Bioethics Discussion Blog: Patient Modesty: Volume 87

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Sunday, May 06, 2018

Patient Modesty: Volume 87









EO, a visitor writing in the Comment section of Volume 86 of this thread title has set the stage for further discussion-- particularly the way male patients are treated within the medical system. I thought his narrative would be appropriate to start this Volume. ..Maurice.
Graphic: My composition using ArtRage and appearing as the graphic on the thread "Order vs Chaos in Medical Practice"

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.

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?

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?

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…

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

BEGINNING JUNE 1 2018 THERE WILL BE NO FURTHER COMMENTS PUBLISHED ON VOLUME 87 BUT COMMENTS CAN BE CONTINUED ON VOLUME 88.

175 Comments:

At Sunday, May 06, 2018 8:35:00 PM, Blogger A. Banterings said...

EO,

You have totally mischaracterized me. First off, I find the same gender care a secondary issue to many of these procedures being unnecessary. The offer of same gender care should be part of every procedure. My goal is to remove the power from those who have been corrupted by it and put it in the hands of the patient.

Yes I was abused when very young. I have avoided healthcare my entire life. Just recently, I spent my first overnight hospital stay, and it was for IV antibiotics. (I should have just taken the Cipro from my friend's horse farm.)

I also do not want to forget, because I can not remember what happened.

I had a physician that signed whatever form I needed for life. You want to see one "man up," try avoiding care all your life.

But it is not about me. When doing placements for my counseling degree, I met victims that said the compassionate care they received in healthcare was exactly the same as the abuse they suffered.

I do not understand what you mean by:

...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...

Medicare fraud? That is very limited scope. Try mail fraud. For most people, a raid on their office by the feds (even when they are completely innocent), will leave emotional scars that rival those of the worst physical/sexual abuse imaginable.

As to what I will or will not do; (I am not proud of this) but in my life I have done some very bad things to both companies and individuals. I am much more complicated than this. I don't like to talk about my life in detail.

What I can say is that your perception of me is totally wrong.



-- Banterings




 
At Sunday, May 06, 2018 10:23:00 PM, Anonymous JF said...

EO, I have been putting off going to my doctors so I can catch up with my medical bills. I needed a break anyway because the medicine made me sooo sick, I ALMOST wanted to die. Most of what you said I've heard other people say or I have thought of. Reading what you said makes me afraid to go back to my doctors. ( well, maybe I should say more afraid than I already was )

 
At Monday, May 07, 2018 11:00:00 AM, Anonymous Anonymous said...

Banterings,

I think you may have misread some of my comments - none of which were directed towards you. I think the reason my friend that was abused doesn't want to take it any further is that he is embarrassed. I think this is the problem for many men that are abused by female providers - the thought of having to tell their specific story of abuse to others, perhaps even in a courtroom. I can totally understand this. That's why it's so important to let as many men (and the women that love them) know of their legal (and of course moral) rights under law and that they can refuse any type of care from these peeping critters or that if they were abused they can file formal complaints with outside agencies such as the DOJ. I did file an anonymous one with the DOJ re Medicare fraud. It probably won't go anywhere considering the massive amounts of medical fraud that are continually occurring! What you have informed us about re mail fraud is something I hadn't even considered. Do you think (now its been some time and the abusive hag was finally fired) that going this route though I have to be anonymous would help? I'll do some research here as well, as it's a field I know very little of. Exactly what agency does one contact for mail fraud?

Again, I wasn't directing any of my comments towards you specifically and I appreciate all the info and time you have spend on this blog.

Thanks,
EO

 
At Monday, May 07, 2018 1:15:00 PM, Blogger A. Banterings said...

EO,

Thank you for the clarification. That is why I said I did not understand your comment.

I would file anonymously as "someone with knowledge of the occurrence."

My personal opinion is that dealing with the postal inspector is like handling plutonium. It will take out your enemy, but it can harm you too. This is just my personal opinion.


-- Banterings


 
At Monday, May 07, 2018 7:30:00 PM, Anonymous Anonymous said...

If you had 4 trillion dollars in THOUSAND dollar bills it would be a stack 255 miles high! This is what we spend on health care each year.Do you feel you get your monies worth, can you actually quantify the quality. How much more do we have to spend to get privacy and respectful
care. I believe there is not enough gold and riches in the universe.

PT

 
At Tuesday, May 08, 2018 11:53:00 AM, Blogger A. Banterings said...

PT,

It would actually save money. Protecting patient dignity would prevent people from avoiding care (just like in the Anthem poll that EO referenced shows). People will be more forgiving of their doctors if they trust them. Even if the doctor makes a mistake, people will not sue a doctor they trust.

Now if they do not trust a doctor, even if they do everything right, patients will have the perception they did something wrong, they are more likely to sue. Trust issues include my doctor did not protect me from opposite gender nurses, students, etc., using me as a teaching prop for intimate procedures.

Obviously the cost of healthcare (as a portion of gross domestic product), Just as patients are charged $100 for an aspirin ("built in to the cost") to offset services rendered to indigent people, law suit costs are built into all other healthcare costs.

If anything, providers are causing us to spend more on healthcare by not providing dignified care. Then comes my issue of not telling patients they can refuse any procedure without retaliation. Unnecessary health care treatment overall is estimated to cost at least $158 billion a year. (Source: Mother Jones: Holding Birth Control Hostage)

A great example is physicians requiring PEs for women to obtain oral contraceptives. Then they throw PAP smears in to the mix. The reason being is that the PAP alone, a 2 minute procedure fetches a $120-$150 reimbursement. Read the Mother Jones article: Holding Birth Control Hostage.



-- Banterings



 
At Tuesday, May 08, 2018 1:31:00 PM, Blogger NTT said...

Good Afternoon:

Today, the US Preventive Services Task Force recommended that men aged 55 to 69 who are considering prostate cancer screening talk with their doctor about both the benefits and the harms of prostate cancer screening and have an opportunity to weigh their values in the decision."

In other words, tell the PCP’s to talk guys out of testing

The reason behind the recent update comes from new research highlighting the benefits of prostate cancer screening.

"When we looked at the evidence now, we found that a few men who choose to be screened will benefit from screening.

About one in 1,000 won't die from prostate cancer, and about three in 1,000 won't get metastatic disease.

"But we also know that many more men will get harmed (from screening). About 240 will have a high PSA, and only about 100 of these will actually be diagnosed with prostate cancer."

According to the task force, this means all men in the 55 to 69 age group should have a thorough and individualized conversation with their health care providers about the risks and benefits of prostate cancer screening and their willingness to undergo additional testing.

Men 70 or older, the task force did not recommend PSA-based prostate cancer screening due to the higher likelihood of false positive results and additional risks associated with further diagnostic tests and treatments.

What they’re saying to male patients is basically when it comes to male healthcare, the American healthcare system is out of office.

They believe their researchers, surgeons and urologists are incompetent to the level they can’t provide a test that will give them a clear answer as to whether or not a man has prostate cancer without first totally stripping him of his dignity then as a thank you, leaving the man with ED and/or totally incontinent for the rest of his life after testing and surgery.

So that being the case, let’s have the PCP’s do the dirty work of talking guys out of being tested where by we save money on research, medical care, and possible lawsuits.

In layman’s terms we’ll trade men’s lives for dollars. They’ll never know we’re doing it.

If this recommendation was for breast cancer, women would be flying off the walls at the healthcare industry but because it’s only the male population we can do it because they don’t want to be seen as being weak so NOBODY will challenge the findings.

I think I said it all.

Regards,
NTT

 
At Tuesday, May 08, 2018 5:06:00 PM, Anonymous Anonymous said...

The female sportscaster Erin Andrews sued Marriott hotels and was awarded $55 million for a peeping tom who recorded her nude body in her hotel room. The peeping tom received 2.5 years in prison.

The female nurse Kristen Johnson who took a cell phone pic of her patient’s penis and then forwarded it to other nurses and friends at a hospital in New York received no jail time.

The male patient was in an ICU fighting for his life. If he survives and is discharged from the hospital he will receive no money.


PT

 
At Tuesday, May 08, 2018 5:25:00 PM, Blogger A. Banterings said...

NTT,

So just like women with PEs, DREs in trauma, PAP smears, etc., these tests are more RITUAL than science.

Does the US Preventive Services Task Force recommend physicians apologize for years of demanding men endure these tests in the name of profit and junk science?

I guess med schools will be going back to peer physical exams for learning PEs and DREs.

But it is OK, they are trained professionals and will act in the utmost professional manner. Not like the classmates will sneak pics to put on Facebook...



-- Banterings




 
At Tuesday, May 08, 2018 9:01:00 PM, Blogger Maurice Bernstein, M.D. said...

After all that is written above, I think that the title of my blog thread "Order vs Chaos in Medical Practice" from which I borrowed my painted graphic for this Patient Modesty Volume is very pertinent here. So I will reproduce my introduction to that previous thread below. What has been written here so far on this Volume and the previous ones leads me to a conclusion that "chaos" and NOT "order" is the proper defining term for the current medical system. And, for me, what input can I as a teacher of first year medical students do about all this?


As patients look at their experiences within the medical system and profession, do you think they find a system that is well thought out and is practiced in an orderly fashion to facilitate the basic premise of medicine to care appropriately for those who are ill? On the other hand, there is always the potential for chaotic disorder when dealing with uncertainties of disease and humans on both sides of the medical relationship. Is there evidence of chaos characterized by unsystematic medical practice which can lead to serious medical errors, higher cost of medical care and inattention to humanistic aspects of patient care? If patients find significant chaos imbedded within the medical system, what might the patients' opinions be regarding the cause of chaos and what might be the remedy to establish order? Do you think that something is missing in student medical education or the medical system itself to properly deal with the aspects of diagnosis, treatment and general patient care which, if attended to might diminish the effects of such lack of order?


On the other hand, does the medical system seem quite properly functioning with signs of disorder either absent or properly managed to the benefit of the patient? What is a patient's view?


Well, based on what has been written on our Modesty blog thread the answer to my last statement would be a definite NO. ..Maurice.

 
At Wednesday, May 09, 2018 12:47:00 PM, Blogger A. Banterings said...

Maurice,

I must do this in multiple parts because of length. Part 1:

It is NOT chaos. If it were, patients would be fighting back with impunity like the providers.

It is all about power.

Power corrupts; absolute power corrupts absolutely...


Let me give you research on the subject, read how the guards acted in the Stanford Prison Experiment, without being given any specific instructions. This experiment (and prisons) bear many similarities exist between prisons and hospitals.

...The prisoners were then brought into our jail one at a time and greeted by the warden, who conveyed the seriousness of their offense and their new status as prisoners...

Each prisoner was systematically searched and stripped naked. He was then deloused with a spray, to convey our belief that he may have germs or lice...

DISCUSSION:
Consider the psychological consequences of stripping, delousing, and shaving the heads of prisoners or members of the military. What transformations take place when people go through an experience like this?

The prisoner was then issued a uniform. The main part of this uniform was a dress, or smock, which each prisoner wore at all times with no underclothes. On the smock, in front and in back...

..Real male prisoners don't wear dresses, but real male prisoners do feel humiliated and do feel emasculated. Our goal was to produce similar effects quickly by putting men in a dress without any underclothes.
Indeed, as soon as some of our prisoners were put in these uniforms they began to walk and to sit differently, and to hold themselves differently – more like a woman than like a man...

...The guards were given no specific training on how to be guards. Instead they were free, within limits, to do whatever they thought was necessary to maintain law and order in the prison and to command the respect of the prisoners. The guards made up their own set of rules, which they then carried into effect under the supervision of Warden David Jaffe, an undergraduate from Stanford University. They were warned, however, of the potential seriousness of their mission and of the possible dangers in the situation they were about to enter, as, of course, are real guards who voluntarily take such a dangerous job.

As with real prisoners, our prisoners expected some harassment, to have their privacy and some of their other civil rights violated while they were in prison, and to get a minimally adequate diet – all part of their informed consent agreement when they volunteered...

...We were, of course, studying not only the prisoners but also the guards, who found themselves in a new power-laden role...

...At 2:30 A.M. the prisoners were rudely awakened from sleep by blasting whistles for the first of many "counts." The counts served the purpose of familiarizing the prisoners with their numbers (counts took place several times each shift and often at night). But more importantly, these events provided a regular occasion for the guards to exercise control over the prisoners. At first, the prisoners were not completely into their roles and did not take the counts too seriously. They were still trying to assert their independence. The guards, too, were feeling out their new roles and were not yet sure how to assert authority over their prisoners. This was the beginning of a series of direct confrontations between the guards and prisoners...

...totally unprepared for the rebellion which broke out on the morning of the second day. The prisoners removed their stocking caps, ripped off their numbers, and barricaded themselves inside the cells by putting their beds against the door...

...The guards broke into each cell, stripped the prisoners naked, took the beds out, forced the ringleaders of the prisoner rebellion into solitary confinement, and generally began to harass and intimidate the prisoners...


...Continued


-- Banterings


 
At Wednesday, May 09, 2018 12:51:00 PM, Blogger A. Banterings said...

Part 2:

...but you couldn't have nine guards on duty at all times. It's obvious that our prison budget could not support such a ratio of staff to inmates. So what were they going to do? One of the guards came up with a solution. "Let's use psychological tactics instead of physical ones." Psychological tactics amounted to setting up a privilege cell.

One of the three cells was designated as a "privilege cell." The three prisoners least involved in the rebellion were given special privileges. They got their uniforms back, got their beds back, and were allowed to wash and brush their teeth. The others were not...

...The prisoners' rebellion also played an important role in producing greater solidarity among the guards. Now, suddenly, it was no longer just an experiment, no longer a simple simulation. Instead, the guards saw the prisoners as troublemakers who were out to get them, who might really cause them some harm. In response to this threat, the guards began stepping up their control, surveillance, and aggression.

Every aspect of the prisoners' behavior fell under the total and arbitrary control of the guards. Even going to the toilet became a privilege which a guard could grant or deny at his whim. Indeed, after the nightly 10:00 P.M. lights out "lock-up," prisoners were often forced to urinate or defecate in a bucket that was left in their cell.
---Sounds a lot like a bedpan. --- On occasion the guards would not allow prisoners to empty these buckets, and soon the prison began to smell of urine and feces – further adding to the degrading quality of the environment...

...There were three types of guards. First, there were tough but fair guards who followed prison rules. Second, there were "good guys" who did little favors for the prisoners and never punished them. And finally, about a third of the guards were hostile, arbitrary, and inventive in their forms of prisoner humiliation. These guards appeared to thoroughly enjoy the power they wielded, yet none of our preliminary personality tests were able to predict this behavior. The only link between personality and prison behavior was a finding that prisoners with a high degree of authoritarianism endured our authoritarian prison environment longer than did other prisoners...
---Career providers? ---

...Continued


-- Banterings


 
At Wednesday, May 09, 2018 12:52:00 PM, Blogger A. Banterings said...

Part 3:


...Prisoners coped with their feelings of frustration and powerlessness in a variety of ways. At first, some prisoners rebelled or fought with the guards. Four prisoners reacted by breaking down emotionally as a way to escape the situation. One prisoner developed a psychosomatic rash over his entire body when he learned that his parole request had been turned down. Others tried to cope by being good prisoners, doing everything the guards wanted them to do. --- Men acquiescing to female nurses? --- One of them was even nicknamed "Sarge," because he was so military-like in executing all commands...

...I ended the study prematurely for two reasons. First, we had learned through videotapes that the guards were escalating their abuse of prisoners in the middle of the night when they thought no researchers were watching and the experiment was "off." Their boredom had driven them to ever more pornographic and degrading abuse of the prisoners...

...Out of 50 or more outsiders who had seen our prison, she was the only one who ever questioned its morality. Once she countered the power of the situation, however, it became clear that the study should be ended.

And so, after only six days, our planned two-week prison simulation was called off.


My point is that left to their own devices, the guards came up with nakedness as a means of power, control, efficiency, and humiliation (as demonstrated in the Stanford Prison Experiment). Even in a controlled experiment, participants suffered psychological trauma, even many years later.

Before one questions the similarities between a hospital and prison, read George Annas book "Judging Medicine," in which he labels the modern hospital a "human rights wasteland."



-- Banterings



 
At Wednesday, May 09, 2018 3:11:00 PM, Blogger Maurice Bernstein, M.D. said...

The "study" described by Banterings above, would never be allowed in 2018 by any Investigation Review Board (IRB) for this social experiment. For more on the study here is the link to Wikipedia: https://en.wikipedia.org/wiki/Stanford_prison_experiment#Ethical_issues

And, as a followup on Banterings mentions Annas, read this review of the public's view of hospital life and behavior with regard to patients' dislike of large and teaching hospitals, try this link:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1072211/pdf/hsresearch00530-0042.pdf

..Maurice.

 
At Wednesday, May 09, 2018 6:02:00 PM, Blogger Biker in Vermont said...

Another parallel to the medical world is the consent form used for the Stanford Prison Experiment. http://pdf.prisonexp.org/consent.pdf

The consent form doesn't provide any specifics as to what the participants might be subjected to, yet Stanford considered it informed consent. My guess is that the participants in the prisoner role were not told before signing that they'd be psychologically tortured and physically abused.

Hospital and medical practice consent forms similarly leave patients woefully uninformed. The info provided verbally to patients before they sign rarely informs the patient how they will be treated or even what they will be subjected to.

 
At Wednesday, May 09, 2018 8:31:00 PM, Anonymous Anonymous said...

Banterings

Those articles are amazing! Once at 4:00 am I went to the Mayo hospital for a kidney stone and what you described in your posts was exactly the way I was treated. Now you know how and why I am where I am today, but after 20 or more encounters similar I decided I’d had enough.

PT

 
At Wednesday, May 09, 2018 9:48:00 PM, Blogger Maurice Bernstein, M.D. said...

Pertinent to the discussions here, you may be interested in a thread I put up in November 2009 titled Violation of the Patient's Autonomy?:Is the Ethical?" and where I had a back-and-forth with a physician on the subject. ..Maurice.

 
At Thursday, May 10, 2018 4:32:00 AM, Blogger Biker in Vermont said...

Dr. Bernstein, the very last comment to the 2009 blog link you posted last speaks to the issue that many of us here object to. In advance of a procedure we are told the medical basics of what will occur (for example we're going to repair an inguinal hernia) and the hospital or doctor take that to have been informed consent. We are never told about how many assistants or observers might be present and certainly not their gender or whether they might even be high school students. We are never told about the level of genital exposure involved, and for many procedures that isn't obvious beforehand to an inexperienced patient.

Patients are similarly not told what the post-surgery actions consist of beyond the basics (you'll probably have a 2 night stay in the hospital and then have visiting nurses at home for a week afterwards for example). While in the hospital the male patient is then ambushed by a female CNA who comes to help him take a shower and a series of female nurses checking the catheter he didn't know he'd still have post-surgery.

The patient is rarely told anything about the things that most impact his experience, and in some cases might have impacted the decision to even have the procedure.

I'm not talking providing the patient every detail, but rather enough of an overview so that the patient isn't taken by surprise on significant privacy matters.

I had responded to a female pediatrician who did an article about teenage boy physicals and what a wonderful job she did being thorough in her exam and in teaching them the importance of genital exams. I challenged her on the boys being taken by surprise but she responded that she is informing them by virtue of the article she wrote. There was not an answer as to how the boys are supposed to know she wrote the article.

She requires a parent be present in addition to a chaperone (and noted she only has females on staff). Being mothers typically bring kids for their appts, I suggested that this info be conveyed at the time the appt is made so that at least the father could bring the boy to the appt. The response was that she allows the mother to turn her head during the genital exam if she wants. If she wants. She had absolutely no empathy for the boy's embarrassment to have a female pediatrician, female chaperone, and his mother there for his genital exam. She instead thought conveying the knowledge of why the exam is important at the time of the exam itself should somehow erase the embarrassment. The very concept of informed consent doesn't occur to her. She should have chosen a field other than pediatrics.

