample. But... The methodology used isn't rocket surgery either.)

Dany

 
At Saturday, May 05, 2018 3:18:00 PM, Anonymous Anonymous said...

Maurice

You said “ My impression is that nursing behavior in terms of their sexual stimulation is a rare behavior and this is not part of nursing
activity. “. You are certainly entitled to your opinion, however, how do you account for the high numbers of female nurses committing
boundary violations. Hospitals are not meat markets, yet large numbers of female nurses do just that. To the uninitiated, a boundary
violation is carrying on a sexual relationship with a patient while they are in your care as well as after they have been discharged.

A boundary violation is explained in the nurse practice act and is subject to license revocation by state nursing boards. Much is said
about this subject that it is a Hugh problem. Boundary violations apply to all healthcare workers, physicians, psychologists, nurses, techs
etc. I suppose the full nude fold outs from playgirl magazines covering the walls of a staff bathroom in an ICU was just for anatomy
reminders. Perhaps the Denver 5, they too were there only for an anatomy lesson. State nursing boards are embarrassed by the increasingly large numbers of nurses accused of boundary violations, felony convictions not reported as well as drug diversions. Take
a look at the state nursing boards lists for license revocation, dosen’t look rare to me.

PT

 
At Saturday, May 05, 2018 4:29:00 PM, Blogger Maurice Bernstein, M.D. said...

I "know" based on communication with my wife who has been a hospital based RN for decades and she has told me about many "good" and "unwise" behavior of the hospital staff including nurses but, to my best recollection, nothing about the wrong or misbehavior of nursing staff in the apparent sexual context. I am not saying that sexual violations are not or "can't" happen but I doubt it is a "very common" occurrence. In addition, working up my office patients when hospitalized, I have not seen sexual misbehavior.
In any event, it is important for staff to be attentive to this as well as, of course, the patient and visiting family and report to administration nursing misbehavior. ..Maurice.

 
At Saturday, May 05, 2018 5:08:00 PM, Anonymous Anonymous said...

Maurice

I seriously doubt you would see, notice or otherwise experience any unprofessional behavior in your presence. As people we have come
accustomed to the fact that no industry can be trusted completely, we just take it for granted any more. It’s been a slow gradual process
almost as an acceptance. It’s the law enforcement industry, healthcare industry, insurance industry, anywhere people have power,
opportunity over other people. When it does happen or if it makes it to the news and very little actually makes it to the news what happens?

Well let’s see, how about some rehearsed comments. Take for example, the incident at Mayo hospital whereby a chief resident took a cell
phone pic of his male patient’s genitals and then sent it and showed everyone. When he got caught, what did the hospital say? “ This
incident is no reflection on our staff here at the hospital.” How about the Denver 5 incident, what did the hospital say?

The hospital said “ this incident is in no way a reflection of our other staff here at the hospital. What did the female physician who has a blog, your counterpart by the way say? “ Well, I don’t know about other operating rooms but here we”. Essentially, what she and other
hospitals say is that “ well we had one staff throw a patient under the bus “ . Now, your counterpart says well other places may throw their patients under the bus but here we do not. “

Let’s go back for a minute and review the Mayo incident. The physician who was reported by someone in the operating room was
issued a reprimand by the state, then kicked out of the hospital residency program. The patient sued and was awarded $250,000
from the hospital. It just proves that the patient can sue over a Hipaa violation contrary to what is printed in the law. Thus, I’ll ask you
this Maurice, does the patient have modesty issues because of what his physician did?

PT

 
At Saturday, May 05, 2018 5:23:00 PM, Anonymous Anonymous said...

Maurice

Then you had the female nurse in upstate NY take a cell phone pic of her patient’s genitals and sent that to all her friends, what did the
hospital say “ this is in no way a reflection of the other staff here at the hospital. She was arrested, fired and her nursing license revoked.

That spin could not be stated in the Dr Twana Sparks case in that it involved the entire operating room staff, as well as the hospital in
Pennsylvania whereby half the hospital staff invaded one or case involving an injury to a male patient’s genitals. What spin did these
two hospitals use in these cases, there were no public comments made. How do you put a spin on that?

