Bioethics Discussion Blog: Patient Modesty: Volume 90

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Saturday, August 04, 2018

Patient Modesty: Volume 90









The animated GIF picture for Volume 90 (thanks to matthen.com via Google images) is my graphic
impression of what has been one of the primary concerns of patients writing here: unwanted, unnecessary or even non-permitted  bodily visual inspection during medical or surgical procedures.  Of course, other unprofessional acts by the "professionals" have also been described but unnecessary and patient unwanted inspection, looking or "peeking" is a common behavior presented. 
However, the graphic should also represent the eye movements and "attention" by patient's themselves, looking out, keeping their eyes open to professional misbehavior coming from any direction.

I think this graphic should emphasize the need for such attention and if unwanted "gazing" other "unprofessional" behavior is found, patients should feel free to "speak up" and contribute to making the medical profession truly "professional" toward a goal directed solely to  patient beneficence and not some other goal set solely for "the system person" or the system itself.  Is there anything further to add describing any relationship of this graphic to the issues brought up in these 90 Volumes?  ..Maurice.
AS OF SEPTEMBER 8 2018, NO FURTHER COMMENTS WILL BE PUBLISHED ON
VOLUME 90. THE DISCUSSION WILL BE CONTINUED ON VOLUME 91

190 Comments:

At Saturday, August 04, 2018 9:06:00 PM, Anonymous Anonymous said...

In 1973 Bruce Lee starred in a film Enterr the Dragon. In the movie he is challenged by an opponent who asks “ what’s your style “.Bruce lee responds by saying “ what’s my style, you could call it the art of fighting without really fighting.” Now of course Bruce Lee could always back up what he said . In corporate healthcare hospital administrators have a similar saying. “ the art of looking important without really being or doing anything important.” On Becks hospital site hospital administrators salaries continue to rise, for what. To them being important is hurrying home to their Louis Vuitton luggage to catch the next flight to another offshore island to look important without really being important.

Next in line are the nursing directors throughout the hospital, they follow the same mantra. They really couldn’t care about the patients or their responses to Press Ganey cause they know the answers are padded and of course the CEO of Press Ganey is a nurse, so no surprise their. Next in line are all the nurses, of course 95% of them being female and what’s important to them is acting like they care about their patients when they really don’t care about their patients. But of course they have to act like a cheerleader and say look at me, I’m a good girl when they hate their job just like everyone on the ladder above them.

So the crux of it is in order to be successful in the hospital setting is that it’s not what you do for the patients, but rather acting like you care or acting important. Thus in a sense everyone what’s to be an actor like Bruce Lee but they really can’t back up much of what they say. It’s essentially this mentality from bottom to top in the hospital setting with the administration boasting that “ well we have a great team and this and that. Little is mentioned about the nurse to nurse bullying, nurse to physician bullying etc. As they say crap flows downhill and much of this negatively affects the patient.

The same can be said about the Joint Commission, they like to look important and act important but what do they do that’s really important other than get paid by hospitals and be given free donuts. They don’t have field offices in every state so they board a plane once every three years or more to visit hospitals. You the patient are paying their salaries, meals and flight fair as well as all the free donuts that hospitals give them cause it comes out of the hospitals budget. As a challenge, call the Joint Commission and ask them yourself what do they do about patient complaints.

PT

 
At Saturday, August 04, 2018 9:33:00 PM, Anonymous Anonymous said...

Let’s face it. I know of no other industry whereby a person pays to be groped, assaulted, molested, raped, inappropriately touched, struck, mocked, gawked, leered, stared, slandered, spyed on, talked about, stolen from, dropped, judged, given a Superbug, wrong medication and death. Even the Mafia has rules and ethics. You pay the hospital who then gets it cut, then pays the Joint Commission, Press Ganey and Big Pharma. These three big companies are getting paid off with your money without doing anything for you. It a systemic corruption that most patients never realize.

PT

 
At Saturday, August 04, 2018 10:10:00 PM, Blogger Maurice Bernstein, M.D. said...

For those reading here who want to know more about how people look at Press Ganey, should read this article in Emergency Physicians Monthly "A Death Knell for Press Ganey?" but also read the 77 Comments, mainly from "professionals" to the article who may define "patient satisfaction" in ways totally different than the "patient satisfaction" scoring by Ganey. Very interesting and fits with what has been written on this Patient Modesty thread. ..Maurice.

 
At Saturday, August 04, 2018 10:25:00 PM, Anonymous Anonymous said...

Hello,

Please read the article (url below) about the lack of informed consent - another blow to patient dignity/ self-determination.


http://blogs.einstein.yu.edu/minnesota-case-demonstrates-continuing-erosion-of-informed-consent/?utm_source=The+Doctor%27s+Tablet&utm_campaign=0a4cc73c66-RSS+Subscribers&utm_medium=email&utm_term=0_807fb5819e-0a4cc73c66-48792693

Reginald

 
At Saturday, August 04, 2018 10:28:00 PM, Anonymous Anonymous said...