 
At Thursday, May 10, 2018 9:26:00 AM, Blogger NTT said...

Good Afternoon:

The medical community today, is trying to conduct business as if it were operating in the past. Say 1950ish.

They want a system where their knowledge and ability go unchallenged by the insurance companies, hospital mgmt. or the patient.

Problem is, time moved on. People that the medical community deal with have become much more enlightened.

As a society, we’ve move into an “information age” where people won’t just blindly accept what someone says.

Much of the control the medical community once had over their patients, is being taken back by the patient.

They no longer want to just do as they were told like in the past. They want more “information”. They want to know the who, what, when, where, and how nowadays before they will go ahead with anything.

They won’t admit it but, it’s this sharing of “power over the individual” that the medical community is having the hardest time coming to grips with. They spent long hard hours going to school then paying their dues to learn their craft so they figure why should they share the power? They’re the ones that went to school after all and have all the knowledge.

It’s because society has come into the age of enlightenment. The age of “Google” and youtube.

The cat is out of the bag and can’t be put back no matter how hard you try. People have a need to know more than they are being told. The medical community needs to come to grips about this and tell the patient everything they should know.

Maybe there needs to be a database that physicians can tie into with say a tablet so that when a patient asks for more information about a test or procedure the physician could grab the tablet, tie into the database and show their patient the who, what, when, and where they are looking for. Or just give the patient a link they can go checkout for themselves on their own time.

The tug of war between the public and the medical community must end. The public as a whole must be involved in any healthcare solution. The medical community can no longer afford to dictate policy. The public won’t stand for it anymore.

The “old ways”, the “good ole days” for the medical community are gone. Time to join society in the “real world”.

Regards,
NTT

 
At Thursday, May 10, 2018 11:55:00 AM, Blogger NTT said...

Good Afternoon:

Interesting article on Cancer Screening. We're moving backwards.

Uncle Sam's Deadly Cancer Screening Advice
https://www.creators.com/read/betsy-mccaughey

Regards,
NTT

 
At Thursday, May 10, 2018 12:32:00 PM, Blogger A. Banterings said...

PT,

On by blog I go much deeper in to what happens. Part of what I show is how the empathy is killed during their medical training. Much of the research is on the lines of the Stanford Prison Experiment. Read the post How to Create a Sociopath: It is quite in depth and long (5 sections).


Biker,

... and Maurice said that Stanford Prison Experiment could not be repeated today due to ethics committees, yet, as you pointed out the permission form for that is similar to hospital consent forms.


NTT,

I have been saying all this ad nauseam.


Maurice,

You have repeatedly went back to the theme of chaos, yet I have just demonstrated that the issue is that of power. The closest to chaos that could explain these problems is "rogue" providers. This was seen in the Stanford Prison Experiment:

...the guards were escalating their abuse of prisoners in the middle of the night when they thought no researchers were watching...

Power corrupts; absolute power corrupts absolutely...

So what are your thoughts about the issue being that of power>



-- Banterings








 
At Thursday, May 10, 2018 12:36:00 PM, Blogger Maurice Bernstein, M.D. said...

NTT, "Uncle Sam" was defined in the article as "Obama" and so the article seems a bit politically tainted. I am sure that overall there was a scientific basis and not political for the recommendations of the government services for changes in the breast and prostate testing practices. ..Maurice.

 
At Thursday, May 10, 2018 1:02:00 PM, Anonymous Anonymous said...

Add to all this mix the national debt was $1 trillion in 1980. Today we spend $4 trillion a year on healthcare. Where it all ends nobody knows.

PT

 
At Thursday, May 10, 2018 1:12:00 PM, Blogger A. Banterings said...

NTT,

So what is your position on the CA screening? (From your comment and the article, I am not sure.)

Are we moving backwards in terms of providers getting us to endure more and more of these useless tests annually at a younger age as a matter of ritual and not scientific proof?

Are we moving back to the Obama days of foregoing these useless tests?

The article is definitely biased to the ritualistic side of medicine. I suspect that the study by Dr. Elisa Port is too. The last paragraph sums it all up:

But let's get real. Enduring a false positive result, even if it means having to undergo a second test or a biopsy, pales in comparison to being told you have an untreatable cancer that was diagnosed too late and that you should say goodbye to your family.

I would not go through a prostate biopsy even if it was confirmed that I had cancer.

The issue here is point of view, and this is from the POV of those diagnosed, not the many more found negative or those with false positives. Let me demonstrate POV with a very famous quote from Ronald Regan:

“Recession is when your neighbor loses his job. Depression is when you lose yours...

Yes reduced screening will result in later diagnosis, but will reduce the harms of screening including false positives (and weights their harms more heavily). This study is only looking at those with positive diagnosis, it does not take into account the number of people spared of false positives (by weighting these lighter), OR the expectations of patients and society.



-- Banterings



 
At Thursday, May 10, 2018 1:40:00 PM, Blogger A. Banterings said...

Let me further my assertions made in my Stanford Prison Experiment post. In a post on Medpage Today, Dr. Andrew Perry writes an article titled: My Greatest Teachers Weren't MDs.

This is extremely disturbing:


...And what about the woman my age, who could have been my classmate? "I could tell how hesitant you were that day. A male doctor and a male medical student. Sure, we had a chaperone, but she wasn't the one performing the intimate examination. Your face exclaimed that you wished it was a female physician doing the exam. I just followed directions, but maybe I should have asked what your preference was first."

All of these sound incomplete. It's not that I feel a deep guilt and a need to apologize for any malicious intent...



No conscience, just how we have always done things. No apologies.



-- Banterings

 
At Thursday, May 10, 2018 2:44:00 PM, Blogger Maurice Bernstein, M.D. said...

Banterings, ..and that is what we emphasize to our first and second year students, it will be your patients who will be your true teachers. In fact, we require our students to end their patient history and physical writeup with a "Reflection". And it is this paragraph or two which expresses in words what personal learning the student obtained About the doctor-patient relationship directly from the interaction with the patient.

The best doctors and the best nurses are those who listen to their patients and be willing take what they hear, whatever the topic, from the patient and use it for the patient's benefit. ..Maurice.

 
At Thursday, May 10, 2018 4:42:00 PM, Anonymous JF said...

The Stanford Prison Experiment! I don't understand how it happened like that. Mock prisoners and mock prison guards? SIX DAYS? What bothers me is that people always justify their own behavior, but how could they justify THAT! I DO understand cowardice. But somebody there got the ball rolling to abuse those MOCK prisoners. Whoever that person/persons were, I bet he abused his wife and kids.

 
At Thursday, May 10, 2018 6:06:00 PM, Anonymous JF said...

Intimate examinations should only occur at patients request. What you just described will cause that boy to avoid medical care in the future. It may possibly put a wedge between that boy and his mother. I know of one other such incidence. The teenage boy was to old to have his mom witness that type of exam but the doctor wanted her to so she did. The boy/guy became of age soon after, married and he and his wife had kids. He cut his mother out of his life though, so she has no relationship with her son or her grandkids.

 
At Friday, May 11, 2018 4:47:00 AM, Blogger Dany said...

Biker in Vermont,

You are correct about patients not finding out about the finer details of many procedures until the last possible moment. And asking questions, assuming you can puzzle out what you need to know, might not get you the information you want.

I've long suspected this was done deliberately, as if they don't want patients to know ahead of time any specifics. This seems more prevalent in cases where a procedure might be painful or embarrassing, or both. I wonder if this isn't ingrained in medical training. I ran into that very issue with the urologist I was sent to when my hematuria was initially discovered.

The guy was nice enough, I guess, but he wasn't too keen on giving me many details about what he wanted to do, or how exactly these tests where going to be done. And despite having done some research on my own beforehand, I still feel I wasn't fully prepared. Let's just say that my list of "I-didn't-knows" got a whole lot longer when it was all said and done. But sadly, that information came to me as things where happening. In my opinion, this was a failure on the doctor's part.

JF,

I fully agree with you. I can only imagine how embarrassed a young man might feel when having his genitals exposed not only to his (female) doctor, but also a (female) chaperone AND his mother (or other parent). That is seriously wrong. It amazes me to see how many patients put up with this nonsense. And it's not speaking well for the parents either.

When I was growing up (at least say after I hit puberty) there never was any question about having anyone else in the examination room (beside the doctor and me). My mother certainly knew better and I would never have agreed to a chaperone. I suppose I was lucky in that my pediatrician was a man and he didn't use chaperones but still...

I apologize in advance Dr. Bernstein, but in my opinion, if a doctor is too scared of his patients, and insists on having a chaperone present, that doctor shouldn't practice in the first place. That is such a huge breach of trust. I would never agree to this. Even if it meant not receiving care. I could not bring myself to trust a doctor who doesn't trust me back.

Dany

 
At Friday, May 11, 2018 5:42:00 AM, Blogger NTT said...

Good Morning:

Banterings, to answer your question, I don't have a problem taking the PSA blood test because I know I won't let anyone push me any further than I wish to go from that point since I've had prior dealings with the medical system and I know how they like to push you on into doing more.

I worry about the newbie that hasn't had prior dealings with the system and what they'll do to him/her.

Yes it could come back elevated. But that doesn't mean it PCa. Could be a lot of things so I'd go the wait & see route & run the rest again in 6 months to a year.

Like yourself, I will never allow myself to be subjected to a prostate biopsy. I stood by a close friend who went that route and he was treated like an object not a human being throughout his ordeal.

If nothing else changes in medicine, the rules when dealing with a patient who presents with a gender specific intimate illness or needs, must be changed to automatically ask the patient before anything gets started if they want same gender caregivers throughout their visit.

If they do, you make it happen from when they walk in until they are discharged.

The system needs to show a more humanity.

Have a great day all.

Regards,
NTT

 
At Friday, May 11, 2018 6:47:00 AM, Blogger Biker in Vermont said...

NTT, concerning your post from yesterday about the cultural shift that has occurred, you are correct that people do not defer to authority in the manner they used to and that people want to know more as concerns their health options. You are also correct that in the "information age" we have vastly more info available to us.

That said, I think the medical community continues to provide as little info as they can get away with and that most patients going for surgery, exams, and various procedures have little concept as to what they will experience, unless they have done it before.

A patient going for their first dermatology skin exam can watch videos showing how it is done, except that videos will not include the presence of a scribe or chaperone/nurse and a complete exam will not include the genital/rectal area. The written literature might make reference to genital exams but, again with no reference to the audience that you will have. Why? If there is nothing sexual and patient dignity is maintained as they say, why not give patients an accurate perspective?

The videos for cardiac caths show the patient talking to the staff fully clothed, then in a gown in bed, and then fast forwards to the patient fully draped and having the procedure, and finally in bed post-procedure. They skip the groin hair clipping piece as well as the pre-draping procedures when the patient is lying there exposed as the antiseptic is applied to the groin area. The written literature may or may not make minor reference to hair clipping. Again why avoid what for the patient are very key aspects of the procedure?

Videos demonstrating male catheterizations do show the full procedure but they frequently show a male nurse doing it. The representation of male nurses in this regard far exceeds what the reality is. It is as if they want to mislead the patient to believe male nurses do most of the male catheterizations. The same occurs with male perineal care demonstrations. They show the full procedure but again the frequency of male staff doing the procedure far exceeds what happens in real life. Why the skewed gender representation?

Testicular ultrasound videos have the patient completely covered and the sonographer is reaching under a sheet to do the ultrasound. In real life the patient is exposed. Why do they not show how testicular ultrasounds are really done?

Videos of urodynamic studies never show the actual procedure and the literature is almost always vague and unclear as to what the patient will experience. Why not try to inform the patient beforehand as to what the procedure actually entails?

Medical practices rarely if ever tell patients upfront that a chaperone (or that they'll call the chaperone an "assistant") will be present, let alone tell men that the chaperone will be a female. Why keep this rather key part of the patient experience as a surprise for when the patient is sitting there in a gown?

And on and on.


 
At Friday, May 11, 2018 6:50:00 AM, Blogger Maurice Bernstein, M.D. said...

Dany, the chaperone is only present because of a physician's concern about threat of professional liability set by the patient for professional sexual or other misbehavior for which legal action on such a legal action would disrupt the physician's practice and effect his care of the physician's other patients. The presence of a chaperone of a gender accepted by the patient would be ideal. If there was no threat there would be no need for a chaperone.

As I have written here previously, my use of chaperone as a male physician was always a female specifically present only for a pelvic exam.

If there was no legal threat, no chaperone would be needed unless for other psychological reasons, a chaperone would be provide verbal support for patient's physical discomfort during a procedure.

..Maurice.

 
At Friday, May 11, 2018 9:05:00 AM, Blogger A. Banterings said...

JF,

Stanford Prison Experiment was to help better understand how the Holocaust could have occurred. Reportedly more than 7% of all German physicians became members of the Nazi party during World War II, a far higher percentage than the general population. (Source: BMJ Journal of Ethics: A long shadow: Nazi doctors, moral vulnerability and contemporary medical culture )

In 1942 more than 38,000 German doctors, half the total number of doctors, had joined the Nazi party.[3][4] While most of these doctors were physicians, some were psychiatrists, and some held doctorates (PhD.'s) in biology, anthropology, or similarly related fields. (Source: The Nazi Doctors and the Nuremberg Code : Human Rights in Human Experimentation and NY Times; Exhibition Examines Scientists' Complicity In Nazi-Era Atrocities
)

I have found that this research has major implications for medicine. Also, it is important to note that the guards were not instructed to abuse the prisoners, this is what human beings come up with on their own. The experiment was prematurely ended (6 days of a 2 week experiment) due to the psychological trauma that the volunteers suffered. You should really read about the entire experiment.


Maurice,

I totally agree with Dany about the issue of the chaperone. Either the physician is saying that I (as the patient) will file a false claim against him, or he cannot control himself (in which case he should NOT be practicing medicine).

What I object to is being the only one in the room undressed with multiple people. I feel bullied, assailed, etc. That triggers the perfectly natural and expected "fight or flight" response. I might be OK with a chaperone if they were undressed as well. Then I would feel that they were protecting more than bullying me.

They should be OK with that, after all they are trained medical professionals...



-- Banterings

 
At Friday, May 11, 2018 9:21:00 AM, Blogger A. Banterings said...

An update on prostate cancer: First, do NO harm...

Screening for Prostate Cancer
US Preventive Services Task Force Recommendation Statement



-- Banterings


 
At Friday, May 11, 2018 12:37:00 PM, Blogger NTT said...

Good Afternoon:

Biker, Dany. I to believe they deliberately hold back information.

1. Because it’s what they’ve been trained or told to do by management.

2. They feel if they tell the patient everything about the test or procedure, the patient will back out rather than go forward with it.

3. They just don’t know all that’s involved in the testing or procedure.

4. Some patients don’t really want to get that level of information. Until they’ve done it once. Then they’ll want to know everything from then on.


If they're not telling you because that’s the way they were trained, find the trainers & tell them they’re done training. If it’s because management told them, then it’s the almighty dollar talking again. If it’s because they just don’t know all the ins and outs, they should have someone from the facility that’s familiar with the test/procedure call you and tell you everything about it which in turn, will allow the patient to make their own informed decision as to how they want to proceed.

YouTube is a great forum for showing and explaining how things are done. One can age restrict the files to keep them out of view of minors. You just have to be truthful and not hide any steps because you think if they know all the steps & who’s involved they won’t do it. That’s a chance the system will have to take. These aren’t children you’re dealing with. These are adults capable of making up their own minds. They just need ALL the fact.

Healthcare is supposed to have some of the brightest minds out there. So, if they know well ahead of time that a test or procedure they want to run will be embarrassing to some patients, why aren’t these geniuses telling their management they need more male nurses and techs so patients don’t walk out when they find out a woman is doing their testing. It’s common sense not rocket science. Excuse me, we’re talking $$$ now.

By not telling a patient who wants to know upfront all that’s involved you are not easing his mind and you force him to seek other sources like Mr. Google. When Mr. Google plays show and tell all your patient may cancel on you. The cancellation may have been avoided if you talked everything out with them can came up with a workable solution for all parties.

Thinking about our healthcare system and all its problems makes my head spin sometimes. Maybe Dr. Linda could do another story called Why Doctors Don't Tell All When it Comes to Testing and Procedures.

Regards to all,
NTT

 
At Friday, May 11, 2018 4:43:00 PM, Blogger Dany said...

Dr. Bernstein,

I get why some physicians would want to have/use chaperones. But I do not agree with it. It undermines the relation of trust between a doctor and his or her patient. And without trust, how can a patient accept - or should I say believe? - the advises given by the doctor? Knowing my doctor doesn't trust me would force me to become suspicious of almost everything discussed. How can a doctor hope to develop that rapport, built that trust, when obviously it is not reciprocated?

Yes, there are levels, or degrees, of trust but when a patient accept to be disrobed and let a stranger look at, and touch, his or her body (or parts of it), that is a tremendous amount of trust put in the hands of that person (in fact, it borders on faith but let's stay way from philosophy). I do not see how bringing a chaperone enhance, improve or even respect that trust. And that trust is not an expectation (no healthcare worker is entitled to it); it has to be earned, every day, with every patient.

If a physician (or any other healthcare professional, for that matter) is going to unilaterally impose a chaperone, then that person ought to be the same gender as the patient's (no ifs or buts about it). Not doing so only adds humiliation to an already broken and disrespectful relation. To use financial considerations to justify the lack of male choices only further objectify the patients (my overhead costs are worth more than your dignity).

Anyway...

NTT,

Of the four possible reasons why a physician wouldn't be up front with his or her patients, I think the likely culprit would be the second one.

I've had the wool pulled over my eyes before by some healthcare workers, and I suspect you have too. When they known something isn't going to be pleasant (to put it mildly), they're going to be very careful about how they word things. Because they don't want to cause more anxiety or fear (and also make sure you don't change your mind, and walk away). They'll just spring it on you (ambush medicine), relying on the "surprise effect" to keep you reeling and not quite able to react normally.

Maybe this is only leftovers from the paternalistic era of medicine. I really don't know. But it annoys the bejesus out of me every time I catch someone doing it.

Dany

 
At Friday, May 11, 2018 9:53:00 PM, Blogger Maurice Bernstein, M.D. said...

I have a new word to enter into this discussion regarding what is going on between the patient and their healthcare providers.
The word is "rudeness". Do you think that the pathophysiology (the basic cause or mechanism) of the conflicts described Volume after Volume here is really behavioral rudeness on the part of the patient which then leads up to rudeness on the part of the medical providers. Or is rudeness going on between "professionals" in the office or hospital ward which then produces a rudeness towards the patient?

Frankly, as a medical professional who helps teaching students to try to understand the pathophysiology of the patient's symptoms, shouldn't I also advise the readers of the Patient Modesty volumes to try to do likewise? And that is where I think we should look to the common (not rare) behavior of rudeness as the etiologic factor which is involved in all that is being described here. And, if this is the main mechanism, what should be the therapeutic approach for treating this condition to prevent noxious outcomes? Maybe the social norms which define when rudeness begins are in need of change?

What is your opinion regarding the etiology of the behavioral issues being discussed here? And could simply personal rudeness on the part of the patient or physician or medical/surgical team be the cause? ..Maurice.

 
At Friday, May 11, 2018 10:47:00 PM, Anonymous Anonymous said...

I’ve spent a considerable amount of time on the subject of patient satisfaction scores particularly in regards to Press Ganey. I have often reviewed past scores both on Yelp and on feedback from Press Ganey at a time when scores were not available to the public. Many past scores as well as comments made by patients regarding their care was disturbing.

There is a tremendous amount of rudeness from healthcare providers directed towards patients. Why do you think AIDET was invented as
a means to be polite. Remember, rudeness takes on many forms and one example is how to address the patient. Referring to the elderly
patient as honey or sweetie is inappropriate yet happens frequently. A young female nurse addressing a male patient as hon or sweetie is in my opinion sexual harrassment and is just plain rude.

PT

 
At Saturday, May 12, 2018 6:53:00 AM, Blogger Biker in Vermont said...