PT

 
At Saturday, May 05, 2018 8:48:00 PM, Blogger Maurice Bernstein, M.D. said...

For all contributors to the discussion on this blog thread, there appears to be times when I click on "Publish" the system may not publish the Comment for me to moderate. If you don't see your Comment published within 12 hours simply write me e-mail (Doktormo@aol.com) its absence on the blog and I will find it and click on "Publish" again. ..Maurice.

 
At Saturday, May 05, 2018 9:09:00 PM, Anonymous JF said...

Usually criminal sexual assault is not the patients fear. It's modesty violations. Some of the bloggers have talked about marriages being damaged. I want to point out that other relationships are damaged also. Here's a scenario: An older child, maybe a teen is being given an intimate exam. The kid's parent and/or sibling is in the examining room also. The child/patient doesn't want their parent or sibling in there and is horribly embarrassed but nobody asked his/her preference on the matter. If that patient would have been me as a kid and my mom. SHE would have been quite amused by my distress. Probably even delighted. If one of my brothIfs would have been in the room it would have put a wedge between me and him also. ( actually a doctor would more likely put the boy patient on display. Im aware of a couple of instances of that ) Ok. Lets say my mom witnessed the exam. She would have talked about it to other people PROBABLY in my hearing. I would have moved in with my dad as quickly as I could get their and our mother/daughter relationship permanently destroyed. But the doctors office/ hospital wouldn't be aware of having harmed anything.

 
At Saturday, May 05, 2018 9:10:00 PM, Blogger A. Banterings said...

PT,

Thank you for your kind words.

A prime example of what happens with nurses is "NETY" (Nurses Eat Their Young).

If this is what they did to each other, then what do they do to patients?

Enough said about nurses.


NTT,

What really drives up healthcare costs are ritualistic care such as forcing women to have PEs and Paps before a gyno will prescribe birth control. This, IMHO is fraud, extortion, and rape.

If anyone threatens you with violation of wiretap laws, here is your defense. You used your cellphone as a weapon for self defense. Indeed, recent events (think black lives matter movement), cell phones are used as a means of one to protect oneself from assault and battery (even death).

Secondly, English Common Law (the basis of our legal system), our Constitution, and Federal and State laws recognizes an individuals right, even as an exception to other law.

Example; if a burglar breaks into one's house and threatens their lives, and the homeowner kills the burglar with a baseball bat, if certain circumstances exist, the homeowner is not guilty of homicide. Just like a cell phone, a bat is a legal item that can be used either for assault or defense. If one beats another with a bat without just cause, that is assault and battery, if they die it is murder.

Wiretapping is illegal (just like murder), but if one argues that the cell is a means of self defense (against nonconsensual (sexual) assault, then the issue of wiretapping is moot.

Furthermore, if you file a criminal complaint for assault, battery, and sexual assault, and you are dismissed, whoever dismissed you, and all involved may be guilty of conspiracy or obstruction of justice.

Conspiracy is a funny crime. In your situation, the PAs do NOT have to be guilty of assault, battery, and sexual assault for those involved with the dismissal to be guilty of conspiracy. A common ploy of federal prosecutors is to convict people about lying about a crime (obstruction), even though the crime lied about was never proven to happen.

Dany,

Your brother could have preformed the swab himself. On my overnight stay for IV antibiotics, I did my own MRSA nose swab myself. He could have done the C dif swab himself withOUT her in the room.

He could have also said I need to talk to my doctor about the risks and benefits of the procedure and of doing or refusing the procedure. When tests come back, nurses cannot share the results with a patient because legally they cannot answer questions related to the tests (such as risk/benefits, diagnosis, interpretations, etc.). This would buy time to talk to someone more reasonable.

In the same way nurses learn to nudge, patients need to nudge back by filing civil and criminal legal proceedings. This sends a strong message about what society finds acceptable.



-- Banterings



 
At Saturday, May 05, 2018 9:27:00 PM, Blogger A. Banterings said...

EO,

...hope to sweep client abuse under the rug...

