Bioethics Discussion Blog: Patient Modesty: Volume 88

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Friday, June 01, 2018

Patient Modesty: Volume 88



So.. based on what has been written in all the previous Volumes of this thread, it appears that a consensus is that the medical system just going "down the drain".  And if so..whose fault? Who should we blame?  And if this analogy is realistic, what is the solution since seems obvious that we (all of us) need trained humans to diagnose and treat us for many of  our illnesses?  Should we have folks not trained in medicine or business to actually run the medical system? Should they be "voted into office" and that by public vote
decisions in medical-surgical practice be made? What is your opinion? Got one? If so, then Comment.  ..Maurice.

As of July 1 2018, Volume 88 will be closed for further Comments.
However, Comments can continue on Volume 89.

Graphic: From Google Images and modified by me with ArtRage 3.


185 Comments:

At Friday, June 01, 2018 11:53:00 AM, Blogger Maurice Bernstein, M.D. said...

How about the 14th Amendment to the United States Constitution with regard to requiring equal gender treatment in the healthcare environment?. Anyone want to go to Court to argue this point? ..Maurice.

14th Amendment:

All persons born or naturalized in the United States and subject to the jurisdiction thereof, are citizens of the United States and of the State wherein they reside. No State shall make or enforce any law which shall abridge the privileges or immunities of citizens of the United States; nor shall any State deprive any person of life, liberty, or property, without due process of law; nor deny to any person within its jurisdiction the equal protection of the laws

 
At Friday, June 01, 2018 1:04:00 PM, Anonymous Anonymous said...

I personally think “ all men are created equal “ is more applicable in this medical scenario but obviously
the healthcare system dosen’t seem to get it when it comes to male and female patients.

PT

 
At Saturday, June 02, 2018 12:17:00 AM, Anonymous JF said...

I think a ratio of medical workers really know their stuff and do all in their power to confront their patient ailments. My mother got that kind of staff when she had a heart attack. Nobody thought she was going to survive, and some of the hospital staff stared in stunned disbelief when she came into the hospital afterwards. ( she was an employee there. ) She lived for 11 years after that horrible heart attack. In my own case,in 2006 my family doctor took advantage of me, the exact same way doctors are reputed to not listen to women patients, he didn't listen to me. I told him immediately that I believed my symptoms were gallbladder. My grandmother ( his patient) same.last name had gall bladder symptoms. This doctor strung me along and caused me to lose the best paying job I'd ever had. Before that I'd never had so.much as a write up over attendance. The surgeon who eventually removed my gallbladder- - I LOVE that doctor. I have no doubt that he saved my life. I probably would have died shortly afterwards if he wouldn't have done the surgery. It was supposed to be same day surgery but ended up being a major surgery. I was in the hospital for a long time.

 
At Saturday, June 02, 2018 8:20:00 AM, Blogger Maurice Bernstein, M.D. said...

Do you think that the role of political view differences between physician and patient is a factor in the "medical system going down the drain", if you agree with that description I created? Could it be that it is also differences in political party or opinion is affecting those writing to this blog thread? Or does political differences between medical professional and patient has nothing to do with what is written here?

Of interest is a Yale News article "Physician's Political Beliefs Affect Medical Treatment" and the AMA article "Patients and Politics: What the AMA Code of Medical Ethics Says"

Do you think "professional behavior" is politically affected? Do you ever ask your physician or nurse what political views they hold or if you suspect one contrary to yours, you are more likely to feel they are also ignoring your modesty or dignity? ..Maurice.

 
At Saturday, June 02, 2018 8:25:00 AM, Blogger Biker in Vermont said...

Dr. Bernstein, concerning the 14th amendment, the medical world apparently does see itself as providing equal treatment to all patients. Female patient intimate care is provided by women and male patient intimate care is provided by women. What could be more equal than that they'll say.

 
At Saturday, June 02, 2018 9:18:00 AM, Blogger Biker in Vermont said...

Dr. Bernstein, I have never shared my political views in a healthcare setting nor have I ever inquired of anyone in a healthcare setting. I have similarly never been asked. None of my business, none of their business.

With one exception, political opinions have nothing to do with what we discuss here. That one exception is modern day feminism which does impact healthcare for men. I have seen way too many articles written by female medical students, residents and younger physicians that celebrate as a good thing women choosing all-female caregivers while labeling men sexist if they prefer male caregivers. I forget the exact words but there was a study done by a female urology resident at the hospital I go to that concluded the advent of female urologists was a great thing for female patients and that male patients who do not want to see a female urologist needed to be disabused of those notions.

This modern day breed of feminists that have gone far beyond equal rights will be a threat to male healthcare as they slowly rise through the ranks and take control of the system top to bottom. They have a decidedly anti-male worldview.



 
At Saturday, June 02, 2018 10:06:00 AM, Anonymous JF said...

I would never ask a doctor or nurse who was treating me what party they were. The last election was the most insane divisive election I have ever seen and I hope to never see anything like it.again. I think one of the weak links in medicine is the insurance companies. People should just automatically pay Medical Care Inc. out of every paycheck. A certain amount everytime. Some people have money already and don't have to work. They should have a certain amount to pay routinely also. Some people just can't pay. That's never going to change and we still need to carry certain people. But insurance companies are just more people wanting money and they try to get out of their big bills.Insurance company employees need to live off of what they've gotten already or find other jobs. Pharmacy is a lot of crooks also and overcharge because they can. Everybody deserves to be paid for what they do but for every person who is overpaid, somebody else has to be underpaid.

 
At Saturday, June 02, 2018 10:40:00 AM, Anonymous Anonymous said...

Maurice

I’m of the opinion that if anyone really believes that healthcare is going down the tubes because of political party association then this thought process is strictly confined to California. Lack of leadership, lack of ethics, no accountability, no transparency and lies, lots of them.

Consider this, although the article is several years old this sums it up perfectly.

www. Healthcarelaw-blog.com/2015/03/cellphones

55% of OR techs admit making cell phone calls in surgery, distracted anesthiologist on the internet during surgery and patient dies.
Nurses on their cell phones posting to Facebook page when they should be doing patient care.
The list goes on and on where it goes above $4 trillion nobody knows.
Yes, healthcare is already well past the drain, problem is there is no water treatment plant waiting for it past the sewer.

PT

 
At Saturday, June 02, 2018 3:12:00 PM, Blogger Biker in Vermont said...

Wow PT. I read the article at the link you posted. I had no idea that kind of stuff was tolerated. Anesthesiologists playing on the internet during surgery and nobody in the room reports them? Nobody speaks up? Obviously in the case with the transcript the guy's insurance is going to pay a hefty settlement, but in a case like that would the Medical Board pull his license? I'm guessing he'd just get a "don't let patients die like that again" reprimand.

 
At Saturday, June 02, 2018 5:00:00 PM, Anonymous Anonymous said...

Maurice, as to your question in Volume 87, is a nocebo effect as applies to modesty concerns/same gender based care being fostered here upon unsuspecting, first time visitors to this blog? Nope, not buying it. Like JF said, people come to this site/stumble upon it because they have had their modesty violated. Considering that male clients experience modesty/dignity violations thousands of times per week, or even per day (that would make for an interesting study) that is in all likelihood the reason they come to this blog. And no, Dany, you did not “contaminate” your coworker, rather you did him a great service by warning him of what lay ahead, especially as regards the sea of female workers that will descend upon him! I read of one male client who stated that sure he could choose a male physician but was appalled at the ocean of females that “pawed at him” wherever he went.

Maurice, you also stated this: “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.” Nope, not buying that either, especially as it applies to male client/female provider. We’ve seen that almost all mak’emsick female workers either ignore, become angry, argue with, ridicule/shame the male client that dares to ask for what female clients receive as a matter of course - same gender care. And boy, when they don’t get see the “goods” they will, as PT noted, holler like HOs! And no, no amount of “training” will change those mak’emsick workers because for so many of them, that’s why they entered the industry in the first place! As for the clueless female physicians, well, they will see that less and less males will use them as men become more aware of the crap that happens in clinics and hospitals and either avoid any medical “care” or will assertively demand that their rights to same gender care be accommodated!

I must agree with Banterings, that “[t]he 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.” Regarding my friend who was made a guinea pig/teaching prop for genital/rectal exams, the physician later fired that NP just because people online were stating that she bad mouthed all clients (patients) after leaving the exam room – he never gave a crap that she was abusing male clients and never reported her to the BON! She has no place even in the mak’emsick industry! But, because that physician was a coward who feared only for his own scrawny hide, she is free to continue abusing! This ugly scenario is so typical of the industry! For a physician to not report abuse like that, is a CRIME, and should be treated as such. As some have stated here, it’s time for civilians to take control of this failing industry. That NP should have been reported, and had her license permanently revoked! Like another friend who was permanently injured by numerous MRIs with GBCA, he was never told of any possible side effects (another female NP!) that have essentially ruined the rest of his life! But, the scimmer/scammer physician, through his little army of mostly female NQuacks and P-Actors (thanks, PT love the real monikers here!) made their kickbacks then kicked him to the street! There’s more coming for them - I’ve got the memory of a million elephants! And here’s a support group for those injured by “enhanced” MRIs: https://gadoliniumtoxicity.com/

Cont. due to word length -- EO

 
At Saturday, June 02, 2018 5:07:00 PM, Anonymous Anonymous said...

Maurice I'm posting this 2nd portion again - as I don't think it went through.

Yes, as some have noted, the numerous studies that purport to explore the importance of the provider’s gender, are basically a pile of steaming dog shit! Yep, they totally ignore the lower level peepers, aka female nursing hags and assorted techs. And that there are now virtual scribes is most alarming!

As for asking a client why they want same gender care – that’s total CRAP! Asking why as regards this issue is a form of interrogation, and I agree with PT that it is an inappropriate, no, more, it is an abusive, question, and that stupid medical student had no idea of the 8 principles of patient centered care! He’s already ruined by the medical system, and will be yet another churned out idiot! A question such as this is in reality the provider trying to control the client – it’s not for “better understanding” or “improv[ing] further interaction.” Bull pucky! To ask this question is yet another form of bullying! Asking it screams that the provider wants to shove that client into their gender neutral box! And I bet water boarding would be a walk in the park compared to the interrogations regarding same gender care for males who dare to speak up and declare their rights as a human! When a female worker even “just” rolls her eyes when a male asks for same gender care is a form of abuse and here’s where lawyers are our friends! If as a male (or female) I state I want only same gender care for intimate care, exams, surgeries, etc. then I should not be interrogated or made to explain my choices. My body, my mind, my choice. This choice should be entered in my medical records and henceforth no one should even ask me anything about this except to assemble same gender teams as needed. And yet more dissembling from medical critters re surgery and same gender requests; since male RNs tend to be more prevalent in surgery and ER, then it shouldn’t be a problem to schedule an all male team!

I also agree with Biker in Vermont who noted that the new breed of feminists in the mak’emsick industry celebrate females who can choose all female mak’emsick workers but insist that males submit to the care of females; these females define the definition of rabid: “irrationally extreme in opinion or practice; furious or raging, violently intense.” It’s not just nursing hags who become vicious in their attitudes and practices towards male clients; it’s the female physicians and those in training as well! That they cannot see that they are not only practicing discrimination against male clients but that their mind set and dealings with male clients are incredibly abusive – well, this leads us to the topic of Volume 88.

Cont. due to word length -- EO

 
At Saturday, June 02, 2018 5:11:00 PM, Anonymous Anonymous said...


There is no saving the present mak’emsick industry. Let’s see – we already know that drug studies are fraudulent and that physicians seem to be entirely ignorant of this fact. But, writing scripts is about all most of them can do. Super hyped “screening” tests do more harm than good. EBM (Evidence Based Medicine) is essentially a scam as it also relies on fraudulent studies. We’ve seen that the mak’emsick industry is founded on the principle of poisoning as a path to health, and it is a vicious monopoly that actually attacks, mainly in the legal arena, those who practice other forms of medicine. Oh, and let’s not forget that medicine in now the leading cause of death in the US! Now, people tend to hate me when I speak the truth but let’s give it a go – the mak’emsick industry is practicing medical fascism. Looking at Oxford Dictionary, the general usage of the word is “extreme authoritarian, oppressive, or intolerant views or practices.” The revolving doors between the Dept. of Health and Human Services, the CDC, the FDA, the National Institutes of Health, Washington, and the pharmaceutical industry has led this nation (and basically the entire globe) to a failed, dangerous system that tramples individual human rights in the name of whatever the medical fascists are calling it that day – the greater good, saving lives, herd immunity, and so on. THE US HAS MILITARIZED PUBLIC HEALTH POLICY. Readers, those who blindly accept authoritarianism via the public-private hybrid of the medical trade (it’s not a profession by any stretch of the imagination) and especially Big Pharma, are causing all of us to be the proverbial frogs in boiling water – and just look at the damage they have wrought! Not all of the drops of water of any water bearing planet in our galaxy would compare to the tears that have been cried by the millions that have been lied to, manipulated individually, manipulated via mass hysteria ad infinitum.

NOW, AS MODERN MEDICINE HAS DONE, ONE CAN DEFINE WHATEVER SUCCESS RATE ONE DESIRES AS LONG AS ONE REDEFINES SUCCESS! We have seen they do this with impunity for drugs and screening tests, such as colonoscopies. This paradigm also applies to male modesty. I recall one account I read of a veteran who expressed a need for an all male team for a urological procedure but his physician defined him as mentally ill! Nice!

Cont. due to word length -- EO

 
At Saturday, June 02, 2018 5:15:00 PM, Anonymous Anonymous said...

There is nothing left to save. I’d like to try answering PT’s question – where does it all end? Well, for those who can bear it, try slugging through the best climate change reports out there. I must admit when I finally did so a few years ago, I was shocked; I did not realize how bad the situation is. So, as global society falls into famine, plagues, wars, and so forth we will see medical “care” ever shrinking until it falls where it should be. Future medical care will be limited to trained technicians for trauma care. Actually, many chronic conditions will fade away as people reject pharmaceutical poisons and begin to learn how to really live a proper human life – with clean water (I was an editor once for the Superfund cleanup, and I can state that aside from mak’emsick “care” taking a shower or drinking unfiltered water is one of the most dangerous things one does on daily basis), clean food, a non-poisoned environment, exercise, and so on. NTT mentioned “simple thinking” as regards same gender care and this needs to be applied across the board. Don’t tell me the positives of a drug or test and not the negatives – I’m neither a child nor a moron! As it stands now, one has to fully research just about ANYTHING recommended by a medical critter because they lie by way of omission. I like what Merlin said to King Arthur when they were speaking of dangers to the throne and the stability of the nation –when a man lies, he murders part of the world. This is precisely what physicians and nursing hags do as a matter of course! It’s how they are trained, and they are not intelligent enough to realize they are but cogs in the wheel of medical fascism. As I now state – the medical mafia is the thinking man’s enemy! If anyone tried to medicate or treat me against my wishes, well, that’s where my Second Amendment rights come in! That we have come to this point illustrates just how corrupt the medical trade is. I must somewhat disagree with JF who said we need doctors and nurses. Many chronic conditions are caused by medical incompetence and dangerous drugs/procedures so why would one want to consult those who are the leading cause of death? And yes, climate change will obliterate the failed medical model we currently endure, and will occur much more rapidly than most can imagine…

Thanks for listening!

EO

 
At Saturday, June 02, 2018 6:52:00 PM, Blogger Maurice Bernstein, M.D. said...

I thank EO for a very great presentation and there is much to discuss from within it but one word "client" (a term I never used for my patients) I think is worth further consideration since it may be part of thinking out much of the understanding or misunderstandings written to this thread. I am presenting 3 resources by address but for one I am taking the liberty of distributing the text in keeping with Fair Use regulations.
Views:
DENTIST
http://www.speareducation.com/spear-review/2012/09/the-difference-between-a-client-and-a-patient

PSYCHOLOGIST
https://www.psychologytoday.com/us/blog/what-doesnt-kill-us/201308/patients-or-clients
CONTINUED ON NEXT POST ..Maurice.

 
At Saturday, June 02, 2018 6:58:00 PM, Blogger Maurice Bernstein, M.D. said...

And now the CANADIAN PHYSICIAN (Fair Use Publication):
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2638036/ ..Maurice.
CMAJ. 2009 Feb 17; 180(4): 472.
doi: 10.1503/cmaj.081694
PMCID: PMC2638036
PMID: 19221365
Shades of grey: patient versus client
Savithiri Ratnapalan, MBBS MEd
Author information ► Copyright and License information ▼ Disclaimer
Copyright © 2009 Canadian Medical Association
I came here for the cut on the head and see no reason to do what you say. You are here to serve me. My taxes pay your salary.” This angry outburst came from a parent when one of our emergency nurses asked her to remove her baby's clothes so she could check the child's heart rate. As I listened to the client demanding the service she wanted, I wondered if we had pushed this client concept a little too far. The baby is our patient–client and the mother is the decision-maker client who pays our salaries. Where do we draw the line?
I started medical school in an era when we only had patients. The health care providers decided what was best and told the patient what should be done. Now we talk about the clients we serve and try to involve them in deciding what is best for them. It seems progressive and the correct thing to do. Lawyers have clients. Accountants have clients. Prostitutes have clients. Doctors, the other great profession, also have clients now.
The client versus patient concept is something that I struggle with at times, and frequently discuss with other people. I found that a group of inter-professional health care providers held different ideas about the client versus patient concept. The emergency medical team said that they were always patients to them. The bleeding human being on the side of the road or the person in severe chest pain is not a client; they are patients who need care not clients with choices. The rehabilitation team said that they were always clients as there is always shared decision-making. The physicians and nurses were divided and said it varies, but mostly they are patients. It was more than demand and supply. Some said it was the connotations surrounding the word patients and clients that made it harder to decide which term to use. Apparently, to these health care providers, clients have choices, while patients do not. (CONTINUED NEXT POST)

 
At Saturday, June 02, 2018 7:00:00 PM, Blogger Maurice Bernstein, M.D. said...

(CONTINUED FROM PREVIOUS POSTING)

So I decided to divide the people we serve into the following categories in order to make it easier to decide who is the patient and who is the client. The categories were 1. Very ill or injured. 2. Not so very ill or injured. 3. Those who think they are ill, but are well. 4. Those who think they are well, but are ill. The very ill or injured are easily categorized as patients and the not so very ill or injured can be called clients. However, those who think they are ill, but are well, and those who think they are well, but are ill should be categorized as patients although they may want to be categorized as clients. Considering as clients those who want a narcotics prescription without any assessment, or the person with angina who insists that it is indigestion, may lead to unfavourable outcomes not only for the health care consumer, but also for the health care provider and the system.
Then I wondered about other subcategories. What about the elderly, the infirm, the babies or the cognitively impaired? What about the 13-year-old who refuses treatment for severe pelvic inflammatory disease? The pregnant woman with a complicated pregnancy who insists on home delivery? Who is the client and who is the patient? Does it depend on the situation, severity of illness, age of the patient or setting in which health care is provided? Should we ask our patient/clients what they think?
Most people do not choose to get ill and shared decision-making undoubtedly allows them to have some control in a situation that is largely beyond their control. But does this make them clients? Isn't shared decision-making part of contemporary medicine, regardless of the names? The client versus patient debate is not black and white, there are several shades of grey, and perhaps it's time to come up with a new word that isn't so laden with old meanings.
Savithiri Ratnapalan MBBS MEd Assistant professor Department of Paediatrics and Public Health Sciences University of Toronto Toronto, Ont.

 
At Saturday, June 02, 2018 7:20:00 PM, Blogger Maurice Bernstein, M.D. said...

My wonderment is whether when we all are writing about the "subjects" and how they are treated within the medical system, are we really writing about "clients" as set forth by EO and not "patients"? Can anyone reading this blog thread set a different view of the distinction between "patient" and "client" then attempted bu the Canadian physician? ..Maurice.

 
At Saturday, June 02, 2018 8:02:00 PM, Anonymous Anonymous said...

Maurice


I’ll address it this way, the words we use reflect how we think about the help we offer. I’ve always felt that client tended to diminish the responsibility, lessen the burden. Nursing homes use the word client as they know those folks won’t get better and most likely die there thus putting those people as more like guests in a hotel rather than a segment of our society that needs long term medical attention.

The healthcare industry in my opinion will continue to look for ways to diminish care, robot like behavior replaces advocating all the while skyrocketing costs at $4 trillion dollars employing healthcare staff that hate and despise their jobs. It’s more than just a juggling of the semantics that apply to those the healthcare industry serve.


PT

 
At Saturday, June 02, 2018 10:59:00 PM, Anonymous JF said...

I can't answer for hospital employees or employees who work at doctors officers but I have loved some of my nursing home jobs and assisted living jobs. Certain of the nurses do also and pour themselves into it. At my last assisted living job, those nurses were our best friends. My one nurse that I worked under would take clothes that needed mending home and mend them. She made little ghosts out of lollipops for Halloween. Once I cut down to every other weekend only so I could make a better wage at a nursing home. She sent me a text requesting me to come back and be part of the team again so I immediately gave the nursing home my two week notice. When I came back they named me the lead resident care giver and matched my wage to what the nursing home had given me.