Dr. Bernstein, I'm not following the "rudeness" thing. Of course there are rude patients and rude healthcare staff but it is not a word I would use to describe my experiences. I do agree that if Person A is rude to Person B, they may well then get a rude response from Person B.

For most of my adult life I was the typical male who quietly accepted the situation without complaint. Most of the time the healthcare staff were very polite even if I was needlessly exposed in some fashion or ambushed. Now I will speak up and ask questions, but I am very polite in doing so.

I realize some people might not be polite, but I can't see how the existence of rude patients is the cause of the healthcare system being as female-centric as it is. How can the occasional rude patient be the reason patient educational literature and videos seemingly purposefully distort what the procedure actually consists of? Or the doctor/doctor's staff not explaining the procedure at the time it is being scheduled? How do rude patients translate into hospitals only hiring female sonographers or only using females for chaperones for example?

Maybe a better word would be avoidance. Rather than speak up, some men will avoid healthcare altogether. Most men who do experience embarrassing healthcare avoid making their embarrassment worse by making believe they're not embarrassed.

Healthcare staff are people too. Many are just as modest as their patients. They know patients are being needlessly exposed and embarrassed, yet they too avoid the issue by making believe male patients have no modesty. Their training tells them to approach the patient in a confident matter and be polite and somehow the patient's dignity will be maintained, that patients will set aside their modesty and not be embarrassed. Playing that game avoids the issue.

Not providing realistic educational literature and videos avoids the issue by making believe patient exposure/modesty is of such little concern to patients that it isn't important enough to even mention. They similarly avoid the issue by not asking the male patient if he'd prefer a male nurse do his catheter or a male CNA help him shower. Making believe the issue doesn't exist avoids having to solve the problem.

Avoidance seems more the issue than rudeness.

 
At Saturday, May 12, 2018 10:25:00 AM, Blogger Maurice Bernstein, M.D. said...

More on rudeness in medical practice:
http://theconversation.com/in-hospitals-a-little-bit-of-rudeness-can-be-a-very-big-deal-46251
and with regard to surgeons and surgery:
https://www.beckershospitalreview.com/hospital-physician-relationships/rude-surgeons-may-also-be-most-hazardous-5-study-findings-to-know.html

Maybe what is considered by the patient to be inattention to patient modesty issues or worse may be a reaction to professional rudeness, exceeding social norms or even religious norms. If those norms were diminished..well, what has been heavily discussed on this thread would be likewise diminished. Of course, I don't see that happening! ..Maurice.

 
At Saturday, May 12, 2018 12:32:00 PM, Anonymous JF said...

One place where I used to work there was a check list on our evaluations and created agitation was on the list. Another place I worked at one of the nurses was terminated for bad mouthing other staff and going back and forth trying to pit people against each other. Its awsome when that kind of behavior isn't ignored.

 
At Saturday, May 12, 2018 3:36:00 PM, Blogger NTT said...

Good Evening:

On the healthcare side, I'd call it a culture that the system has allowed to grow and fester into the cancer it is today.

You have management asking healthcare workers to do more with less. That in turn puts added pressure on staff.

Doctors take out their frustrations on the nurses. They in turn take it out on their fellow nurses and support staff. Then nurses and support staff turn around and put the patient in their bullseye.

The culture has taught them that "They" have the power not the patient.

They have unwritten rules that say you treat a female patient with respect and protect her privacy at all times.

The other thing they are taught in this culture is that men have no modesty so don't worry if he's left exposed or gossiped about . Ambush if you like. Try not to get caught but if you do, don't worry, you'll get paid time off then come back as if nothing happened.

They want respect from their colleagues & patients.

Respect isn't given, it's earned and the US medical community has a long way to go to earn respect back from their patients.

Until this culture is rooted out from top to bottom the medical community will continue to spin its wheels.

Stop fooling yourselves. Hire and train the staff needed to care for all your patients not just one gender. Lets get rid of this cancerous culture & start building a healthcare system together that will be world class.

Regards,
NTT

 
At Saturday, May 12, 2018 7:33:00 PM, Blogger Maurice Bernstein, M.D. said...


NTT, could it be that the current medical culture which you describe is that our culture sets both on the professional side and the patient side standards of behavior which are unfair, inappropriate and unreasonable? Would this analogy set to the matter in Medical Daily titled "Social Media Challenges Social Norms, As More Users Experience Online Rudeness" be pertinent to my entry of "rudeness" into the Patient Modesty discussion? Is there something going on in medical practice which is provoking rudeness perhaps analogous to the manners within social media? ..Maurice.

 
At Saturday, May 12, 2018 9:00:00 PM, Anonymous JF said...

PTT, I agree that men should not be put on display for female scribes or female chaperons or female ANYBODY without his ok first. Its as fully wrong as male scribes male chaperons or male nurses seeing a female patients junk without her prior consent. The doctors who practice medicine that way are doing "something wrong" Whoever does the hiring and hires only female staff is doing "something wrong" to. I know its more common for males to not be unaccommodated but if you think we're never ambushed and our genitals and anus put on display for scribes and chaperons then you've got it all wrong. Doors are left opened or opened at wrong moments. Intimate care given in front of family or other visitors. Doors unlocked and people opening the doors.( sometimes it's kids that run and open doors before anybody can stop them ) Male patients have accidentally walked in also. My best friend was ambushed by a group of med students. Her doctor was gonna let those students practice on her but she said NO. I'm not against a chaperone being in the room, depending where she is located. My family doctor once had a male med student watching my pelvic exam but I was ok with it because he stayed at the head of the exam table and couldn't see anything. That is a healthy blind of protecting the doctors and still protecting the.patients privacy.

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

Amount consumers in this country spend each year for healthcare, $4 Trillion

Amount consumers in this country spend each year for prostitution. $15 billion

Highly dissatisfied with healthcare based on 3 hospitals surveyed, averaged 1.5 stars, yelp

Highly satisfied with prostitute providers based on 20 surveyed by the public, 4 bananas out of 5 is 80%, the erotic review

Now, many will say well PT this isn’t a very scientific review is it. Maybe it is but you know when female nurses tout during

nurses week with their cartoon that “ nurses see more penis than prostitutes “ then maybe just maybe they can learn a thing

or two from from an industry they are comparing themselves with.

PT

 
At Saturday, May 12, 2018 10:47:00 PM, Anonymous Anonymous said...

After all many female nurses according to State nursing boards commit boundary violations. Therefore, if you have a male patient paying for his healthcare with his insurance and a female nurses is interested in a sexual relationship while he is in her care then that makes her a
prostitute. She’s not guilty of a boundary violation, but rather prostitution. That is how I see it and that i# why the law should be changed.

The components are there, male patient, paying for healthcare, the nurse wants sex. She gets paid her hourly nursing salary.

PT

 
At Sunday, May 13, 2018 3:42:00 AM, Blogger Biker in Vermont said...

Dr. Bernstein, I don't think social media has contributed to rudeness in healthcare settings. If anything, the opposite might be true because healthcare practices and facilities know they might be quickly called out on social media if they are inappropriate in some fashion. People aren't as quick to just suffer indignities as used to be the case.

I would also add that patients are treated better today as concerns privacy/modesty than was the case some decades ago. Protocols have improved and staff has been better trained. I can give specific examples if people would like.

An exception to my comments here on the impact of social media is the presence of cell phones. Some healthcare staff seemingly can't resists photographing that which catches their interest, and then sharing it on social media. I can see the day coming where hospital risk managers ban staff cell phones from patient areas.

 
At Sunday, May 13, 2018 8:33:00 AM, Blogger Maurice Bernstein, M.D. said...

Biker, I wasn't trying to say that one (social media) was part of the cause of the "rude behavior" of the other (medical system). I wondered if there was similarities in the social dynamics which which allow either to happen. For example, less monitoring by others or the underlying system of actions or expression of rudeness between individuals or groups such as the ease of writing rude remarks to others on the internet and the ease of "wrong talk" to fellow readers of social media of the internet and seeming ease of "wrong talk" between members of the medical professional team or medical professionals toward or by the patients.

In both situations (internet system communication and communication between parties within the medical system) societal norms have been reset without control of behavior leading to this "rudeness" and its consequences. I am just trying to find the etiology of the "misbehavior" expressed in both social environments. ..Maurice.

 
At Sunday, May 13, 2018 10:41:00 AM, Blogger Biker in Vermont said...

Sorry if I misunderstood you Dr. Bernstein. The anonymity of social media often allows participants to behave outside of societal norms as concerns basic civility. People say things they would never say if that discussion were happening face to face. Social media operates under a different set of interpersonal interaction rules.

If there is a parallel with healthcare, it is that the healthcare system has exempted itself from societal norms as concerns patient privacy and dignity. In regular society we do not expect and generally do not allow people to be exposed to the opposite gender in bathrooms, locker rooms, dressing rooms, in swimming venues, and so forth. Most people are socialized to keep their privates private, especially with the opposite gender, romantic liaisons excepted of course.

Receiving medical care often does require exposure but the system largely ignores all societal norms in how it goes about it, especially for males. Do healthcare staff somehow view patient encounters as the equivalent of anonymous interactions? I can appreciate that in urban settings the odds of a nurse or tech ever seeing a patient in a social setting are slim. That is not true in rural areas and small towns however, yet the same ignoring of societal norms occurs in rural and small town settings where it is very hard to be anonymous.

The commonality with social media is thus the system allowing healthcare to operate outside of societal norms. The real question is why does healthcare do this? Why is respecting patient privacy and dignity restricted to that which is convenient for the staff rather than trying to approach societal norms to the extent reasonable?



 
At Sunday, May 13, 2018 12:57:00 PM, Blogger Biker in Vermont said...

Dr Bernstein, as a physician and as an educator of the next generation of physicians, why do you think the medical community operates without regard for societal norms as concerns gender-based privacy and dignity?

 
At Sunday, May 13, 2018 6:36:00 PM, Blogger Maurice Bernstein, M.D. said...

Biker, in answer to your last question, I would say that the medical profession believes virtually all patients and/or their surrogates (for those patients at the time without decisional capacity) that proper diagnosis and treatment is the goal of interaction between patient with their doctor and medical staff. That means that, in order to accomplish that goal, in some patients it is necessary to briefly forgo some usually physical modesty issues. And, without feedback to the contrary by the patient, bodily examination and treatment for that goal is acceptable. Dignity and privacy is to be maintained in such examinations and treatments. This is the professional understanding throughout most of my medical career.

However, in the recent decade or so, there have been assumptions made by professionals that without concern expressed by the patient, this professional understanding holds despite now including scribes, many assistants and others including "shadowing" students. Just as I had been unaware of a proportion of patients who have strong feelings against these assumptions despite the overall medical benefit of the attempt to cure symptoms and illness, I am sure many other physicians and others in the medical system are still unaware and continue to consider some loss of modesty a necessary acceptance by the patient to accomplish the goal. That concept had been considered by the profession a "societal norm". Obviously, this assumption is not fully valid. And this is where the medical profession needs to be educated and with your feedback to your doctors, nurses and system managers, hopefully we will all become educated and devise changes in current professional behavior to meet the standards set by your feedback. ..Maurice.

 
At Sunday, May 13, 2018 7:18:00 PM, Anonymous Anonymous said...

First, I would like to acknowledge that I recognize and appreciate that as an MD, Maurice, you have an open mind and have put aside any fears of your industry being exposed for what it is, an abysmal failure. Most MDs and others in the industry are much too fearful, greedy, indoctrinated and so on to take an honest look at the travesty that labels itself “healthcare,” at least in the US. So, this forum is very important especially as an educational resource for clients.
Now, there has been some discussion as to whether chaos or power exerts the most negative actions and consequences across the board regarding the make’emsick industry. Well, to enlarge that area of discussion, it must be understood that the make’emsick industry is basically a house of cards. As I noted previously, John Ioannidis’ 2005 article “Why Most Published Research Findings Are False” shows intentional fraud behind pharmaceutical “research” (choke) and how the public and physicians have been hoodwinked into believing that dangerous drugs/devices are the solution for just about every ill, and that for the most part these drugs are safe, or, at least better than the “disease” they are supposedly managing (never curing of course, for it is foundational to profit that people remain ill). This deception of course also applies to the host of dangerous, deceptively labeled tests and procedures which are supposedly preventative, and we’ve explored the great prostate hoax and the colonoscopy scam. Another hoax is of course the mammography scam, which much like the prostate scam actually causes more harm than good. It’s just another medical ritual/money maker. I’ve never had one, and my mother had breast cancer, twice. I’m doing great without the test!
To have any real understanding of how Western medicine has come to be such a shark tank, I must reiterate that all people should educate themselves on how this dangerous hydra grew into the full monster that we now experience. Let’s take a term from the present sad spectacle in Rome – oops I meant D.C. – collusion. Maurice, you have asked if medical education needs to be amended and the answer is a definitive YES! I urge everyone to listen to, or read “How Big Oil Conquered the World.” This link provides a written transcript: https://www.corbettreport.com/episode-310-rise-of-the-oiligarchs/
Basically, the “fortunes of Carnegie, Morgan and Rockefeller financed surgery, radiation and synthetic drugs. They were to become the economic foundations of the new medical economy…The takeover of the medical industry was accomplished by the takeover of the medical schools…The doctors from that point forward in history would be taught pharmaceutical drugs. All of the great teaching institutions in America were captured by the pharmaceutical interests in this fashion, and it’s amazing how little money it really took to do it.” Read the transcript – it’s easy to see how we now have a failing medical model and system and the most unhealthy nation in all of the developed nations. This information is a good foundation for understanding how deceptive, damaging, and much touted terms such as “evidence based medicine” and “unavoidably safe” have led us to the present state of the make’emsick industry and it now being the NUMBER ONE KILLER OF AMERICANS. Indeed, the report entitled “Death by Medicine” by Gary Null, Ph.D., PhD; Carolyn Dean MD, ND; Martin Feldman, MD; Debora Rasio, MD; and Dorothy Smith, PhD, explains how our medical system is the leading cause of death and injury, and this review is 15 years old! Here’s the Abstract: A definitive review and close reading of medical peer-review journals, and government health statistics shows that American medicine frequently causes more harm than good. The number of people having in-hospital, adverse drug reactions (ADR) to prescribed medicine is 2.2 million.1

cont. due to length (EO)

 
At Sunday, May 13, 2018 7:22:00 PM, Anonymous Anonymous said...

Dr. Richard Besser, of the CDC, in 1995, said the number of unnecessary antibiotics prescribed annually for viral infections was 20 million. Dr. Besser, in 2003, now refers to tens of millions of unnecessary antibiotics.2, 2a
The number of unnecessary medical and surgical procedures performed annually is 7.5 million.3 The number of people exposed to unnecessary hospitalization annually is 8.9 million.4 The total number of iatrogenic deaths shown in the following table is 783,936. It is evident that the American medical system is the leading cause of death and injury in the United States. The 2001 heart disease annual death rate is 699,697; the annual cancer death rate, 553,251.5 Here’s a link: http://www.medicinekillsmillions.com/articles/death-by-medicine-is-leading-cause-of-death.html
If one takes the time to explore this area, the deaths per annum via the medical hydra are actually well over one million! And, these figures above are from 15 years ago!
Now, rudeness on the part of medical critters is just a minor note in their playbook of POWER! Once the ugly monopoly of US “health” care is investigated and understood from its origins, we see that above all it is the imposition of POWER over another (the client) that the make’emsick workers desire and use in so many devious ways.
Hey, here’s an “interesting” one from Beckers: “UK surgeon who burned initials into 2 patients' livers sentenced to pay fine, serve 1 year of community service.” Talk about a freak! https://www.beckershospitalreview.com/hospital-physician-relationships/uk-surgeon-who-burned-initials-into-2-patients-livers-sentenced-to-pay-fine-serve-1-year-of-commununity-service.html

That physician should have had his license permanently revoked and he should have served jail time! But, no, like the Denver 5 and endless more examples, he’ll continue practicing “medicine.”

Yet, we should also look at the term chaos. And here, we’re speaking rather of the chicken and the egg (or, a poet would ask what comes first, the image or the word?), for it is a chaotic mind that would do such a thing as burning one’s initials into a client’s liver! It is a chaotic mind that would believe that the path to health is achieved via dangerous poisons and dangerous “screening” tests. Heck, even the term screening implies deceit. Yep, we could go on and on about the zillions of deceptions that medical critters exert every day, every minute, over clients. It’s built into the model of first poison, then try another one if that doesn’t work and/or makes the client sicker. As Biker noted, avoidance is a definitive tactic in make’emsick workers’ playbook to keep their power over the client. Let’s be honest – avoidance is the same as lying! And on the subject of pediatricians believing that explaining the” importance” (yet another deceptive term used a zillion times a day) of genital exams for males in front of at least two females is just fine and dandy if somehow the boys read her brilliant words – I’m smelling lies here as well. Most female pediatricians are WAY too eager to perform intimate exams on male children, and many share the female nursing hags’ predilection for viewing naked males, no matter the age. There are studies now emerging as to what this kind of power/deception over young males is causing to their psyches!

As NTT noted: “The other thing they are taught in this culture is that men have no modesty so don't worry if he's left exposed or gossiped about . Ambush if you like. Try not to get caught but if you do, don't worry, you'll get paid time off then come back as if nothing happened.[And yet] (t)hey want respect from their colleagues & patients.”

Cont. due to word length (EO)





 
At Sunday, May 13, 2018 7:25:00 PM, Anonymous Anonymous said...

As PT noted, we spend 4 trillion dollars per year on “health” care in the US, and we cannot receive privacy and respectful care for that? I agree that nurses that should be prosecuted as prostitutes since they’re emulating them. Maybe law enforcement would understand it from that angle since all they currently do is say we don’t have enough evidence or like nonsense and then hand over the hags to the medical facility for a highly paid slap on the wrist! And may I add another facet – nurses are always bitching about how little money they make! Since they kill hundreds of thousands per year, I think a NA’s salary would be more appropriate for their disrespectful and deadly “care”!

And, any society that spends one-fifth of its GNP (gross national product) on sickcare is indeed a very ill society, not only physiologically, but more importantly, psychologically. Where does it all end, as PT asks, well that is a subject I will try to write about when I find a few more nano-seconds!
As consumers, we must understand and bear in mind at all times that power and chaos are intricately linked!

EO

 
At Sunday, May 13, 2018 9:21:00 PM, Anonymous Anonymous said...

Maurice

As I see it rudeness = arrogance, and as EO phrases it the mak’emsick industry in my opinion is the only industry that is arrogant to its customers all the while expecting to get paid. From the very unscientific evaluation I made prostitutes have a higher customer satisfaction
than hospitals, ( which we all know is a result of nursing). Nursing says they see more penis than prostitutes and based on state boards of nursing stating high numbers of boundary violations ( sleeping with their patients). Nurses apparently should be licensed dually as nurses and prostitutes.

If a customer visits a high end clothing store and the help is rude or arrogant, will you stay and buy their product? If you are asked by the nurse to change into a gown and a) dosen’t close the curtain b) barges in while you are changing. You decide to leave you will be expected to pay the ER bill. I say the old adage should now apply to medicine at least if this is how they want to run their business and that adage is how do you make a HO holler, don’t pay her

PT

 
At Monday, May 14, 2018 4:37:00 AM, Blogger Biker in Vermont said...

Thanks for your explanation Dr. Bernstein. It basically comes down to physicians and other staff thinking that so long as all of the staff and other observers are polite to the patient that the patient's dignity and privacy will have been respected. That is the fundamental disconnect. Being polite is not the same as being respectful.

 
At Monday, May 14, 2018 2:18:00 PM, Blogger A. Banterings said...

Maurice,

You stated:

...the medical profession believes virtually all patients and/or their surrogates (for those patients at the time without decisional capacity) that proper diagnosis and treatment is the goal of interaction between patient with their doctor and medical staff. That means that, in order to accomplish that goal, in some patients it is necessary to briefly forgo some usually physical modesty issues. And, without feedback to the contrary by the patient, bodily examination and treatment for that goal is acceptable...