Conspiracy or obstruction of justice. They need to file a criminal complaint.


Maurice,

I have spent considerable time in LA, I find it hard to believe that you (and your wife) live in such a bubble. Less than a month ago, the following was all over the LA news:

Apr 19, 2018 - Los Angeles, CA – Patients who were sexually assaulted by doctors and lost loved ones to doctors' negligence shared their medical horror stories today and pressed the California Medical Board to adopt a new Patient Bill of Rights and ensure future patients are protected. T Source: Patients With Medical Horror Stories Demand the California Medical Board Back Patient Bill of Rights Requiring Transparency, Accountability To Prevent Patient Harm


Thinking like a physician (scientifically), I would ask (NO offense to you), but have you never been exposed to such behavior OR did you just NOT recognize it?


-- Banterings


 
At Saturday, May 05, 2018 9:58:00 PM, Blogger A. Banterings said...

JF,

Before asking the patient's preference, the discussion of "would you like me to (even) perform this exam is missing.

I know what you are going to say, that children (under 18) cannot refuse exams, only their parents can.


Wrong, wrong, wrong.


All 50 states and DC allow minors to consent to STI testing without the need for parental approval.

Now, if one is allowed to consent, one must be allowed to decline consent. So even though a child's annual physical exam (or any examination of the genitalia), along with looking at normal development, tanner staging, rashes, etc, ALSO looks for the presence of STIs.

So just as a child can consent (on their own) to these exams, they can also DECLINE these exams.

In order for informed consent to be present, a physician must let a patient know they can refuse these exams.

How many peds let their patients know that they can refuse genital exams (at the very least those meeting the state guidelines for being able to approve STI testing)?

How many gyns tell women they can refuse PEs and Paps and still get BC? How many require PEs and Paps for BC? (I have addressed these numbers in previous volumes.)

This then makes them guilty of battery (criminal). This is malpractice as well (civil).



-- Banterings

 
At Saturday, May 05, 2018 10:08:00 PM, Blogger Maurice Bernstein, M.D. said...

Oh Banterings, my answer to your two part question is really No......No!
But the answer would be YES...NO! if what you mean by "exposure" is reading in the Medical Board of California periodic publication to us physicians and I suppose he public in general, a direct listing of all the current cases on physicians and their various misbehavior or worse case outcomes--describing the physician's name and city of practice and in various degrees of detail the physician's actions and current response by the board. That information thru the Board has been available for years but in the recent year or so, I can no longer find this listing in such a direct public display. Maybe I didn't click on a link in the current e-mail publications.

But yes, I have always known sexual misbehavior or worse expression has been going on and "I recognized it" thanks to the Medical Board publication. But that is all I can document. I hope this answers your question. ..Maurice.

 
At Saturday, May 05, 2018 10:20:00 PM, Blogger A. Banterings said...

Maurice,

Thank you for your candid response.

I brought up the issue not so much as to hear an answer, but rather to stimulate some critical thinking in you (just as you have with contributors on this blog).

Sorry to knit pick, but of you having never witnessed it, you can only say that you think that you can recognize it.

Is that not what new physicians are taught about diagnosis? (Until you actually diagnose it, how do you know that you can truly recognize it?)


-- Banterings



 
At Sunday, May 06, 2018 11:56:00 AM, Anonymous Anonymous said...

California needs a new patient bill of rights! How many patient bill of rights does there need to be? You would think one would be enough
but apparently not. I think we need a new nurse practice act, new core values for every hospital in the US. Wait a minute, what am I
thinking, they don’t read the ones they have. I seriously doubt there is one nurse in the entire US that could recite one law or regulation
from the nurse practice. Instead of having I’m a sexy nurse all over their scrubs there should be 4 regulations written on every nurse scrub
sold in the US.

1) I will not try to sleep with my patients
2) I will not try to steal my patients medicines
3)I will be open about my felony convictions
4)I will not go to grocery stores in my scrubs

PT

 
At Sunday, May 06, 2018 3:12:00 PM, Anonymous JF said...