Definition of hokey- fake, artificial, fraud


Press Ganey had a gross income in 2015 of a quarter of a Billion dollars. What does Press Ganey do? They are the ones who sends surveys to patients about their hospital care. What kinds of questions do Press Ganey ask the patients? How was the taste of the hospital food? Now if you know anything about hospital food served to their inpatients it’s formulated by a dietitian. Because a lot of patients are diabetic, so it’s important.

Billy bob is brought by ambulance to the hospital and admitted and he is found to have a high blood sugar of over 600. Technically, he should be in a coma. Billy bob dosen’t like the hospital food cause it tastes bland so Billy Bob orders a pizza from the local Pizza Hut and has it delivered to his room, his favorite, anchovies, pepporini, double cheese and mushrooms. But Billy Bob is non-compliant with the physicians orders regarding ordering food he should not be eating.

Billy Bob once discharged will never get a survey from Press Ganey. Nor will any patient that makes a complaint about the hospital while an inpatient. All patients pay for Press Ganey through their hospital bill but not all patients are surveyed. Dosen’t that seem unfair, to pay for a service you don’t recieve. Better yet to pay for a HOKEY survey that is a sham that only benefits the hospital for medicare re-imbursements. You see Press Ganey dosen’t know who the hospital patients are, the hospital sends Press Ganey only the patients they want surveyed.

Press Ganey knows this and it’s why it’s structured this way, to mutually benefit financially and to help the hospital get their Medicare re-imbursements. Medicare has established rules that require a certain level of patient satisfaction scores in order to recieve re-imbursement. Medicare does not require all patients to be surveyed, only a small percentage. Thus you the patient are paying for a sham survey that you never most likely will not get to participate in and if you do make sure to say the food was delicious.

PT

 
At Sunday, August 05, 2018 8:57:00 AM, Blogger Maurice Bernstein, M.D. said...

I know this repetitive offer may be getting boring to some but I think it is important for us to get feedback about the medical profession behaviors not only from those visitors in the United States but also elsewhere in the world. So at 5:50am my time we got a visitor to this Volume from France.
I would have appreciated greatly if that visitor contributed their experience or what they understand from others with regard to an individual's interaction with the medical profession in France.

How common are the issues described here in other countries from a patient's perspective? I know we have the visitors and now I look forward toward their experiences. ..Maurice.

 
At Sunday, August 05, 2018 4:15:00 PM, Blogger Biker in Vermont said...

PT, the hospitals decide which patients get the Press Ganey survey? I never knew that. So patients that they know had a problem of some sort are purposely left out. Those things really are useless. And here I had hoped to get one after my dermatology visits this past year. For sure they'd of coded me as "no survey".

 
At Sunday, August 05, 2018 6:47:00 PM, Anonymous Anonymous said...

Biker

That is correct, the hospital decides which patients are to be surveyed which is a very small amount ~ 3-5%. Many in healthcare despise patient satisfaction scores and the survey process. I believe it is a positive move, however, all patients should be surveyed. Furthermore, Press Ganey in addition to the redundant questions that are asked has a small box for comments. I can tell you with absolute certainty no one in administration ever cared about the comment or the scores. If you want a more accurate reflection of what patients think about the facility take a look at Yelp. Press Ganey unfortunately has been acquiring other data gathering businesses which I do not feel is a positive thing only because Press Ganey is bad at what they do thus the bad performance grows. Another thing Biker, if you are chosen to get a survey you typically get the survey within 4-6 weeks.

PT

 
At Sunday, August 05, 2018 9:34:00 PM, Anonymous Anonymous said...

Who are the surveys sent to? Is it possible for patients to communicate without the hospital's cooperation?

 
At Sunday, August 05, 2018 11:23:00 PM, Anonymous Anonymous said...

Due to Hipaa compliant issues you cannot communicate directly with Press Ganey. Why would you want to? The logistics are simply to insure re-imbusement. If you want to be heard about a complaint as I’ve said previously attempt to stop it from happening. Start with the charge nurse or director otherwise ask for the house supervisor. Inform the house supervisor of your concerns are of a patient issue and that you don’t want to take it to the BON. I should mention the house supervisor is in close reach to the Ceo and the Cno,

The house supervisor does not want this to rise to the level of an incident. If you still are unsatisfied you can first complain to the CEO, secondly file a complaint online with the BON and if it is a serious enough patient care issue you can complain to the state. I assure you if you follow this pattern you will be heard. Your best complaining power is while you are still a patient, not three weeks discharged home. At that point no one will care.

PT

 
At Sunday, August 05, 2018 11:34:00 PM, Anonymous Anonymous said...

Anonymous


If you would like to give me three different scenarios while you are an inpatient an your care was not up to standards I’d be happy to go through some solutions for you.

PT

 
At Monday, August 06, 2018 6:51:00 AM, Blogger Maurice Bernstein, M.D. said...