This is WRONG! Medicine has been told that this is not the expectations of society. I offer you POLSTs, Advance Directives (living will), DNR, etc. There is also the entire issue of informed consent/refusal.



-- Banterings




 
At Monday, May 14, 2018 2:56:00 PM, Anonymous Anonymous said...

Hello,

The following is the url to How I saved my daughter from a medical error, written by a physician :https://www.kevinmd.com/blog/2018/05/how-i-saved-my-daughter-from-a-medical-error.html. Most telling is the excerpt, "Ask lots of questions. Specifically, ask about the action plan. You as the patient are the only one that faces permanent consequences for medical errors." Please read again, "You ... are the only one ...." Of course, this presupposes that one, who is a non-physician, knows the questions to ask.

Reginald

 
At Tuesday, May 15, 2018 3:18:00 AM, Blogger Biker in Vermont said...

Reginald, the problem is most people don't know what questions to ask,just as most men don't know that they can ask for same-gender staff or refuse the presence of scribes, chaperones etc.

 
At Tuesday, May 15, 2018 2:10:00 PM, Blogger A. Banterings said...

Here is a link to the article that EO referenced: Death by Medicine .


-- Banterings

 
At Tuesday, May 15, 2018 6:27:00 PM, Anonymous Anonymous said...

Yes the list EO referenced grows daily, where it stops nobody knows. The female nurse in the news recently in Puyallup Wash. that has
been arrested and accused of infecting 2600 patients with Hep C. Folks, come on, this happens all the time, everyday in healthcare. As
I’ve said all along, you only hear about it when one gets caught and it makes it to the news.

But, if there is anything that the List EO referenced does not say and cannot say is that no one can fully comprehend, appreciate, put a
price on the emotional toll all this costs patients. It never goes away, no pill, no amount of counseling can ever take away the hate, the
distrust that has manifested in us, ever.

PT

 
At Wednesday, May 16, 2018 5:25:00 AM, Blogger Biker in Vermont said...

I accept that physicians and other healthcare staff may not always arrive at the correct diagnosis in a timely fashion and take it as my responsibility to give them as accurate info as I can concerning symptoms, history etc. This is why we have the phrase "the art of medicine". There are always unknowns and ambiguity.

I accept that having various tests are often necessary to aid the physician in determining what the issue was, even if it proved the tests did not lead to an answer. Last year a cardiologist did a T.E.E. and a gastroenterologist did an upper endoscopy seeking the source, or at least ruling out possibilities, of an ongoing issue I was having. Neither figured it out. Then my 1st visit with a newly minted Physicians Assistant correctly identified the source of the problem and addressed it.

Hard as it may be, I also accept that physicians and other healthcare staff are human and mistakes can happen or diagnoses can be wrong. I have personally paid dearly for a long ago incorrect diagnosis, but there was a range of possibilities and the wrong one was picked. Nothing malevolent involved. Again, "the art of medicine".

All of the above can be deemed doing the best they can with good intentions. No matter how much training physicians and other staff may have, the human body is even more complex. Yes sometimes a line is crossed that constitutes malpractice and when it occurs people should be held accountable.

Coming to the general nature of this forum, treating patients with respect and dignity is something that is totally controllable. This is something that they can get right, yet it doesn't seem they even try when it comes to gender based privacy matters, at least for men.

 
At Wednesday, May 16, 2018 2:22:00 PM, Anonymous Anonymous said...

I agree with PT when he stated thusly: "But, if there is anything that the List EO referenced does not say and cannot say is that no one can fully comprehend, appreciate, put a price on the emotional toll all this costs patients. It never goes away, no pill, no amount of counseling can ever take away the hate, the distrust that has manifested in us, ever."
I totally agree with the above, and WILL HATE AND MISTRUST THE MAKE'EMSICK INDUSTRY UNTIL I LEAVE THIS MORTAL COIL!!!
Here's just one example of what happened many decades ago when my mom had surgery for breast cancer. At that time radical mastectomies were performed, and her surgeon committed a rookie mistake - he cut a major nerve. When she came out of surgery, her right arm was frozen in an unnatural position and stayed that way for a long time. She had to keep it in a special sling. She endured terrible pain - dreadful pain - for the last 30 years of her life, on all sorts of opiates and even had some radical, experimental surgery to help with the pain, but it was not very successful and it is not done any longer. I recall how we might be out for a nice dinner and then the pain would come on and we would leave without finishing our meal and I'd make sure she got home to bed with some pain meds. But, here's the real kicker: that b*^$#*& of a surgeon told her and my dad that since she was entering menopause - THE PAIN WAS ALL IN HER HEAD - SHE WAS A SILLY, CONFUSED, MENOPAUSAL FEMALE! My parents waited too long to sue. I hope that b*&^%$# surgeon received his just dues some where down the line.
And, readers, how about that UK surgeon I referenced that burned his initials on the liver of a transplant client! This sort of behavior goes way beyond arrogance (as a contributor said it's arrogance, not rudeness, and I agree and we see as the number one killer of Americans that the make'emsick workers have NOTHING to even be arrogant about) - this is aberrant, dangerous behavior - it should, by a sane society, be labeled criminal or criminal by way of insanity! Yet, the UK surgeon got off with a fine and a paltry 120 hours of BS community service! He should awaiting trail for criminal behavior!
In addition to my question earlier as to why Western medicine objectifies clients - why do we, as a society, allow the make'emsick industry to commit criminal behavior - all sorts like the Denver 5 and the UK surgeon? Why do Western societies permit and cover up criminal behavior by workers? Why are most of the medical mistakes kept hidden? Like PT noted, the nurse that infected 2600 clients with Hep C - most of these events are kept hidden from the public, and often from those that have had them inflicted upon them. Why is such a plethora of malpractice and criminal behavior tolerated? Amy other industry would have been long gone or cleaned up by now!

EO

 
At Wednesday, May 16, 2018 2:43:00 PM, Anonymous Anonymous said...

And here's the verdict on the female gymnasts abused by Larry Nassar: Michigan State to pay Larry Nassar victims $500 million in settlements - https://www.usatoday.com/story/sports/olympics/2018/05/16/michigan-state-larry-nassar-abuse-victims-500-million-settlements/615308002/

But (baring the small percentage of clients harmed by the make'emsick industry that sued and won, and of course that's not counting the lifelong emotional distress) for the millions of victims of medical malpractice and millions of male clients abused by the nursing hags - ZERO!

EO

 
At Wednesday, May 16, 2018 4:07:00 PM, Blogger Maurice Bernstein, M.D. said...

The title for this posting should be "What to Expect is What You Get" and it deals with the "nocebo effect", not of pills or medical or surgical procedures but of professional behavior. First, for those who may know the definition of "placebo" but not "nocebo", read the 2012 article in American Journal of Bioethics:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3352765/

Do you think that the "side effects" of the patient engaging the "doctor and his or her pals" for medical/surgical professional assistance as described on this blog thread and, elsewhere on internet sites and "the news" actually become "nocebos", eliciting "symptoms of professional misbehavior or worse" as anticipated or suffered by the patient and yet as with nocebos in general are simply "patient created" symptoms based on those descriptions? Understand the nocebo concept and it's psychologic effect on patients and then see if it can possibly apply and might be "in play" to the issues described on this thread. Are most professional interactions constructive and ethical but the published nocebos are out there awaiting a patient to accept the warning and then suffer the experience?

I know I am throwing out to my visitors a controversial possibility but, on the other hand, that is what "discussion" (a word in the title of this blog) is all about. ..Maurice.

 
At Wednesday, May 16, 2018 5:27:00 PM, Anonymous Anonymous said...

Maurice

These days people just look for hundreds of excuses in an attempt to explain away their mistakes as to why professionalism or ethical
behavior can’t be maintained. Blaming the patient is the easy way out and when was the last time any patient gets praise for voicing a
concern. The second method is to simply sweep these problems under the rug, that’s why risk management was created. The third method
is simply to deny it ever happened, this is the most popular method.

PT

 
At Wednesday, May 16, 2018 6:13:00 PM, Blogger A. Banterings said...

Maurice,

This article (The Problem of the Nocebo Effect for Informed Consent), is another attempt to return to paternalism. It will never happen. The internet has shown medicine does not know best. So what is the best way to protect patients?

Put them in charge of their own healthcare. If they so choose to hand the reigns over to the physician (who has earned and continues to earn their trust), so be it.

The genie is out of the bottle, and it is never going back in.

Slowly the last remnants are being washed away. Just as with dangerous animals, society is muzzling them and putting them on a short leash.

The biggest mistake made is that medicine holds back the truth. That is the one singular thing that a group can NOT do. You can cheat, steal, abuse, etc., just do NOT lie.

One lie is enough to question ALL truths.

As long as the profession clings to this failed philosophy, power is going to be stripped away to nothing. If the profession continues to to embrace their failed religion of paternalism, then what comes next is penance to atone for the transgressions of the past.

At least handing power to the patient, the only one to blame is oneself.


-- Banterings




 
At Wednesday, May 16, 2018 6:37:00 PM, Blogger Biker in Vermont said...

Dr. Bernstein, I'm not sure I can answer question you posed about nocebos but the article does make me wonder do physicians and other healthcare staff ignore patient privacy/modesty issues out of fear that if they mention it that patients might in fact say that yes they are embarrassed. I suggest that the reality is that patients are embarrassed with or without the matter being spoken to by healthcare staff, but that if the staff make believe that it is not embarrassing that patients will remain silent so as to be viewed as a "good patient".

 
At Wednesday, May 16, 2018 7:24:00 PM, Blogger A. Banterings said...

I also thought of another VERY important fact:

Nonmaleficence is part of a PR campaign that has been around for a long time. The name of that fluff and window dressing is called the Hippocratic Oath. It has absolutely no legal standing.

On the other hand, informed consent is the law.

To justify lying to patients with a fairy tale is just one example of deviant values of the medical industry as a whole.

The truth will set you free.



-- Banterings



 
At Wednesday, May 16, 2018 10:35:00 PM, Blogger Maurice Bernstein, M.D. said...

Let me clarify a bit better what I am trying to express: Could it be that much of what is being written on this blog thread by the commentators is simply providing to those visiting this thread with no opinion on the modesty issues of concern here, a description of the potential "hazard of being a patient in this pill called the medical system". The patient goes to a physician or hospital (the :"pill") with this hazardous warning of a possible misbehavior (a "nocebo). Wouldn't this cause some visitor patients to fear their next interaction with a physician or hospital system? By telling the patient the potential harmful behavior within an upcoming examination (the "pill") and the patient deciding not to take the examination (the "pill") in view of the "nocibo" effect of that education here of that patient. "Nocibo" because if the patient took the "pill" (went to the doctor or hospital) no harm would that patient actually experience from that interaction. What they would have read on this blog thread for that specific patient going to that doctor or hospital would have been simply a "nocibo pill" --a toxic effect attributed by others to the event which never materialized.

Can anyone help me with this analogy and perhaps express it better even though some writing here warn that all these pills are 100 percent TOXIC. ..Maurice.

 
At Thursday, May 17, 2018 8:28:00 AM, Blogger Maurice Bernstein, M.D. said...

More on the "nocebo effect" and how much to tell the patient: my blog thread from 2012 titled "How Much Truth Should the Doctor Tell the Patient in View of the NOCEBO EFFECT?"

So with regard to the topic of our current thread, how much should our commentators here warn the public visiting here warn them about the "bad" or "toxicity" of the medical providers as a"bad pill" to swallow.

I realize I seem to be belaboring a topic here but what I am trying to get at is that isn't it the right (hopefully effective but also ethical) approach to aim your comments directly to the system,the regulators, the politicians) and not to taint the visitor's upcoming doctor-visit with a warning of toxicity when a poisoned relationship may, in most cases, not occur.

As you can see, I am trying to rationalize all the dire warnings given on this thread which seems to potentially apply to every doctor-patient interaction. ..Maurice.

 
At Thursday, May 17, 2018 10:58:00 AM, Blogger chirp said...

I am so sorry any distress ever happened to you! that is not ~ and never has been ~ the purpose of the medical profession. ~ And, NO, I am Not a Doctor or Health Care Services employee. However I have been a Patient. (Breast cancer sucks as much as prostate cancer may suck also.)

I am concerned about the Broad Brush approach of painting everything and everyone with the same color of paint: Right & Wrong matter, and in my own experience, I have NEVER UNDERSTOOD whatever the Doctor (or staff) was telling me, in their Duty To Inform Me, as Their Patient.

I have to understand the benefits and detriments of a proposed procedure? when I need it (and am not feeling well) is the absolute worst time to ask me! And yet that is the construct of what we have created!

We need to understand that our future is going to be limited: we DO each die, sometime. How we meet that destiny has everything to do with what we decide now, today. Who we nominate to serve as our Health Care Agent: is s/he up to the task? Or is there a potential for bias? If not my spouse/child/best friend/mate, then WHO?????

And do I know that person well enough to discuss My Issues? Including right to privacy and/or genitals issues? Or must I wear pajamas in order to do so? (Once I notarized a document for a Patient who was wearing nothing, due to a very sensitive skin allergy, and we were both were united on the purpose of the communications and the transaction. Isn't that what can make the difference????????
chirp

 
At Thursday, May 17, 2018 11:17:00 AM, Blogger A. Banterings said...

Maurice,

I believe that most everyone here has been injured and traumatized by something that has happened to us within the healthcare system. I have also met many through my counseling degree that heal by becoming advocates for others like them, warning others in their situation (or the public) of the dangers, and working to change the circumstances of what lead to their trauma.

I guess you can say that your "nocebo effect" was raised by the trial and conviction of Dr. Larry Nassar has lead to false allegations against Dr. William Strampel, the former Michigan State University dean (who oversaw Dr. Larry Nassar)?

Why are we not discussing the "nocebo effect" about the potential side effects of medications in advertisements? Soon these are coming to the State of California.

Finally, I blame the government more thany anyone else for the failure to protect patients. Read how Medicare Slow to Boot Docs with State Sanctions.



-- Banterings





 
At Thursday, May 17, 2018 1:45:00 PM, Anonymous JF said...

This blog helps people know how to speak up and be accommodated. A person who hasn't been unnecessarily violated wouldn't likely be looking at this blog.

 
At Thursday, May 17, 2018 1:45:00 PM, Blogger NTT said...

Good Afternoon:

Here's yet another black mark for the medical community.

Doctor accused of false diagnoses in $240M health care scheme.

A Texas doctor is accused of falsely diagnosing patients with diseases and administering chemotherapy and other treatments to people who didn’t need it, reports said.

Dr. Jorge Zamora-Quezada has been charged in a $240 million health care fraud and money-laundering scheme that included the false diagnoses and improperly prescribed meds and treatments, ABC 7 reported.

Prosecutors allege the 61-year-old rheumatologist performed the unnecessary medical procedures, and falsely diagnosed patients with degenerative diseases such as rheumatoid arthritis, to fund a lavish lifestyle complete with a million-dollar private jet, luxury properties from Aspen, Colorado, to Puerto Vallarta, Mexico, and a Maserati emblazoned with his initials.

https://nypost.com/2018/05/17/doctor-accused-of-false-diagnoses-in-240m-health-care-scheme/

Ain't America Great.

Regards,
NTT

 
At Thursday, May 17, 2018 2:33:00 PM, Blogger Maurice Bernstein, M.D. said...

NTT et al: But should we put all the physicians and their colleagues and assistants within the same apple basket as some "bad apples" such as Nassar and your reference about Zamora-Quezada?

Coincidentally, can you believe it?.. I even have a blog thread titled "Painting Groups with the Same Brush as Outliers: Is That Ethical?" from 2009 and guess who is doing the "back and forth" with me.... PT! As you see, this isn't a settled topic. ..Maurice.

 
At Thursday, May 17, 2018 2:43:00 PM, Blogger NTT said...

Hi Dr. Bernstein:

No sir we shouldn't but this does show the healthcare industry needs stronger civilian oversight now more than ever.

Regards,
NTT

 
At Thursday, May 17, 2018 4:43:00 PM, Blogger Biker in Vermont said...

Dr. Bernstein, no we shouldn't presume everyone is guilty just because some are. I don't think I personally have done that, though clearly from some of the posts here, some do view all healthcare staff negatively.

JF is right that people who come here already have had bad experiences or have been thinking something is wrong with the manner in which their privacy & exposure is handled. For me, coming here affirmed that I was not alone and that I was not imagining things. More importantly it helped me find my voice.

I do agree however that there is a risk of a becoming hypersensitized resulting in a bit of the nocebo effect happening.

People who have no bodily modesty aren't going to come here, thus there is no chance a nocebo effect could affect them. The same goes for those who genuinely trust that anyone who dons scrubs is a full fledged professional for whom there would never be a sexual component to their work.

 
At Thursday, May 17, 2018 7:36:00 PM, Anonymous JF said...

Its further evidence that Healthcare workers are the same caliber as the rest of humanity. A certain ratio of criminals. A certain ratio of heroes. The only marked difference is they completed medical school.

 
At Thursday, May 17, 2018 8:16:00 PM, Blogger A. Banterings said...

Maurice,

One is either part of the problem or part of the solution. Most in medicine are part of the problem. They may not be the ones abusing, but they cover it up by denying that abuse happens, they accuse the patient of being mentally ill, they deny the dignity and modesty humans are brought up with, they have one set of rules for themselves and another set for everyone else.

Remember pelvic exams on anesthetized women being the way all physicians learned to do PEs? That was NOT outliers, that was ALL physicians.

If this practice like many others was not exposed by the internet, they would still be continuing to this day.

Read the article: Has Gynecology Ever Faced Its Shameful Past?

Since the profession has not faced its past crimes against humanity, society is imposing justice, read hoe Dr. James Marion Sims statue removed from Central Park.

Even what was once thought as compassionate healthcare has been determined to be torture by the UN and WHO. It was found that the treatment of intersexed individuals in healthcare amounts to torture and was more for the benefit of medical students than the patients.

It is not painting all individuals with the same brush, it is the reputation that the industry has earned. It is the truth, something the profession wants to hide. Until all members are ready to allocute to the abusive past of the industry, confess their own infractions, make contritions and make amends, apologize, and make real changes to the expectations of society, then the reputation is earned.


-- Banterings


 
At Thursday, May 17, 2018 8:30:00 PM, Blogger Maurice Bernstein, M.D. said...

First I want to thank Chirp for joining us here and expressing her view of what is needed as a patient with regard of who helps us, and also how, with our medical problems.

Now for the bad news: the "bad" of medical practice "comes home again".

Read this current article in the Los Angeles Times:
"A USC doctor was accused of bad behavior with young women for years. The university let him continue treating students"

So after two physician Deans of the University of Southern California Medical School where I volunteer my teaching (one after another in succession) misbehaved and finally let go, here is another physician who allegedly over a long period of time allegedly misbehaved in his role as gynecologist at the student health center and the University failed to inform the California Medical Board.

I can't deny there are "bad apples" in the medical profession (here are 3 examples, close up) yet, I refuse to "paint all physicians and their helpers with the same brush". What is bad too is the system "hiding" them until newspapers such as the Los Angeles Times picks up the story.
..Maurice.

 
At Thursday, May 17, 2018 9:52:00 PM, Anonymous Anonymous said...

Maurice said

“ what is bad too is the system “ hiding “ them until newspapers such as the Los Angeles times picks up the story. “

As I’ve said for years on this blog, this happens all the time, everyday. It’s only when one case makes it to the news
that people somehow think, Oh, this must be an isolated incident cause I’ve heard it on the news and I haven’t heard
this happening before.

Most people are not “ tuned “ in to this kind of subject nor research this kind of subject matter. Very few people have
ever heard of propublica and they tend to believe what they want to believe. Many people just can’t handle the truth
and many just don’t want the truth to be known. See, hear and speak no evil seems to be the words of the day.