 
At Sunday, June 03, 2018 2:13:00 PM, Blogger Maurice Bernstein, M.D. said...

I would conclude that "partner" ("partner in the resolution of illness") is the better definition of the relationship between the two partners (whether the partner of the human needing medical care is a physician, a nurse, a tech or someone else in the medical system). To attain the goal set by the ill partner requires understanding and cooperation on both sides of the partnership.

I think the misbehavior of those within the medical system is a direct example of lack of understanding or ignoring the partnership concept. I think that this partnership relation is one that is underemphasized in medical education and instead should be actually stressed. ..Maurice.

 
At Sunday, June 03, 2018 2:42:00 PM, Blogger NTT said...

Good Afternoon:

As EO plainly put it, our healthcare system is broke. My fear is we don’t have the people (both professional and civilian), who can put profits and politics aside to rebuild a system already riddled in politics and profits.

EO also stated that our public health policy has been militarized.

Our country’s military is guided by civilian oversight. If the public health policy of the country has been militarized as EO says, then it too should be guided by a civilian oversight board.

If we let the medical people, big pharma, and the government try rebuilding the system alone, we will be right back where we are today, trillions of dollars wasted and our citizens having sky high premiums and/or no insurance coverage at all.

Those that want a say in any rebuild must be heard. The easiest way that can happen is for elected officials to hold town meetings in their districts so the people can say what they think the system should be.

If the civilian population doesn’t have a say in whatever they come up with, I fear more men will walk away from needed care rather than be subjected to anymore public embarrassment or humiliation by so-called healthcare workers and more people won’t be able to afford insurance.

As far as client/patient goes, I’m of the opinion that if you are in a long-term care facility or nursing home environment you might be called a client otherwise, you should be called a patient.

Currently there is no "partnership" in the patient/provider relationship because the providers want to keep control and the patients are taking it back. When the providers show that the patient is in charge then you will see a "partnership" between the two side blossom for the betterment of all.

Regards,
NTT

 
At Sunday, June 03, 2018 3:08:00 PM, Blogger Biker in Vermont said...

I would prefer to be called a patient but I don't really care if they want to call me something else. Given how quickly society manages to render the latest buzzwords meaningless through over use and misuse, calling me a client or a partner isn't likely to change behavior. The working definition of patient vs client vs partner would be identical in everyday use.

All I really want is to be treated in a respectful and dignified manner, taking into account my definition of respectful and dignified. If you want to go down the "partner" road, then this would be the classic case. If every person from the physician down to the MA gets to decide for themselves what is respectful and dignified regardless of what the patient thinks, then their use of the term partner is meaningless.

 
At Sunday, June 03, 2018 8:01:00 PM, Anonymous Anonymous said...

You might be a patient, client, the gallbladder in room 202,the guy in 106, whatever. As a male patient you also might be referred to as hon,sweetie, babe etc. Try referring to a female you don’t know in that regards and see the response you get or rather see how long you stay employed if you as a male refer to a female client or patient in that regards. The truth is males are more of an anomaly or some kind of an experiment gone wrong rather than treated respectfully as patients should. It’s a fact that men pay the bulk of health insurance, the
bulk of the $4 trillion dollars that flows into the coffers of the healthcare economy, yet we for the most part use it less than women, yet
most healthcare services are custom tailored for female patients. Men pay for the pink robes that are given to female patients when they visit those mammography centers, you know, the ones that don’t accept men when they need a mammogram. The vast majority of that $4 Trillion
dollars flowing into the healthcare economy pays for 95% of female nurses, so men get dinged twice. How convenient for them.

PT

 
At Sunday, June 03, 2018 8:29:00 PM, Anonymous Anonymous said...

Currently, I can think of no other industry of which I as a male pays into that automatically discriminates against me not once, but twice. The idea that not only am I not given the same privacy, respectful care as women, but I am also penalized ( or penis lized) as I like to spell it to have to pay the salaries of those that make this all possible. I pay the salaries that feeds all the nurses, techs, cna’s and some physicians who go to lengths to discriminate against me.

I’m thanked by the car insurance company for being a loyal customer and have never been in an accident for a claim. For that my rates are fairly low with multiple and rather expensive vehicles insured by them. Too bad I can’t say that for my high health insurance premiums that I pay each month. My homeowners insurance for the homes I own are low thanks to no claims that I’ve made against them. I once made a call to my health insurance company to make a concern about a Urology office, not one of the all female staff knew how to perform a proper blood pressure, not one knocked before they entered my room, they don’t answer the phones ever at this clinic, it takes 3 months to be seen. My pain issue regarding my prostate issue was never addressed.

The health insurance company with all their female employees didn’t seem too concerned and never logged my call as a complaint, I can’t but wonder if I logged a similar complaint with my car insurance company would it be different. You see, I fired the Urologist. If I had a similar complaint with my homeowners insurance or my car insurance company I could just fire them too and go with other companies but it’s not that easy with your health insurance company. You can’t just fire them and maybe that’s part of the problem.

PT

 
At Sunday, June 03, 2018 9:05:00 PM, Blogger Maurice Bernstein, M.D. said...

PT, I wonder how transgender patients are treated under the views and actions you described. Within my generations of internal medical practice, I have never had one as a patient even in the most recent years.

Actually PT, I thought I would do a bit of Googling this evening and came up with some interesting links..such as transgender male biologic female who desired or became pregnant:

https://www.sfgate.com/health/article/Transgender-patients-face-challenges-in-health-5899764.php

and the need for research regarding barriers to health care and issues related to workforce behavior:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4802845/

It may be that the transgender patients face issues just as upsetting as those of biologic males who live to preserve their gender at birth and have that gender respected by the medical profession

..Maurice.

 
At Sunday, June 03, 2018 11:25:00 PM, Anonymous Anonymous said...

Maurice


In my experience, one transgender patient came to our emergency room about 8 years ago. Unfortunately he was not treated well by nursing staff, the patient was referred to as it. Sadly, in my opinion if you present to an emergency room with the following conditions such as a) transgender, b) hermaphroditism c) micropenis d) gay with objectin rectum, you will be treated if you are a Freak show.

PT

 
At Monday, June 04, 2018 8:21:00 AM, Blogger Maurice Bernstein, M.D. said...

PT your ER observation as described emphasizes the need for a better definition of the "doctor-patient" relationship if the medical system is to improve and be more humanistic and considerate in the many ways described on this blog thread it is not.

So here, in the literature, is another literary attempt to make the relationship better and more understandable:

No "doctor-patient"
No "provider-client"
but, how about:
"HOST-GUEST" relationship as detailed in the book "The Renewal of Generosity: Illness, Medicine and How to Live" by
Arthur Frank?
http://medhum.med.nyu.edu/view/16833

or

does everyone here feel there is NO realistic way to describe the relationships in medicine which, if followed, would raise the medical system out of the "cesspool" and "drain" where it is now headed which is implied by virtually all of the commentary here on this thread? ..Maurice.


 
At Monday, June 04, 2018 8:27:00 AM, Anonymous Anonymous said...

Let’s remember that although a majority of physicians are now employed by corporations there are many private physician practices in this country, and in those private physician practices the physicians approve any personnel hired. So then the question becomes why, in these private practices, do the physicians not hire male medical assistants and male nurses? Why do they intentionally only consider their female patients, and totally ignore any consideration of male patients?

About 38% of practicing physicians are women now. Women have complained about discrimination in medicine for so long, it would be interesting to see what their hiring practices are. Do they hire almost exclusively female MAs and RNs too? Why?

If this is the case the issue is NOT the patient. It is the discrimination by the physicians and the medical system in favor of female patients only and against any equal consideration of male patients.

I would love to see a study of the hiring practices of male private physicians & female private physicians. We will never see it because it could reveal hiring discrimination that could have legal consequences. I suspect most physicians are not as opened minded, as egalitarian, as they present themselves and thus a major part of the problem in medicine lies with them. - AB in NW

 
At Monday, June 04, 2018 11:19:00 AM, Blogger A. Banterings said...

...that the term somehow tarnishes the sanctity and integrity of the doctor-patient relationship...

So what has pelvic exams on anesthetized women without explicit consent done? Was has participating with prisoner torture (enhanced interrogation) and rectal feedings (at GITMO) done? What has NOT policing their own ranks and allowing bad doctors to continue to practice done for the doctor-patient relationship?

Patient is paternalistic, it implies (like the Psychology Today article states), "doctor knows best.

Client recognizes shared decision making, he requirement for the physician to earn and keep TRUST. (More work...)

From "Shades of grey: patient versus client",: ...clients have choices, while patients do not.

There is ALWAYS a choice.

As to "partner," until the physician "has skin in the game" with my illness, the physician is NOT a partner.

How are transgendered patients treated? They are tortured in healthcare.


-- Banterings

 
At Monday, June 04, 2018 12:00:00 PM, Blogger A. Banterings said...

Maurice,

Your original question was:

...the medical system just going "down the drain". And if so..whose fault? Who should we blame?


The answer is simple, it is the system itself.

If one does not know the history of the AMA, it was founded by John D. Rockefeller (owner of the Standard Oil MONOPOLY) and the Carnegie Foundation (as in Carnegie Steel). It was a way for Standard Oil to create a monopoly on the chemical/pharmaceutical industry (via Standard Oil's controlling interest in a huge German drug/chemical company called I.G. Farben).

The AMA was not concerned with protecting the public as it was with money and power (such as sell selling the "AMA Seal of Approval." Just look at the war the AMA waged against the chiropractic profession AND
subsequently found the AMA and others guilty of an illegal conspiracy against the chiropractic profession in September of 1987, ordering a permeate injunction against the AMA and forcing them to print the courts findings in the Journal of the American Medical Association. (Source: NY Times)

The AMA was NOT set up to protect the public or patients.

The 1847, the inaugural Code of Ethics of the American Medical Association (AMA) stated, “The obedience of a patient to the prescriptions of his physician should be prompt and implicit. He should never permit his own crude opinions as to their fitness, to influence his attention to them.

Again, the root of the problem is power.

Power tends to corrupt, and absolute power corrupts absolutely. - John Emerich Edward Dalberg-Acton, 1st Baron Acton


-- Banterings


 
At Monday, June 04, 2018 1:28:00 PM, Blogger Biker in Vermont said...

Whatever labels we use to describe the doctor-patient relationship aren't going to matter if they are not being used as part of the resolution of a defined problem. What we talk about here is not yet recognized as a problem, thus new labels to define the relationship aren't going to help.

If you look at articles and training materials dealing with dignity, what the patient thinks is never a consideration. That men might see it differently than women is never a consideration. Here is a representative example I just pulled with a quick search. Note that the person answering is deemed an expert in the subject matter.

Q. What happens when a female caregiver is required to bathe a male elder?
A. Like with many things in caregiving, you do this delicately and respectfully. You have to disassociate any gender role and explain that you are just going to assist with the bath. In the hospital baths are generally given by females and thus it is in a home setting. There is no male/female dynamic. It's a bath and part of the daily routine. It's the same thing with assisting a male to the bathroom. It has to be done and therefore you just do it. Taking of personal hygiene issues is part of the job and as long as you do it with dignity, there should be no problem.

How the male patient feels about it is not a consideration. It never is. Until the medical world is willing to admit that they might need to do more than just be polite to male patients nothing is going to change.

On the male staff issue, I just learned today in a correspondence with my primary care provider that they have a male RN there. He was the one handling the correspondence. I had previously noted that urology has a couple male RN's at that hospital too. I know that the gastroenterology dept. has some male nurses as well. It can be done if practices and facilities want to. Dermatology is the dept. still stuck in the female staff only mindset at that facility.

 
At Monday, June 04, 2018 1:49:00 PM, Blogger Maurice Bernstein, M.D. said...

Banterings et al: for this blog thread "Patient Modesty" to be more effective in "speaking out" the issues and suggesting but also wanting to receive "remedies", it is essential that this thread gets some help from its current participants to publicize its presence so that we can get more readers and Comment contributors. Since there is no financial component or monetary benefit to this blog or myself, whatever advertisement can be made to bring people here to read and write is purely in the public (our) interest and for social change.

I am really not an active or knowledgeable participant in the social media (except for this blog and a participant in a few professional listservs where I follow my signature with a link to my Bioethics Discussion Blog) so I ask for help in publicizing this particular modesty thread.

If anyone here has suggestions for publicizing this thread please write me:
doktormo@aol.com and thank you. There is too much of value here to tend to limit its presence. ..Maurice.

 
At Monday, June 04, 2018 3:00:00 PM, Anonymous Anonymous said...

For many years I have researched Boards of nursing and State medical boards. For the most part I can find actions by State medical boards against Physicians going back 25 years. I can find out what medical school they attended, their speciality and where they practice. I should say that I would never hold it against any physician a reprimand for I have many physician friends that I know to be excellent. On the other hand Boards of nursing are not at all transparent. They do not list the names of those whose nursing license has been reprimanded or revoked, Why? Never will you be able to ascertain where they work if their license was reprimanded.

There is a case I’d like to share that I learned of recently regarding a male physician. This case came into view with the medical board in Arizona in 1996. A male physician who is very well known in treating patients with HIV/aids was accused of being molesting two male patients during their genital exams. In conclusion, the medical board issued an order to the male physician that a chaperone must be present during any genital exams. The male physicians had 3 female medical assistants employed in his office and during follow-up investigations by the medical board the female medical assistants testified that not all male patients were chaperoned. After the investigation the state medical board took no further action against the male physician and the 3 female medical assistants are no longer employed at the physicians office. Several of the female medical assistants testified that they would watch the exam of a male patient and the physician by seeing the exam unfold from a picture mirror located in the exam room. Very odd case.

Lastly, this is a case of which I cannot validate but was a post by a male patient in regards to an incident by a female nurse taking a cell phone pic of her male patient’s genitals. The poster states that he had to have a cystogram, that he was told that he would be awake for this cystogram. Now he stated previously that his first cystogram he was given conscious sedation but this time he would be awake. He went on to state that the female anesthiologist continually insisted that he wear headphones to listen to music. The patient insisted that he wanted to hear what was going on, but the female anesthiologist further mentioned that he should wear headphones and listen to music. The patient stated in his comments that he has a micropenis and according to him he learned that the female anesthiologist did not want him to hear the female nurses laugh at him. I cannot validate the truth to this story as it was posted as a long comment in regards to the female nurse in upstate NY who took a cell phone pic of her patient’s penis.

PT

 
At Monday, June 04, 2018 3:26:00 PM, Blogger NTT said...

Good Evening:

I totally agree with AB in the NW.

I am willing to bet at least 98% of all private physicians play the sex sells card where their male patients are concerned so as to not upset the all-female makeup of the physician’s office whereby causing a huge headache for them to deal with.

Instead of hiring male staff to make the men feel more comfortable, they go out and hire young, good-looking female staff under the premise that the staff members good looks will be the distraction the physician is counting on to keep their male patients happy all the while they are being intimately exposed for exams, tests, or procedures in plain view of the opposite sex.

Hiring discrimination at its finest.

Regards,
NTT

 
At Monday, June 04, 2018 5:57:00 PM, Anonymous Anonymous said...

AB in NW

I have researched many female physicians in private practice, I’ve not seen one male in their office. A female plastic surgeon notes that on her website as well as advertisements in magazines that “ no males are employed in my practice”. Take it a step further and look at medical assisting schools, there are no males in those classes. On one medical assisting site one male nots that he has been trying to get a job for 10 years, who is even engaged in a job search for that long? The commentary is that your best bet is to join the navy and work as a medical assistant on a submarine.

PT

 
At Tuesday, June 05, 2018 9:21:00 AM, Blogger A. Banterings said...

Maurice,

I regularly tell providers that I have encounters with about your web site, especially when the discussion turns to patient dignity. My friend up north does the same.



Now I am going to start defending physicians...

We all know there is an exception to consent to be photographed by the patient when it is for educational purposes. The latest scandal, where least seven lawsuits have been filed against a surgeon in Georgia who shared videos of herself dancing on YouTube during surgery while patients are in view and under anesthesia.

This is highly educational. It shows that physicians are the gods that they think themselves to be AND (as stated in the 1847, the inaugural Code of Ethics of the American Medical Association); “The obedience of a patient to the prescriptions of his physician should be prompt and implicit. He should never permit his own crude opinions as to their fitness, to influence his attention to them.

This not only educates medical students that they can do what ever they please, that the patient is no more than a warm cadaver, but you can also have celebrity status (such as a YouTube music pop star).

So to all those who cry that Dr. Windell Boutte has done something wrong, I say to you, know your place AND never permit your own crude opinions as to their fitness, to influence his attention to them.



-- Banterings



 
At Tuesday, June 05, 2018 10:08:00 AM, Anonymous Anonymous said...

A. Banterings

Where on earth did she learn those terrible dance moves, medical school?

PT

 
At Tuesday, June 05, 2018 10:39:00 AM, Blogger A. Banterings said...

Mandatory Shared Decision Making by the Centers for Medicare & Medicaid Services for Cardiovascular Procedures and Other Tests

...This is the third instance in which the Centers for Medicare & Medicaid Services (CMS) has required shared decision making as a condition of coverage. The CMS mandated shared decision making in 2015 for lung cancer screening with low-dose computed tomography and in 2016 for left atrial appendage closure (LAAC) for stroke prophylaxis in atrial fibrillation. The CMS seems poised to extend mandatory shared decision making to other treatments and tests.


Wait, I thought all this compassionate care we receive must include shared decision making.

Maurice has even told how he teaches his students shared decision making.

So why is it being mandated?

Paternalism is NOT dead...




-- Banterings

 
At Tuesday, June 05, 2018 12:51:00 PM, Blogger Maurice Bernstein, M.D. said...

Banterings, some decision-making in certain specific medical but particularly skilled surgical activity is so technical, both technique wise and pathophysiology based on published documentation not readily understood by a patient that it becomes patently unfair to "dump" the final decision with regard to this specific activity onto the patient for an independent decision. Virtually all decision should be finalized by patient understanding and acceptance but some must be purely a professional decision but agreed to by the patient. ..Maurice.

 
At Tuesday, June 05, 2018 12:59:00 PM, Blogger NTT said...

Good Afternoon:

Banterings I too saw the videos.

It should be a warning to every american that uses our healthcare system that this is a PRIME example of how the American Medical Assoc protects its own instead of the american people they are supposed to be protecting.

OPEN YOUR EYES PEOPLE. This so-called doctor has NO business still practicing. Yet the healthcare system that you and I pay for still allows these crackpots to maim innocent people with impunity.

ANYONE in that operating room that didn't have the guts to report this women should lose their license to practice permanently and be booted out of healthcare all together for life.

If people can't see the system is broke and needs civilian oversight now more than ever, then there's no hope for them.

Its amazing how much the paying american public will put up with from the medical community.

Regards,
NTT

 
At Tuesday, June 05, 2018 2:15:00 PM, Blogger A. Banterings said...

PT,

Agreed. Those dance moves warrant a license suspension in and of themselves.


Maurice,

You state:

"...by patient understanding and acceptance but some must be purely a professional decision but agreed to by the patient."

What does that even mean?

Doctor: You have sustained atrial and ventricular rhythm disturbances even though you have no history of preexisting atrial tachyarrhythmias. I recommend an atrial pacemaker.

Possible side effects may include atrial fibrillation or "flutter." Atrial fibrillation is not affected or demonstrated by your age, aetiology, pacing history, or the measured intracardiac P wave.

Being that this is too complicated for you to understand, we are sending you to pre-op prep and then to surgery to implant the atrial pacemaker. Is that OK with you?

Patient: I guess...

Doctor: Have a safe trip.

THAT IS NOT INFORMED CONSENT!

That is a delusion of grandeur used to justify paternalism and making the doctor work less.


The reason for patient autonomy being legislated as a protected right and required by CMS is because societal expectations are is so technical, both cognitively and emotionally, based on published documentation (this blog, my blog) not readily understood by a physician that it becomes patently unfair to "dump" the final ensurement with regard to the specific activity (of shared decision making) onto the physician for an independent decision (by the patient). Virtually all decision should be finalized by physician understanding and acceptance (of the wishes of the patient and the expectations of society), but some must be purely a patient-based decision but agreed to by the physician.



-- Banterings









 
At Tuesday, June 05, 2018 2:28:00 PM, Blogger A. Banterings said...

NTT,

I so agree with you that "the system is broke and needs civilian oversight now more than ever".

We are getting that. When the profession refused to live up to its Social Contract with Society, society still kept its end of the deal that grants the profession self-regulation.

Society has however required thats physicians carry liability and professional insurance. Market forces make the cost of these extremely high for bad physicians thus obtaining the same outcome as (failed) self-regulation.

Just like with any danger to the members of society, healthcare is being muzzled and put on a short leash.

My only lamentation will be that those guilty of infractions of human dignity from earlier days may escape the upcoming wave of justice.



-- Banterings


 
At Tuesday, June 05, 2018 8:00:00 PM, Anonymous Anonymous said...

I would like to remind everyone that regarding this subject matter physicians represent only part of the problem. I think a lot of people get half-cocked because Maurice is the main one listening but the real culprits are hospitals and nursing. Within that nursing subgroup I’ll list the medical assistants, cna’s and a small host of techs ie ultrasound. There never be a win-win for us by trying to go after the whole medical industry by lumping in physicians on top. The old saying divide and conquer has to be our principle and to be effective we need to start with the smaller fish first.