I recently read an article about Twana Sparks and her coworker who turned her in. The article said that the coworker got terminated but Twana didn't even though it was proven she'd been sexually abusive to her.patients. The article said that Sparks was a cash cow and would bring $20000000 into the hospital over the next 10 years. My question is what would she be doing to get that amount that another person doing her job wouldn't? In order for the hospital to receive that money, somebody else has to be forking it out. Is it ethically obtained? The one tiny little trouble she got into was she has to have a chaperone. And no more touching reproductive organs. Some of you do lots of research. Can you tell me what you know?

 
At Sunday, May 06, 2018 3:55:00 PM, Anonymous Anonymous said...

Though I am encouraged that many of the contributors to this blog have become activists as regards affording male clients (patients) the same rights as female clients when it comes to modesty/dignity, I see little hope that the system will change in any broad or meaningful manner. There has been some discussion regarding the corrupt corporate takeover of the make’emsick (medical) industry and how this relates to discriminating against male clients, but until the collusion between Big Pharma, private insurers, federal and state governments, and healthcare providers is truly revealed and 100% amended, there will be no real change on the industry’s part as regards the discrimination against male clients. Like the current swamp in D.C., the make’emsick swamp is just too powerful and entrenched to be brought to justice.

Wow! Thanks, PT, for bringing that incident to our attention, wherein a female hag made fun of a male urology patient’s pain level after a prostatectomy (I can only imagine that type of pain such as having a hysterectomy), called him a wuss, made fun of his career as a marine and other commentating hags told the student nurse to get used to because you’ll be gossiping about your patients like we do! Like you said, patient privacy suffers even more because “it’s attributable to what I call the hate factor, devoid of caring, devoid of advocating.” Most people go into the make’emsick industry for the money (and they think the prestige, but man are they fooling themselves here!). I’m sure hags are making ugly comments about clients about a zillion times a day!

That men would even have to think this way as one contributor has written, BESPEAKS VOLUMES about the abusive foundations of Western medicine: “Men will be afraid to come forward and take their case to its conclusion through the courts of public opinion and the criminal justice system out of fear of seaming weak in front of the world and out of fear of retribution from caregivers against those men currently in treatment.” Wow, that ill male clients are afraid (and justly so!) that caregivers will retaliate is abominable! How can a society accept such sordid scenarios? From the little I’ve had to read, female caregivers, especially the nursing hags, retaliate in many and vicious ways! Here’s just one little, minor example: A hospitalized male client refused the nursing hag’s “offer” of shower help (he was totally ambulatory) and angry she could not attend that peep show, she canceled his dinner! Nice, huh! One male has described hospitals as “humiliation factories” where males are “treated like farm animals.” This is a pretty apt analogy!

Banterings, my friend who was abused just wants to forget – he won’t file anything, and we’ve caught the physician in Medicare fraud – charging thousands for a program he did not attend. As you mentioned, he could file for “conspiracy or obstruction of justice… a criminal complaint,” but he won’t do it. This is a typical scimmer-scammer type of physician who opens tons of offices and stocks them with – I love your terms, PT – PAs (Physician Actors) and NPs ( Nurse Quacktitioners). I’ve done what I can with anonymous reports which I’m sure will go nowhere. Time for other avenues… As one contributor pointed out – that good men do nothing that evil prosper.

Continued due to length…
EO

 
At Sunday, May 06, 2018 3:59:00 PM, Anonymous Anonymous said...

Maurice, you ask “WHAT IS IT ABOUT PATIENT MODESTY that has attracted so much interest by visitors and writers for this blog? There are so many other life and death topics throughout this blog and yet with them the number of responses from visitors is relatively trivial (though, to me, they are also important and worthy of responding to) but WHY PATIENT MODESTY leads the way and continues to do so?’ Banterings mentioned “social justice” as a reason, and others have indicated the damage that is rendered to male clients re modesty concerns as an assault on one’s very soul, etc. I must concur with both. However, to the make’emsick industry ( I can no longer even call it the sickcare industry since this past year two friends have suffered terribly at the hands of inept surgeons, one losing permanent vision in one eye and the other losing a leg!) male modesty is of trivial concern at the most. Thus, we must ask – why is this so? It is pure common sense that dictates that same sex or gender concordant care (something about the term is rather a put off – just call it what is in plain speech) should be not even questioned, but rather same sex teams should be automatically assigned to clients and if they wish, then opposite sex or mixed gender teams would be arranged. Others here have written of this. This automatic assignment of same gender would put an end to many modesty violations, and as others have written should be codified into federal law that all facilities, whether hospitals or private clinics (if they accept Medicare/Medicaid payments and who doesn’t!) then Title VII dictates that same gender providers for intimate care is ALWAYS PROVIDED. Man, will the nursing hags be disappointed when they can’t run around to peep at whomever they choose!