On top of the $4 trillion dollars that we spend each year for health care, now we will spend another $500 million for
Dr. Nassar lawsuits and who knows what other lawsuits that will arise. On and on it goes, where it stops nobody
Knows.

PT

 
At Thursday, May 17, 2018 11:55:00 PM, Anonymous JF said...

Medical staff doesn't have to criminally sexually assault patients to embarrass or humiliate them. A huge part of the problem is they see way too much nudity and forget to protect patients privacy.

 
At Friday, May 18, 2018 6:41:00 AM, Blogger Biker in Vermont said...

As Dr. Bernstein's and Bantering's posts point out, the medical world is just as guilty as colleges, churches, and other institutions of looking the other way when it comes to sexual abuse of patients, students, and members as the case may be. In pretty much every case that the media picks up on, it seems the institution was more interested in protecting its vested interests than in protecting the victims. They thought the cone of silence would not be breached, but then it was.

Specific to the medical world, even breaching the cone of silence might not trigger action. The "Denver 5 body bag penis" episode saw the nurses quickly returned to duty. The hospital didn't see it as a problem, nor apparently did the Nursing Board. What are the odds those nurses were at least reassigned to female-only care? Slim to none.

The hospital Twana Sparks worked at similarly did little to nothing after her abuse surfaced. The Medical Board in turn gave her a slap on the wrist is all and she continued operating on patients until she retired. The hospital's apparent only interest was the revenue stream she represented. What are the odds the hospital at least ensured she did not do surgeries with female-only crews? Slim to none. Recall that her female-only crews went along with her antics for years before the abuse surfaced.

Using Dr. Bernstein's USC example, the school was OK with this doctor continuing to see patients for years while receiving reports of improprieties.

If Nursing and Medical Boards do not view actual sexual impropriety as problematic beyond the potential lawsuits and bad publicity, it starts to become understandable why hospitals don't see the kinds of routine gender-based privacy/modesty matters we discuss here as anything to be concerned about.

All that said, I do not even remotely think that most healthcare staff purposely misbehave in the manner the USC GYN, the Denver 5, and Dr. Sparks did. I do think however that most healthcare staff think that patients should be accepting of whatever degree of exposure the staff members exposing them are comfortable with.

Using one of my personal examples, the medical world thinks it is OK that I was fully exposed for my 1st abdominal ultrasound and then not exposed at all for my 2nd because in each case the female sonographer would have deemed the manner she went about it respectful, dignified, and appropriate. Another example is my most recent cystoscopy prep where post-prep, pre-urologist arrival my penis was covered with a cloth vs prior cystoscopy preps where I was left exposed. In both cases the medical world views it as having been respectful, dignified, and appropriate because in each case the nurses involved were comfortable with handling my exposure in those differing manners.

My two personal examples are not abuse in any fashion but rather speak to if staff are given great latitude to determine for themselves what is respectful, dignified, and appropriate that a small minority of them are going to carry it to an extreme and the USC GYN, Denver 5, and Dr. Sparks are going to be the result.


 
At Friday, May 18, 2018 8:36:00 AM, Blogger A. Banterings said...

The problem is that there is no duty to report accusations. What will change this is when a university board is charged with "conspiracy."

Conspiracy is a funny crime; you can be guilty of conspiracy, but the not the crime you conspired to commit. See the 1906 Columbia Law Review paper: Conspiracy to Commit Acts Not Criminal "per se".

This would then create a legal obligation (such as the Miranda Warning). Although there is no specific law that requires the Miranda Warning, court decisions created the necessity to do them.

In the same way, one major criminal case may create the obligation for facilities to report complaints.



-- Banterings


 
At Friday, May 18, 2018 12:34:00 PM, Blogger A. Banterings said...

The nocebo effect strikes again....


VA doctor abused male patients during prostate, genital exams in Watertown, records charge



-- Banterings


 
At Friday, May 18, 2018 4:07:00 PM, Blogger Maurice Bernstein, M.D. said...

Moving away from the nocebo matter (or maybe it is a reflection of the same concept), here is what I wrote to all my readers of Patient Modesty Volume 35 July 13 2010.


May I suggest for those following the Patient Modesty volumes to take a look at the following blog thread on clitoral stimulation testing in young girls as part of a followup study after surgical clitoral trimming for apparent enlarged clitoris. Is there more in the issue than a patient modesty issue? Is there any relationship in that issue with the various aspects of patient modesty written on the Patient Modesty volumes? Please write your responses here if pertinent to the discussions here. ..Maurice.


I got a bunch of interesting Comments both on the clitoris thread and here on Patient Modesty Volume 35. If you have the time and certainly the interest read both sites and if you have any additional views not previously discussed in detail on either site, enter them here but in the context of what you had read at either of those sites.
You know, on thinking this over, this whole subject and how it was presented to the children and parents could well be defined as a nocebo (a potentially harmful enlarged clitoris and its surgically treated consequences.) Hmmn? ..Maurice.

 
At Friday, May 18, 2018 4:18:00 PM, Blogger Maurice Bernstein, M.D. said...

The start of the discussion in Volume 35 regarding the clitoris subject began with my Comment July 13 2010. ..Maurice.

 
At Friday, May 18, 2018 7:01:00 PM, Anonymous Medical Patient Modesty said...

I am definitely not surprised about what happened at USC. They should have fired Dr. George Tyndall many years ago. The truth is male gynecologists have no business working in student health centers at colleges. They should only allow female nurse practitioners or doctors to do gynecological exams. Many male gynecologists abuse women and get away with it for years.

In fact, we have an article on MPM's web site encouraging women to avoid male doctors for intimate exams.

Misty

 
At Friday, May 18, 2018 8:33:00 PM, Anonymous Anonymous said...

In no way am I defending Dr Tyndall, however, after reading the narrative and I have read a number of these I can’t help but wonder
about the nurse who complained. It seemed that she had an agenda against him, I mean going to the rape center and it seems she
attempted to put words in the patient’s mouths. If this were his private office I’m sure things would be different, she was terminated
in the end.

Here is the crux of the matter I want to present. I have read where a number of gyn physicians being forced out of University student
health settings because of their age. In one case an older gyn physician was told that the young female patients want a young male
gyn. I seriously doubt that is the case, but I feel there are a large number of female health care workers that resent male physicians
examining a large number of the female student population.

Interestingly in the Dr Twana Sparks case the female nurse anesthiologist who eventually complained about Dr Sparks was in a lesbian
relationship with Dr Sparks and things went sour, it’s public knowledge. Therefore, in my opinion when female healthcare workers engage
in unprofessional behavior towards male patients, the reporting is done essentially to protect their license, not because of the unethical
issue with the behavior.

Consider the female nurse in Penn who took a cell phone pic of her patient’s penis and sent it to other nurses. The nurses know that
it’s on their phone and if they delete it without reporting it their license is in jeopardy. Female nurses as well as other female healthcare
workers are more reluctant to report unethical behavior amongst themselves when male patients are involved, yet will willingly report
male healthcare employees and that includes physicians.

In conclusion, if you say that male gyn physicians should not be employed by colleges and universities, then you should restrict all
female physicians from working there as well. Furthermore, go a bit further and remove the female medical assistants from Urology
clinics. They need to go back to wherever they went to school and relearn how to take a proper blood pressure.

PT

 
At Friday, May 18, 2018 9:01:00 PM, Anonymous Anonymous said...

Misty

Did Dr Tyndall rape any of the female students, no. Yet the nurse went to the rape crisis center on campus and complained. Would
she do the exact same thing if a female physician, pa or nurse made comments about the genitals of their male patients, no. If she
did regarding a male patient they would probably laugh at her and fire her right then and there for being a nutcase. Therefore, until
any provisions are made for male patients, I’ll never agree, endorse nor advise anything for female patients, and speaking of female
patients they are partly the cause for the pathetic, discriminatory and unethical rut that male patients find ourselves in.

PT

 
At Friday, May 18, 2018 9:15:00 PM, Blogger Maurice Bernstein, M.D. said...

Yet, Misty, The role of men vs women in the profession of obstetrics-gynecology is more complex and not simply sexual misbehavior of some of the participants in the field. There are still two sides to the Ob-Gyn gender story.For example, this interesting recent article in the Los Angeles Times http://www.latimes.com/health/la-me-male-gynos-20180307-htmlstory.html

There is much more to the changes in the gender makeup of ob-gyn physician over the past few decades than professional sexual misbehavior.The question is whether this switch from male to female professionals will be the best for all, everyone of the women patients, or not.That remains to be seen. But my view is that it is not all about sexual misbehavior by male physicians. ..Maurice.

 
At Saturday, May 19, 2018 4:33:00 AM, Blogger Biker in Vermont said...

Dr. Bernstein, female GYN's who pronounce men unsuited to be GYN's are applauded as standing up for women's rights. At the same time female urologists decry men as sexist if they don't want them as their doctor, and feminists cheer them on.

If the best and brightest women who have become physicians can only see privacy/modesty considerations as applying to female patients, there would seem to be little hope for men as these female physicians rise through the ranks of medical schools and hospital systems.

That female physicians can't see the double standard is very telling.



 
At Saturday, May 19, 2018 8:01:00 AM, Blogger Dany said...

Good morning all,

The first time I heard of the "nocebo effect" was in relation to statins. My opinion was (and still it, to some degree) that this idea is nothing more than a clever ploy hatched by healthcare providers to encourage patient compliance. That somehow, side-effects experienced by patients are not real, but only the results of mass hysteria, or psychosomatic in nature. I find that insulting, to say the least. The benefits (real or perceived) of any medications, treatments or surgical interventions is - first and foremost - the patients' own decision. Not the providers.

Obviously, doctors and other healthcare professionals have a whole lot more knowledge, skill and experience in that field, which is why we go see them. There is an element of implicit trust taking place, but that "trust" is based on the notion that the recommendations made will be unbiased, and offered with all relevant information. The overall aim being to offer choices and let the patient decide.

A provider deliberately withholding information about a given intervention because he/she believes his or her patient, once made aware, might not consent to it, is doing nothing more than manipulating that patient. That is lying, if only by omission.

With regard to this blog and whether or not it might be some convoluted form of "nocebo" effect, I hope, Dr. Bernstein, that I have misunderstood your opinion. Are you suggesting that, by and large, what the patients don't know can't hurt them? That if a patients isn't aware of any possible questionable behaviours from any healthcare professional, or hasn't fully formulated his or her own opinion on that issue, than it shouldn't be brought up. For fear that it might sour the relationship? Is that what you are getting at?

As to using a broad brush to paint all healthcare workers, no I do not believe it is so. Speaking for myself, I do not "hate" doctors, but I am cautious around them. I find myself unable to fully relax and trust most physicians. Admittedly, I am less comfortable with women then with men, but only marginally so. And my caution will quickly turn to suspicion the moment I realize the person I am talking to attempts to manipulate me, sway me, or otherwise abuse their position to coax me into anything I don't want to do.

(I use the word "doctor" here but I want to make clear that I do not single out this profession. I include all healthcare workers such as PAs, NPs, RNs, etc. in that group.)

In a way, this blog provides a leveling effect. Whereas most of the information regarding the healthcare industry seems to be within the hands of only one side of the equation (the healthcare professionals), patients interact with this "world" in a somewhat clueless fashion and may not know any better. That is, until it's too late.

Worse to me, is that it would seem that these so-called professionals endeavor to keep things that way. I mean, you can't fail to appreciate the irony of a healthcare system that is self-regulated, self-administered, and appears to be extremely resistant to any demands from the very people they allege to dedicate their life to help.

Dany

 
At Saturday, May 19, 2018 8:36:00 AM, Blogger Dany said...

I honestly do not know if a doctor specializing in the medical field of Ob-Gyn is any more capable, or qualified, than another by virtue of being born with a vagina. Would being a man preclude a doctor from providing professional, appropriate and compassionate care related to obstetrics? I do not think so.

Some might argue that only a woman is truly capable of understanding (or relating) to the difficulties related to child-birth and that, try as they might, a man will remain somewhat clueless about this. I suspect there is some truth in that.

Conversely, the same argument can be made for male-specific conditions. Can a woman truly understand and relate to testicular pain? Or prostate issues? Does that preclude them from entering fields such as urology (as it relate to male issues)? I suspect there is some truth here, as well.

What it comes down to, is a matter of personal preferences for the patients. I support any woman choosing to be seen and cared for, by a female obstetrician over a male one if she feels more comfortable doing so. Her body, her choice.

As a man, I should be offered that same choice. I refuse to be cared for by a female doctor for issues related to my reproductive system. My body, my choice. This also extends, in as much as I can control it, ancillary staff.

Dany

 
At Saturday, May 19, 2018 8:52:00 AM, Blogger Maurice Bernstein, M.D. said...

Dany, what I am implying is that setting a "nocebo" to all doctor-patient relationships or even nurse-patient relationships is really "nudging" (remember our prior discussion of "nudge?) the patient to be "on guard" or even to "anticipate" unethical, unprofessional acts by the physician or nurse or other healthcare workers they are about to encounter. Is that the "nudge" that we really want to convey here to the visitor-potential patient? That is what seems to be the approach in some Comments written here.

Surely, the direction of the "nudge" or even a "push" would be to the directors of the various components of the medical system but not against the patient's upcoming healthcare provider.

Potential patients should be correctly informed, as they are being done here on this blog thread to "speak up" to their physicians, nurses and others and to express their uncertainties or fears of the system and demand that these elements of uncertainty be adequately explained and, if necessary, modified, if possible, to the needs of the patient. But to "contaminate" an upcoming relationship between patient and healthcare provider with fears of professional misbehavior expected to possibly occur is wrongly directed.

It is educating the public and the administrators of defects and inequalities of the medical system not the upcoming doctor visit which I think is more appropriate rather than a "paintbrush warning" to the patient's upcoming relation consequences with their providers.

Let's avoid embedding "nocebos" into our helpful hints to others but appropriately repeat the urging to the patient "speak up your uncertainties and requests". ..Maurice.

 
At Saturday, May 19, 2018 8:54:00 AM, Anonymous JF said...

Your right PT. ALL those changes need to happen. I think we have a modern day Sodom and Gomorrah ( only its straight people this time )

 
At Saturday, May 19, 2018 8:58:00 AM, Anonymous JF said...

Two wrongs don't make a right. Otherwise I completely agree. Women SHOULD NOT attend to nude men unless he specifically requests her.

 
At Saturday, May 19, 2018 9:07:00 AM, Anonymous JF said...

Dr B, A large number of women LIKE being checked out by a make doctor! I've heard enough women admit to it. Let those perverts and the male doctors have each other. Actually some of the patients may have pure motives. I've heard that a lot of female gynecologists treat their patients badly

 
At Saturday, May 19, 2018 9:35:00 AM, Anonymous JF said...

Being unnecessarily exposed is extremely common and being warned about it in advance is better less traumatic than being ambushed. Maybe a better plan would be ALWAYS inform patients if exposure is going to happen. ALWAYS allow patients to know if there are gonna be other people witnessing their exposure. The patients can then decide. I for one think we need medical care. But how many people are run off because of ambushing?

 
At Saturday, May 19, 2018 11:14:00 AM, Blogger Biker in Vermont said...

We should not be painting all healthcare staff as likely to misbehave professionally. For me that is akin to the boy who cried wolf. A modern day parallel might be the vast overuse of the words "racist" and "sexist". When every white person is deemed a racist and every man a sexist, then those labels no longer have meaning. For our purposes here to label all healthcare staff as "professionally misbehaving" equally renders the term meaningless. Professionally misbehaving connotes purposely doing that which they know is wrong, and potentially putting themselves at legal or licensure risk. It happens but it is not representative of most intimate exposure medical encounters. What is representative is a general lack of concern as to how patients, especially men, view those encounters.

The message should thus not to be expecting professional misbehavior but rather that the staff is not particularly concerned whether you will find the procedure embarrassing, and if you are then it is up to you to speak up. That is not saying they purposely embarrass patients but rather whether the patient is embarrassed or not is not a driving concern on their part, at least for male patients. I will allow here that perhaps what I see as lack of concern is their avoidance of nudging the patient. By that I mean if they tell the patient "I know this may be embarrassing but..." some patients who otherwise wouldn't have been embarrassed might then be embarrassed. Conversely those of us who are embarrassed might have had our embarrassment lessened by their show of empathy.

Most of what we here encounter are people doing the job they were hired to do and in the manner they were trained to do it. The problem is we may not be comfortable with that person on account of their gender or the manner in which they go about doing their job on account we feel our exposure was not properly minimized. It is a disconnect between the patient's comfort and expectations and the medical system's standards of care. The onus is on us to speak up when this occurs.

The in-between area is where there is no professional misbehavior and at the same time there is something more than just doing the job they were hired to do. Having experienced it (on an exception basis, not as the norm) this is what makes me wary as I go into intimate exposure encounters. Said succinctly, is she enjoying her job for the wrong reasons? If I am guilty of an unwarranted nudge, this is where it lies.

I say the above because most healthcare staff do not deal with exposed opposite gender patients on a regular basis. Only a relatively small percentage do. The question then is do some choose high exposure specialties such as urology for the wrong reasons?

 
At Saturday, May 19, 2018 11:22:00 AM, Blogger mitripopulos said...

Here is an interesting scene which I went thru this past week. I went in for basic blood tests. Yet again for the third time in the past year I was presented with the university's consent to treat form. As usual I voided such items such as having to comply to all directives for treatment, have psychological services if recommended, have still or motion pictures taken and accept all treatments done by whoever and dispose of tissue or body parts as they see fit. I saw the desk person go for the manager who wanted a private chat in her office which I refused and made her state her concerns pubicaly. She said I couldn't have blood drawn after altering the consent form. I reminded her that I could legally alter any form. She then wanted to know why to which I replied that it was contrary to my religious beliefs. She started to question me as to what church I belonged to and what my beliefs were. I sharply told her that was a violation of federal regs and that in court if I state something is against my religious beliefs the argument ends and for her to pursue the point is the one major issue that I could sue them in Federal court under HIPPA regs and the government will glagly take them on--all of which is legaly true. Yey again she brought up why I would have a problem with still or motion pictures being taken as they ask first. I replied that that statement needs to be in print as this was a contract and full disclosure and transparency was required. In court I would not have a leg to stand on with a "he said she said" and that I simply did not trust their vagueness. She didn't excuse herself as she quickly turned and walked away without further argument.

 
At Saturday, May 19, 2018 11:40:00 AM, Blogger NTT said...

Good Afternoon:

JF, Being unnecessarily exposed may be extremely common however, it's something that should NEVER happen.

As PT stated, we as Americans spend Trillions of dollars on healthcare. Premiums are high and are going higher every year. Yet we the general public that’s doing the paying, don’t seem to have much say as to how the system should be run.

Why shouldn’t we as adults and premium payers know how things are run and done?

Biker said a mouthful earlier when he said how they want us to go for tests and procedures, but they don’t want to tell us about them.

What are they afraid of?

We’re adults, we have the right to know.

Are they afraid if they tell us we’ll cancel? Are they afraid of adult conversation back and forth exchanging thoughts, ideas, and suggestions?

There’s no give and take in the system. It’s they do all the giving and they expect the patient to do all the taking. Not vice versa. The reason there’s no give and take is because they don’t want to give up their perceived power which in turn will expose all the shortcomings of the system.

If “we the people”, want a better healthcare system, then its up to “we the people” to open our mouths wide and SPEAK UP.

If you want a system that treats each and every patient with dignity and respect, YOU HAVE TO SPEAK UP.

If you want a system where anyone can get same gender care whenever they wish, YOU HAVE TO SPEAK UP.

If you want a system where there’s no hidden agendas, where transparency is the rule, YOU HAVE TO SPEAK UP.

This isn’t a male or female thing. This is a WE thing. WE THE PEOPLE.

The system we have in place today basically sucks. We have to pull teeth to get information from a system that’s trying to hold on to the past for dear life.

The only way we are going effect change to this system is by speaking up each and every chance we get. Use the power of the vote to effect change. Write your elected officials and tell them you demand change or they are out of office.