We have some very intelligent people posting on this blog, this is where our strength lies. I recall quite a few years ago while posting on this blog there were a number of people who just didn’t believe and doubted anything that was posted. Now, those people are either believers or have gone away, good riddance! There are many shortcomings in healthcare regarding fair gender treatment, the skill is recognizing it, whose fault it is, bringing it to the attention of those responsible and if they won’t fix it and believe me they won’t. This is how healthcare works I know I’ve dealt with those idiots for over 40 years so they way you change things is bringing it to an even bigger attention audience.

You see, healthcare is very very slow to change, yes the technology from an equipment standpoint evolves and medical techniques evolve but from a people standpoint very very slow, very very stubborn. That is because the same people in there nursing directors, etc may hold on to the same job for 35 or more years. The only way to get them out of there is if they die but the CEO’s just replace them with the same retrograde thinking mentality. I have some suggestions on the small fish first.

PT

 
At Tuesday, June 05, 2018 11:21:00 PM, Blogger 58flyer said...

You see, healthcare is very very slow to change, yes the technology from an equipment standpoint evolves and medical techniques evolve but from a people standpoint very very slow, very very stubborn. That is because the same people in there nursing directors, etc may hold on to the same job for 35 or more years. The only way to get them out of there is if they die but the CEO’s just replace them with the same retrograde thinking mentality. I have some suggestions on the small fish first.

PT

I am interested in hearing your suggestions on the small fish, PT.

Mike

 
At Wednesday, June 06, 2018 5:09:00 AM, Blogger NTT said...

Good Morning All:

In reference to Dr. Bernstein;s question about patient/client, I came across an article this morning written back on Apr 3rd in Physicians Practice called Communication Will Enhance the Doctor-Patient Relationship. It was written by a Ronni Burns who is a consultant, coach and professor of communications.

http://www.physicianspractice.com/patient-relations/communication-will-enhance-doctor-patient-relationship?rememberme=1&elq_mid=1701&elq_cid=121070&GUID=B08AB8C9-143A-41AB-B7F7-6D8242EE8C19

She thinks doctors should think of the patients as a valued clients and patients in turn should think of the doctor as a trusted advisor. Her thinking is that the two together will go a long way toward reaching the long-term positive outcomes we all look to achieve.

Regards,
NTT

 
At Wednesday, June 06, 2018 5:55:00 AM, Blogger Biker in Vermont said...

Given a million or so physicians in the US and multiple times that many nurses, techs etc., finding examples of incompetent or misbehaving individuals is never going to be hard. They need to be dealt with, and for sure the current self-regulation system is pretty lax, but to use the exceptions as representative of the norm only serves to distract us from the larger issues.

Paternalism as has been being discussed is an issue as well, but healthcare workers who use a paternalistic approach behave no different as concerns patient modesty/dignity than do the less paternalistic in their ranks. Both the paternalistic types and the non-paternalistic types at all levels of healthcare deem respectful and dignified care to be whatever they say it is. It doesn't occur to either side of the paternalism spectrum that the patient, especially male patients, might have a different definition of respectful and dignified.

The overarching issue remains that the healthcare system at every level and in every setting refuses to acknowledge that being polite is not synonymous with respecting a patient's dignity. They refuse to acknowledge that healthcare is not gender neutral. To acknowledge either would incur the burden of doing something about it, and at this juncture the healthcare system does not care whether the manner in which they provide healthcare needlessly embarrasses patients, especially male patients.

I would add that part of the gender neutral mantra is that there is nothing sexual about healthcare, yet much effort is given over to keep men away from female-specific healthcare. If there is nothing sexual why do we do that? Why do we celebrate women no longer having to see male doctors if medicine is gender neutral? Why is it acceptable for female nursing and lower level staff to discuss male patient attributes if there is nothing sexual about healthcare? The only expectation is that they keep it amongst themselves. PT has reminded us multiple times of how common this is.

The definition of dignity does not include what the patient thinks. Medicine is not gender neutral. These are the issues that the healthcare system has suppressed from any public discussion. These are the issues that need to be addressed if we are to have any real change.

 
At Wednesday, June 06, 2018 8:02:00 AM, Blogger Maurice Bernstein, M.D. said...

How about changing the composition of the state medical boards from virtually all medical professionals to virtually all general public such as found in trial juries? ..Maurice.

 
At Wednesday, June 06, 2018 9:08:00 AM, Anonymous Anonymous said...

Hello,

After a very modest and dignified hip replacement (which I'll explain in detail in a later post), I received literature from the hospital - Krames On-Demand - identifying how to prevent SSI's and Deep Vein Thrombosis. I immediately thought how beneficial info of this nature would be for "routine" tests/ exams. Consider the following: The doctor recommends text X at your next visit. You receive literature regarding this test which states how the procedure will unfold. 1. You'll be asked to totally disrobe and don a show-all gown. 2. A nurse will take your vital signs - BP, Temp and Heart Rate. 3. The doctor will enter and ask you to lower the top of your gown to listen to your hear and lungs. 4. You'll be asked to raise your gown you to …., etc. If you have any questions, concerns or if you need any accommodations, please let us know so that we may have everything ready for you at this future appointment. Literature of this nature would, initially, be time consuming to produce; however, once done, there'd be little future modification. Patients would be fully informed of the step-by-step procedures. There'd be no "ambushes". Accommodations could be made in advance. This would be a win-win situation for everyone. How can we get physicians to do this service for their patients/ clients/ whatever? Wouldn't all parties be well-served? Ideas?

Reginald

 
At Wednesday, June 06, 2018 10:08:00 AM, Blogger Biker in Vermont said...

Concerning the makeup of medical and nursing boards, the problem with virtually all being non-medical/nursing people is whether they could properly assess quality of care at a technical level. I wonder about two boards, one for strictly medical/nursing technical matters and another for behavior issues. The technical board could be majority physicians/nurses and the behavioral majority non-physicians/nurses.

The seeming injustices that we have discussed are in the behavioral arena rather than technical competence. The industry does not want to take a hard line on behavioral matters. For example, a non-physician board likely would have pulled Twana Sparks license whereas a physician majority board gave her a slap on the hand and sent her back to work. Same with the Denver 5 penis body bag gang. A slap on the hand and back to work rather than pulling their licenses.

 
At Wednesday, June 06, 2018 2:13:00 PM, Blogger Maurice Bernstein, M.D. said...

I just wanted to add here an issue about medical provider personal identification for later action in the terrible behavior cases described here, again and again. But this case,just presented by a physician on one of the ethics listservs I subscribe, shows potential hazard by easy personal identification. Want to talk about it?


We had a patient who was brought to the hospital (he has previously been placed under arrest) by law enforcement because he started complaining of chest pain. It turns out this was due to the fact that he had swallowed a large plastic bag of narcotics. He was treated for this and the bag was recovered. Because he believed that his healthcare providers had betrayed his confidence, after he was out on bond he came to the hospital medical records department to request a copy of his MR, which he received. This was a relatively unedited copy (as is customary) and he quickly was able to identify the names of all the doctors and nurses who cared for him. He then started calling them up at the hospital, asking for them by name. The staff were quite concerned. Those who had somewhat unusual names were even more concerned because of the relative ease with which he could have found out where they lived.


There are always two sides to worrisome behavior within the medical system. Right? ..Maurice.

..Maurice.

 
At Wednesday, June 06, 2018 2:24:00 PM, Anonymous Anonymous said...

Generally speaking state medical boards are composed of a variety of technical backgrounds, physicians, attorneys and usually a general public layperson. You must have some physicians on the board otherwise do you think a general public layperson or for that matter a group of them would understand the standards of care related to medicine?

There needs to be an overhaul of most nursing boards. 1) they typically are all composed of females 2) lower echelon nursing boards consist of investigators. They are not transparent and tend to conceal from the public the problems that exist within the nursing population. They do not want the public to know the extent to which drug diversion, felony backgrounds, boundary violation and other cases of moral turpitude exists within the file and ranks.

Medical assistants should fall under state medical boards. Currently they are under the jurisdiction of the physicians license but truthfully that is somewhat of a lie. I have never ever heard of a case before any medical board regarding a physicians medical assistant. It just dosen’t get to that point. Think about this for a moment, cosmetologists are more regulated than medical assistants.

That’s right, there is a cosmetology board but no medical assistant board. How can that be? You have herds of medical assistants at all these physicians offices who truly do not know how to properly perform blood pressure. The person who cuts your hair is held to a higher standard than the person performing your blood pressure. Speaking of that I need to go check mine cause that’s how stupid, pathetic and ridiculous our healthcare system is!

PT

 
At Wednesday, June 06, 2018 3:28:00 PM, Blogger BJTNT said...

Reference: "There are always two sides to worrisome behavior within the medical system. Right? ."

Right, but what are the percentages? We need to remember that "Extreme cases make poor laws.".

BJTNT

 
At Wednesday, June 06, 2018 4:27:00 PM, Blogger Biker in Vermont said...

Certainly there are always two sides to an issue but specific to the staff identification matter, what are the relative orders of magnitude? What is the frequency of potentially vengeful criminals vs ordinary people having their dignity needlessly compromised by staff members that don't bother to introduce themselves or the others who are tagging along with them.

I will add one of my pet peeves are people who wear name tags but have them turned around so you can't see who they are anyway.

 
At Wednesday, June 06, 2018 5:01:00 PM, Anonymous Anonymous said...

Maurice

Regarding the article, all hospital staff are required to wear name badges. The name badges will only state the staff’s first name. Staff are not allowed to give out employee information over the phone. Anyone can go to the medical records department and obtain their medical records per Hipaa laws. To be technical any hospital or medical facility must provide the patient’s medical records within 30 days by law.

However, most records are given the same day. Medical records will state the provider ( physicians) full name on the medical record but will not state staffs full name. Medical imaging, ie x-ray, Ultrasound, MRI, Nm and CT will be provided by disc along with the radiologists name in full. Surgical records which will state all staff involved in the surgical case will state the surgeons full name, anesthiologist full name, only the first name of the scrub tech and circulator. The surgical report will not list student observers or reps.

In this day and age just about anyone can determine who lives where often using a cell phone number. I want to mention that hospitals are prime industries for personal identify theft. Hospitals and medical industries are directly responsible for many patients identiy theft. This is why Hipaa was created in the first place to protect patient’’s medical information.

It would be no surprise to me at all if as a patient at any hospital you are able to get other patient’s personal information, why? Hospital staff leave it everywhere, nurses don’t cover their cab screens as visitors walk by, patient name bands are thrown in the trash instead of the Hipaa bin. You name it, I’ve seen it. Don’t be surprised if medical records gives you someone’s else’s records. To obtain your medical records technically only a drivers license, or a passport are the only forms of identification accepted.

If this patient has gained the addresses of staff I have to ask whose fault is that, probably staff giving that information out. But then the other side of the coin is as the article states, who violated his right to privacy? The hospital certainly knows everything about him BEFORE he knee anything about them!

PT

 
At Wednesday, June 06, 2018 7:45:00 PM, Anonymous JF said...

The Twana Sparks case really revealed the flaws in the medicine world. No profession should be allowed to self monitor. Not cops, not judges. Not medical. The article I read about Twana Sparks talked about the money she made the hospital, and referred to her as a cash cow. What did she do that another doctor couldn't have done to bring in that extra money? Was it rightfully obtained? What am I missing?

 
At Thursday, June 07, 2018 8:15:00 AM, Blogger Maurice Bernstein, M.D. said...

A physician-ethicist writing on the listserv which I participate made the following statement regarding the hospital case I recently posted here:
Patients have a right to know who is treating them..
Are any of my visitors here provided the full names and identification of every individual participating in their medical care, nursing and in any way participating during the examination? If not, this may be a important absence to insist upon.
I am not against the patient knowing the individuals first and last name and specifically their role before attending a session. for example, the physician states to the female patient "Mary Jones, my nurse, will be your chaperone during my pelvic exam which I will next perform".
I see nothing wrong or unethical itself in such information provided to the patient along with the nature of that individuals presence or participation. ..Maurice.

 
At Thursday, June 07, 2018 9:33:00 AM, Blogger Biker in Vermont said...

My observation is that name tags sometimes are just the 1st name with a designation such as RN, or name tags with the 1st name in large print and the last name in small print, along with their designation. To read the last name for female staff might risk a sexual harassment claim given one has to peer closely and intently to read it given the small font size.

My observation is that the doctors will introduce themselves using their last name and then not introduce anyone with them. Nurses will introduce themselves using only their first name, and then again not introducing anyone that is with them.

Again, my pet peeve are those who have their name tags backwards so that they can't be read at all. That and not introducing who and what everyone in the room is.

 
At Thursday, June 07, 2018 2:11:00 PM, Blogger BJTNT said...

What's really sad is that if you repeated the problems that we have been describing here to employees in the medical community, many would reply with "What's the problem?, Where's the problem?" They are reflecting the following culture:

We are all professionals here.
We are the experts.
We are the good guys.
You [patient] came to us.
You gave us your body.
We know what's best for you.
You don't need to know what we will do.
Don't question us.
We are going to do our thing.
If you bug us, we will extract vengeance on you.

BJTNT

 
At Thursday, June 07, 2018 2:20:00 PM, Blogger Maurice Bernstein, M.D. said...

To clarify relationships and actions within the medical system which may help to facilitate the intended goals of both the system and the patient, in which "clarification" should be a functional value, I present the following possibilities:

What do you think about General Consent Forms which a patient may be handed prior to entry to a hospital, clinic or office? Should one expect the patient to sign the form, accepting as read or should they be simply, with no signature needed, to inform or warn the patient regarding what the institution considers their "principles of practice" and thus provide the patient an informed option of whether to enter the system. Should the latter be simply a sign posted at the entry to the hospital, clinic or office?

How about the patient entering the hospital, clinic or office with their own list of requests and general requirements for the institution to accept or reject? Have you, in fact, ever done that?

What I am asking is whether any of these approaches are of value to the raising of the medical system, prevent the move into the "cesspool" and provide understanding and support for the patient? ..Maurice.

 
At Thursday, June 07, 2018 7:26:00 PM, Anonymous Anonymous said...

Maurice

Those consent forms are poorly written and I can tell you with absolute certainty that they are given to the patient at the last second to sign, never given an opportunity to read. In the middle of those consents is a place to sign wether you agree to observers. That is never pointed out to patients and I’m absolutely certain that unless it is an approved hospital form nothing you request on your papers you present is legally binding.

PT

 
At Thursday, June 07, 2018 7:36:00 PM, Blogger Maurice Bernstein, M.D. said...

PT, what is the legal reason for the inequality of legal binding between what the hospital writes and what a patient writes? This is more of significance if one looks at the patient as a "client" of the services provided as has been introduced as a title in the medical literature. It is the client who finally sets the goal of the provided service. ..Maurice.

 
At Thursday, June 07, 2018 11:10:00 PM, Anonymous Anonymous said...

Maurice

Upon admission to the hospital if a give them a hand written or typed piece of paper expressing my demands ( expressed consent) that I require M&M ‘s for desert and Sushi as my only meal will that happen, No. is it legally binding, No. Will they scan that in to my medical records, No. it will be passed around to staff to laugh at ( technically a Hipaa violation) and will end up in the trash instead of the Hipaa bin, a second Hipaa violation.

Why would I expect the hospital or medical facility to follow my wishes when most of the time they don’t follow the request of written signed consent on an approved hospital consent form? Btw, so that our readers know there are technically over 4000 approved forms on a web site that hospitals use. Most nursing staff are only familiar with maybe 3 or 4 of those forms, I can tell you many patients who have signed DNR request forms ( do not resuscitate) are still resuscitated.

There are many procedures that are performed without physicians orders and these orders go way beyond what a standing order should ever entail. Sometimes nurses get busted and sometimes the physicians stand up for them and write the order later but sometimes the nurses end up losing their license, called operating outside the scope of their license. It’s well know that 30% of all medical tests are unnecessary. There are many intensive care nurses who are guilty of this, operating outside the scope of their license.

PT

 
At Friday, June 08, 2018 11:35:00 AM, Blogger A. Banterings said...

The Great State of Pennsylvania has enacted


Act 2010-110 by the General Assembly in November 2010. It
is codified at Section 809b of the Health Care Facilities Act (35 P.S. §448.809b), which went into effect on June 1, 2015.

Section 809b requires that certain health care employees in certain health care settings must wear photo identification tags or badges that contain specific information.


The Act establishes standards for identification tags of health care workers/providers, with a staggered implementation process.




The act's requirements are:

1.) A recent photograph of the employee.
2.) Employee’s name (first and last name).
3.) Employee’s title:
- The title must be as large as possible in block type and occupy a one-half inch tall strip as close as possible to the bottom edge of the badge.
- The title for a medical doctor or doctor of osteopathy should be "Physician".
- The title for a registered nurse should be "Registered Nurse".
- The title for a licensed practical nurse should be a "Licensed Practical Nurse".
4.) Name of the employee's health care facility or employment agency.


Here are links to state requirements (NOT all inclusive):


California
Georgia
Illinois
Iowa
Maryland
Massachusetts
Nevada
North Carolina
Pennsylvania
Rhode Island
Texas
Virginia



-- Banterings




 
At Friday, June 08, 2018 2:47:00 PM, Blogger Maurice Bernstein, M.D. said...

First I want to thank Banterings and all the others who go to the extra work in preparation of a response to this blog thread including links to the pertinent parts of their discussion. Presenting documentation is an important part of all discussions. Of course, I was interested in clicking on California on Banterings last posting.

Secondly, I thought I should throw in another issue that goes beyond the full name and the honest and full and true description of the role of the individual within the exam or hospital room. That issue is learning the sexual orientation of the healthcare provider. And guess what? I just put up on my blog thread "Would You Accept a Gay or Lesbian Physician as Your Doctor?" which started in 2010 and continued through the years, a response today by a reader. Does every male or female on our blog here agree that sexual orientation of the provider is something that the patient of either gender should include as part of "full disclosure"? ..Maurice.

 
At Friday, June 08, 2018 4:31:00 PM, Blogger Biker in Vermont said...

For me the sexual orientation doesn't matter. I am not so naive as to think I haven't been in many a locker room with gay guys over the years. Doesn't matter to me. The PA that I was so impressed with last year was gay. I was disappointed that he left the practice.

Why doesn't it matter to me? I grew up in an era of forced male nudity with other males (mandatory showers after gym and mandatory swimming in the buff with other males) and then plenty of locker room time as an adult. It thus doesn't phase me to be exposed to or with other males.

The other factor in healthcare settings is than male staff know they will be dealt with harshly for inappropriate behavior that women get a pass on. The odds of a gay male healthcare worker doing something inappropriate is relatively slim.

Gender is what matters to me.

 
At Friday, June 08, 2018 9:52:00 PM, Blogger Maurice Bernstein, M.D. said...

Biker, how about a female healthcare worker who was a lesbian? Would you feel different about genital exposure compared with a non-lesbian female worker? That is, of course, if you were aware of their sexual identifications? ..Maurice.

 
At Saturday, June 09, 2018 4:38:00 AM, Blogger Biker in Vermont said...

Dr. Bernstein, I know that in theory I should be more comfortable with a lesbian healthcare worker, but I'm going to see her as a woman like any other rather than seeing her through the lens of her sexual orientation. Perhaps it is a reflection of where I have spent my life (MA & VT) but I don't judge people on their sexual orientation, thus I'm going to see them as just male or female. Be they straight or not, I will continue to avoid female staff for intimate exposure matters to the extent that I can.

 
At Saturday, June 09, 2018 8:16:00 AM, Blogger NTT said...

Good Morning.

Dr. Bernstein I agree with Biker. I have no issue with sexual orientation. It's all about gender even if she's a lesbian, she's still a female so I'd ask and/or wait for a male.

Regards,
NTT

 
At Saturday, June 09, 2018 1:32:00 PM, Anonymous JF said...

Most intimate care shouldn't be happening in the first place. Most catheters don't need to be inserted. Most swabs could be done by the patient themselves. Genital checks should be done when there are symptoms, per patient request. Not for summer camp or sports or for a new job.

 
At Saturday, June 09, 2018 1:35:00 PM, Anonymous Anonymous said...

Many men and women are bisexual, flip a coin how it lands nobody knows. Maybe that’s the true definition of gender neutral who knows but all one can say is that any institution that operates a mammography department is guilty of discrimination in that they don’t provide 100% same gender care or at least some male employees in other departments for male patients who make the request. At this point I’m surprised that the government ( for those facilities that accept Medicare) has not made some reference that you must have so many males employed. I’m surprised this ruling has not come to that yet, perhaps it will at some point.

It just surprises me that two gay men can take an issue all the way to the Supreme Court for a baker not willing to bake them a wedding cake when a male can’t get same gender care at a medical facility. What is wrong with this issue? I do not like to reference gay or lesbian in my comments, I am not gay, however, I believe female nurses have long used this as an excuse to keep men out of nursing by perpetuating this myth.

PT

 
At Saturday, June 09, 2018 3:43:00 PM, Anonymous JF said...