So, we’ve seen that all the meaningless platitudes of “we’re all professionals,” “standard of care,” “patient dignity is respected,” – the “fake core ethics” as PT noted - and etc. can be seen as nudging/bullying. Recall the stats on colonoscopies and that scam! Well, I’d like to introduce a term that is bandied about as an excuse for whatever the provider wants to do – EBM (evidence based medicine). It is this term that the make’emsick industry shoves down our throats. TALK ABOUT NUDGING! It was probably John Ioaniddis’ 2005 article in PLOS, “Why Most Published Research Findings Are False,” that really brought the false narratives of EBM into the public arena: http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.0020124.

Here’s a quick overall read: https://medium.com/@drjasonfung/the-corruption-of-evidence-based-medicine-killing-for-profit-41f2812b8704

I encourage people to read the latest reports of Big Pharma’s fraud, there’s plenty to read out there, and you’ll wonder why people would take any pharmaceutical after educating yourself of their deceptive practices. One of my “favorites” is the bogus medical journal they created in Australia, which promoted certain new drugs. And, be sure to read about the Rockefellers and how they helped to create the AMA and how many safe and USEFUL alternative therapies and practitioners were run to ground/banned. Rockefeller saw a HUGH opportunity to profit from the pharmaceutical poison model, and not so coincidentally this ugly monopolization occurred at the same time he was monopolizing the oil industry.

And here we are today, the richest nation on the planet with (outside of hellholes such as Syria and others) the worst health outcomes. Hmmmm, why could this be?

Continued due to length…
EO

 
At Sunday, May 06, 2018 4:03:00 PM, Anonymous Anonymous said...

One of my major points is that the current foundation of the make’emsick industry is based on giving dangerous poisons (pharma drugs) to supposedly “manage” chronic conditions (all “evidence based” yippy!), and conducts significantly more tests (often harmful!) but look at how low US “health” care ranks among developed nations –one of the lowest in terms of infant mortality, life expectancy, emotional and physical health, etc. and is headed lower! We had been discussing the useless DRE (and PSA) tests and how Albin regards the PSA test. Let’s look a little closer at this example of nudging. One expert cited by Ablin says perhaps half of the urologists in the United States would go bankrupt without the gold rush of prostate-removal surgery that followed the PSA discovery. “When a 50-year-old man went for his yearly physical,” explains Ablin, “he routinely had a PSA test, quite often without his knowledge. The level of his PSA could propel him into the prostate cancer industry . . . the prostate gland is at the epicenter of a worldwide trillion-dollar industry and the PSA test as its kingpin. Think of PSA as oil. If the test were made irrelevant, an industry would crumble. You don’t have to be a conspiracy theorist to grasp what the stakeholders will do to keep this industry booming.” Guys, you may wish to read his book: The Great Prostate Hoax: How Big Medicine Hijacked the PSA Test and Caused a Public Health Disaster" by Richard J. Ablin and Ronald Piana. Here’s where I found mention of it: https://nypost.com/2014/03/01/why-the-prostate-cancer-test-is-useless/