Washington is in bed with the big pharmaceutical companies. Time to kick them both out on their duff.

If “WE THE PEOPLE” want a “WORLD CLASS” healthcare system then NOW is the time to SPEAK UP.

If not, what you see today is what you get.

I know I don’t want what I see today.

Regards,
NTT

 
At Saturday, May 19, 2018 12:21:00 PM, Blogger Maurice Bernstein, M.D. said...

Mitripopulos, you were subjected to totally unnecessary requests and totally unprofessional behavior on the part of the institution and its employees for a venepuncture and the obtaining of blood for routine testing. This is where you should "speak up" to the administration.

Though I am not an administrator nor to I have an administrator's mindset, as one involved in hospital ethics for decades, my ethical philosophy is that premature "informed consent" of any event or procedure is NOT truly "informed" as to the clinical parameters at the time of the signing and therefore the degree of "prematurity" provides no meaning or validity to assuming the patient is "informed" at the time of the signing and represents any support of "informed consent" assumption of what is signed by the patient.

Realistically and fairly, if an institution wanted to have a patient sign an "informed consent" form prior to venepuncture (which I never have seen happen) would be to warn the patient that the procedure might be interrupted prior to a specimen being taken by the patient suffering a emotional based vaso-vagal syncope spell (fainting) and obtaining all the needed blood specimens may be interrupted or delayed or that a hematoma bruise at the puncture site may occur or that the order sheet for the lab may be erroneous or incomplete or misread by the lab or the blood tubes broken or misplaced and the patient may have to return for a repeat venepuncture.

I haven't seen an institution or medical office presenting such a "informed consent" to a patient for a blood test. But, if one had to be signed, it would contain such details for patient understanding and final consent. ..Maurice.

 
At Saturday, May 19, 2018 12:35:00 PM, Anonymous Medical Patient Modesty said...

PT,

I understand your disgust with female nurses treating male patients. I agree with you that many female nurses and even doctors have misbehaved toward male patients by abusing them. We both are well aware that many female nurses make fun of male patients’ genitals. It bothers me that many urology clinics force female nurses or assistants on male patients. There should be more all male urology clinics with male nurses and assistants for male patients similar to all-female ob/gyn practices. I feel that it is much harder for female nurses or doctors to be reported for abuse of male patients than female patients because so many men do not speak up or people just do not believe them. Our society has taught men to be silent and that if they speak up they are weak.

In fact, I am planning on making some booklets about men and modesty in medical settings. It’s a much needed resource for men. So many men may not even have any intimate medical care until they are in their 50’s or so. Many women go to a gynecologist starting in their teens or 20’s because they have children or gynecological problems.

I feel you need to change your approach. I do not agree with this: Therefore, until any provisions are made for male patients, I’ll never agree, endorse nor advise anything for female patients, and speaking of female
patients they are partly the cause for the pathetic, discriminatory and unethical rut that male patients find ourselves in.


The best approach would be to talk to urologists, hospitals, college campuses, etc. about how they need to be more sensitive to male patients and that male patients deserve to have same gender medical professionals similar to female patients at all-female ob/gyn practice. I understand your frustration that many women do not understand that male patient modesty is as important as female patient modesty. I feel we need to educate women on this issue.

There are some great female nurses who understand male patient modesty and I have met some of them. In fact, one of the colonoscopy patients I helped a few years ago shared his concerns with a female nurse and she ordered some colonoscopy shorts. She was also very supportive of his wishes to have an all-male team for his colonoscopy.

I really appreciate the nurse for reporting the sexual abuse of gynecology patients to the college’s rape center. Dr. Tyndall definitely sexually abuse those female college students. It is very likely that the nurse may not even participate in intimate procedures on male patients. Nurses in gynecology or Labor & Delivery often only work with female patients. I personally think that all college campuses should have a male clinic staffed by a male doctor and a male nurse or nursing student for male patients.

Misty

 
At Saturday, May 19, 2018 12:48:00 PM, Anonymous Medical Patient Modesty said...

Biker in Vermont:

In Response to your comments:



Dr. Bernstein, female GYN's who pronounce men unsuited to be GYN's are applauded as standing up for women's rights. At the same time female urologists decry men as sexist if they don't want them as their doctor, and feminists cheer them on.

If the best and brightest women who have become physicians can only see privacy/modesty considerations as applying to female patients, there would seem to be little hope for men as these female physicians rise through the ranks of medical schools and hospital systems.

That female physicians can't see the double standard is very telling.



I have seen this too. I am thankful that many female doctors understand the importance of modesty for female patients. But it concerns me that many of them do not seem to understand that modesty is as important to many men. In fact, I talked to a female doctor at a health expo a few years ago. She seemed to understand how important modesty was to women. But she seemed a little surprised when I talked to her about how important it was to hire male nurses for male patients. I think that many women have fallen to the lie that modesty does not matter for men and many men do not really care. I think we need to educate women that this is not true.

Misty

 
At Saturday, May 19, 2018 1:04:00 PM, Anonymous Medical Patient Modesty said...

Dr. Bernstein,

I had already seen that article about male gynecologists disappearing and I was very encouraged by that. It is definitely for the best because male gynecologists are most likely to sexually abuse women than any specialties. It is best to leave the ob/gyn field to women. Medical schools made the mistake by not allowing women to be doctors. In fact, there were no male gynecologists or males who participated in childbirth or gynecological procedures before the 1800s.

Check out an article, Time and Tide . This is about a good male family doctor's account of an encounter with an attractive female patient. He always had a nurse present with him when he did a pelvic exam. This proves that a nurse cannot chaperone a doctor's mind. This was a publication in American Medical Association.

Look at how a male medical student wrote an article about “Why Women Should Actively Seek Out a Male Gynecologist”. He was disturbed that there is a big increase in female gynecologists and that many women prefer female gynecologists today. Of course, I do not support his argument that women should seek out male gynecologists. However, he wrote about the historical progression of pelvic examination and how men were not allowed to examine women’s sexual organs before 1800s. This author has it right that women were not allowed in medical schools and that’s why we only had male gynecologists for many years. Look at his important section about historical progression of pelvic exam below:

“The oldest medical text known to man is the "Kahun Gynecological Papyrus", written by the Egyptians around 1800 BCE. The papyrus provides a glance into early gynecological medicine and unveils the traditions of reproduction, conception and delivery in ancient Egypt. For the Egyptians, the main treatment modalities provided by the "swnw" (pronounced sounou, physician figure) were founded on pharmacopoeia from animals, plants and minerals; surgical intervention was never recommended (2). Magic spells were whispered, as it was believed that diseases were demonic in origin.

Due to compliance with religious doctrine, men were not allowed to be present at births or at other rituals that dealt with the intimate parts of a woman. Instead, it was the role of the midwife to take care of women and to assist them with their gynecological needs. Interestingly enough, the "Kahun Papyrus" provides some of the earliest evidence of midwifery in history.


(Continued on next posting)

 
At Saturday, May 19, 2018 1:04:00 PM, Anonymous Medical Patient Modesty said...

Similarly, in the middle ages, it was often the norm for a woman's sexual organs to be examined by midwives, nurses or other females who previously had had similar problems to the patient's. By the early 1800's, with the advent of modern medical degrees and physical examinations, the pelvic exam began to be performed by male physicians, as women were not allowed to enroll in medical school. However, this examination was a variation of the modern version as it consisted of a "compromise" in which the physician kneeled before the woman but did not directly inspect her genitals, only palpated them. In addition, it was during this period that the use of a chaperone became a part of the clinical examination. The chaperone's role was to emotionally support and reassure the patient during a procedure that she found embarrassing or uncomfortable. The chaperone also acted as a witness in cases of malfeasance by the physician. Today, in many parts of the world where religious and cultural precepts often discourage female encounters with male physicians, chaperones still attend gynecological examinations.

By the 1970's, only 9% of enrolled medical students in the United States were women (3). The numbers have drastically increased since then: now 58% of medical students are women (4), yet there are still disparities in gender among the specialties. In Obstetrics and Gynecology, female residency enrolment rates have quadrupled from 1978 to the present, leaving men in the minority (women account for 71.8% of Obs/Gyn residents today). Between 1989 and 2002, the proportion of female Ob/Gyn residents rose from 44% to 74% while the proportion of female graduating medical students only increased from 33% to 44% (5).”


Misty

 
At Saturday, May 19, 2018 3:29:00 PM, Blogger Maurice Bernstein, M.D. said...

Misty, if I was a female patient, I would select to be under the care and examined by a male gynecologist. Not being a female, the specialist will be more gentle in their examination and objective in their evaluation since they haven't had all the personal gynecologic "experiences" having been associated with the personal life of a female gynecologist. For example, what the female patient expresses as some gynecologic "discomfort" might be considered by a female gynecologist "usual, expected, "I have experienced this myself and 'no problem'" Whereas, to a male gynecologist, the "discomfort" may be taken more seriously as a pertinent patient symptom that even if clinically trivial may warrant a few more words of support and reassurance. A "routine" complaint to a female gynecologist may be of more need for supportive management by a physician who is a male. One could use the same argument in arguing for a female urologist in relating to their male patient.

Sometimes, being more objective in evaluation and therapeutic in communication by being personally unexperienced of the opposite gender is worthy and I open this concept for discussion. ..Maurice.

 
At Saturday, May 19, 2018 6:06:00 PM, Anonymous Anonymous said...

Maurice

I doubt your last paragraph is applicable at least in regards to female nurses and male patients. They don’t see to understand that male patients should be afforded the exact same privacy ( draping, closing the curtain etc etc) given to their female patients and it is that context
alone that makes them unprofessional.

PT

 
At Saturday, May 19, 2018 6:07:00 PM, Blogger NTT said...

Good Evening:

Regardless of her specialty, if any female doctor really wants to have the privilege of caring of male patients, she will have to first and foremost prove to those patients that she has nothing but their well being on her mind.

The first thing she does to put her money where her mouth is, is she has male healthcare assistants available at her calling to step in at a moments notice for her female staff when a male patient says he's uncomfortable with female assistants.

If she can do that one thing without making a big issue out of it for her male patients, she will be on her way to earning their trust.

The vast majority of female doctors can't or won't do that therefore they are the ones that are one shot and done with most of the male population.

They just don't get it. Men will no longer allow the medical community to treat them disrespectfully anymore. Men want their dignity respected and privacy protected on an equal basis with women.

No equality equals no male patients.

Regards,
NTT

 
At Saturday, May 19, 2018 6:13:00 PM, Anonymous JF said...

I love it!

 
At Saturday, May 19, 2018 6:16:00 PM, Anonymous JF said...

Thank you! I wonder if tape recording with our cell phones would be helpful.

 
At Saturday, May 19, 2018 6:19:00 PM, Blogger Biker in Vermont said...

Dr. Bernstein, one key difference is that the woman who goes to a male GYN knows she will have another woman in the room. There is 0% chance a male scribe, chaperone, nurse, or assistant will be brought into the room. The female patient knows the male GYN is the only man she will be dealing with.

The man who goes to a female urologist knows that any scribe, chaperone, nurse, or medical asst. who will also be in the room will be another female. Whereas many men might be OK having a female physician, adding female non-professional staff (and I include nurses in that definition) into the room as observers or assistants totally changes the dynamics.

Perhaps the female urologist would be more objective as you suggest and be a more therapeutic communicator, but for me and many other men, the negatives of her adding a 2nd woman into the mix is a deal breaker.

When female doctors finally come to understand this they may see that men are more accepting of them for intimate matters.

 
At Saturday, May 19, 2018 6:42:00 PM, Blogger Dany said...

Dr. Bernstein,

Carrying on the "nocebo" discussion, have you ever heard the saying "it's only paranoia if you're wrong?" I believe a healthy dose of skepticism goes a long way, particularly in medical situation. Let's be honest here... The "art" of medicine focuses on influencing a patient's behavior. Presumably for the explicit purpose of improving the patient's health, but it doesn't change the fact that there's no small amount of "nudging" (if you insist on using that word) taking place. What I object to is how that nudging is done. It is the gray area between offering recommendations and almost-but-not-quite forcing a patient to accept what is presented (and the ways to accomplish this are numerous).

To raise awareness of this fact is not, in my opinion, contaminating a potential patient-doctor relationship. It is only stating that it will probably happen. Be aware of it, recognize it, and take it into account when talking with your care provider.

I recently had a conversation with a coworker about an medical issue he is having. We were in a car, as we were both headed to the military health clinic. He was telling me that he's been having a recurrent UTI accompanied by intermittent gross hematuria. He was going to the clinic to provide a urine sample for further testing. I inadvertently glanced at the lab order he held in his hands and saw the test was urine cytology. "Oh boy" I thought.

I told him he will likely be referred to a urologist pretty soon. He asked why and I went on to explain my own adventure in urology land. I told him what he should expect, as far as testing goes, and what that would be like (what to watch out for, what to ask). I wasn't trying to scare him, but I didn't sugar coat anything either. He definitely wasn't thrilled by the idea (and who would, to be honest?).

I felt I should share my experience with him because I wasn't confident he had any idea what he was heading into. He didn't even know what a urine cytology test was for. Now... I wonder why that is.

Did I "contaminate" this patient? Only time will tell. I'd rather think I gave him an honest heads-up about how things will likely go. This, I hope, will leave him better prepared to deal with what might come, without any unpleasant - and unexpected - surprises.

Dany

 
At Saturday, May 19, 2018 6:44:00 PM, Anonymous JF said...

A staff meeting where the female gyno's are called out about their problem attitude could transform them. Especially if threatened with a lesser wage. ( wages should be influenced by evaluations.)

 
At Saturday, May 19, 2018 7:29:00 PM, Anonymous Anonymous said...

Misty

I’m for more women entering OB-Gyn. You see many women today forgo pre-natal care, they wait till their last month right before they drop that kid and then wonder why it was stillborn. They wonder why there were so many complications post delivery, they wonder why their child is in the nicu for months and not to mention they don’t have insurance let alone know who the ( baby daddy) is. I’ve known several Ob-gyn guys who were sued and subsequently lost their medical license because at the last moment they took on a high risk pregnancy that was doomed from the moment of conception. Oh don’t forget all of the nurse quactitioners that work along side the nurses who intubate these kids and then wonder why they are brain dead the next day ( oops, the et tube was no where near the corina, not even close). These women right off the gitgo want to sue the doctor cause their baby was born premature. At 8 months and two weeks they want to know what sex the baby is so they find an excuse to go to the emergency room. Of course, the physician or pa doing diligence and practicing the standard of care are going to order a OB pelvic ultrasound. It is with this ultrasound that the ultrasound technologist can see what sex the baby is.

But the ultrasound techs know why they are there and decline to tell the women what sex the child is and for that they get cursed out. It’s
not their job anyway to tell them. So these women with no insurance just ran up a $5 grand Er bill. Who was on call for OB-gyn that
night, a male OB-Gyn physician, why? Female OB-gyns don’t want to pull call, they don’t work 50-70 hr workweeks because they have
a family and children. So when male physicians decline to enter that speciality they will need more female physicians to fill those spots.

I can just see the fighting and bickering right now. Ask me how many L&D suites across the country have closed recently and why. Ask
me how I know and the reasons. I’ve known many many female OB-Gyn physicians who refuse to pull call. Ask me about women who
are dilated and ready to drop that child and go to an er that has no L&D suite, (DUH). You would think they would have this planned by
having an OB-Gyn with regular pre-natal exams. That is a ticking time bomb so all these new female OB’s can jump in there cause this
is what they wanted and when they’ve had enough, lost their license or pay exuberant malpractice insurance and wish to god they
selected a different specialty. Yea, I’m all for it.

PT

 
At Saturday, May 19, 2018 7:30:00 PM, Blogger Dany said...

Dr. Bernstein,

You suggestion that we should seek opposite gender for intimate care is... Uhm... Certainly interesting.

I disagree, however, with your conclusions. I am not convinced that having a female urologist would enhance my experience, in any way shape or form. Nor do I believe a female would be more attentive/receptive to my concerns than a male one. On the other hand, having experienced some "rough handling" by female medical personnel in the past, I will politely decline this suggestion.

And Biker in Vermont certainly brings a very valid concern. The doctor is one thing, but what about her posy?

Dany

 
At Saturday, May 19, 2018 7:51:00 PM, Blogger Maurice Bernstein, M.D. said...

I know that I am getting visitors from countries outside of the United States to this blog thread on Patient Modesty. I also know that virtually all of those commenting here are from somewhere in the United States (though also from Canada, if I recollect correctly).

I really want to encourage those from other countries to present their own understanding of medical culture there and their own experiences. Are we discussing here a unique issue isolated to these United States or do patients in other countries have similar issues. It would be great to read personal experiences from those in Muslim and other countries where there are strict religious or social rules regarding "undress".

Remember, this lengthy subject thread began here in 2005 with an initial topic "Naked"
http://bioethicsdiscussion.blogspot.com/2005/08/naked.html
which was started after I read an article "Naked" by Atui Gawande MD, in the August 18 2005 issue of the New England Journal of Medicine. Dr. Gawande, two years out of his surgical residency had the opportunity to talk with physicians who have practiced in other cultures around the world describing how the concern of modesty is handled in their country. Unfortunately, I can't reproduce the article here.

So now 13 years later, it would be most interesting to read the knowledge and experience of those reading this thread from outside of our United States, ..Maurice.

 
At Saturday, May 19, 2018 9:01:00 PM, Blogger Maurice Bernstein, M.D. said...

I found the link to the Gawande full article "Naked" in the NEJM:


https://www.nejm.org/doi/full/10.1056/NEJMp058120


..Maurice.

 
At Saturday, May 19, 2018 9:35:00 PM, Blogger Maurice Bernstein, M.D. said...

I just finished re-reading the article which I hadn't read for many years and I hope my visitors click on the link and read too.
Is there anything about what Dr. Gawande writes that makes you feel comfortable about his views and actions or do you think he has missed some important facts or behaviors?

One thing I would say is that it is important for all physicians, all nursing staff, all techs, all scribes take time out and think about this issue of physical modesty in those whom they treat.

It is strange but yet understandable how concerned and attentive first year medical students are about the issue of patient physical modesty and yet later as physicians I wonder how many will, as Dr. Gawande does, try to dissect out the issue and be attentive to make the patient as comfortable as possible when "delicate" parts of the body are being exposed or handled. ..Maurice.

 
At Sunday, May 20, 2018 4:14:00 AM, Blogger Biker in Vermont said...

Dr. Bernstein, my guess is that your 1st year students are attentive to the modesty issue because they themselves are not yet comfortable with patient exposure. Once they are comfortable they tend to forget that maybe the patient isn't.

I read the "Naked" article and he makes a good point. There isn't much in the way of standard protocols for the handling of patient intimate exposure. This is what I had noted just a couple days ago. For the most part each staff member and/or institution determines what is respectful, dignified, and appropriate. This is how I came to have such extreme differences in my two abdominal ultrasounds (1st one full exposure vs 2nd one no exposure) at two different hospitals. This is how my friend was surprised to hear that standard practice at my dermatologist is a female scribe and female LPN in the room vs his dermatology visits never having anyone but himself and the doctor in the room.

It is no wonder that patients are often caught unprepared. No doubt but that some of the complaints doctors and hospitals receive are a result of patients encountering a lesser standard than they experienced elsewhere.

 
At Sunday, May 20, 2018 2:56:00 PM, Blogger Maurice Bernstein, M.D. said...

Biker, you write: "some of the complaints doctors and hospitals receive are a result of patients encountering a lesser standard than they experienced elsewhere." True but unfortunately the "standard of care" in the medical profession is really a legal term "what the average physician would customarily or typically do in similar circumstances." And again "unfortunately" there has been no standards set for "office behavior" except perhaps the presence of a chaperone if a male physician performs a pelvic exam. But where are the standards for "leaving an exam door open" or "how many or who should be present in the exam room" and more? There are no legal and fixed standards other than "what the average physician would customarily or typically do in similar circumstances."
And, well, it is that standard that needs to be "reset" if the concerns displayed on this blog thread are to be resolved. ..Maurice.