Unless an employee tells their supervisor they are gay, how would they even know? Not every person who looks or sounds gay lives a gay lifestyle. Not all care that goes on in a medical setting is intimate anyway. Let the known gay do non intimate care and the presumably straight people do dramatically less intimate care. Less witnessing also.

 
At Saturday, June 09, 2018 5:10:00 PM, Blogger Maurice Bernstein, M.D. said...

Here are some admissions from physicians as written in an article "The Doctor Diaries --What physicians Wish Patients Know" in the June-July 2018 issue of AARP. I can't give you all a link to the article because it is for members only but maybe some of you are AARP members and can access the issue. I can give you the titles of each of 12 physician statements which might prove to be a stimulus for discussion since they all may represent some admissions by the medical system.(According to the article, by Joanne Jarrett M.D. "who polled dozens of doctors to find out what they'd tell you, if only they could.")

1. "We are working on your case, even if it looks like we have disappeared"
2."When we keep you waiting, it's not because we think our time i more valuable than yours"
3. "We need complete honesty from you"
4. "We know lifestyle change is hard"
5. "Many of us have PTSD"
6. ""We wish we had better advice for weight loss"
7. "Sometimes the internet is right"
8. "We know you've answered this question already"
9. "Yes, some of us are jerks"
10. "We worry about you"
11. "We make mistakes"
12. "We want the very best for you"("just know that. It is the bottom line")

I have a hunch my visitors here will be munching on these 12 points. You might find some distasteful.. so spit it out. On the other hand, I do find some realistic based on my own professional experience. ..Maurice.

 
At Saturday, June 09, 2018 7:09:00 PM, Blogger BJTNT said...

This comment has been removed by the author.

 
At Sunday, June 10, 2018 4:27:00 AM, Blogger Biker in Vermont said...

Any professional group in surveys of that nature are going to give a mix of positive attributes that they want to sell while mixing in a few truths of what they really think. They will leave out anything that they know will be received badly by the general public.

The "things they won't tell you" lists are usually more real than the "things we want you to know" ones. There is a big difference between the two. I recall one "things they won't tell you" nursing list that said "yes we do look".

Concerning this specific list I do note it didn't occur to them to say anything about wanting us to know that they are concerned with patients feeling they've been treated with the same respect and dignity that they'd want for themselves. Yet another example of patient dignity just not being on their radars.

 
At Sunday, June 10, 2018 10:20:00 AM, Anonymous Anonymous said...

And that one nursing had on their list “ yes we do look” was covered and concealed very quickly as Biker pointed out. Whoa inappropriate was quickly concealed as well. So why have lists, they’re meaningless just as those core values that sit on the shelf of the Twilight Zone somewhere at every hospital. Marcus Welty MD would be turning over in his grave right now if he could only read half this crap. And then Florence nightingale well I seriously doubt she would even move at all, she’s probably laughing since she caused most of this crap.

Lists are useless and they are meaningless, actions speak for themselves. So far all you see are lies, more lies, discrimination and that $4 trillion dollars is the real driving force that keeps all this going, where it stops nobody knows.

PT

 
At Sunday, June 10, 2018 5:51:00 PM, Blogger Maurice Bernstein, M.D. said...

You know, on review and consideration of what has been written in all the Volumes on this thread of "Patient Modesty" and, of course, with PT's last paragraph, the "medical profession" appears as the character if not the reality of a "crime family". a virtual Mafia organization: with actions of deception (unnecessary procedures and testing), frank criminality including sexual misbehavior,opioid "drug trafficking" and finally the "the money". Is that really the profession that I entered years ago and reinforcing each year with a new crop (students) to enter that "family"? Sad, sad, if this analogy is true. What do you think? ..Maurice.

 
At Sunday, June 10, 2018 10:00:00 PM, Anonymous JF said...

Dr B. I think there is a mix. There is enough of what PT talked about to create real problems but we'd also be in a world of hurt if we didn't have medical staff and hospitals/ clinics. I'd be dead, I'm very sure. I think pharmaceutical is greedy and insurance companies make rules up for everybody. The medical worlds commitment to showing their patients naked bodies off to scribes and patients families and people in the hallway is a pet peeve for me. Also the cost.

 
At Sunday, June 10, 2018 10:42:00 PM, Anonymous Anonymous said...

I just visited the California board of barbering and Cosmetology on line. Wow, I had no idea, it’s in 3 or 4 languages. There are soo many new regulations on cutting hair, disenfecting lectric and nonelectric hair cutting equipment, it’s mind boggling all the rules and new rules and all the new regulations coming out. Then the license requirements that they have to pay on top of all that. I like to go to great clips here in Arizona, they are very nice when I go in to get my hair cut. I always leave a good tip and I notice they all wear little name badges, very nice people. They always answer the phone right away and are very friendly. I fell like they are professional and they are cause you know who’s who and they all have their license posted at their booth when you sit down in those nices chairs you get your hair cut in.

Yet when I call that stupid Urology clinic it just rings and rings and rings and rings and rings. When they finally answer they sound like you are bothering them. I ask how long does it take to get in to see Dr so and so.Well he dosen’t have an opening for two months, I can detect sarcasm in their voice, that’s their perceived job security, who knows. When I do show up two months later, I’m given about 15 double sided sheets asking if I am married or single. ( what does that have to do with my prostate). Everyone is very rude, no one wears name tags, and no one ( medical assistants) has a license that’s because there is no licensing board for medical assistants. There were so many people working there, staff wise.

The medical assistant who took my blood pressure did not know how to perform a proper blood pressure, nor did she knock on my door to have me stop for a blood draw after I saw the physician. How difficult is it to know how to properly take a blood pressure.Ive been to that clinic twice, I fired them after the second visit. Arm position is very important when you have your blood pressure taken as well as knowing the systolic and diastolic numbers. But in today’s healthcare I guess it’s not important to perform those functions and not have a license. Maybe healthcare can learn a lot by visiting any Great Clips hair salons, they are a chair so it’s not hard to find one at all.

PT

 
At Monday, June 11, 2018 6:53:00 AM, Blogger NTT said...

Good Morning:

A virtual crime family you say Dr. Bernstein?

That might have an organization that looks something like this then.

The Surgeon General of the USA would be the Godfather.

All the doctors in the US would then be his Lieutenants.

Then all those wonderful nurses would be the Enforcers.

And the np's, pa's, & cna's would be the cleanup crew.

regards,
NTT

 
At Monday, June 11, 2018 9:13:00 AM, Anonymous Anonymous said...

NTT

Exactly, in the next few installments I will explain how this crime syndicate finances itself so well from the unsuspecting public.


PT

 
At Monday, June 11, 2018 10:48:00 AM, Blogger A. Banterings said...

Maurice,

You ask, " Is that really the profession that I entered years ago...?

Did you even read my post about the AMA? The Huffington Post article, "How the AMA Got Rich & Powerful: 'The AMA’s Seal of Approval' "k states:

"There are also numerous stories about Fishbein’s efforts to purchase the rights to various healing treatments, and whenever the owner refused to sell such rights, Fishbein would label the treatment as quackery (Ausubel, 2000). If the owner of the treatment or device was a doctor, this doctor would be attacked by Fishbein in his writings and placed on the AMA’s quackery list. And if the owner of the treatment or device was not a doctor, it was common for him to be arrested for practicing medicine without a license or have the product confiscated by the Food and Drug Administration (FDA) or the Federal Trade Commission (FTC). Fishbein denied these allegations, but the AMA was tried and convicted of anti-trust violations for conspiracy and restraint of trade in 1937. Further, Fishbein wrote numerous consumer health guides, and his choice of inclusion for what works or what doesn’t work was not based on scientific evidence.

Fishbein extended Simmons’s idea for the AMA seal of approval to foods, and by including a significant amount of advertising from food and tobacco companies, he was able to make the AMA and himself exceedingly rich. In fact, under his reign, the tobacco companies became the largest advertiser in JAMA and in various local medical society publications. In fact, Fishbein was instrumental in helping the tobacco companies conduct acceptable “scientific” testing to substantiate their claims. Some of the ad claims that Fishbein approved for inclusion in JAMA were: “Not a cough in a carload” (for Old Gold cigarettes), “Not one single case of throat irritation due to smoking Camels,” “More doctors smoke Camels than any other cigarette,” “Just what the doctor ordered” (L&M cigarettes), and “For digestion’s sake, smoke Camels” (because the magical Camel cigarettes would “stimulate the flow of digestive fluids”).

By 1950, the AMA’s advertising revenue exceeded $9 million, thanks in great part to the tobacco companies.

Coincidentally, shortly after Fishbein was forced out of his position in the AMA in 1950, JAMA published research results for the first time about the harmfulness of tobacco. Medical student Ernst Wynder and surgeon Evarts Graham of Washington University in St. Louis found that 96.5 percent of lung cancer patients in their hospitals had been smokers. Very shortly after the Morris Fishbein left the AMA, he became a high-paid consultant to one of the large tobacco companies, and JAMA finally was able to publish a slew of studies that confirmed the real dangers of tobacco.
"


Here is a link to Stamford University's research on tobacco use in the US, specifically advertising doctors promoting smoking.

I am guessing that you graduated medical school in the late 1960's, but definitely during the Tuskegee syphilis experiment. Then there was the whole Thalidomide disaster. There were also Plutonium injections, the skid row cancer study, and others prior to your graduation from med school.

See a list of medical ethics cases here:

So Maurice, forgive me for asking, but how could you NOT know?


The only possible excuse is that medical school does not teach the entire history of the AMA, just a white-washed version of it.

What does your school teach about the history of the AMA?




-- Banterings




 
At Monday, June 11, 2018 11:05:00 AM, Blogger A. Banterings said...

PT,

I have handled the history portion of the syndicate...



-- Banterings



 
At Monday, June 11, 2018 12:48:00 PM, Blogger A. Banterings said...

The #MeToo movement may make it easier for abusive behavior to be reported. As usual, medicine is thinking of itself first (like don't worry, I have seen it all before...). This time it is providers protecting themselves from providers.

In the MedPage Today article, How Best to Manage Sexual Harassment in Medicine? -Suggested strategies include better institutional policies on reporting without fear of retaliation, the AMA House of Delegates meeting is discussing sexual harassment.

Of course, the AMA has primarily been about protecting their own self interest. They are worried about defectors from within their ranks to the #MeToo movement. What is going to happen is that these policies will make it easier to report patient abusers (like Twana Sparks).


-- Banterings


 
At Monday, June 11, 2018 1:18:00 PM, Blogger NTT said...

Good Afternoon:

Dr. Bernstein, healthcare has lost its way. With civilian oversight, I do believe we can rebuild and have a healthcare system everyone will be proud of.

Way back when, the industry asked the public to allow them to self-govern themselves and the public back then said yes.

When they said yes, times were different. Back then, people knew everybody, you left your front door unlocked, and most of all people cared about one another. Self-governing was easier back then.

As times have changed, other than technologically, healthcare didn’t change with the times.

As a result, they find themselves these days unable to cope with today’s problems.

There’s a “new breed” of person that’s been entering the healthcare field. These people aren’t entering for the same reason they did in the old days.

Today, it’s all about “them”. What can the healthcare system do for and give them, not what do they have to offer the system.

Today, healthcare’s answer to problems is money and binding non-disclosure agreements. Get the problem, perpetrator(s), and victim(s), before any press gets out then, move the perpetrator to a different position within the organization and, payoff the victim(s) and to keep their mouths shut make them sign a binding non-disclosure agreement. Then go about business as usual.

It’s this “we can do as we want attitude” that has to go. Healthcare workers are violating their patients and getting away with it.

The system MUST HAVE transparency. What’s out there now if as far away as you can get from it.

If you violate a patient, regardless of who you are and what title you may hold, you are fired, your license is revoked in all 50 states so you can’t pickup & go somewhere else & start over again and, you face any legal consequences.
Your name is put into a national database where any medical institution can check quickly if you’ve been fired for violating a patient.

Texas has seen the light and has started putting female teachers that violate their male students where they belong. In prison. Just the other day a teacher was sentenced to 6 years in prison, 10 years’ probation, and life-long name on the sex offender list.

Hopefully soon, they will start dealing with healthcare workers that violate their patients in the same manor. The nations judicial system could take a lesson from Texas.

Our healthcare system doesn’t need people like these. There are plenty of people who want to care for the sick and advance the human condition that are waiting in the wings to step in.

The only way to have this level of transparency, is with civilian oversight.

Nobody likes change, especially the healthcare system but if implemented correctly, change can be a good thing.

The needs of the many, outweigh the needs of the few, or the one.

It’s time to let go of the past and together build something we can all be proud of.

Regards,
NTT

 
At Monday, June 11, 2018 2:51:00 PM, Blogger Maurice Bernstein, M.D. said...

NTT, on the other hand, the victim within the medical system is not just the patient but as written about and written about over recent years from residency and beyond is "physician burnout" but even including some medical students too while in medical school. The cause includes "patient expectations" and the physicians' own expectations of their professional responsibilities as well as managers of the medical system in various aspects of the system who are out to keep the "system going" and are not personally on a one to one basis responsible for the outcome of the illness of the patient nor even the outcome of the physician but are responsible for the financial gains.

Is the medical system "higher ups" paying attention and trying to resolve the problem? Read this article of the New England Journal of Medicine "Catalyst" 2016 survey showed
At the time, not much! ..Maurice.

 
At Monday, June 11, 2018 2:53:00 PM, Anonymous Anonymous said...

Too many unnecessary Mri’s And Cat scans amounting to $35 billion annually, it’s actually a lot more than that.

www.cbsnews.com/news/to-many-unnecessary-mris...

A Doctor’s daughter was injured in a car accident. They kept doing cat scan every day on her until he told them to stop.

The problem with the article written in 2009 is this. In 2006 the basic Cat scan costs $3800.00, the most basic MRI costs $5,000.00

It is a know fact that for every 1000 children who receive a Cat scan, 1 will die of cancer, those are the statistics.

Realistic unnecessary medical studies are at $100 billion annually. Where it stops nobody knows.

PT

 
At Monday, June 11, 2018 3:16:00 PM, Anonymous Anonymous said...

How many people check their hospital bill after they have been hospitalized, about 1 in 15,000.

It is on the patient bill of rights, that you have a right to get treatment costs/payments.

But, how accurate is your bill, truth is there are always errors, duplicate charges, charges for
services and supplies you never received, why?

www.nerdwallet.com/blog/health/medical-records..

If you are being charged for say an imaging study, a respiratory treatment or a medicine and there is no Doctors
order for it in the medical records then you are NOT responsible for paying it. Why should you, the insurance
company won’t pay it either.

The fact is hospitals have a very poor system of billing charges, there is no real accountability. Patients are
overcharged and charged for services never rendered.

$4 trillion every year, where it stops nobody knows

PT

 
At Monday, June 11, 2018 3:54:00 PM, Anonymous Anonymous said...

Over the years while posting on this blog I’ve never mentioned any of my skills in health care.

I am for one an expert on billing and coding to name a few. What does the hospital pay for a
Foley bag from the Bard company, $34.00, what does the hospital charge the patient, $200.00

What does the hospital pay for the catheter that goes with the Foley bag, $20.00, what do they
charge the patient, $250.00; thus the patient is charged an average of $450.00 to be Catherized.

Now, Maurice may tell you that there needs to be a physicians order for a patient to be catherized
but that’s not true. You see at many hospitals there is something called NURSES DIRTY LITTLE SECRETS.

Nurses dirty little secrets results from nurses being LAZY. If they give you a urinal to void in then invariably
some urine gets spilled on the bed sheets, which would prompt them to have to change the sheets.

So what they do is have their charge nurse tell the emergency room that patients that are admitted to the
intensive care must all have a urinary catheter. 95% of those patients don’t need a urinary catheter, it’s
just for their convenience.

How much does it cost to treat someone with Mersa, an infection that can result from urinary in dwelling
catheter, what’s a human life worth. What’s a UTI worth, what’s an injured urethra worth? What does a patient
do, should they have to pay all this when there was no order from a physician in the first place. At any given
time there are over 1000 individual items (supply) in the materials SPD of any hospital at any given time.

This is just one example of many many examples that patients are given and or charged for supplies and
services that they never received or authorized to receive in the first place. Many patients are charged for
medications they never received while in the emergency room and are given when there was no physicians
order to begin with.

Patient seen for an ankle injury but was given a breathing treatment with albuterol yet no physicians order for
respiratory breathing issues. The dead can’t check their billing statement, few people realize how many deceased
patients are charged for in hospital services after they have died!

PT

 
At Monday, June 11, 2018 4:13:00 PM, Blogger NTT said...

Good Evening:

Doctor Bernstein yes I agree, physician burnout is a serious problem that cannot be ignored.

Problem is you have bean counters instead of a people's person at the head of the table. Doctors are being asked to do more with less everyday.

Tensions within facilities are getting to the point where colleagues are barking at each other and that in turn cause them to unknowingly take it out on their patient.

Healthcare should be about ways of making the sick better, not the almighty $$$$$.

Regards,
NTT

 
At Monday, June 11, 2018 11:27:00 PM, Blogger BJTNT said...

Thanks to Banterings, PT, NTT et al for stating the issues so well. I know why I discard my drafts. The point is that as a casual observer with limited exposure to the medical community, the same issues that these posters expose are obvious to me. With the unsatisfactory [unacceptable{?}] rate of MD burnout and suicide, you would think that MDs themselves would be demanding transparency, civilian oversight, and experts from outside the medical community evaluate their world. Physicians heal thyself.
BJTNT

 
At Tuesday, June 12, 2018 12:46:00 AM, Anonymous JF said...

Some of why anybody works is to make money and improve our lives and the lives of our families. Nothing is gonna change that and nothing SHOULD change that.
There needs to be a healthy balance though, making improvements for a patients health and not robbing them blind in the process is kinda important to.
I sure not know what the solution would be though. As far as having more male nurses and CNA's, I don't understand why that is such a hardship for medical. A certain number of female staff quit or get fired anyway. Replace them with.male staff.
They want a higher wage? Give it to them, being the patients are overcharged for their services anyway.
I think maybe there wouldn't be any financial loss in the long run anyway as the guys wouldn't put off needed care until the last possible moment then.

 
At Tuesday, June 12, 2018 7:57:00 AM, Blogger Maurice Bernstein, M.D. said...

What do you think has been the effect of the Affordable Care Act (Obamacare) and the recent generation of the presence of HMO and PPO in terms of the behavior or misbehavior of physicians and the others who attend patients reflected back to the individual patient? When more patients must be seen in a more limited time and the payout for each is substantially reduced what happens to patient relationship to provider and the associated provider "unprofessional" behavior that has been amply described here? ..Maurice.

 
At Tuesday, June 12, 2018 12:17:00 PM, Blogger Maurice Bernstein, M.D. said...

Here is an example, already happened TODAY. A pre-publication document released representing a conference sponsored by The National Academies of Sciences, Engineering, Medicine on the topic of "Sexual Harassment of Women, Climate, Culture and Consequences in Academic Sciences, Engineering and Medicine".
Here is the link to that pre-publication, rather extensive document available on the Internet:
https://www.nap.edu/read/24994/chapter/5#58

Perhaps some of my visitors here will have the time to read this current document and return to describe and comment particularly as the concern applies to women in medicine.

After reading the document and knowing what has been written over the years here on this thread, I wondered where is the studies about the sexual harassment of men (both as professional but also patients) in medicine.

Take a few minutes and let us know what you think about this study. ..Maurice.

 
At Tuesday, June 12, 2018 2:29:00 PM, Anonymous Anonymous said...

Maurice

Payment has nothing to do with people’s behavior in the regard you mentioned. With the affordable care act more patients are able to seek out care which for the healthcare industry has been a boom. Each time I’ve made an appointment with the Urology clinic my wait time approached 2 hours, Why, a result of overbooking.

Sexual harrassment of men is not looked upon with any kind of realism or concern and apparently neither are young boys considering the number of female teachers arrested. I will not waste my time reading some article that precludes men in the sad spirit of discrimination.

PT

 
At Wednesday, June 13, 2018 8:58:00 AM, Anonymous Anonymous said...

Hello Dr. Bernstein,

Unlike PT, I wasted my time reading the Sexual Harassment of Women …. Let's hope it dies in pre-publication. Although it purports to be an analysis, it seems more like a meta-analysis (i.e. analyzing previous studies). I've selected excerpts which can only be termed ludicrous (my comments are bracketed):

P 54“… the structure of the academic workplace is still one best suited to men who have a wife at home serving as domestic caretaker full time (Valian 1999; Xie and Shauman 1998 …)[A 20 yr old citation of a 1950's life-style]

Chart P57 Fig. 3-1 Percentage of types of sexual harassment experiences among female university employees. Source: Adapted from Schneider, Swan and Fitzgerald 1997. [Again, a 20 yr old citation]

P 60 Figure 3-2 Faculty/Staff-on-student sexual harassment incidence rates for female student by type/level of sexual harassment (Penn State University System). Categories: Sexist Hostility, Crude Behavior, Unwanted Sexual Attention, sexual Coercion [This is undated and the categories are so vague as to be meaningless. Additionally, one wonders whether Jerry Sandusky was included in this Penn State study]

There is no rigor here. Has your experience in academia been anything similar to what is described in this chapter?