So, how to reform a Frankenstein-like industry ruled by Big Pharma whose private, monetary interests are sanctioned and ENFORCED by the state (via the make’emsick industry) and in some arenas are not subject to any usual redress via the legal system? How many men abused by nursing hags have sought justice in a court of law? Not too many, as we have witnessed time and time again, and of course the events that make it to the news most likely reflect 1/10 of 1% of such events. As it appears that most morons go into the make’emsick for the income (and yes we must include female hags that go into it for the viewing of naked males), we return to REL’s line of reasoning, that is, we must attack their money/income just as they attack vulnerable, ill male clients. We see that it is VERY effective to boycott certain companies for needed changes. I must disagree, Maurice, that the abusive events are rare – they are most certainly not! If they were, this blog would not exist! Now this is from some 6 months ago, but here’s a team in Bolivar dancing about mocking a naked male patient on the operating table, here’s one of the links: https://www.mirror.co.uk/news/world-news/doctors-nurses-fired-after-outrageous-10112888

It seems Western “medicine” (vomit) is conducive to patient abuse, no matter the geographical area. And perhaps we must come to the conclusion that the make’emsick industry is but a reflection of a society in steep decline. I do ask this: What is it about Western medicine (as opposed to other systems of medicine) that so objectives clients and is overrun with degenerates, whether nursing hags sexually abusing male clients, doctors’ semen ending up on female colonoscopy patients, or hags stealing hospitalized clients pain meds, etc. etc. ad infinitum?

Continued due to length…
EO



 
At Sunday, May 06, 2018 4:06:00 PM, Anonymous Anonymous said...

Now, male clients that value their modesty and want to have the same consideration as female clients have been referred to as outliers. I don’t believe this is true, but the make’emsick industry certainly promotes this incorrect idea. That it does so actually tells us that this industry is well aware of this issue, but desires to hide it by distorting the facts. Besides the obvious sexual urges of many workers, especially the female nurses (humiliation of a male client does make for some great convo in the break room!), that many females in managerial positions responsible for their nursing brigades and the hiring, protect the female nurse and discriminate in yet another way against males by not hiring male nurses - this discrimination is against male clients as well as male nurses. And, that physicians allow their office managers to hire almost all if not all female MAs, techs, etc. informs us that they don’t care about the modesty/dignity of their male clients.

I disagree that modesty violations are not sexual abuse – they certainly are! Like the hags telling a male patient to take off all clothes for an EKG and then being terrible disappointed when they flung open the gown to not being able to peep as underwear were still on or the hag threatening a hospitalized client with having a guard perform a rectal swab – these are sexual abuse incidents! They should be treated as such! One writer mentioned having non-medical groups that serve as watchdogs and this is surely needed!

And PT, thanks for the detailed info on just how non-sterile/filthy operating rooms are. I didn’t even think of the cigarette chemicals invading open wounds and until recently thought that the make’emsick industry was really trying for clean ORs. Call me naïve but I thought the surgical teams changed scrubs between surgeries but instead track everything from the last (perhaps infected) surgical client to germs from the cafeteria and cigarette chemicals and the effluvia from a flushing toilet to the next surgical victim (client)!

Sorry, but I think I am extremely disappointed (yeah, okay, angry) that so many male clients won’t speak up for themselves, but will accept this situation. However, a recent poll by Anthem shows at least 60% of males will not return to a female provider after seeing one for the first time. I was skimming some blog (maybe Allnurses) last week that had female providers discussing how to retract the foreskins of male children and adults. Why would they think that this is just fine and dandy when so many young men are humiliated and mortified by these kinds of (usually unnecessary!) exams, and this leads to not only avoiding the make’emsick industry altogether (actually, most people will be healthier by avoiding the industry), but leaves many with lifelong emotional scars? Hmmm…. And until recently, these medical morons in the US, especially the females, didn’t know it could harm a male child or teenager to have his foreskin prematurely retracted – that is – ripped down! Stupid is as stupid does…

Continued due to length…
EO

 
At Sunday, May 06, 2018 4:09:00 PM, Anonymous Anonymous said...