 
At Sunday, May 20, 2018 4:23:00 PM, Anonymous JF said...

An honest heads-up is the way it should be, every single time.

 
At Monday, May 21, 2018 12:09:00 PM, Anonymous Medical Patient Modesty said...

PT,

Women’s choices for a female gynecologist are much better than decades ago because more all-female practices in many major cities have been developed. But there are many small towns that do not have this option. If a woman chooses an ob/gyn practice that has 3 female doctors and 1 male doctor, she has a 25% chance that the male gyn will deliver her baby. This is not acceptable for many women. We have an all-female ob/gyn directory that lists all-female ob/gyn practices in the United States.

Sadly, there are hardly any all-male urology clinics in the US and I think that really needs to change. I personally think they should move many of the female urologists to the all-female ob/gyn practices. I think it would be nice for some of the all-female ob/gyn practices to have a female urologist on staff. I cannot believe that some urological practices in major cities such as Atlanta do not even have one male nurse or assistant available for their male patients. I wish that many of those urological practices would get rid of their female nurses (they are best suited for other specialties such as OB/GYN where they do not deal with male patients).

I can tell you I think that many all-male urological practices would be lucrative because many men would flock to them. Many men just avoid healthcare right now because of modesty concerns. Many men would even be willing to drive to all male urology clinics. They can use the same advertising as all-female ob/gyn practices. I think those all-male urology clinics should also hire a male gastroenterologist to assist with colonoscopies on men. The medical industry needs to become more sensitive to male patients.

Misty

 
At Monday, May 21, 2018 12:35:00 PM, Blogger A. Banterings said...

The problem with all of these arguments is the assumption is made that these procedures MUST be done. Many women avoid prenatal visits because they insist on doing a PE every time. When women go in for delivery, many tell horror stories of PEs every 15 minutes and these are NOT always done by a physician.

On this very blog, we have discussed residents doing intimate exams then the attending doing them.

USPSTF has scaled back all sorts of intimate exams because they cause more harm than good. The standard of care is to OFFER such exams. (This is even supported by federal law.)

Protocols and procedures have been bastardized to say that these must be performed. (The purpose is so that the physician does not take any shortcuts.) Medical students are never taught the proper way to ask and allow patients to decline certain things without retaliation. Instead, the hidden curriculum teaches them how to bully patients under the false belief that they MUST perform these procedures. Couple that with their enthusiasm for learning, and patients simply amount to little more than warm cadavers.

A woman that I work with called around to many gynecologists in her area, ALL required a PE before they would prescribe oral birth control for her. So why is this?

The answer is the way they are taught; you MUST do this. I am sure that Misty can provided hundreds of stories of women wanting prescription refills for things NOT related to gynecological issues being told that they need a PE before the office will refill a Rx for depression, anxiety, etc.

The solution is to teach attorneys how to prosecute and sue providers for these breaches of trust that lead to a lack of true informed consent and thus medical battery. Only then will the profession change.


-- Banterings


 
At Monday, May 21, 2018 1:09:00 PM, Anonymous Medical Patient Modesty said...

I wanted to encourage everyone to read a new article, I wrote about What You Need to Know If You Have Been Referred to a Gynecologic Oncologist?

 
At Monday, May 21, 2018 2:01:00 PM, Blogger A. Banterings said...

Dany,

Like you, I too have a High School diploma. I also have multiple degrees after that.

I find it hard to believe that you have only a High School diploma. The way that phrase things and your dissection of complex concepts shows a very deep understanding.


-- Banterings


 
At Tuesday, May 22, 2018 5:55:00 PM, Anonymous Medical Patient Modesty said...

I wanted to let everyone know that I have written a new article, Surgery and Your Modesty. You will notice that we address both male and female patients.

Especially look at the arguments by medical professionals and my rebuttal. It is time for patients to take control and not allow medical professionals make decision about our modesty anymore.

Someone brought to my attention the other day that she felt that doctors who preferred intimate care by same gender medical professionals were more likely to be sensitive to patient modesty. This person made this statement: Only a doctor that's him or herself uncomfortable seeing a doctor of the opposite sex understand that and will therefore respect it. Her female dermatologist volunteered she would never see a male doc after her experiences in med school with pre-service doctors.

She said, “ I will now always ask a new doctor, "how do you feel about receiving care from someone of the opposite sex?" to determine if the doctor understands the importance of modesty and same gender intimate care. Many medical professionals argue that gender does not matter and that you should just focus on the doctor’s knowledge and skills.

Misty

 
At Wednesday, May 23, 2018 5:34:00 AM, Blogger NTT said...

Good Morning Everyone:

Misty I agree with what you are saying. The only way things will change is with a fundamental change in thinking within the entire medical community. Right now, the only way that will happen is with new federal regulations as that's the only thing they will listen to.

The medical community thinks they are so smart they don't know how to "think simple".

The change in thinking could start out with a simple line on a piece of intake paperwork.

"Do you require same gender caregivers for all gender specific intimate care?" By having that on file in their electronic health record, the information will filter down thru the system so the doctor and the hospital both know, when this person comes in for help have same gender care givers available if they are presenting with a gender specific intimate related issue.

Very simple.

If you have a patient going thru breast cancer, prostate cancer, or BPH treatments, ASK BEFORE things get started if they'd like same gender caregivers. Believe me people going thru these kind of treatments who have same gender caregivers at their side if they want them, goes a very long way to giving them a positive outlook and outcome.

Most surgeries, are planned in advanced. So using "simple thinking", if you have a surgery that's gender specific intimate related, ask you patient ahead of time, will they be more comfortable with a same gender surgical team. Since you're scheduling in advance, that gives you the time to get the people in place that are needed whereby making the patient more comfortable, contributing to the best possible outcome. The patients gender preference may already be in their electronic health record if you have access to it.

Gender specific care is important to both men and women. It's time the medical community stopped thinking everything is complex and we have to send it to committee after committee to resolve the issue.

Lets start using "simple thinking".

Most healthcare professionals went to medical school & got their degrees because they wanted to help "PEOPLE" and advance the human condition.

If you really want to help people, don't wait for federal regulations. Start using "simple thinking" and make the necessary changes to help people.

Regards,
NTT

 
At Wednesday, May 23, 2018 2:36:00 PM, Blogger Maurice Bernstein, M.D. said...

This morning I had a cataract extraction of my "other eye", the "first" eye was in October last year. Both operations were at a local hospital-affiliated outpatient surical center and both times I was NOT required to remove my pants or shoes for the surgery. The pre-surgical process took over 2 hours but at no time was there any improper behavior on the part of anyone attending me.

One might argue that on the charting material I was identified as a physician but in moving from one pre-op and post-op rooms containing a number of patients in process, curtains were drawn and I observed nothing unprofessional to describe on my blog thread.

This is my observation of professional behavior on th part of the surgical staff as an example today. By the way, so far no surgical complications though my eye will be fully covered until tomorrow. ..Maurice.

 
At Wednesday, May 23, 2018 5:06:00 PM, Blogger Biker in Vermont said...

I'm glad your surgery went well Dr. Bernstein and am pleased to hear they let you keep your pants on. I am not familiar with cataract surgeries and hope that is the norm.

It is good to hear positive examples. I had one earlier this week that is very minor in the scheme of what we discuss here but it was far from the norm. This was a routine visit with a PA to get a prescription renewed. No exposure, just briefly lifting my shirt for heart & lungs to be listened to. What caught my attention in a good way was that when the PA was in the room with me, someone knocked on the door but didn't enter. The PA went to the door, opened it just enough to slip out into the hallway where she tended whatever it was they wanted her for. This happened twice.

I contrast that to a dermatology visit earlier this year where a woman entered the room after I loudly said not to enter. I had just finished undressing and was reaching for the gown when she came in. I then yelled loud enough telling her to get out that for sure everyone in that practice heard me. She did not come back. The doctor was walking on eggshells for the entirety of my exam.

 
At Thursday, May 24, 2018 6:04:00 AM, Anonymous JF said...

I was recently reading about when doctors first started delivering babies, and a large number of the babies and their mothers were dying. Nearly 5 times as many as when the midwives delivered the babies. Then in 1847 Dr Ignaz Semmelweis committed himself to finding out why. What he discovered was the doctors had often come from other patients. Some had even died and the doctors kept their same clothes on and didn't wash their hands. The other doctors when they heard his theory, weren't happy with him at all. I guess it would be an awful blow to learn babies and their mothers were dead because of something they ( the doctors ) had done wrong. It would be extra hard to live with themselves if they believed that. I made a parallel. Maybe doctors and nurses don't want to believe their disregard towards modesty is what is keeping patients ( especially male patients) away from Healthcare.

 
At Thursday, May 24, 2018 9:35:00 AM, Blogger Biker in Vermont said...

JF, you make a good point. I have long thought that healthcare acts as if gender and modesty issues don't exist because to acknowledge it would mean they'd have to do something about it, at least as concerns males. Without acknowledging it they do quietly make sure that women receive same-gender care in most instances.

The system hides behind making believe that being polite is synonymous with treating patients with respect and dignity. It is not. That the female staff and the female observers all maintain a proper game face while a man has an intimate exam or procedure does not mean it is dignified, yet they maintain that it is. They maintain that there is nothing sexual about it, but they themselves would never submit to the same exam/procedure with male staff and male observers.

What is incomprehensible to me is how male urologists can make believe that none of their male patients are uncomfortable with the 100% female staffing model those urologists use.

 
At Thursday, May 24, 2018 6:11:00 PM, Anonymous Anonymous said...

With the $500 million being set aside for settlement monies in the Dr Nassar lawsuits we have a new
big money lawsuit emerging from USC and their gynecologist. So I ask, where are the lawsuits from
the Denver 5, Dr Twana Sparks, the cell phone incident in New York or the incident regarding the penis
surgery in Penn. Are male patients not eligible for big lottery money payouts as female patients are
able to command.

PT

 
At Thursday, May 24, 2018 11:07:00 PM, Blogger Dany said...

Banterings,

I'm not sure what to say other than thank you. I'm happy letting people make any assumption they want about what I know (or don't know). It's more fun that way.

Misty,

I read your article and it is bang on. I'll have to remember to ask that question to my doctor, next time I see her.

NTT,

I agree with what you are saying, but there are so many factors involved in this and, sadly, they have nothing to do with patient comfort, dignity or satisfaction. Gainful employment, unions, overhead cost, scarcity of resources (mostly personnel). Many improvements could be made but these are inconvenient, expansive, or would require a shift in the medical culture.

Most people, and definitely organisations, are extremely resistant to changes. I should know, I work for one the biggest organisation there is in my country. Cultural shifts take years to come to effect.

Dr. Bernstein,

I am glad your surgery went well. Wasn't there a study that came out not too long ago which conclusion was that there was no impact of post-surgery infection rate if patients were fully dressed or not? This study was specific to cataract surgeries. Maybe the word is finally (but slowly) getting out.

Dany

 
At Thursday, May 24, 2018 11:52:00 PM, Blogger Dany said...

I recently was made aware of a disturbing situation in my home town. My brother-in-law, who's been dealing with kidney stones for most of his life, was telling me of the lack of choices in urology services. I got curious and decided to do some research of my own (because I couldn't believe it, at first).

I was shocked when I found out that there are only two urology doctors practicing there, and both of them are women. Digging a little more, I went to look at the online "ratings" (or reviews) for both these doctors and... Well, it's as I expected.

The one doctor has an average review, with comments being mostly positive an a few that aren't so great. The other one has terrible reviews, where most of the comments are negative in nature. In both cases, the vast majority of negative comments were made by male patients. They ranged from poor communication skills to being outright rude, unprofessional and lacking any kind of empathy and respect.

The less liked doctor, according to rumors (and words of mouth), is that she does not like caring for male patients at all. My brother-in-law can attest to that himself, as he was referred to the "bad" one (much to his disappointment). He also wasn't impressed with her. I'll spare his exact words but he was rather explicit.

In fact, the word on the street is, if you are a man and need urology care, avoid her at all cost.

I should explain that, in Canada, we have universal Healthcare. This means that it is "free" but you don't necessarily get your pick of where you go or who your doctor is. There are private clinics available, but if you go there, you pay out of pocket.

Now, I have to wonder. What doctor, in her right mind, would choose to specialize in urology, if she is biased against some of her patient? Didn't she realized that a large portion of her clientele would be male?

I understand that online reviews are flawed, and perhaps many comments made were as a result of her patients being shocked, and angry, over the fact they had no idea they would be referred to a woman and it made them very uncomfortable. I suspect quite a few were upset over the fact that they had little choice. So they vented where they could. And perhaps this tainted the relationship somewhat. That's human nature, unfortunately.

But I wonder... How many men from there, knowing all this, purposely avoid care when they need it? Given those options, I know I would.

Dany

 
At Friday, May 25, 2018 2:42:00 PM, Blogger NTT said...

Good Evening:

Hi JF.

In the minds of most medical people, if a patient doesn't follow thru with the treatment prescribed, it's not because they might have in some way disregarded the patient's dignity & privacy that caused them to back away.

It's only because the patient chose not to follow doctors orders. A patient's dignity and privacy rarely comes into their minds when dealing with male patients especially.

It's never their fault.

Regards,
NTT

 
At Saturday, May 26, 2018 6:19:00 PM, Blogger Maurice Bernstein, M.D. said...

You know, most everything unprofessional that is being described on this blog thread can virtually be resolved by the entire medical staff and system following expression I read:
"..doing something WITH the patient and NOT FOR the patient." I think whatever feedback you give to any segment of the medical system for change and improvement should be centered on this expression. What do you think? ..Maurice.

 
At Sunday, May 27, 2018 5:06:00 AM, Anonymous JF said...

Where is everybody? For a whole week, hardly anybody is talking. I check on this blog everytime I get on Facebook and it seemed like the other bloggers did to. As far as the medical workers working with us instead of on us,that would be awesome. I'm not convinced that its all an innocent mistake though. Medical staff are the same as the rest of the population. Some are decent and good and some aren't anything close to decent or good.

 
At Sunday, May 27, 2018 1:26:00 PM, Anonymous Medical Patient Modesty said...

I am so glad to hear that your cataract surgery went well Dr. Bernstein. I am glad that they were sensitive to your modesty and that you were not asked to take your pants or shoes off. The truth is there is no reason for cataract eye surgery patients to take their clothes off. I’ve heard that outpatient surgery centers are much more sensitive to your modesty so it is best for patients to have as many surgeries as possible at outpatient surgery centers. If you had been under general anesthesia, it might have been a different story. I had my wisdom teeth extracted in a dentist’s office many years ago and I was fully clothed. Sadly, it was a different story for one of my friends who had her wisdom teeth extracted under general anesthesia in a Connecticut hospital probably about 30 years ago. She was stripped naked.

Most people here including me do not care about the gender of medical professionals for surgeries and exams that do not involve private parts such as eye, foot, knee, etc. as long as private parts are never exposed.

Misty

 
At Monday, May 28, 2018 6:22:00 AM, Anonymous JF said...

It sounds good to me Dr B. Patients being treated like they have a fully functioning brain, signing whether or not if they want this proceeder - or not.

 
At Monday, May 28, 2018 12:36:00 PM, Blogger Maurice Bernstein, M.D. said...

It seems that Blogger.com has not been recently sending me e-mails of Comments by visitors here for me to publish. I thought the hiatus in posting was due to the Memorial Day holiday period. I have to see what is happening and what I can do about it. ..Maurice.

 
At Monday, May 28, 2018 1:22:00 PM, Blogger Maurice Bernstein, M.D. said...

Hopefully, I have now published the missing Comments for Volume 87 located at the dates that they were submitted. If I have missed any write me doktormo@aol.com.
..Maurice.

 
At Monday, May 28, 2018 4:49:00 PM, Anonymous JF said...

Any NURSING HOME I haved worked at, we would be fired if caught with a cellphone in patient areas. Even in Assisted Living homes, people have been fired. I would ASSUME taking naked pictures of patients would land somebody in jail and make them ineligible to work in Healthcare ever again.

 
At Monday, May 28, 2018 5:04:00 PM, Blogger Maurice Bernstein, M.D. said...

Now, let's get back to what I think is "super-important": "WITH THE PATIENT rather than simply "FOR THE PATIENT".

It could be that "FOR the patient" was the orientation which set the physician "paternalism" in the past. "FOR the patient" meant the physician was the "know it all" with regard to setting the history "straight" and performing the "necessary" physical examination and defining the testing and procedures which needed to be performed in order for the physician to "cure" the patient. The patient was more of an "object" FOR which the physician was carrying out all these activities--and usually for a fee. That was then. In recent few decades or less, we, in the medical profession, know that the matter of patient "autonomy" has become an ethical requirement. With this "norm", it is the patient who finally will and should be setting the pathway to resolution of the illness. With this new orientation, it is the patient who sets the limits of the disclosure of the history, it is the patient who should set the limits of the physical exam, the limits of the diagnostic tests and the limits of the treatment procedures. All these patient limits are part of the patient autonomy concept. And actually, in many cases, yes the patient does set the limits But, unfortunately there are many within the medical care profession who forget it requires the active understanding, approval and participation by the patient to hopefully lead to a clinical success. And that is where all those in the medical profession must understand that the beneficent goals and time and knowledge and skill used to attain them is not simply a product of the professional FOR the patient but requires in every step of the way a working together WITH the patient to lead to a goal which will benefit BOTH healthcare provider and the patient. Why "benefit" for the provider? The outcome or individual consequences of an action whether "good" or "bad" is a learning experience for the provider regardless of level in the healthcare system, an imprint on the emotions and even the financial benefit or loss. That why with every encounter, regardless of the provider occupational status both provider and patient become the subjects of the encounter and the "FOR" just to one party or the other is meaningless.

I think this philosophy about the patient-doctor interaction is something both parties should be aware and if it appears that those in the medical profession who you are interacting are behaving unaware of this realism, they should be informed by the patient their missing attention: "patient, speak out!" ..Maurice.

 
At Monday, May 28, 2018 6:26:00 PM, Blogger Biker in Vermont said...

Dr. Bernstein, I may not be totally getting the subtleties of "with" vs "for" but I am thinking you are saying that rather than telling us what will be done and expecting compliance that instead we should be told why something should be done and how it would be done so that we the patient can make an informed decision. In other words we the patient are an active participant in the process. If I got this right, then yes that is how I'd like for things to be.

For me the first time I saw this in action was years ago when my grandfather was diagnosed with stomach cancer at age 85. Against his doctor's wishes he refused treatment, went about his normal life for a year or so, then got sick and died at 87. The way he saw it he was 85, had a pacemaker, and could have ended up in a nursing home after the surgery. He didn't see enough of an upside for himself which put his interests at odds with the doctor's financial interests in treating him.

Bringing this back to the nature of what we discuss here, an example of "for" might be me going for my first cystoscopy. All I knew was I had an appt. post-surgery with the urologist. Even if I had known it was a for a cystoscopy I'd of had no idea what that was let alone known the realities of how it was done and who would be prepping me. I wouldn't have been a deer caught in the headlights that day if he had worked with me and I understood what was coming and why it was necessary.

 
At Monday, May 28, 2018 7:15:00 PM, Blogger Maurice Bernstein, M.D. said...

Biker, your grandfather story is a perfect example of "with". Your own personal experience demonstrates an absence of "with" in the doctor-patient interaction.

Remember, physicians are always planning and looking forward, mapping paths and trails toward a goal. But, in reality the patient is the one actually walking the walk on the path or trail and has to make their own personal decision which path or trail is the most personally acceptable, after being educated regarding the details, to reach that goal or even set another more personal goal, one, perhaps not mentioned by the physician. This becomes the patient's contribution (the "with") to what will follow. ..Maurice.

 
At Tuesday, May 29, 2018 6:16:00 AM, Anonymous JF said...