Reginald

 
At Wednesday, June 13, 2018 10:37:00 AM, Blogger Maurice Bernstein, M.D. said...

Reginald, where have you been within the past year to miss the horrible sexual harassment and more in the University of Southern California where I teach?-- a dean of the medical school fired, a followup dean of the medical scho ol fired both within 2017, a male gynecologist at Student Health fired in the past year...all for sexual misbehavior of or with students of various degrees and finally the President of the University out for gross administrative misbehavior in handling these cases.

With regard to clinical residency positions at Los Angeles County-University of Southern California School of Medicine:
"Sexual Harassment and Exploitation Policies Sexual harassment is an illegal and prohibited behavior. It is a violation of the Federal Civil Rights Act of 1964, Title VII, as well as Los Angeles County Department of Health Services and Medical Center policies. The Medical Center also strictly prohibits unlawful harassment because of race, religious creed, color, national origin, ancestry, physical handicap, medical condition, marital status, sex or age. Actions by any County employee that are in violation of these policies shall be subject to immediate and appropriate disciplinary action (up to and including discharge). Detailed procedures for residents who feel that they have been harassed or sexually harassed are available through the Medical Director or Chief Medical Officer’s Office or the Office of Human Resources."

I am not aware of sexual harassment practices of either gender with regard to the admission to education in any of the medical service programs at our University nor hiring or advancements of faculty members.

Medical students are given documents regarding the issue of sexual harassment and options for reporting. Medical student verbal sexual harassment by patients are rarely reported, in my experience but, of course, sometimes patients refuse a student interview and physical based on gender.

..Maurice.
"

 
At Wednesday, June 13, 2018 11:28:00 AM, Anonymous Anonymous said...

Hello again Dr. Bernstein,

My reading of the USC situation is "Dr. George Tyndall, a former gynecologist at the school's student health center, ... complaints of sexual harassment during pelvic exams." The article you referenced was relative to harassment of women in the academic, medical WORKPLACE; or, did I misinterpret the essence of the article.


Reginald

 
At Wednesday, June 13, 2018 12:00:00 PM, Blogger Maurice Bernstein, M.D. said...

Reginald, you are correct, however with regard to professionals as victims within the system, it was the firing of Dr. Rohit Varma who was first only disciplined in 2003 following allegations that he sexually harassed the young researcher while he was a junior professor supervising her work. He was then more recently chosen but then fired as Dean. ..Maurice.

 
At Wednesday, June 13, 2018 2:58:00 PM, Anonymous Medical Patient Modesty said...

I wanted to encourage everyone to take time to look at updated and new articles about male patient modesty on Medical Patient Modesty’s web site below:

Male Patient Modesty (I used some of Biker in The Vermont’s article for this article) - Make sure you look at the sample petition you could download to possibly start a petition in your community encouraging the local urology practice to hire more male nurses or assistants.

Tips For Modest Male Patients

What do you think about the tips for modest male patients? Do you see any tips that I might have missed that I could add?

Misty

 
At Thursday, June 14, 2018 8:20:00 AM, Blogger A. Banterings said...

Maurice,

In regards to what has happened at your institution:

...don't worry, you don't have anything I haven't seen before AND this is the way we have always done things...



-- Banterings



 
At Thursday, June 14, 2018 9:12:00 AM, Blogger NTT said...

Good Afternoon:

All the incidents mentioned in this blog along with the Denver 5, Pittsburgh, the Michigan doctor, and the recent Baylor heart transplant unit that is in the news are all just further factual evidence that the healthcare system is no longer equipped to self-rule and regulators along with the general public need to step up and help even though the medical community won’t ask for it.

The American public needs to open its eyes before more people are needlessly hurt. Greed and mis-management are putting all our lives at risk.

Profits before peoples lives, has to end.

I don’t pretend to know or have all the answers but I know a couple of things.

Only with the open exchange of ideas and suggestions between government regulators, the medical community, and the general public will we be able to weed out the greedy sob’s and perverts that have ruined our system which in turn, will allow us to rebuild a world-class system.

You can’t build a system without contributions from all three sides. Everybody has to come to the table with an open mind or don’t come.

Protections will need to be put in place for those people in the industry that speak up about wrong doing in the workplace.

People must not be afraid of any type of retaliation or loss of wages for speaking up against wrong doings by colleagues. It’s those wrongdoers who are ruining the system for everybody that we want to get rid of and the best way to do it is have colleagues report them.

Without that fear the workplace with become a safer environment for workers and patients.

So, the only question left is how long is it going to take for people to see, self-rule is no longer viable or acceptable for our healthcare system?

I for one want a system nobody has to fear going to for medical help.

Am I just a dreamer? Or are we as a people strong enough to put aside our differences and come together to weed out the greedy sob’s and perverts and have a healthcare system that’s the envy of the world.

Regards,
NTT

 
At Thursday, June 14, 2018 4:41:00 PM, Anonymous Anonymous said...

A. Banterings

That’s priceless!


PT

 
At Thursday, June 14, 2018 7:51:00 PM, Anonymous Anonymous said...

An article in today’s NY Times, “When the Bully is a Doctor” reflects on the bullying that occurs in the chain of command in Medicine. The physician author recounts how he was bullied as a medical student by residents and attendings. This used to be very common in medical training of physicians. Many of my family members, that are physicians, experienced this decades ago in their training. It was very prevalent and very nasty. Which brings us to the question - if the system is permeated with bullying from when you first enter it, you quickly learn that COMPASSION and concern for the patient is not high on the list of desirable qualities to work in medicine. That cannot help but be reflected later in how patients are treated or rather mistreated.

Then fold in the fact that now in outpatient arenas its all about maximum volume and patient throughput. Minimum time is to be spent on each patient. Move them through. Its a factory, there is at best a minimal consideration of compassion/dignity towards the patient (“politeness” is substituted instead). It must be minimal because the scheduling and financial demands it in todays overbooked medicine.

Medicine has responded by creating tailored, “pleasing” environments for the patients that is meant to supplant compassion and dignity. Give them an attractive place to visit for their care. Well, at least they’ve done that for the female patients who have at most medical centers at least a half dozen specific women’s clinics to address their medical needs (with feminine decor, all female staffing, robes, etc.) Nothing for the male patients - just move them through - bully if necessary - keep them moving.

Turning to hospital inpatient areas everyone is assigned a work load that is maximum, otherwise expenses are not optimized, the labor expense is unnecessarily high. So we are back to the situation where just managing the mandated work load necessitates forgoing much in the way of compassion or dignity for the patient. Compassion and dignity for the patient, especially for male patients, always fall to the bottom of the list of competing priorities minute to minute, hour to hour, day to day.

Given how the system has evolved I don’t see compassion/dignity per se making a come back in medicine in the near future. On the other hand, so many of the jobs, including nursing, technologists, & physicians have become more technical and so much more demanding the old crap about women are needed because of “caring and nurturing” is obsolete. Males can perform these duties as well, perhaps in some cases better, than females and really should consider many of these jobs. They pay better than jobs a large portion of men work in now, and they are technical and demanding jobs (with little requirement for compassion, caring). Perhaps this will ultimately lead to a much higher representation in medicine by men.

One final note. The urology department I’ve gone to for several years at a large medical center now has 3 male Medical Assistants out of the 7 total. Progress, slow, and still many issues, but progress. - AB in NW

 
At Friday, June 15, 2018 12:53:00 PM, Anonymous Medical Patient Modesty said...

I wanted to encourage everyone here to read a new article, How Urologists Can Be More Sensitive to Men's Modesty?.

I would love for you all to consider printing this article and give it to urologists in your community.

I am going to see if I can get some urology publications / magazines to print this. I feel that every male urologist should read this article.

Dr. Bernstein: If you work with some urologists, can you please share this article with them?

Misty

 
At Friday, June 15, 2018 7:06:00 PM, Anonymous Anonymous said...

Doctor patient confidentiality dosen’t exist anymore, I think back in the day it did more so than now, what happened? You should always be able to meet with your provider in private. Are there people (observers) when you meet with your attorney? No, of course not. Your meeting, consultation, whatever you want to call it with your physician should be private, no scribes, nurses etc should not generally be present. The same scenario applies when the surgeon comes to visit you in your hospital room or the hospitalist for that matter. You have a right to Doctor patient confidentiality and it states so in the patient bill of rights.

Can you visualize people standing around as you speak to the psychiatrist or psychologist, optometrist, ophthalmologist? I can’t. So why does it happen these days in general medicine? Why does there need to be such audience? Do providers just feel that they need an audience, three is a crowd kind of mentality? Attorneys have scribes too, they are called paralegals, secretaries, legal researchers but they don’t just stand there in the room while you are in a Private Consultation with the attorney, they have better things to do. One would think the emergency room nurses or the floor nurses have other patients and better things to do, not just barge in and stand there while you speak with the provider. This has happened to me a number of times and I just don’t tolerate it anymore. It’s an invasion of your privacy so what I do is simply state, “ I’m meeting with my provider, therefore privacy is an expectation. “ Then using your right hand in a fluttering motion to shoo away. They get the point.

PT

 
At Saturday, June 16, 2018 2:42:00 PM, Blogger Maurice Bernstein, M.D. said...

With regard to institutional admission consent forms, a knowlegable ethicist writing to an ethics listserv to which I subscribe wrote:

"For the record, in the Veterans Health Administration (VHA) health care system general consent for admission (or any type of blanket consent) is not required, recognized, or used.

Since general/blanket consents don’t satisfy even the most basic ethical frameworks of informed consent we do not find them to be practically useful or ethically justifiable (i.e., they do not reflect an informed discussion/dialog about current/foreseeable circumstances followed by a voluntary choice from a patient with capacity (or an authorized surrogate)).

If it is true that those "informed consent" forms on admission are not a document accepted by the government Veteran's Administration, a service paid for by all who pay taxes in the United States, shouldn't non-governmental institutions follow suit? ..Maurice.

 
At Saturday, June 16, 2018 4:44:00 PM, Blogger Biker in Vermont said...

I’m surprised that the typical general consent form hasn’t been challenged in court and found to be unenforceable given it does not even remotely prove informed consent. This is especially so when combined with the practice of shoving them in front of surgery patients in pre-op after their glasses have been taken away, and with nurses telling the patient “this just allows us to bill your insurance”. I’ve made them give me back my glasses and wait until I’ve read the whole thing. I don’t care if they get irritated (and they sometimes do).
Something very similar are the pre-written visit summary docs we get. They include lots of boiler plate language saying what was explained to us, much of which never occurred. Standard pre-written language also includes that the patient was properly draped, that the patient tolerated the procedure well etc.
I attribute this stuff to the lawyers, not the doctors. The doctors and nurses are just following procedures dictated from above. What is on the doctors and nurses is their choosing to make believe being polite is synonymous with providing respectful and dignified care.

 
At Saturday, June 16, 2018 6:21:00 PM, Blogger Maurice Bernstein, M.D. said...

Tomorrow, June 17, 2018 is "Father's Day", as celebrated in the United States. Despite all the disregard for the needs and attention to the modesty and dignity issues of the male gender described on this blog thread, there seems to be one male property that is worthy of courtesy, attention and celebration: being a father! I am one. Are you? ..Maurice.

 
At Saturday, June 16, 2018 7:44:00 PM, Anonymous Anonymous said...

Maurice

There might have been more Father’s added to the celebratory list if not for spoon toting female nurses intent on wrecking inane physiological responses of male patients.


PT

 
At Sunday, June 17, 2018 4:40:00 PM, Blogger Biker in Vermont said...

I’m a father and grandfather and had a very nice day. Maybe we would all be better off if female medical staff stopped to think how would they like their father treated when he is a patient, and then did the same for their male patients.

 
At Monday, June 18, 2018 9:36:00 AM, Blogger A. Banterings said...


In the latest round of compassionate doctoring: ER doctor suspended for mocking black patient suffering anxiety attack: 'You people come here for drugs'

Note that in the article the father states:

"She never first came in and introduced herself," he explained. "She never said her name, she never asked for his name, she never really examined him."


Pretty much what the status quo...



-- Banterings


 
At Monday, June 18, 2018 4:02:00 PM, Anonymous Anonymous said...

I’m not playing the devils advocate here, the physician is most likely frustrated and burned out. She should have had her corporate game face on but truthfully the emergency rooms these days are filled with drug seekers. Anxiety is at an all time high, the phrase manic-Hispanic is a used even by hispanic physicians to describe the Latina patient’s who abuse the emergency rooms for panic attacks. I have seen patients use an ambulance ride to the hospital just to get up from the bed and say “ well thanks for the ride, I just live next door”.

The stress levels that exists among staff in emergency rooms is stratospheric, there is just an insane amount of abuse that exists, patient’s abusing the emergency room services. Furthermore, this patient went to the er at 3am which if possible you as a patient want to avoid going to the emergency room from 6pm to 730 am. Why? Night shift nursing staff at any hospital are miserable, hate their jobs more than day shift nurses. Problems exist on both sides of the coin regarding patients and the hospital staff.

Personally, I think the care in emergency rooms would improve if patients stopped abusing the emergency services. Unless you’ve worked in an emergency room for any period of time you just cannot understand how ridiculous it can become for hospital staff. On the other hand there is much that can be done to improve the care and respect that is delivered to patients. My opinion on the video, the patient was a drug seeker, flat out. The family member that was with him, an enabler. The physician was rude, unprofessional, frustrated and burned out. I’ve seen this very scenario played out thousands of times.

PT

 
At Monday, June 18, 2018 4:50:00 PM, Blogger NTT said...

Good Evening:

Late this afternoon, the ER doctor Banterings wrote about has been fired by the hospital.

Regards,
NTT

 
At Tuesday, June 19, 2018 10:24:00 AM, Blogger A. Banterings said...

PT,

I agree with you about the ERs/EDs. I personally take the approach of Monty Python: "its just a flesh wound...".

I get it, the ER/ED is a rough place. They have implemented triage to make things easier. Here is the problem, whether or not people are legitimately injured or just drug seekers, EVERY human being deserves to be treated with respect and dignity. Human Rights (Human Dignity) are ABSOLUTE! There is absolutely no excuse not to treat a fellow human being without respect and dignity.

Once healthcare commits that infraction, then the entire system becomes suspect. (One lie is enough to question all truths.) I did not watch the entire video with undivided attention, so I really cannot comment on the credibility of the patient.

Just as there are patients that game/abuse the system, so to are providers that game/abuse the system. The only problem is that when the providers game/abuse the system, people can get hurt bad.

See:
Watered down chemo drugs given to 1,200 cancer patients
Drug-Diluting Pharmacist Gets 30 Years
Medical College of Wisconsin knew doctor was accused of performing unnecessary surgery
Doctor convicted in Medicare 'greed' fraud blames Obamacare

2 wrongs do NOT make a right.

If I am a patient coming to the ED, I do NOT care that you are burned out, that your last 3 patients were drug seekers, or what kind of day that you are having. If I am seeking compassionate, competent healthcare delivered with respect and dignity, I better damn well get that.

If you cannot deliver that, then you do NOT belong in that job.

Go find meaningful employment elsewhere.

I am so sick of this attitude in society where things do not need to be good, just good enough.



-- Banterings




 
At Tuesday, June 19, 2018 11:30:00 AM, Blogger Maurice Bernstein, M.D. said...

I do not intend to defend the medical caregivers but I just want to emphasize that regardless of the years of medical training and medical or surgical or nursing expertise they learned in preparation, they are still human beings potentially as frail a human as their patients.

No patients should look at their physician, nurse or tech as some "God" because in reality they are not gods. Yes, they may be in some respects "learned" compared to their patients but in some respects they are "ignorant" relative to the knowledge and judgment of the patients which they attend. It is when these professionals look at themselves as some creature superior to the patient they are attending then the professionals' behavior may become "unhelpful", inappropriate or worse (as documented by our Commentators here.)

We are paying our medical professionals for their technical skills and knowledge but otherwise they are just as "human" as their patients. "Professionalism" is something that others write or speak about but in any doctor-patient relationship the behavior of the "professional" is set at the time by the individual professional and how he or she reacts. All patients should enter the relationship with that in mind. With this viwepoint in mind is why I, despite being a physician, am all in favor of patients understanding what I wrote above and their need, as necessary, to "speak up". ..Maurice.

 
At Tuesday, June 19, 2018 1:06:00 PM, Blogger A. Banterings said...

Maurice,

If you read the AMA's Journal of Ethics's Professionalism and Medicine's Social Contract with Society, being a frail human is not acceptable within the profession. Is that not why the Flexner Report of 1910 called for the standardization of medical education?

...or was it to sell their seal of approval?

What about accountability? What does that doctor owe that patient?

The whole concept of medical ethics, compassion (in healthcare), and respect of patient dignity is fluff and window dressing designed to protect medicine's wish to have a monopoly.

Here is just another example, the AMA Code of Medical Ethics is only available to AMA members that pay for it.

I can understand paying for the printing, but the code should be available to the public.

The "Hippocratic" Oath is appropriately named.



-- Banterings



 
At Tuesday, June 19, 2018 2:32:00 PM, Anonymous Anonymous said...

The patient said, “ I cannot move, I cannot sit-up.” But what is simply miraculous is once they get their pills, they just fly out of that Er. It’s nothing short of a miracle. Now, I don’t know what tests his physician ordered and I don’t know if he had insurance. But I know that if some providers or perhaps a pa( physician actor) would have ordered a brain ct given the possibility of a stroke. The patient said he could not move, now did he fall? It would be prudent to request a thoracic and lumbar ct and perhaps an MRI 24 hours later to truly evaluate for ischemic stroke, this is after he has been admitted to the floor and of course a full battery of lab tests. So where are we on the cost of these tests after a perhaps one night stay. We have surpassed the $30,000 mark easily. Without health insurance hospitals legally go after patients for years, garnishing wages, going after any property the patient has.

Now if there were a blog for me to rag on people who abuse medical services, believe me I’d be on it night and day. You see in part we the consumer, responsible consumers who pay for health insurance are penalized in part for those who don’t have insurance, who abuse the health care system. Many of these patients like to assault health care workers, which in part that is why due to the frequency of occurrence that it’s a felony. Now as I’ve said, I believe the physician was rude and unprofessional yes, was she burned out and frustrated with patients like this, yes. Do I think that if people would stop abusing the emergency room that it would improve care for everyone who truly needs the services of the er, absolutely.

Emergency rooms are required for their patients to be seen in 30 minutes or less wether it’s an emergency or not. I’ve seen patients come to the er just to get a script refilled from a provider they got in another STATE! My comments are not about privacy but rather selfish people abusing a valuable medical service. As I’ve said you will never understand nor appreciate this concept unless you’ve actually worked at an inner city trauma center. You have severe abdominal pain, you have a triple AAA, sorry the nurses and everyone are bogged down cause 3 gangbangers had a shootout at the local liquor store down the street.

PT

 
At Tuesday, June 19, 2018 3:03:00 PM, Anonymous Anonymous said...

My next number of comments on this blog may better explain WHY sometimes we are not given the privacy and respectful care that we are paying for. In my opinion, this is my opinion that 60% of all emergency room visits are unnecessary. The other point I’ll make is that typically only 15-25% of all emergency room patients are insured. Furthermore, in my opinion 25-40% of all emergency room patients are drug seekers.

Would we need scribes in the emergency rooms if not for these unnecessary influx of patients? This is after all where scribes originated from was to help physicians meet that 30 minute mark once you walk through that emergency room door. Emergency rooms have a fixed number of nurses, physicians, techs and secretary. There are a fixed number of er registration staff as well. This is just one of many many examples I can state as to why your privacy is not regarded because of patients abusing medical services.

PT

 
At Tuesday, June 19, 2018 6:34:00 PM, Blogger Maurice Bernstein, M.D. said...

Now.. our visitors from Canada and England existing in a different medical economic environment than those of us in the United States, please enter the current discussion here and tell us about your country's healthcare provider's behavior and whether all the "bads" described here exist there. ..Maurice.

 
At Wednesday, June 20, 2018 9:03:00 AM, Blogger A. Banterings said...

PT,

You state that "...in my opinion 25-40% of all emergency room patients are drug seekers."

I think in reality it is much higher than that. After all, drugs bring relief and is that not what people are seeking?

So how many are addicted and looking for their next "fix"?
How many are in real pain, agony, anxiety, and looking for relief?

The conundrum that healthcare faces is how many legitimate patients get hurt trying to weed out the illegitimate patients?

I am sure that PT and others here who have spent time in an ED can attest to this technique used; they tell the patient that they need to perform a painful and/or embarrassing before they can prescribe, just to rule "something " out. It may be a urinary catheterization, rectal exam, etc.

The thinking is that someone in true pain would consent to such a procedure, but one seeking (recreational) drugs would not.

It is actually the opposite that is true. An addict will do ANYTHING to get their "fix." Some years ago I heard of a fraternity that would hire drug addicted prostitutes as entertainment. Because of their wealth and privilege, and the fact that so many people pooled their money, the payoff was very lucrative for the prostitute. Essentially they wanted to see what limits such a person has.

Again, for those who have worked in EDs, especially urban locations, you know that these people (pretty much) have have no limits when seeking a "fix." This is illustrated in the White House Office of National Drug Control Policy (ONDCP) newest ad campaign, formally called "The Truth About Opioids" (see videos here).