Perhaps I (and others I know) are the true outliers. I have absolutely zero trust in the make’emsick industry and its workers, wherever they are on the scale, from physicians to NAs/MAs. As I have 30-60 IQ points on the average physician (I come from a long line of physicists and philosopher/poets and the two arenas are not as different as they may seem as they both permit for highly critical thinking abilities), why would I trust someone who is hopelessly corrupted by a false medical model? I would only consult an MD (would never accept a PA or NP) in extremis, armed with a protector (advocate) and my attorney’s number on speed dial! And though I may need a diagnosis, for the most part there is nothing these physicians could offer me outside their regime of dangerous pharmaceuticals and many times equally as dangerous surgery. I won’t go into detail as this is a blog for male dignity, but suffice to say I have lifelong health issues due to individual providers’ malpractice as well as the industry’s widespread practices that are making so many of us, especially our children, damaged for life. And, many decades ago, I was abused on several occasions. I remember hitting one male doctor and he wheeled around and scurried out of the exam room like the dirty little rat he was! I was just a young thing at the time, and tried to forget it, but the awful feelings are still with me decades later. So, I have some personal experience in this area as well.

Now, the fact that medical “care” (can one scream and vomit at the same time?) is seen as the third leading cause of death in the US is old hat – some 2 decades years outdated. The true fact of the matter is the make’emsick industry is the LEADING CAUSE OF DEATH and everyone from Big Pharma, individual providers, and hospitals are fighting not to have the Codes updated so as to truly reflect actual causes of harm and death. (Look it up –the real stats are out there for those that wish to take the time to research.) Their facilities would be almost empty! I can tell ya, folks, people like me just don’t go! A yearly physical exam is out of the question! As regards nudging I call it bullying/propaganda, and if any medico tried to convince me that a certain drug, vaccine, or procedure is considered “standard of care” (The Exorcist vomit!) depending on the provider’s attitude I might very well consider this bullying and would respond appropriately. And here’s the point: Using useless and meaningless terms such as “evidence based medicine,” “standard of care,” “we’re all professionals,” “patient dignity is respected” etc. is nudging/bullying, more, it is lying.

I’ll briefly mention one more example of the lies of EBM, that of enhanced MRIs. Talk about a euphemism! The EU has restricted/banned many GBCAs as yes gadolinium is deposited in the brain, bodily organs, and bones, and has harmed untold numbers but now people are waking up to this particular scam and are suing: http://www.ema.europa.eu/ema/index.jsp?curl=pages/medicines/human/referrals/Gadolinium-containing_contrast_agents/human_referral_prac_000056.jsp&

But of course the good ole’ FDA though it admits GBCA are deposited in the brain finds no evidence that heavy metals in the brain (and other areas of the human body) are damaging! Like radiation, heavy metals are incredibly damaging and yep I’ve got another friend permanently damaged by multiple “enhanced” MRIs. That PAs and NPs as well as PCPs are ordering these dangerous tests leads us back to the lies of EBM and of course, good old fashioned greed. Physicians admit to ordering over a million unneeded tests per annum for the kickbacks but we know this figure is much higher. This does not occur in other medical systems where kickbacks are not allowed.

So, we have a false medical model, an industry that does significantly more harm than good, and mostly female medical workers doing their best to peep on male clients, all topped off with a huge dose of greed! What’s not to trust?

Thanks for listening…
EO





 
At Sunday, May 06, 2018 4:56:00 PM, Blogger Maurice Bernstein, M.D. said...

EO, thanks for your taking your time on this Sunday and expressing your information and views on this worthy aspect ("professional"behavioral acts considered tr "treatment" of male patients) within the general category of "Patient Modesty"
With my posting, we are now at 180 Comments on this Volume 88 and it is about time to move on to Volume 87.
EO, since the introductory phase of the blog thread has apparently no character limit. I plan to continue the narrative you had to divide into 4 parts as the Introduction to the new Volume.
The question is "Is the medical system going to "pot" in what you describe and in other ways and nobody is aware or nobody is doing anything to correct it?"
I'll start putting together Volume 87. ..Maurice.

 
At Sunday, May 06, 2018 5:57:00 PM, Blogger Maurice Bernstein, M.D. said...

THERE WILL BE NO FURTHER COMMENTS POSTED ON VOLUME 86 AS OF MAY 6 2018. CONTINUE POSTING COMMENTS ON VOLUME 87 . ..Maurice.

 

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