I think a large number of doctors work too many hours but nobody does their best work if they aren't getting enough sleep and taking care of their own needs. I don't know if this is workable or not. Train 3 times as many doctors and divide their medical school bill down to a third of what it is now. Or only train twice as many and divide their medical school bill in half. These people shouldn't be halfway killing themselves working so many hours trying to get rid of those bills. Plus that, if there were more doctors around, maybe they could actually be accountable for those life ruining modesty violations that they do/allow as well as the other problem behaviors that overwhelmed people have.

 
At Tuesday, May 29, 2018 10:19:00 AM, Blogger A. Banterings said...

Maurice,

"WITH" the patient is just marketing fluff (like the Hippocratic Oath). If it were ever to be "with" the patient, then the chaperone would also be undressed.

What healthcare needs to be is "at the patient's direction." Just like with financial ADVISORS, physicians are to be HEALTHCARE ADVISORS. If the physician can't earn (and keep) the trust of the patient, and convince the patient their recommendations are best, then the fault most likely will be that of the physician (not earning/keeping trust, bad explanation, wrong recommendation).

If what the physician is recommending IS the best course of action, the patient should want that. (Of course, it does not mean what is recommended may be the ONLY, FEASIBLE option.)

With the patient is thinking that an intimate procedure must be done and same gender care is afforded, "at the patient's direction" questions if the intimate procedure is even necessary (or just ritual).


- Banterings



 
At Tuesday, May 29, 2018 3:20:00 PM, Blogger NTT said...

Good Day:

Patient autonomy is a good thing.

Under our current healthcare system, it could also cause even more men to walk away from needed care unless, there is as Dany spoke about, a fundamental shift in culture within the entire medical community.

In order for patient autonomy to work for everyone, it is vitally important that the medical community fix the gender imbalance they have created throughout the system.

The people are out there. The system just needs to hire them.

Back in the old days nurses and techs were mostly female. These women joined the service, applied their craft, and over time, rose up through the ranks to become hiring managers where today, they do what they have to (meaning hiring only female employees), to keep their rank and file happy and on their side.

If patient autonomy is to have any chance at working, hiring managers everywhere be thee male or female will have to be instructed that the good ole days are gone. Today with such a diversity of patients the system needs both men and women on staff if they are to meet the demands of the people they take care of.

If they don’t listen and change hiring practices on their own, then its time for hiring quotas to be put into place.

When it comes to hiring, the buddy system is over. Patient autonomy will not work properly until and unless the gender scales are balanced first.

If the scales aren’t balanced, men who would go forward with critical testing may decide it’s more important to them to keep their dignity and privacy intact. The reason they are making that decision is because the system isn’t truly male friendly.

Medicine MUST be gender friendly at ALL times to BOTH sexes or they have failed in their mission and more people will die that didn’t have to.

When one is taking their journey down the yellow brick road towards their emerald city it would be comforting to know there won’t be any surprises along the trip from wicked witches.

One last thing any new healthcare system MUST HAVE is transparency. Something the current system woefully lacks. NO more brushing things under the rug because it may be bad PR. Too Bad. Stop hiding things from the public you are supposed to take care of.

Regards,
NTT

 
At Tuesday, May 29, 2018 4:00:00 PM, Anonymous Anonymous said...

Another deeply flawed study published today. https://www.medscape.com/viewarticle/452213_4

I have no doubt there are gender preferences. But we all know that for male patients the dynamics are more complicated. What all these studies fail to control for is the presence of others in the exam room, i.e., chaperones and scribes. Until they control for the others in the room for genital and rectal exams (and subsequent office tests/procedures) they have executed a poorly designed research project and their conclusions cannot be used to address gender issues in medicine. In addition, the article seemed focused on women only. Sigh... - AB in NW.

 
At Tuesday, May 29, 2018 4:56:00 PM, Anonymous Anonymous said...

The ENTIRE healthcare industry needs to close its doors for one day just like Starbucks is doing and have
sensitivity training although it’s not about race but rather respecting patient’s rights. Healthcare is and has
always been Anti-male, the services are geared for female patients, female employees.

PT

 
At Tuesday, May 29, 2018 5:05:00 PM, Blogger Biker in Vermont said...

Doctors working with patients is certainly preferable, and my guess is that it comes a bit more naturally with younger doctors who come into the profession with different cultural sensitivities. At least this has been my observation.

Extending that "with" approach to modesty and gender issues is quite a leap though, and it includes the whole array of healthcare workers. This includes the clerical staff that we must make gender based requests with or modesty based questions about the procedure to. Often the table has been set before we ever get to interact with the doctor or nurses or techs that will do the procedure. If the medical world wants to adopt a "with" approach, they need to do so at all levels of the system.

The problem is that healthcare only defines dignity from the perspective of what each healthcare worker feels it is. What the patient thinks is not part of the equation, thus they are not working "with" the patient in this regard. Some male patients might feel their dignity had been preserved if the female CNA helping him shower was polite and maintained a proper gameface. Others would find it demeaning to have a women help them shower no matter how polite and professional acting she was, yet in both cases the CNA will have declared the patient's dignity was preserved because she gets to make that decision without the patient's input.

Is the healthcare system ready to include dignity as defined by the patient as part of working with patients? My guess is not yet. They would say dignity is a primary component to working with patients, but only if they are the sole arbiters of what is dignified.

 
At Tuesday, May 29, 2018 9:41:00 PM, Blogger Maurice Bernstein, M.D. said...

I agree with AB in NW that based on the discussion in the article presented failed to study the complexity of current medical care system from receptionists, various office assistants, nursing staff in offices, clinics and hospitals and then all the other folks of one gender or another who are present and/or interact with each patient beyond the physician within all the environments patients enter.

Actually, gender concordance is an issue that also affects medical student-patient interaction. This is an area of occurrence primarily in the third and fourth years of patient interaction and responsibility but even can be present in the first and second years when students are history taking and performing physical exams on real patients (not simply standardized actor-patients).
The students are instructed to obey the patient's requests rejecting the student though it is permissible to ask "why" but then follow the patient's request.

Here in the AMA Journal of Ethics regarding Gender Concordance oriented toward medical student education. ..Maurice.

 
At Wednesday, May 30, 2018 3:46:00 AM, Blogger Biker in Vermont said...

That study that AB in NW posted is typical of just about every study I have seen. How such intelligent people can be so astoundingly clueless is amazing. Do they really think patients don't care who else is in the room as an active participant or observer? That the gender of these others is just as important to the dynamic as the gender of the physician?

 
At Wednesday, May 30, 2018 5:57:00 AM, Anonymous JF said...

One gynecologist that I went to.one time shared his office with a woman who had a desk job. He didn't have to round up a chaperone because she was in the room already. She wasn't coming and going from the room or invading my privacy. But if a problem would have come up. Patient saying "Stop" or "Let me up" she would have been aware of it. Why couldn't doctors have 2 offices like that? One with a man working at a desk. The other, a woman working at a desk. Nobody seeing the patients junk except the one person who does the exam.

 
At Wednesday, May 30, 2018 10:08:00 AM, Anonymous Anonymous said...

Maurice

The article you presented regarding AMA Journal of ethics to me seems flawed. Whereby the medical student was committed in patient-centered care he was confused as to why the female patient denied his presence for the examination. I’ll mention that the concept of
patient-centered care is composed of 8 principles, one of them being respect for patients preferences. The medical student was not
entitled to an explanation from anyone. I’ll take that further and this applies to all healthcare workers, nurses, techs, cna’s etc.

If a patient expresses their preference on gender care that’s it. Patients are not required to give a PhD dissertation as to why they
prefer same gender care. Why should the medical student seem confused if he is indeed committed to patient centered care. It
is my opinion that asking a patient why they prefer same gender care be considered inappropriate question.

PT

 
At Wednesday, May 30, 2018 10:34:00 AM, Anonymous Medical Patient Modesty said...

I thought you all would be interested in reading this article by a male nurse about how he does not want any female nurses or doctors himself,
Confessions of a Male Nurse.

Misty

 
At Wednesday, May 30, 2018 1:06:00 PM, Anonymous Anonymous said...

Many year ago I read a blog regarding why there are no male mammographers, why males are excluded from working in areas of
healthcare such as L&D, and why female nurses only want female nurses taking care of them. A male nurse responded and said,
“ female nurses, female cna’s, female techs and female physicians don’t want to be treated like they treat their male patients”.

PT

 
At Wednesday, May 30, 2018 1:34:00 PM, Blogger A. Banterings said...

Maurice,

I am disgusted with our healthcare system. I am at the point now, "I am the customer, do the job that I am paying you to do, OR I am going to complain to your employer.


-- Banterings

 
At Wednesday, May 30, 2018 2:03:00 PM, Blogger Maurice Bernstein, M.D. said...

PT, I wrote in my last posting "The students are instructed to obey the patient's requests rejecting the student though it is permissible to ask 'why' but then follow the patient's request." This fits with the team concept "with" in the patient-doctor relationship. The relationship once established is two sided.

Asking the patient "why?", if the patient responds, may provide information regarding the patient's previous experiences which may be helpful in better understanding the patient and so improve any further interaction, if the patient agrees to continue but with limitations.

By the way, this concept of the value of "why?" asked by a med student or later as a physician can apply in history taking particularly when a patient refuses to answer questions about sexual or drug history which are important components of the patient's past history. Asking "why" may provide information that can lead to clues to the current disease. But, yes, it is the patient's prerogative and right not to explain the "why?" ..Maurice.

 
At Wednesday, May 30, 2018 3:14:00 PM, Anonymous Anonymous said...

Maurice

I disagree with you, that is not a necessary part of history taking. As you know for many years patients have been asked
many questions that have finally been deemed inappropriate. I could cite many of those questions but looking further into
this matter this unnecessary questioning could lead to attempted bullying by physicians, nurses etc. Would it be appropriate
to ask every mammography clinic patient why do you feel so enabled that you know well you are being given an exam that
will not include a male tech?

Perhaps the patient practices a Muslim religion and does not want staff to know this, perhaps the patient has a history of sexual
assault. Perhaps the patient has had too many instances where their privacy was not respected. I believe that any further kind
of questioning could lead to an interrogative atmosphere that would only degrade what any trust that patient had by putting them
on the defensive. I’ll just say that there is a very fine line when it comes to bullying a patient by nursing staff and hospitals with
the patient satisfaction scores being in consideration of reimbursement by Medicare I thinks it would be a rocky road to venture
down.

It’s interesting that hospitals have core values and now they want to embrace the concept of patient-centered care but now you
want to interrogate the patient’s. What’s next? Water Boarding?

PT

 
At Wednesday, May 30, 2018 4:56:00 PM, Blogger Biker in Vermont said...

Dr. Bernstein, I'd be OK being asked "why" if it was done in a genuine trying to understand manner. I would not be OK if it was done in an accusatory or threatening manner. It is all in the delivery.

Given the hostility some female staff have towards male patients who dare to ask for same gender care, we cannot automatically assume they'd set aside their hostility in an attempt to understand where the patient is coming from. Whether physicians/residents/medical students would be better asking the "why" question than nurses/techs/CNA's/MA's I don't know. The dermatology resident I tried expressing my concern to last autumn was not receptive at all. Nor was the LPN I tried talking to, or the scheduler, or the Head of Dermatology. It was only Patient Relations that was willing to discuss my concern with me.

It would be good if appropriately phrased and appropriately delivered "why" questions did take hold because then finally the issue would at least be acknowledged.

 
At Wednesday, May 30, 2018 9:02:00 PM, Blogger Maurice Bernstein, M.D. said...

PT, "Water Boarding", that is a bit out of context for a discussion regarding a simple "why" question to the patient. The "why" is only to obtain insight into the past experience or current concerns. Nothing more..nothing threatening. All personal questions asked the patient and all the acts performed during the physical exam is not for the personal benefit of the physician. It is to accomplish a goal of diagnosis and appropriate treatment. The only exception would be for the medical student from year 1 to year 4. Yes, in the case of the medical student the underlying benefit is for the student and every patient should be so informed as part of the introduction disclosure to the patient by the student. Our students know this is their initial disclosure to the patient.

"Why" as applied to a patient's refusal to explain or to allow an action is of interest to the physician as part of "understanding" the patient and not anything sinister. ..Maurice.

 
At Wednesday, May 30, 2018 9:26:00 PM, Anonymous Anonymous said...

Maurice

I never thought that in the process of paying for services of any kind that I may be interrogated. That’s a new one
on me, can I plead the 5th and will they provide me an attorney if I can’t afford one. I can just see this now going down
with risk management that a patient was interrogated simply asking for privacy, respectful care and same gender care.

I joined the military during the Vietnam war and during my group full nude physical exam there were non medical
female observers. I’m not surprised that later I learned that this was actually used as a torture technique on Muslim
suspected terrorists, so waterboarding is not too far from that. It just sickens me what healthcare has become considering
the costs.

Yes I’m with Banterings that I’m beyond disgusted with healthcare, all the fake ramblings with core values, ethics,
patient-centered care, makes the average patient want to puke. What’s the point of having people in bioethics in the first
place when basic rules are never followed. Yep, I thought I knew it all and read it all until I learned that patient’s will be
interrogated. I didn’t know medical staff were taught techniques of interrogation.

PT

 
At Wednesday, May 30, 2018 10:51:00 PM, Anonymous JF said...

Employer as in doctor? The doctors are the ones requiring/ allowing the extra people violating the modesty concerns.

 
At Thursday, May 31, 2018 6:48:00 AM, Anonymous JF said...

I don't know for sure but I think he means that we shouldn't have to tell them that its embarrassing or humiliating to us. For some people acknowledging the feeling, increases the feeling. I think whether or not we are ok with witnesses should be asked on our paperwork, a check list. There will be plenty of patients ok with it. Even opposite sex.

 
At Thursday, May 31, 2018 8:43:00 AM, Blogger Maurice Bernstein, M.D. said...

PT, the student or physician asking "why" the patient rejected the request is not the start of the usual definition of "interrogation". It is simply providing the patient the opportunity to, if desired by the patient, have the medical student or physician better understand the patient's request. The response by the patient provides education to the one asking "why", nothing further. Such education may be important in any further relationship with the patient or education which may apply to future experience with other patients. The patient is not being treated as a criminal suspect and the patient has the right to avoid responding or terminating the relationship.

In no way is medical history taking or physical examination a legal or illegal interrogation or "strip search". It is a shame on the medical system that by actions or inactions of their professionals, the public was directed to such a conclusion. ..Maurice.

 
At Thursday, May 31, 2018 10:11:00 AM, Blogger Biker in Vermont said...

I'm still in the camp as one who would welcome being politely asked why. Not accusatory or threatening, but in a genuine I want to understand better manner. I see it as an opportunity to help the healthcare staff involved better understand where some of us are coming from.

While I don't understand how anyone who works in healthcare at any level does not inherently know that some men are not comfortable with opposite gender intimate exposure, many apparently are that oblivious. They are aware of female modesty even if they sometimes ignore it, but for men they act surprised that it is even possible.

To Dr. Bernstein and any other healthcare worker here, have you any idea how so many healthcare personnel come to be so oblivious? How was it possible that the Dermatology Resident automatically assumed there must be something wrong with my genitalia if I wasn't comfortable being observed by a female scribe and female LPN up close and personal?

Given the widespread nature of obliviousness, medical schools, nursing schools, and medical tech, CNA, and MA training programs all need to incorporate patient modesty into their curriculum. Just teaching them to be polite misses the point.

 
At Thursday, May 31, 2018 12:14:00 PM, Blogger A. Banterings said...

PT,

I love the waterboarding analogy!

I have referenced (ad nauseum) how what was once thought as compassionate healthcare has been determined to be torture by the UN and WHO. It was found that the treatment of intersexed individuals in healthcare amounts to torture.



JF,

When I say employer, I mean the healthcare system that the physician (or other provider) is employed by. Very few physicians have their own practice anymore.




Maurice,

Asking "why" is a useless IMHO. As I have stated before, one of my undergrad degrees is counseling. One of the first things that one learns is you never ask "why".

This was a case that we studied as to the reasons that "why" does not get the true information being sought.

On August 29, 1995, a 40-year old upper class insurance executive killed his wife and mutilate her body. When asked by police "why" he did it, he responded that he argued with his wife and killed her over a pan of burnt ziti.

Obviously, the burnt ziti was NOT the reason "why," it was the TRIGGER that set him off. Their marriage had been under a lot of strain from the demands of his job, and the couple was not getting along at the time.

Beyond that, when I refuse to answer such questions, I simply say Because it is my RIGHT not to answer, AND I am under no obligation to answer.

I can tell you providers are not happy with that answer. They will say that I need to understand the situation for informed refusal. Invoking one's rights is not evidence of incompetence.

Other answers are:

-- It is not relevant.
-- None of your business.
-- Some irrelevant answer. (i.e. Do you have sex with men, women, or both? My answer is "47" to that question.)
-- I do not know, or never thought about it.
-- Let me get back to you. (i.e. Deferred.)
-- Part of my religious beliefs (or other belief system).


I hope that you can see the folly of "why".



-- Banterings








 
At Thursday, May 31, 2018 2:45:00 PM, Anonymous Anonymous said...

Maurice

First you interrogate, then torture, then interrogate some more then torture. I know no one will believe me but
many patients in healthcare have been tortured, I’ve seen it happen. If you want the disgusting details Maurice
I will be happy to relay them here for every one to see, however, for my response now I’ll discuss unnecessary
questioning which really amounts to interrogation.

Not very long ago a female nurse assisted a woman interrogate her husband recovering in post-op from the effects
of anesthesia. The woman wanted to know if her husband was having an affair and the nurse assisted her with the
interrogation. Propofol can be a useful truth serum as well as other narcotics just prior to becoming unconscious or
while coming back into consciousness.

Many years ago just prior to having knee surgery the pre-op nurse wanted to know “ for the record” what were the
names of my siblings and what their occupations were. At the time I just wanted the surgery done but in retrospect,
I think “ what the hell does my knee surgery have to do with the occupations of my siblings”. In registration I listed
an emergency contact, provided my health insurance card etc. So why the unnecessary questions, they are not
medically RELEVANT!

It’s because people in healthcare are nosey, they are into control and spend far too many hours watching medical
tv shows AFTER they have worked in healthcare all DAY. Who does that? The questionaires required at medical
facilities in my opinion goes too far. Personally, it’s no ones business what your SS number is, what your occupation
is, if you are married or single and realistically how many children you have.

Aside from the 19 pages of information you already provide then you get further interrogation. I would suspect that
if a female chose a female gyn she wouldn’t suspect there to be a male medical student to examine her, furthermore
she refused the exam with him, would should she even be asked why? I would feel the same way if I went to my
Urologist and should he have a female med student there to do the exam and would be polite and just say, get the
F#&k out. This is exactly how you have to respond to crap like this any more.

PT

 
At Thursday, May 31, 2018 7:00:00 PM, Blogger Maurice Bernstein, M.D. said...

We have arrived at 173 postings on Volume 87 with this posting--less than 1 month. I am in the process of preparing Volume 88 which most likely will be available for posting tomorrow. ..Maurice.

 
At Friday, June 01, 2018 8:51:00 AM, Anonymous Anonymous said...

In his May 31st post, Biker in Vermont asks “How anyone who works in healthcare at any level does not inherently know that some men are not comfortable with opposite gender intimate exposure?” My suspicion is that, in fact, they know very well that many men are uncomfortable with such exposure but their pretension that they are oblivious to this fact is simply a compliance technique they use to convince patients to do what they want them to do. By acting clueless as to why a patient might refuse such care , they are simply trying to make the patient feel that he is some sort of strange outlier who is behaving inappropriately hoping that the patient will believe this and comply so as not to be thought of as an aberrant personality.
MG

 
At Friday, June 01, 2018 8:58:00 AM, Blogger Maurice Bernstein, M.D. said...

As of June 1 2018, NO FURTHER COMMENTS will be posted on Volume 87. Comments can CONTINUE on Volume 88. ..Maurice.

 

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