There was also a website that exploited the homeless (addicted) called bumfight.com which started out by having homeless people fight or do (dangerous) stunts for (as little as) $10, a pack of cigarettes, and a fifth of whiskey.

While such things are morally reprehensible, they still are no excuse to justify behavior by any medical provider or their staff that disrespect ANY person's human dignity.

Forgive me PT, I totally understand the anger and frustration that these people bring, but your position seems to justify bad behavior by providers.


-- Banterings






 
At Wednesday, June 20, 2018 2:03:00 PM, Anonymous Anonymous said...

A. Banterings

There are always 2 sides to every story. I’m not going to spend too much time on this discussion as I’d have to deviate away from this modesty issue, however, when I say “ drug seekers “ I mean just that. People who have no real illness or pain but are seeking narcotics to satisfy an addiction. One of the modis operandi of drug seekers is to claim pain or a recent injury and typically that is their chief complaint.

Now, once an IV is started some form of pain relief is administered or it may be given po( by mouth). To appropriately evaluate if there is an injury or perhaps a disease process some form of an imaging test needs to be performed along with lab work. Once these patients get their pain relief they have skipped out, left as in AMA( against medical advice) before any lab results come back or before an imaging test is done. Actually as the nurse is charting that the medication was given the patient is headed for the door.

Now these patients may do this all day and night, going from one hospital er to another. I was once given a glimpse of a room in the hospital er registration that had pictures of patients ( drivers license) advising that these patients are known drug seekers who go from facility to facility. There were soo many that lasts months had to be removed to make way for the new ones.After 40 years I’ve seen enough to know the general statistics and it’s not a problem with just emergency rooms, it’s physician offices as well. They too face the challenge of drug seekers and I might add that physicians frequently have their license revoked for over medicating patients who are drug seekers.

Regarding the video, if you read the article it was mentioned that security was called to the patient’s room. This is usually not a good sign for it’s usually a problem with a family member in a threatening manner or the patient themselves being aggressive. Think about this for a moment as to why it’s a felony to assault a healthcare worker in any regarding why that legislation came about, btw this is the case in every state. It’s not a felony if you walk up to a random stranger and punch them or slap them. The legislation came about due this frequency of occurrence, patients get mad when that can’t get their fix, meth users, drug users. What do you think the percentage of patients who come into the er for overdose?

Hospitals have codes announced overhead for a patient or a visitor with a gun, code silver, or a combative patient or visitor, code grey. Take a guess how many times you hear that announced overhead in an inner city hospital? Back in the day your typical drug user, meth user would flood mostly hospitals in the lower socioeconomic neighborhoods. Not any more, they are frequently prevalent at even the most prestigious facilities in very high end neighborhoods.

PT

 
At Thursday, June 21, 2018 4:50:00 AM, Blogger Biker in Vermont said...

My guess is that the drug seekers are hitting every ER. Rural communities are also plagued by drugs. No gangs or shoot 'em ups but plenty of drug abuse nonetheless. I don't recall the exact words as its been two years since I was there but our local hospital's ER has a sign near the entrance about this. My guess is it is intended to tell the druggies that they are aware of the situation and are on the watch for them.

The doctor in the video may have just been burnt out enough from dealing with druggies to have forgotten all semblance of professional bedside manner. Or maybe she just doesn't have any and that was normal behavior for her.

Regardless, with millions of doctors, nurses, and other healthcare staff out there, it is never going to be hard to find bad apples amongst them. The societal problem is that the medical and nursing boards seem loath to do much about them. Coming back to the general topic of modesty, if medical and nursing boards look the other way at what the general public would deem unprofessional behavior, there is little chance they will do anything with modesty-based complaints, especially from men. Even with civilian oversight, not much will happen if the average person does not think men are entitled to the same level of dignity afforded women.

Something I wonder about are two conflicting trends. Young men today have been raised to be shy around other men. They have not grown up with mandatory gang showers or swimming in the buff with other boys, or even sharing bathrooms with brothers. One would think they might be quite demanding for privacy in medical settings. You can see the shyness in locker rooms where they are loath to dress in front of other men let alone shower with them. One can only imagine their level of shyness with women in medical settings.

Conflicting with that is the political correctness they have been raised with in which they likely fear women judging them sexist if they request same-gender staff for intimate matters.

 
At Thursday, June 21, 2018 1:47:00 PM, Blogger A. Banterings said...

Maurice,

Here is more of medicine being more concerned about economic matters than patients. See:AMA: CVS-Aetna Merger Should Be Blocked

AMA says: After very careful consideration over the past months, the AMA has come to the conclusion that this merger would likely substantially lessen competition in many health care markets, to the detriment of patients...

AMA means: More due paying members (physicians) will lose their jobs.



-- Banterings

 
At Friday, June 22, 2018 6:55:00 PM, Blogger Maurice Bernstein, M.D. said...

After many Volumes on "Patient Modesty", is the "modesty" still confined to issues of physical modesty and sexual misbehavior within the medical system but only of actions and not isolated to only words? If also words, should the goal of the words be for illness prevention or to establish a diagnosis and not to initiate some sexual misbehavior by that the inquisitor?

I got into this question as I read published document on which I am tested in order to obtain Continuing Medical Education credit for my renewal of my California medical license.

Here are some of the questions physicians are reminded to ask their patients as the history is taken: The "Five Ps":

Partners:
• “Do you have sex with men, women, or both?”
• “In the past two months, how many partners
have you had sex with?”
• “In the past 12 months, how many partners
have you had sex with?”
• “Is it possible that any of your sex partners in the
past 12 months had sex with someone else while
they were still in a sexual relationship with you?”

Practices:
• “To understand your risks for STIs, I need to
understand the kind of sex you have had recently.”
• “Have you had oral sex, meaning ‘mouth
on penis/vagina’ sex?”
• “Have you had vaginal sex, meaning
‘penis in vagina’ sex?”
• “Have you had anal sex, meaning
‘penis in rectum/anus’ sex?”
• If yes to any of the questions above, “Do you
use condoms: never, sometimes, or always?”
– If “never”: “Why don’t you use condoms?”
– If “sometimes”: “In what situations
(or with whom) do you use condoms?”

Prevention of Pregnancy:
• “What are you doing to prevent pregnancy?”

Prevention of Sexual Transmitted Infections (STI):
• “What do you do to protect yourself from
STIs and HIV?”

Past History of STI:
• “Have you ever had an STI?”
• “Have any of your partners had an STI?”
• Additional questions to identify HIV and
viral hepatitis risk include:
– “Have you or any of your partners ever injected
drugs?”
– “Have you or any of your partners exchanged
money or drugs for sex?”
– “Is there anything else about your sexual
practices that I need to know about?”

So clarify the "modesty": It's all about actions and not clinically useful words. Right? ..Maurice.



 
At Friday, June 22, 2018 7:12:00 PM, Blogger Maurice Bernstein, M.D. said...

Continuing on: If the initial history taking by your physician included any of the preceding questions would you simply reject to respond or argue with the doctor regarding why you are being asked these questions?

Does "patient modesty" in your opinion involve history taking? What would be your response to a physician who included the questions relating specifically to sexual history and behavior?

I just wanted with these postings to clarify exactly what "Patient Modesty" issues we are trying to resolve. ..Maurice.

 
At Friday, June 22, 2018 7:59:00 PM, Anonymous Anonymous said...

Those five P’s will be asked of you in the waiting room of the physicians office lobby by the secretary or by the physician in front of his/her scribe. Coming soon to a physician office or emergency room near you.

PT

 
At Friday, June 22, 2018 8:46:00 PM, Blogger Maurice Bernstein, M.D. said...

The views of my visitors regarding the "5 Ps" has some practical value to me in my role of a first year medical school instructor.
"Sexual History" is an integral part of the "Personal History" component of the "Past History" and all students are instructed to include the sexual history in their writeup of the patient's history for me to review and provide constructive comments. As I said it is a required component. Well, occasionally the student writes that the patient refused to answer this section of the Personal History. (Although there is always the possibility that the student was "shy" to ask with their first patients.)

If the history taking by the physician was within a privacy environment and if the physician did ask you some component of those "P5" questions, would you consider this appropriate part of a general medical history and, for this, divest yourself of any "modesty" concerns? Our school and I am sure all other schools teach this part of a complete medical history is an important professional component. But what do you think? ..Maurice.

 
At Saturday, June 23, 2018 4:43:00 AM, Blogger Biker in Vermont said...

Dr. Bernstein, I accept that the sexual history can be important for physicians to fully understand the patient they are treating, and perhaps help with a diagnosis or plan of action. However if the reason the patient is seeking medical care has nothing to do with their sexual history, say a broken arm, the physician needs to use some common sense and not be asking sexual questions.

If the patient is there for a suspected STI then the patient is going to understand why the questions are being asked. If the reason for asking the questions is not self evident to the patient, the physician needs to explain why the questions are pertinent.

All that said, I suspect the trend is going to be patients being less willing to fully divulge this info as they come to realize the days of confidentiality between patient and doctor are long gone. Even without a scribe in the room, if the info is going into the electronic record, everyone in that practice and any other part of that health system has access to it. This concern with confidentiality is especially so in rural and small town areas where it is all but impossible to be anonymous. For this reason I suspect more than a few patients lie to their doctor when asked these questions. Maybe they trust their doctor, but not necessarily everyone that works for him and elsewhere in that system. One nosy staff member can do a lot of damage.

That last point about confidentiality relates to the recent discussion about medical and nursing boards tending to look the other way on bad behavior. That breeds distrust of the system. Similarly if hospitals and medical practices look the other way "because the patient can't hear it" when staff gossip about patients in salacious or otherwise inappropriate ways, it breeds distrust that their sexual history would be kept confidential.

Living in a rural/small town area perhaps I see these things differently than do urban folks. For example, last year when I had a billing problem with the small local hospital, a friend told me to just call his daughter who works there. When I saw an NP for something I learned she lives on the other side of the mountain from me, and of course she knew exactly which property was mine. I sit on a Board with my former PCP's mother-in-law. Someone I bump into when going for walks is an OR nurse at the hospital. The anesthesiologist lives up the road. The cardiologist used to live in my house and now lives just a mile or so down the valley. A woman who comes to parties a mutual friend has is an LNA at the hospital, and she is downright creepy. I feel like she undresses me with her eyes, and I'm supposed to trust her if I were a patient there? It doesn't take much to directly or indirectly connect with someone in rural/small town areas. It makes for a great quality of life in most regards, but you can't forget the ease of those connections includes when seeking medical care.

An example of the above was some years ago I carelessly cut a finger badly and had to go to the ER. I was very embarrassed over my stupidity and tried keeping my bandaged up hand hidden at work the next day. I wasn't planning on telling anyone how it happened. I did not see anyone I knew at the ER, yet the next day at work, a friend knew exactly what had happened. Someone working in the ER apparently connected me to his/her friend and divulged my injury to him.

 
At Saturday, June 23, 2018 6:40:00 AM, Blogger Maurice Bernstein, M.D. said...

Biker, I fully understand your arguments, especially concern about small community loss of privacy, however, as physicians we are trained to keep an "open mind" regarding the etiology of a patient with physical trauma (fractured arm lacerated finger) in look for "sexual abuse" as well as "elder abuse" when presented with physical trauma where the etiology of which is a bit ambiguous. ..Maurice.

 
At Saturday, June 23, 2018 8:37:00 AM, Blogger Biker in Vermont said...

DR. Bernstein, I'm not questioning doctor's being able to keep an open mind on sexual history matters. The issue is whether the doctor can somehow guarantee that the info will be kept confidential. If it goes into the electronic records then all of the staff throughout the system have access to it and all it takes is one nosy person wanting to know what so and so went to the urologist for.

 
At Saturday, June 23, 2018 10:25:00 AM, Blogger Maurice Bernstein, M.D. said...

Well, Biker, in the United States there is HIPAA and it's violation and penalty as exemplified in the case of UCLA hospitals a decade ago.

By the way, the medical students I teach as well as myself specifically inform the patients who are volunteering to participate that what the students write about them (identified solely by initials) is only for me to read and comment upon and that no one else has access. ..Maurice.

 
At Saturday, June 23, 2018 12:18:00 PM, Blogger BJTNT said...

Biker - Keeping patient records secure is possible only if the culture is there. With the previous system of paper files, a "medical assistant" placed the file in the box outside the exam room for the MD. In other words, everyone in the office had access to patient records. Nowadays, electronic medical records could be password protected with totally limited access if anyone was interested. Who in the medical community is interested in protecting these records? Lots of marketing and propaganda, but only token enforcement protecting patient privacy. Until the medical community changes the culture, it's all lip service.

Dr. B. - It's all good talk in medical training. Where's the walk out on the job? It's the culture.

The medical community is not alone in disrespecting privacy. The medical community is mucking in the depths with politicians in that classification means nothing to politicians and their staff if disclosure promotes their political agenda.

It's the culture, it's the culture.

BJTNT

 
At Saturday, June 23, 2018 3:12:00 PM, Anonymous Anonymous said...

These 5 P’s, is it really a need to know. How will it benefit the patient if their chief complaint is not related to these potential medical issues. If stating your sexual preference going to improve your medical care or will it open up a CAN of bias towards you. If I state that yes, I’ve had 22 sexual partners in the last 6 months will that change the medical viewpoint as to how medical staff view me. After all the healthcare industry is without doubt the most judge mental industry out there. Many years ago I have seen male patients who were diagnosed with AIDS treated poorly.

Electronic medical records are for everyone to see, I will be considered a sleeze when medical staff see that I’ve had 22 sexual partners in the last 6 months. Would that mean the patients have to disclose all the partners names that patients have slept with. Would female patients have to disclose that they work as prostitutes and if so what’s the reaction of medical staff to them. Will physicians have to disclose to law enforcement when female patients state that they have exchanged sex for drugs. There is no such thing as privacy when it comes to medical records wether 2ritten or electronic.

PT

 
At Saturday, June 23, 2018 5:24:00 PM, Blogger Biker in Vermont said...

The question with HIPAA is what % of violations result in any kind of meaningful penalty. How often are violators fired and reported to the licensing bureaus vs just told to knock it off vs nothing being said at all?

Does the medical world even view as a HIPAA violation a nurse telling her co-workers to make sure they take a turn checking the catheter on the guy in Room 330? She is passing on info about a patient that the other staff didn't need to know. Or perhaps her just telling her co-workers certain things about that good looking patient in Room 330?

Bringing this back to Dr. Bernstein's question, yes there are good reasons for doctors to ask sexual health questions and they should, but patients have good reasons (confidentiality) to not always answer them honestly. Too many people have access to patient records that they don't need access to. Also, medical settings are far too casual with patient physical privacy, and I include in that staff defacto being allowed to talk about patient intimate matters amongst themselves. Medicine needs to take patient confidentiality and privacy more seriously if they want to elicit total trust on the part of the patients. BJTNT is right, it is a culture issue.

 
At Sunday, June 24, 2018 7:00:00 AM, Blogger Dany said...

Good day all,

I must say I am quite surprised by the extensiveness of the questions a patient would be asked regarding their sexual health history. I can honestly say this never happened to me. To be fair, my health needs since I enrolled in the CAF have been provided by the military (CFHS). It could be that out in "civy" street, they do things that way. I'd have to ask my relatives to know for sure.

Recalling my last Periodic Health Assessment (which is the closest to what many would call a yearly check up except it's not happening every year), the process is not as exhaustive. I have mentioned this before but I'll briefly summarize it again.

In the CAF, PHAs are done in two parts. Part I includes a medical history form, any lab works required, the taking of vitals (including weighing and measuring), a basic hearing and vision test, that sort of things. Part II usually happens a week or so after, and this is where you meet with a doctor (or PA) and they then go over the lab results, findings, etc. And they do a physical examination.

The medical history form is about 8 or 9 pages long. The section that touch on sexual/reproductive health is near the end and has 2 questions (yes, really). One asks about any suspected STI symptoms (yes/no/specify) and the other ask if you have any sexual health concern you wish to discuss with your physician (again, yes/no/specify).

By answering no to both, you're pretty much guarantying this topic will not come up when you meet with your physician. That has been my experience in recent years. Now, prior to that, I had a few physicians asking specifically about sexual health during the physical examination but it was not in any great detail. I think it was more an attempt at confirming that I did not have any concerns.

The Canadian Armed Forces has its own version of an EMR/EHR (CFHIS) and this is one reason why I'm always a little cautious about what I say or bring up during my PHAs. I have withheld information before from them, and I will continue to do so. My concern is that way too many people have access to this information and I do no know that I can trust every single one of them. So, because I cannot control where this sensitive information will go, I prefer not to disclose it.

Another important aspect to this, at least for me, is that I believe I have enough knowledge to decide what my doctor needs to know, and what he or she doesn't need to know. As a patient, I am the one deciding how much I will benefit from the healthcare system and if I were to choose not to seek help, it is my decision. And yes, I am more than willing to live with any possible consequence of that choice. That, in my opinion, is what being a responsible adult is all about.

This level of intrusiveness (referring to the sexual health history) seems very infantilizing to me (and quite insulting as well). I understand not everyone has the same level of knowledge and education about sexual health and maybe this is a cultural thing. All I can say is that I don't think I'd play along if I was faced with that many questions.

Dany

 
At Sunday, June 24, 2018 9:40:00 AM, Blogger Maurice Bernstein, M.D. said...

Dany, thanks for presenting your Canadian experience, even though it is more military oriented and probably a bit different than a civilian within their own Canadian medical system.(or am I mistaken?).

I hope nobody thinks that physicians are order to ask each question in the P5 list.
As in all medical questioning applied to a patient under diagnosis, the questions are based on whether they are pertinent to follow through on the answers provided by the patient. I have never asked every P5 questions to my patients but I understand the 5 categories of questions to "follow through" from the previous patient responses. Yes, we do have our students ask a few questions from the P5 to survey the sexual life of the patient, male or female.

By the way, everyone should be aware that no patient under any circumstance is legally compelled to answer any question asked by their physician. ..Maurice.

 
At Sunday, June 24, 2018 8:26:00 PM, Blogger Maurice Bernstein, M.D. said...

I got a bunch of visits today from an individual in Montreal Canada. If this isn't Dany, I would like that visitor to add to Dany's comments regarding modesty experiences in Canada's medical system. ..Maurice.

 
At Monday, June 25, 2018 6:59:00 AM, Blogger BJTNT said...

Quote: "Well, Biker, in the United States there is HIPAA and it's violation and penalty as exemplified in the case of UCLA hospitals a decade ago." Unquote.

UCLA had to receive a penalty because celebrity patient data was violated with considerable negative publicity. If it had been a deplorable like me the HIPPA penalty to UCLA probably would have been something like "Tell your employees not to do it again. Tell your employees to be more discreet".

If only one case in a decade makes big news, you know how feckless HIPPA is for the common patient. Don't HIPPA and the medical community share a common culture?

BJTNT

 
At Monday, June 25, 2018 7:05:00 AM, Anonymous Anonymous said...

The 5 P’s, really LOL?

Let’s see, a patient either has symptoms or is concerned about exposure to an STD; that’s the only thing the physician needs to know! Makes absolutely no difference how you were exposed or with whom!

Ed

 
At Monday, June 25, 2018 8:12:00 AM, Blogger Maurice Bernstein, M.D. said...

Ed, in order to make a diagnosis or provide to the patient risks of exposure, more of the 5P's detailing is necessary to do that. The way that sexual transmitted diseases are clinically expressed is so broad and easily simulating symptoms or findings of unrelated causes, supports such detailing. Yet, not every 5P question needs to be asked since the detailing depends on the responses to the previous questions. That is what medical history taking is all about in seeking a diagnosis of the patient's symptoms. ..Maurice.

 
At Monday, June 25, 2018 8:32:00 AM, Blogger Maurice Bernstein, M.D. said...

By the way, the acronym is correctly HIPAA.
Here are links to the summaries of what HIPAA is all about
https://www.paubox.com/blog/what-is-hipaa

and its violations

https://www.paubox.com/blog/hipaa-violations

..Maurice.

 
At Monday, June 25, 2018 9:46:00 AM, Blogger A. Banterings said...

Maurice,

The 5Ps are a bunch of BS. Read what the CDC tries to put forth:

...A sexual history needs to be taken during a patient’s initial visit, during routine preventive exams, and when you see signs of sexually transmitted diseases (STDs)...A sexual history allows you to identify those individuals at risk for STDs, including HIV, and to identify appropriate anatomical sites forFor a more complete picture of your patient’s health, the following guide offers parameters for discussion of sexual health issues. A sexual history needs to be taken during a patient’s initial visit, during routine preventive exams, and when you see signs of sexually transmitted diseases (STDs). The dialogue lends itself to the opportunity for risk-reduction counseling and sharing information about behaviors that may place your patient at risk of contracting STDs. A sexual history allows you to identify those individuals at risk for STDs, including HIV, and to identify appropriate anatomical sites for certain STD tests. certain STD tests...

...Some patients may not be comfortable talking about their sexual history, sex partners, or sexual practices. Try to put patients at ease and let them know that taking a sexual history is an important part of a regular medical exam or physical history...
Source: a guide to taking a sexual history


Guess what is missing from every guideline and medical textbook that I have ever read?

Answer: Accepting and respecting the patient's RIGHT to REFUSAL!

So a newly minted physician reading the CDC's guide to taking a sexual history and sees no where does it discuss respecting the patient's RIGHT to REFUSAL. Now they believe there is no other option.

Using words like "MUST" nullify informed consent and open providers to charges of battery, bullying, and coercive behavior. And others reading this take the wrong message away.

Even insurance companies get it wrong. Read how Priority Health sees this as a "MUST."

...Physicians and other healthcare providers must routinely and regularly obtain sexual histories from their patients and
address management of risk reduction.


I argue that the standard of care is NOT to provide "generally agreed upon procedures fore a certain condition", but to OFFER them. All of the literature that reminds providers to do these invasive exams such as genital exams ONLY supports a standard of care of not performing such exams (because so many providers regularly omit them). At the very least, they should be OFFERED, AND refusal MUST be RESPECTED.

So where does our newly minted physician turn for guidance for the patient refusing the 5Ps?

Obviously not the CDC...

IMHO, any guideline that omits ACCEPTING and RESPECTING a patient's REFUSAL is NEGLIGENCE, and the guideline only promotes malpractice and opens the provider to civil and criminal actions.

"AcceptingI and respecting a patient's refusal" does NOT mean ...try to put patients at ease and let them know that taking a sexual history is an important part of a regular medical exam or physical history... and that is it. It is good practice and expected that the provider try to advise the patient to do what they think the correct course, but they MUST RESPECT the patient's final decision.

Another item missing in all these guidelines is letting the patient know tat they CAN REFUSE any or all RECOMMENDED procedures (tests, exams, etc.) by the provider. Again, failure to do this nullifies informed consent.



-- Banterings




 
At Monday, June 25, 2018 11:38:00 AM, Blogger Maurice Bernstein, M.D. said...

Banterings, I fully agree with the entire context of what you wrote. At no time, do we teach our students that their patient, in any way,should be subtly or frankly compelled to answer any question be it of sexual nature or not. We are not police officers, professional judges or legal prosecutors. In fact, (I may have mentioned this here previously) but I have always been concerned about students taking a medical history from a "jailed" patient at the Los Angeles County hospital where even though the patient's one leg is bound to the bed, occasionally the police officer is sitting in the room. My concerns include that the patient's lawyer is, of course, not present. (This scenario has been, of course a very rare circumstance since most County patients are not under jail watch) but nevertheless, I have talked to my students and others about this and on one occasion when the officer didn't leave spontaneously, I requested and he sat behind the closed door of the patient's room which is their usual practice. ..Maurice.

 
At Monday, June 25, 2018 12:34:00 PM, Blogger A. Banterings said...

Maurice,

But do you teach them to start out by saying "You do not have to answer any of these questions if you do not want to..."?



-- Banterings

 
At Monday, June 25, 2018 1:48:00 PM, Blogger Maurice Bernstein, M.D. said...

Banterings, to answer your question specifically: No. However, in the first contact with the patient, the students must request permission and explain that they will be taking a history as part of their current education. However, when, during the history taking, the patient refuses to answer, some students will ask "why" and some will just "move along" to another topic. From the description within the students' writeups, it appears that, correctly, they do not become argumentative if the patient refuses to answer.

Later, as physicians who have the responsibility to attempt to make an appropriate and hopefully correct diagnosis, the physician should immediately explain to the patient the diagnostic importance of an attempt to answer the physician's question. But, again, this is not a legal exercise by a prosecutor or court and even in response to a physician's clinically appropriate question there is no legal compulsion for the patient to answer.
..Maurice.

 
At Monday, June 25, 2018 4:20:00 PM, Blogger Biker in Vermont said...

I've never been asked a lot of intrusive questions but if it is something I consider none of their business I'll give them a terse "everything is OK" answer and they get the message to move on. I figure the onus is on them to explain why it is they need that kind of information.

If I were to get a politically based question (for example do you have guns in the home) such as I understand some doctors ask, I will give them the answer they want to hear. None of their business whether I do or not and it has nothing to do with my health.

The proliferation of EHR systems has destroyed any sense of truly having confidential discussions with doctors. I may trust the doctor in that regard but I have no idea who else will be accessing my data. That HIPAA says no one is supposed to without a specific need doesn't mean much when medical practices and hospitals look the other way when staff violate patient confidentiality and privacy. If salacious gossip or other inappropriate behavior is allowed when the patient can't hear or is not conscious, I can't trust those same staff members won't look in my EHR records if they're nosy enough.

 
At Monday, June 25, 2018 9:15:00 PM, Anonymous Anonymous said...

Biker in Vermont

I absolutely agree with you. My most biggest pet peeve is when providers want to know what is your occupation. It’s a nosey question, non relevant in any regards. The paperwork you fill out when you are a new patient in my opinion is unlawful. The questions, are you married, do you have children, what is your occupation, unlawful. I’ve had their secretary say to me, this is required. My response, no it is not.

If I recall, hospital staff are not allowed to ask if you have health insurance with the exception of er registration staff. I know nurses were very judge mental if patients did not have insurance. I allow them to take my photograph, they can make a copy of my insurance card and my drivers license. That is all they need to know as relevant information is on the drivers license.

Hospital and Er physician providers know if the patients have insurance and this varies between the insured and non insured patient which in my opinion is a very a very unethical issue. Patients wether insured or non insured ( self pay) don’t always recieve the same level of care. The so called face sheet available to all hospital staff once you are admitted to the hospital should be outlawed. It’s lists all personal information from what you provide as well as your health insurance company.

PT

 
At Monday, June 25, 2018 9:50:00 PM, Blogger Maurice Bernstein, M.D. said...

This posting may be a little late in the evening for Biker and those readers on the U.S. east coast but I just had to clarify the meaning of "modesty" as used on the title of this blog thread. So much has been written on the entire thread over these 13 years in terms of physical modesty and abuse of this property within the medical system particularly in the male gender

But currently is there interest in the addition of (let's call it "historical modesty" (Isn't that what we are currently talking about?). Or is that term not appropriate to define the current discussion? I am all in favor of discussing historical modesty as part of this thread since it seems to be a disturbing factor in the relationship between the patient and those taking or reading a patient's history documentation.

One question in this regard: Is it easier for the patient to control "exposure" of one's history than one's body when involved within the medical system? ..Maurice.

 
At Tuesday, June 26, 2018 5:35:00 AM, Blogger Biker in Vermont said...

Certainly it is easier to control the exposure of one's history than one's body in healthcare. For me, I pick my battles, and sharing my work history and family status is not one of them. I do fully understand that some others prefer not to. If I get a question I consider too personal and not relevant to my health, they'll get a non-answer from me is all. The onus is on them to tell me why it is relevant.

All that said, a physician wanting to know occupational history could be a life saver if a person's occupation puts them at particular risk of certain diseases. My father died before his time due to occupational exposure. Had he seen private doctors rather than only the company doctor, and that private doctor asked about his occupation, it is possible he'd of been warned of the risks and been actively monitored to at least catch his cancer early rather than after it metastasized.

I still think the larger issue isn't so much the questions being asked or whether you can trust the doctor to be discreet, but rather the system that gives access to patient info to many people who don't need access. Combined with that is an us vs them culture that looks the other way on staff violations of patient confidentiality and privacy so long as the patient doesn't know they're doing it.

 
At Tuesday, June 26, 2018 8:39:00 AM, Blogger A. Banterings said...

Maurice,

How do patients know that they can refuse to answer any question, refuse any provider, or refuse any procedure if they are NOT explicitly told so?

As an ethicist surely see the fault in this line of thinking. You state that history taking is OT an interrogation, BUT even in an interrogation the first thing that a person is told is that they have the right to remain silent... i.e. do not have to answer any or all questions.

These are called "Miranda Rights", and the purpose is so that there is no deception in the person's right NOT to answer a question.

As an ethicist, you either have to say that Miranda Rights are unnecessary if you apply the same ethical standard to medicine.

It is this "silence equals consent" attitude that healthcare embraces. Indeed, this is illustrated inJoan P. Emerson's paper, Behaviour in Private Places. She states that the nurse or physician uses the word "need" so as to give the impression there is no negotiation or other alternative.

Indeed, this is a common occurrence with doctors holding birth control hostage/.

As an ethicist, what is your view (Maurice) of doctors holding birth control hostage/?



-- Banterings


 
At Tuesday, June 26, 2018 9:29:00 AM, Blogger Maurice Bernstein, M.D. said...

The ethical premise of decisions within medical practice should be oriented to "best interest of the patient ". The only exception should be if the behavior or physical condition of the patient poses a real threat to other humans. The decisions should not be related to "best interest" of the providers although if there is moral or religious interest contrary to the request of the patient, the physician should attempt to find for the patient another resource for attending to the patient's request. That's the ethics as I see it. ..Maurice

 
At Tuesday, June 26, 2018 10:35:00 AM, Blogger A. Banterings said...

Maurice,

Best interest of the patient...

But WHO decides the best interest of the patient? The physician?

So let me ask you, is it in interest of the patient to know that they can refuse to answer any question, refuse any provider, or refuse any procedure?



-- Banterings



 
At Tuesday, June 26, 2018 2:17:00 PM, Blogger Maurice Bernstein, M.D. said...

Banterings, of course it is "in the interest of the patient to know.." but virtually all adult patients know that interacting with the medical profession at any level is not the same as interacting with police or the courts. Virtually all doctor-patient interactions is initiated by the patient unless in a medical emergency the patient lacks capacity. And, if the physician recognizes that the patient misunderstands the patient's power of autonomy in history taking, physical examination, testing or treatment then it is the duty of the physician or other healthcare provider to educate the patient about that autonomy and how to exercise that ethical power. Sure, one could put a reminder plaque on the front door of the institution but the first duties by the physician for the patient is to "listen to the patient" and not start up with a "lecture". This is what we teach our medical students and this is what we expect of them as they move along into the profession. ..Maurice.

 
At Tuesday, June 26, 2018 5:47:00 PM, Anonymous Anonymous said...

Banterings, you referenced the well known statement by John Emerich Edward Dalberg-Acton, 1st Baron Acton: “Power tends to corrupt, and absolute power corrupts absolutely.”

Thus, looking at the widespread and absolute REFUSAL of the mak’emsick industry as a matter of routine to provide male clients (how about “customers” as a term?) with same gender care is but a symptom of a much larger picture, a much more devious and dangerous scenario. PT wonders why legislation ending the discrimination against the male client has not been enacted by this time. The refusal to give males the same rights as females is deliberate, and I will attempt to explain why. American culture is vicious in its portrayal and treatment of about one half of the population – males, that is. Why is this so? The systematic denigration of males has been going on for quite some time, and indeed even the rabid feminist movement was pushed by those in power – and allopathic, so called mainstream medicine is but one facet to render males docile and obedient. Yes, the pathologicals (my term for the global elite, i.e., the banksters and like ilk) intent on global domination and subservience of all humans (and all other life forms as well) simply use the medical mafia as one of the primary facets of controlling los sheeple.

Now, I have referenced but one part of the creation of the medical mafia we have today that passes for “healthcare.” The Rockefellers, the Rothchilds, the Bush family,and others created the monster we now endure, which is but one arm of their ugly hydra. I urge everyone to read "George Bush: The Unauthorized Biography" by Webster G. Tarpley & Anton Chaitkin: https://www.bibliotecapleyades.net/bush/bushb.htm#3%20--

All chapters are available on line, and once read, one wonders if one can do anything to stop the fascist totalitarian regime that is engulfing the US and indeed much of the world. The dots connecting our present system of poisoning termed euphemistically as medicine or healthcare and the Nazi regime are clearly delineated in the above referenced book. And that’s why I don’t trust ANYONE in the mak’emsick industry, for they are but tools for the banking/chemical/petroleum complex. Of course, some mak’emsick workers have good intentions, but they don’t have the intellectual vigor or curiosity to realize that they are but tools. And tools are not sentient. Enough said, read the book, and pray for your grandchildren.

Here’s an interesting snippet from a blog I just stumbled across, Fred on Everything: “The boys were not told that masculinity was toxic. Hysteria over imaginary rape was well in the future. Little boys were not dragged from school by the police for drawing a soldier with a rifle. The idea of having police in a school would seem insane when it first appeared... I think feminism plays a large part in the collapse of society in general and specifically in pushing boys over the edge. In my school years boys were allowed to be boys. Neither sex was denigrated. Doing so would have occurred to nobody. Then came a prejudice against boys, powerful today.

All of this affected society in its entirety, but especially white boys. They are constantly told that being white is shameful, that any masculine interest is pathological, that they are rapists in waiting. They are subjected to torturous boredom and inactivity, and drugged when they respond poorly. They go to schools that do not like them and that stack the deck against them. Many are fatherless. All have access to psychoactive drugs.

Add it up.” Fred’s got a valid point.

Cont. due to length.

EO

 
At Tuesday, June 26, 2018 5:56:00 PM, Anonymous Anonymous said...

Now, some on this blog have referenced Abu Ghraib and the often unnecessary nudity forced upon unsuspecting males when they enter the mak’emsick maze. Readers, it’s much worse than most of you suspect. Our society is collapsing, and this collapse is DELIBERATE! Just as rabid feminists and docile males are being created, so is the horrendous wave of drug addiction and mental illness. For those with an open mind, I urge you to read the latest studies (of course, none from America where the pathologicals have such a firm grip on what passes for “science” that no one dares fund such vigorous studies) that explore mental illness and vaccinations: https://jbhandleyblog.com/home/2018/4/1/international2018.

Here’s a snippet: “An important finding in the rat BCG/Hep B study is that many of the effects of hep B vaccine did not appear until age 8 weeks. This finding undermines claims of vaccine safety, which are almost always based on short-term outcomes of a few days or weeks. Furthermore, 8 weeks is a long time in rats. 8 week old rats are almost fully mature adults. This suggests that adverse effects of vaccines may take years or decades to appear in humans. This is consistent with what is known about immune activation and schizophrenia. Immune activation in the fetus can cause schizophrenia 20–30 years later. The accumulating scientific evidence and the Li et al study in particular suggest that vaccination may cause mental illness. The mental illnesses would emerge years or decades after vaccination of an infant. Vaccines are likely contributing (to)[the] the rise of mental illnesses in the USA over the last 25 years. The rise in mental illnesses in the USA is coincident with the dramatic increase in vaccination that started in the 1980s.”

And physicians are being urged to discuss gun ownership/storage with their clients? The writing on the wall is crystal clear here for those who can think for themselves! Of course the intent is to disarm the populace!

What better way to collapse a society than to render so many people mentally and physically ill? Let’s remind ourselves that the mak’emsick industry is now the leading cause of death here in the States. That the mak’emsick industry tolerates sickos such as the Denver 5, Twana Sparks, the dancing surgeon in Georgia, and ad infintum bespeaks volumes of a deep and pervasive corruption. And the “Five P’s” that physicians are now told to ask their clients is just another form of coercion - in fact it somehow reminds me of Abu Ghraib. Even if I had an STI none of the questions are pertinent to my diagnosis/treatment. And, that the CDC (Center of Deception and Corruption) states that a full sexual history needs to be taken just ties in with humiliating people and taking away any sense of their individual worth and privacy. No one needs to know how or with whom I contracted a STI in order to treat it. That’s where lab tests come in! BEAR IN MIND THAT MOST TOTALITARIAN DICTATORSHIPS ROUTINELY ABUSE PEOPLE'S SEXUALITY AS A FORM OF COERCION AND A BREAKING OF THE HUMAN SPIRIT. There are myriad examples of this ugly practice throughout human history! And let’s remind ourselves of how a totalitarian government needs to invade the privacy of all people and demanding a sexual history/practice is just one form of such. In fact, since sexuality is so inherent and such an important part of the human, breaking down people via any kind of sexual abuse/modesty violations in the medical setting is a great way to gentle the herd!

Cont. due to length EO

 
At Tuesday, June 26, 2018 5:57:00 PM, Anonymous Anonymous said...

I’d like to end with a quote from Mahatma Gandhi: “I was at one time a great lover of the medical profession… I no longer hold that opinion … Doctors have almost unhinged us… I regard the present system as black magic…Hospitals are institutions for propagating sin. Men take less care of their bodies and immortality increases… ignoring the soul, the profession puts men at its mercy and contributes to the diminution of human dignity and self control… I have endeavored to show that there is no real service to humanity in the profession, and that it is injurious to mankind… I believe that a multiplicity of hospitals is not test of civilization. It is rather a symptom of decay.”

The powers that be are turning up the heat on our communal kettle, and I choose to live by P. Henry’s words: “Give me liberty, or give me death.”

EO

 
At Tuesday, June 26, 2018 8:14:00 PM, Anonymous JF said...

Patrick Henry said" Give me liberty or give me death!" but he kept his wife locked up in the basement and he had her in a straight jacket.

 
At Tuesday, June 26, 2018 11:27:00 PM, Anonymous Anonymous said...

When EO refers to the CDC as ( Center of deception and Corruption), one can assume that came as a result William Foege, former director of the CDC. Taking a new acting position on the board of Theranos, a company who has milked investors out of $900 million by proposing a new micro blood testing system. Thousands of patients in Caif and Arizona were given innacurate results. The board members have been indicted. Thus the words deception and corruption.


PT

 
At Wednesday, June 27, 2018 12:26:00 PM, Blogger Biker in Vermont said...

What the global elite do and what their motivations might be are beyond anything the medical staff I interact with can possibly know. I doubt any of them could even tell you who "they" are. The extent to which those staff members that I interact with respect my privacy and dignity is on them, not on some anonymous group that doesn't even know I exist.

Whether there are male staff members available for patients that request them is a result of the value that hiring managers for that practice or hospital places on meeting the needs of male patients. If that weren't the case the urology practice I go to wouldn't have a couple male nurses vs most urology practices having none. There isn't a "they" out there that mandates male staff can't be hired in urology practices.

It is how the individual physicians, nurses, techs, medical assistants, CNA's etc. choose to treat us that we experience, within the context of what the hiring managers have put in place staffing-wise. If the hiring managers choose to only hire females, it is not the fault of the individual staff members that our requests for male staff can't be met, but they still control how they interact with us. If they don't knock or don't pull the current etc, that is on them as it reflects a choice they made, just as there not being any male staff reflects a choice the hiring managers made.

That society as a whole doesn't respect male patient privacy and dignity doesn't stop individual hiring managers and individual staff members from doing so.

 
At Wednesday, June 27, 2018 12:55:00 PM, Blogger Maurice Bernstein, M.D. said...

In terms of making our conversations on this blog thread productive, it is important for me to describe that we are attempting to be "driving forward but only looking in the rear-view mirror." What do you think? ..Maurice.

 
At Wednesday, June 27, 2018 2:06:00 PM, Anonymous Anonymous said...

Maurice

That’s partially true, I’m looking in all directions or am I the only one on the road with a drivers license. It certainly feels that way when you have to traverse the dangerous, slippery slopes of the healthcare system. Hipaa is a failed attempt to protect patient’s privacy and I believe as you’ve just read that modesty ( I hate this word, physical privacy) and irrelevant data about patients are interrelated, intertwined so to speak. You can be guaranteed that when you are a patient one of the two will be violated, we are guaranteed that will happen. I feel almost as strongly about Hipaa violations as I do about physical privacy violations.

These two issues are at the very top of my concerns whenever I’m a patient. Would you be surprised if I told you that a proper diagnosis is not at the top of the list of my expectations provided that the mistake was at the MD, DO level. I understand those people are human and mistakes do happen but Hipaa and physical privacy violations are not mistakes. I most likely would not sue a provider ( MD,DO) for a mis-diagnosis but for a Hipaa or a physical privacy violation I’d just throw everyone under the bus. I am going to be looking at how a few states have managed to require all healthcare workers, nurses, lpns, techs and ma’s To wear a name badge along with their function at the facility they work.

PT

 
At Wednesday, June 27, 2018 2:24:00 PM, Anonymous JF said...

I don't agree with you that humiliated men become docile men, unless they were docile already. If the men are really humiliated theg will be ANGRY and will either find a way to retaliate on their care givers or take the anger out on whoever happens to be around.

 
At Wednesday, June 27, 2018 6:48:00 PM, Blogger A. Banterings said...

Maurice,

Forgive me, this is NOT a personal attack upon your person, but your logic is flawed...


You sound like a physician now (and NOT an ethicist).

First off, you make an assumption that patients know that they can refuse to answer any question, refuse any provider, or refuse any procedure.

...but how can you be sure that every patient knows this? If a patient does not know, then there is truly NO INFORMED CONSENT!

Yes healthcare is not like interacting with the police, but when dealing with legal issues are people NOT more aware that they have protected rights (from our Constitution) than in healthcare?

You also say, ...if the physician recognizes that the patient misunderstands the patient's power of autonomy in history taking, physical examination, testing or treatment then it is the duty of the physician or other healthcare provider to educate the patient about that autonomy and how to exercise that ethical power.

Yet you urge the patient to ...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.

You are constantly (pushing blame back on the patient) saying that patients should SPEAK UP!


Which is it?

Or is it a failure on the part of the physician for NOT recognizing (or NOT caring) when a patient is unaware that they can speak up?

Looking at the Athena Health study on gender preferance, with 51% to 60% of patients not returning to new physicians of the opposite gender, that is potentially a significant failure on the part of the provider.

Granted that there is an attrition rate built in, but assuming that it is 20% to 25% (similar to other professions), that is still a significant number of physician failures. There is also a failure rate in those numbers as well of the physician NOT recognizing (or NOT caring) when a patient is unaware that they can refuse to answer any question, refuse any provider, or refuse any procedure.

Finally, providers have pushed preventative medicine on patients with the adage, " an ounce of prevention is worth a pound of cure," WHY NOT TELL THAT TO THE PATIENT UP FRONT?

Just as many physicians comment on MedScape articles about recent guidelines doing away with DRE prostate exams, IT IS NOT PAINFUL AND TAKES LESS THAN A MINUTE.

Again, I ask, WHY NOT DO IT, especially at the beginning of the encounter?



...besides, I thought physicians liked being thorough...



-- Banterings








 
At Wednesday, June 27, 2018 6:59:00 PM, Blogger A. Banterings said...

EO,

I LOVE the Gandhi quote!!!

Have you looked at my blog or Twitter?

You have some great points.



-- Banterings





 
At Thursday, June 28, 2018 9:24:00 AM, Blogger A. Banterings said...

In the latest news concerning patients knowing that they can refuse to answer any question, refuse any provider, or refuse any procedure, Hennepin Healthcare is suspending a clinical trial of the sedative ketamine in emergency situations following criticism that its hospital, Hennepin County Medical Center, enrolled patients in the study without their knowledge.

...I guess the patient just needs to speak up???

If one cannot resist unwanted sexual advances (assault and battery) under the influence of ketamine, then how are they going to be able to provide informed consent (or refusal)?

...oh wait, that is the idea...

Is agitation NOT a sign that that the patient misunderstands the patient's power of autonomy in history taking, physical examination, testing or treatment? What about the duty of the physician or other healthcare provider to educate the patient about that autonomy and how to exercise that ethical power?

Medical Ethics are an OXYMORON!

TIME FOR BRUTAL HONESTY.

Telling patients that they can refuse to answer any question, refuse any provider, or refuse any procedure, WITHOUT retaliation from the practice, provider, or staff at the beginning of the encounter IS A GOOD IDEA.


There is no logical, ETHICAL argument that can be made against it.

For one to say that people are intelligent enough to know this, one has obviously never watched Jay Leno's JayWalking?

Let us also be honest, that despite being such a self evident, common sense, brilliant idea, it is NOT practiced and NOT taught in medical school.

The argument that can be made against it is that the profession is self serving and doing so eliminates the defense of "implied consent."

Maurice's suggestion of a plaque on the door/wall stating such is a great idea. (Then the provider does not have to waste a precious 30 seconds.)

So if it is NOT taught and NOT practiced, what must medicine believe? I would suggest the the archaic, paternalistic notion that because I am a doctor (that's why), AND I know what is best for you (despite what you may want as an autonomous human being). Also, there will be retaliation.

Again, being brutally honest, medicine has failed patients (and continues to fail patients) by NOT (practicing and teaching) telling patients, at the beginning of the encounter, that they can refuse to answer any question, refuse any provider, or refuse any procedure, WITHOUT retaliation from the practice, provider, or staff.

Any arguments?




-- Banterings




 
At Thursday, June 28, 2018 1:05:00 PM, Blogger Biker in Vermont said...

I'm going to differ from the majority here. I don't think patients need to be told they don't have to answer questions or that they don't have to do every procedure that is suggested. Medical settings are intimidating but people have to take some responsibility for their own lives.

If the need for answers to the questions isn't obvious it would help the process if the doctor/nurse/tech etc would tell the patient why the question is important, but again, people have to take some responsibility. The same goes for procedures being suggested.

A simple example here. Last year I had an upper endoscopy. The medical asst tells me I need to completely undress. I ask why is that necessary and she tells me because I will be sedated. I wasn't going to be sedated and a nurse says then no I don't have to undress. I agree it would have been better if the MA told me why she wanted me to undress, but she didn't and so I asked the "why" question rather than blindly follow an instruction that didn't make any sense to me.

For that same procedure their starting point when the appt. was made was that I would be sedated. Yes it would have been better if they said sedation wasn't absolutely required but this is why they suggest it, but they didn't, and I advocated for myself saying no to the sedation.

 
At Thursday, June 28, 2018 2:36:00 PM, Blogger BJTNT said...

This comment has been removed by the author.

 
At Thursday, June 28, 2018 6:43:00 PM, Anonymous Anonymous said...

Sorry, but I don't care what Patrick Henry did to his wife - I used his words to make a point - and one of those points being informed consent and my inalienable rights as a human being. As Americans, we no longer possess the right of informed consent. I’m sure you’re probably thinking of women’s rights and how they were trampled upon, but that is not the most pressing issue that faces us currently, not in the US anyway.

Let’s cut to the heart of the matter in medical freedom. Anyone who believes that the CDC (as well as the WHO) is some sort of beneficent organization is 100% misinformed. The CDC is nothing more than an enforcement agency for what we can call Big Pharma, the Banksters, and like ilk. A friend of mine who was Army Special Ops for 27 years would call them by their true name – thugs. That’s why I regard all mainstream mak’emsick workers as tools, for most actually believe these comforting fairy tales. (BTW, the CDC owns patents on 56 vaccines. No conflict of interest here, nothing to see here folks, just keep on moving along…)

How many are aware that the CDC has the power to kidnap anyone (without right to an attorney or trial) and force a person to medical examination, treatment (always forced vaccinations) and cyber tracking after being released including wearable tracking technology such as ankle bracelets? Yes, physicians and lower level providers will be employed to do just this!

I say male modesty is the Indian elephant in the room, whilst individual freedom/medical freedom is the African elephant. That’s why I link male modesty to an exponentially larger arena – that as Americans we are no longer free to true informed consent, just as male clients’ rights are systematically ignored/trampled upon in the mak’emsick industry. Let’s not forget that throughout history it is the almost always the male who is on the front line of a physical battle, while the female stays protected in her cave!
Here’s the link to the new medical martial law we will soon be witnessing:
https://www.federalregister.gov/documents/2016/08/15/2016-18103/control-of-communicable-diseases

This rule is no longer “proposed”; it is now in effect, coming to a mall or town or private home near any one of us! Though a long document, I urge all to read it. Here’s a brief summary of this draconian, totalitarian rule: https://jonrappoport.wordpress.com/2016/09/05/the-cdc-medical-police-state-the-right-to-detain-anyone/.

Now, supposedly this frightening rule was amended to just cover communicable diseases such as Ebola, SARS and about 8 others. However, the rule grants individual States the rights to subject Americans to this rule for measles, mumps, etc. The pathologicals are seeing a new movement against their incredibly lucrative business of Big Vac (mandated vaccination) and are fearful that their medical lies are being exposed by an increasing number of well informed people. Here’s just several of the stories that American main stream media black listed: http://stopnop.com.pl/poland-is-fighting-for-human-rights-violated-by-the-mandatory-vaccination/
https://vaccineimpact.com/2017/italians-take-to-the-streets-to-protest-new-mandatory-vaccination-law/
https://yournewswire.com/sweden-mandatory-vaccinations/

Cont. due to length. EO


 
At Thursday, June 28, 2018 6:47:00 PM, Anonymous Anonymous said...

Readers, do you believe that you will retain your First Amendment rights under this sort of totalitarian rule, that of freedom of religion, speech, press, peaceful assembly and petition? Hardly! The water in the kettle is being turned up! Here’s the latest assault on medical freedom in California: https://californianewswire.com/with-sb-1424-california-moves-to-kill-free-speech-and-health-says-wellness-activist-dr-harte/ and this: https://vaccines.news/2018-05-18-senator-richard-pushing-bill-crime-question-vaccines.html

SB 1424 is still moving forward, and may soon become law. So, our speech is to become circumscribed as is seen in all totalitarian regimes, not just Nazism and Russian Communism, but other violent dictatorships such as Pot Pot’s Khmer Rouge, Mae Tse-Tung’s (Zedong) Great Leap Forward and so forth.

BTW, Banterings, I have read the first two parts of your blog on sociopaths – wonderful info here! One can readily see how the mak’emsick industry has so many sociopaths among its ranks. I will read all. (Lots of sociopaths in totalitarian regimes!)
And Maurice, I must give you credit for having the courage to publish my comments, as almost all physicians would scoff or be fearful of such information. Maybe there is some hope for reform of the mak’emsick industry, but all enforcers such as the CDC and others will need to be disbanded, along with private companies providing “health care” insurance. And of course, medical education would have to be amended from ground zero.

And for the legions of corrupt pediatricians that claim they don’t make a dime on vaccines for kids, here’s a link to their kickbacks from just one company: http://www.whale.to/c/2016-BCN-BCBSM-Incentive-Program-Booklet.pdf and here’s a short summary on their compensation: https://raisingnaturalkids.com/kickbacks-pediatrician-gets-vaccinating/

For instance, Blue Cross pays a pediatrician a $40,000 bonus for fully vaccinating 100 patients under the age of 2; 200 patients, the bonus is $80,000. This is on top of the funds received for the office visit and so forth! Nice racket!

Looking at corrupt regimes, we see that the underlings who follow their masters and comply with trampling human rights are the ones that make good money, and/or have access to clean food, good housing, and so forth. So, yes, greed is the carrot that the pathologicals use to entice providers to follow their regime of greed and complete control.

Okay I’m tired and need an hour off! Thanks for reading!

The fiercely freedom lovin’, forever rebel EO.








 
At Thursday, June 28, 2018 7:38:00 PM, Anonymous Anonymous said...

I’m seeing a number of advirtisements in my local newspaper about new treatments for erectile dysfunction. Not that I have ED but the adds take up half a page. Interestingly, the adds advertise a new type of treatment called wave therapy although some cities advertise it as Gainswave. A probe from what I’m able to gather it placed at areas on the penis and the wave or shock is applied. The article states that these new clinics only have to be overseen by a physician, that a physician does not have to actually administer the treatment. We all know how these clinics will end up being managed but on the safe side they might as well include in the add or even in the window that these are Spoons are not necessary environments.

PT

 
At Thursday, June 28, 2018 8:26:00 PM, Blogger Maurice Bernstein, M.D. said...

Just to let you all know that I posted a link to this Volume 88 thread to a world-wide listserv for medical educators and I also reproduced Banterings presentation from this morning there. Checking my statcounter, we have had a giant increase in first time visits to this Volume. I do hope that some of the medical school instructors and department deans will participate here and provide their views of how students should be and are currently educated relative to the approaches presented here by our regular contributors.

If those from the medical education listserv are reading this now, I hope an anonymous but identifying your professional role vistor would provide us with your views. Those views would be of great interest to me but I am sure the other visitors to this blog thread. ..Maurice.

 
At Friday, June 29, 2018 9:03:00 AM, Blogger A. Banterings said...

Biker,

You are completely wrong in your assumption. By your very own storied, you complied with requests early on that you now object to. But now the science to back what I say...

Milgram Obedience to Authority Study has demonstrated that ALL people (patients included) exhibit an innate obedience to authority.

Not only is this quirk of human nature used to induct new physicians into the cult of healthcare, but it is a useful tool to control patients. That is why physicians have suits with formal white coats and patients are half naked (you know your place).

Taking responsibility for one's self (something that I am all for) means living a healthy lifestyle. People with prostate problems are not responsible for their prostate. How many times has the answer "because that is the way we have always done it" been given as the answer?

What about the ritualistic, junk science that patients have been handed (pelvic exams, prostate exams, routine physical exams)?

By saying that at the beginning of the encounter providers know that they will have to justify all requests. Medicine has violated the rights of patients time and time again and demonstrated they do not know what society expects (PE on anesthetized women).


EO,

I posted your CDC info and mandatory vaccine stories on my Twitter site. Great info.



-- Banterings




 
At Friday, June 29, 2018 10:31:00 PM, Blogger A. Banterings said...

Maurice,

Thank you for posting to listserv.

So, have you changed your opinion about "telling patients that they can refuse to answer any question, refuse any provider, or refuse any procedure, WITHOUT retaliation from the practice, provider, or staff at the beginning of the encounter" being a good idea and should happen?

Can you also clarify your contradiction whether should patients speak up OR the physician is responsible for recognizing that the patient misunderstands the patient's power of autonomy in history taking, physical examination, testing or treatment then it is the duty of the physician or other healthcare provider to educate the patient about that autonomy and how to exercise that ethical power?




-- Banterings



 
At Saturday, June 30, 2018 7:37:00 AM, Blogger Maurice Bernstein, M.D. said...

Banterings, in answer to your first question:
"Not really". I (and probably most of the other instructors) don't want to teach that the humanistic way of starting up a new relationship with a patient is one of dictating to the patient a series of "rules". "Rules" is not what most patients come to a physician for (they are concerned about some sickness symptoms they have been experiencing). The first professional words to a patient should be to the effect "tell me what is bothering you" (the first "open ended" question, as we call it.) This perhaps followed by "is there anything more to tell me?" To start out with a series of "rules" (even though others might call them "relationship facts" regarding mutual behaviors) is not what we believe most patients would want in those first words between the parties. As I have noted in the past, these "open ended" questions are then followed by "direct questions" based on what the patient narrated but oriented to clarify and establish a diagnostic pathway to a "differential diagnosis"if not the "final diagnosis".

Yes, yes, yes.. if at onset or at points through the relationship, the physician becomes aware that the patient is uncertain or has questions about the patient-doctor relationship standards including the autonomy of the patient with regard to the communication and decision making, at that time the physician should interrupt the history or physical exam and introduce or reinforce the concept of patient autonomy. But this reinforcement should be guided by the "needs of the patient" at the time.
And the "needs of the patient" in the very first moments of the patient-doctor relationship is the physician understanding the concerns which led to the patient's coming. "Miranda" belongs in the hands of the police officer or lawyer at the onset. Concern for the symptoms and the medical needs of the patient should be in the "heart" of the physician at the onset. ..Maurice.

 
At Saturday, June 30, 2018 2:47:00 PM, Blogger BJTNT said...

Quote: To start out with a series of "rules" (even though others might call them "relationship facts" regarding mutual behaviors) is not what we believe most patients would want in those first words between the parties. Unquote.

Yet it's perfectly permissible to ask the inappropriate 5 Ps and do you own a gun w/o establishing a relationship?

BJTNT

 
At Saturday, June 30, 2018 3:42:00 PM, Blogger Maurice Bernstein, M.D. said...

BJTNT, asking the pertinent 5P question(s) or "do you own a gun" without establishing a relationship with the patient is NOT at all "perfectly permissible" and would be totally contrary to what we teach our medical students.

In my next posting I will reproduce a multiple choice "test" for student discussion only based on the student's selections of their answer. The "test" is presented on the second meeting of the first year medical school group. You can select your choices too but also explain the reason for your selection. ..Maurice.

 
At Saturday, June 30, 2018 3:50:00 PM, Blogger Maurice Bernstein, M.D. said...


Introduction to the Interview: The purpose of the following is to provide a takeoff for further discussion and not for grading. Check the single best answer.
1) You enter the hospital room of a 44 year old white male who has crumpled Kleenex scattered over the floor and who is coughing. What is the first thing you would say to him?
A) "Why are you coughing?"
B) "Why did you come to the hospital?
C) "Who are you?"
D) "Are you in any pain?"
E) If none of the above, then what would you say?
"I am , a first year medical student"


2) You enter the hospital room of an elderly white man and there is a bad odor in the room. What should you do first?
A) Ignore the odor completely.
B) Immediately say to the patient "What is that bad smell?"
C) Leave the room at once and call the nurse.
D) Without disturbing the patient, during the interview, attempt to identify and find the source of the odor.
E) Go to the window and open it.



3) Your instructor has assigned you to a 31 year old white female. Moments after the instructor leaves and you are alone with the patient, she yells at you "Get out! ..Get out of here!" What is the first thing you should do?
A) Turn and leave the room without saying a word.
B) Sit down on her bed.
C) Say to her "I am I am a first year medical student. Why did you say that?"
D) Attempt to hold her hand.
E) Say to her "Don't say that. I was told to interview you."
4. You enter the hospital room of a 55 year old black female who is moaning in apparent pain and after you introduce yourself what are the next words you speak?
A) "Do you hurt?"
B) "When did you come to the hospital?"
C) "Are you married?"
D) "What is the matter with you?"
E) You speak no words but immediately leave the room and call a nurse.
5. You enter the hospital room of a young woman about your age and assigned to you by your instructor. You observe that she is weeping. What would you do next?
A) Leave the room and tell your instructor that you are only a first year medical student and that you don't know enough to help her.
B) Leave the room at once without discussing what you observed with your instructor.
C) Identify yourself and then hand the patient a Kleenex from the box on her bedside table.
D) First ask "What brought you in the hospital?"
E) Leave the room at once and call a nurse.

I will present the appropriate teaching answers on a subsequent posting. ..Maurice.

 
At Saturday, June 30, 2018 4:02:00 PM, Blogger Maurice Bernstein, M.D. said...

Due to a blog reproduction error: the expression where the student identifies him or her self as a first year medical student should also include the student's full name. ..Maurice.

 
At Saturday, June 30, 2018 6:15:00 PM, Blogger Maurice Bernstein, M.D. said...

Pertinent to the current discussion on this blog thread, what I am attempting to demonstrate in the above example is literally what I attempting to teach students about their initial relationship with a patient. You may not agree but what I am presenting to the students before they go to the ward and interview their first patient is that the first words or actions are NOT to first explain RULES OF THE "GAME" but to actively take and show an interest to the patient as a human being who is ill. Call this behavior an identity name but it is NOT "Miranda". ..Maurice.

 
At Sunday, July 01, 2018 3:46:00 AM, Blogger Biker in Vermont said...

I hear what people are saying but I don't want the start of my healthcare visits to be a legal negotiation where I'm being read the medical equivalent of my Miranda rights. I want it to flow the way Dr. Bernstein is teaching his students.

Govt. is trying to insert non-medical matters into healthcare (do you have guns, do you feel safe at home etc). That's not the doctor's fault and I'm not going to get into an adversarial relationship with them over it. I'll give a simple answer or perhaps a non-answer and let the appt. move forward. Those are not battles I see worth fighting.

What I do want is to be told why a question is important if it is something that wouldn't be obvious to the average person. That would allow me to help them help me if I understood why the question needs a real answer. It could be that the explanation would affirm for me that it doesn't need a real answer, but I will have made an informed decision as to whether and how to answer.

What I want most of all is have my dignity respected and to not be ambushed. Don't bring a scribe, chaperone, or anyone else into the room without introducing them as to who and what they are and why they are there, preferably doing this before they enter the room. I also want to have procedures explained to me beforehand, including what my state of undress will be and who will be present. I've had some unpleasant surprises in that regard in the past.

Absolutely key to respecting my dignity is when I ask for male staff for intimate procedures, do not bully or insult me. If there just isn't any male staff, I realize that isn't the fault of the person I am speaking with, but I do expect them to show empathy and to explain to me how my exposure will be minimized and how I will otherwise be treated knowing that I am concerned with my exposure.

 
At Sunday, July 01, 2018 5:48:00 AM, Blogger NTT said...

Good Morning:

Our "Dancing Doctor" has agreed to give up her medical license for at least two and a half years, according to an agreement filed Friday with the Georgia Composite Medical Board.

The consent order signed by Windell Boutte, a board-certified dermatologist, says that her license to practice medicine in Georgia is indefinitely suspended, but after two and a half years she can petition to have the suspension lifted.

Let's see how fast she opens up shop in another state now.

Have a great day all. Stay cool.

Regards,
NTT

 
At Sunday, July 01, 2018 7:09:00 AM, Blogger Maurice Bernstein, M.D. said...

Biker, to add: we teach the students and as physicians later they should remember that anytime the patient asks the physician a "why?" or "what?" in reaction to a question or a statement or some action made by the doctor, the physician must stop and answer with a response that provides medical education and understanding. Unless the patient is unconscious, the physician's "interaction" with a patient is just that an interaction in which both parties are participating in whatever activity is in progress. This is what medical students "should be" and are taught. How they follow this teaching in face of their future "time limitations" set up by the government and medical system is the issue of significance. But if the students later don't follow this teaching, then they also should bear some responsibility for the consequences since they are citizen participants in the government and professional participants in the medical system. Correct? ..Maurice.

 
At Sunday, July 01, 2018 7:18:00 AM, Blogger Maurice Bernstein, M.D. said...

Oh my! We are at 183 Comments in just 30 days and I will have to create Volume 89! Oh, by the way NTT, we are cool these days in Southern California compared with the mid-west and east coast--a most unusual weather dichotomy at least for the upcoming week. ..Maurice.

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

NTT

If your medical license is revoked, suspended in one state, there are no provisions to practice in another state. And btw, the same applies to your drivers license.

PT

 
At Sunday, July 01, 2018 3:44:00 PM, Blogger Maurice Bernstein, M.D. said...

NO FURTHER COMMENTS WILL BE PUBLISHED ON VOLUME 88 AS OF JULY 1 2018. COMMENTS CAN CONTINUE, HOWEVER, WITHIN VOLUME 89.

 

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