Just a reminder: those who want to sign in to this blog anonymously (and all are not to be discouraged to do so) should nevertheless provide at the finish of the comment with a consistent and previously unused pseudonym so we all can identify the writer and make the text more meaningful. Better still is to provide a permanent pseudonym via registering a pseudonym with blogger.com as JF and Biker have done. Thanks. ..Maurice.

 
At Monday, August 06, 2018 8:34:00 AM, Blogger Biker in Vermont said...

PT, I'm nowhere as knowledgeable about hospital operations as you but some facilities might also have Practice Managers that are above the top docs in given areas. When the Head of Dermatology ignored my complaint and I then took it up with Patient Relations, it was the Practice Manager that they went to and worked out a resolution. Oddly, the Practice Manager (a young woman) at that hospital oversees Dermatology and Urology.

 
At Monday, August 06, 2018 9:33:00 AM, Blogger A. Banterings said...

Maurice,

You asked:

Biker et al, in a little over a week from now, I will be starting the teaching of a group of six "fresh" first year medical students on how to interact with patients of both genders in how to take a medical history and the beginning learning of how to interact with a patient as in year 1 they learn how to take vital signs, abdominal exam, neurologic exam, mental status exam and ophthalmic exam.
I will have 2 or 3 female students in my group of 6. Do I teach differently based on the gender of my student and reflecting on the gender of their patient? If you were teaching what would you say to those 3 male and 3 female students?

Here is the chance for those visitors to this blog thread to contribute something to my education and possibly to the education of 6 medical students. And, remember, they are only one group of 6 and not the entire medical system.


So my answer is It does NOT matter what you tell them. By your own admission (Maurice) in other volumes, you do NOT know if your students treat patients with dignity or not when they reach residence, fellowship, and practice. You even speculate that all your work will be undone by the hidden curriculum.

So why not be brutally honest and just tell them that most will end up being like Dr. Larry Nassar although most of the Dr. Larry Nassars never get caught. Of those that end up in the bottom 99% of providers (based on wealth and power), lacking the VIP status they once had, one day they will experience the same compassionate care that they (your students) provided to their patients as they become patients and the doctors and nurses that care for them take pictures of their naked bodies to share with world on the internet.



-- Banterings



 
At Monday, August 06, 2018 10:01:00 AM, Blogger A. Banterings said...

Biker,

Thank you for sharing. I will say a prayer of healing for you.

My friend up north, is not well endowed. He is also brutally honest about the situation. He says that his is "hung like a bull mouse..." He owns this status, so no one can shame him with it.

He also has a sexual prowess that rivals that of Casanova. He is in his late 40's, and has many "friends" in their early 20's. He is also very discreet, he says that they are (only) friends. I also do not believe that he is compensating, that is just his personality. He is extremely flirtatious whether at a restaurant (with waitresses) or the cashiers at the supermarket.

I believe that women are attracted to him because he is the proverbial "bad boy." Despite being a successful businessman, he lives life on his term.

My point is that your main sex organ is between your ears. To simply judge one by what is between their legs only shows how little one understands of sexuality.



-- Banterings




 
At Monday, August 06, 2018 10:18:00 AM, Blogger A. Banterings said...

Reginald,

Here is another assault on informed consent from Great Brittian: Britain plans to increase the number of organ donors by changing the rules of consent and presuming that people have agreed to transplants unless they have specifically opted out.



PT,


As you point out, our $4 trillion spending on healthcare, here are 2018’s Best & Worst States for Health Care...



-- Banterings



 
At Monday, August 06, 2018 12:23:00 PM, Blogger BJTNT said...

Recently my sister had a laminectomy. The scheduler called the day before surgery to confirm. When my sister was told the surgery was now scheduled for 2:30 PM instead of 6:30 AM, she asked why. The response was an emergency. My sister said that an emergency would be done today and not scheduled for tomorrow. Without missing a beat the scheduler then said that the other patient had scheduled weeks ago. My sister replied that she had also scheduled weeks ago and why wasn't the schedule conflict resolved then. When my sister asked to speak to the supervisor, she undoubtedly just talked to another receptionist with the same story.

When my sister realized that she had a choice of either a 2:30 PM appointment or wait weeks in pain, she back-pedaled, calmed the waters, and became compliant for the the 2:30 surgery. Being a retired nurse with 20 years of surgery experience, she did not want any of this conversation communicated to any one involved with her surgery including the surgeon.

Enough said.

BJTNT

 
At Monday, August 06, 2018 1:07:00 PM, Blogger Biker in Vermont said...

Bantering, just out of curiosity, is your "bull mouse" friend OK with female caregivers for intimate care? My guess is yes based on what you say but it is possible he is not given the context difference of the voluntary aspect of his personal life vs the involuntary nature of healthcare.

I am fine, modest, but fine. My life has been full in every respect. I just haven't wanted to be defined by the loss of a testicle. Others here may not have ever noticed but men who have had testicular cancer are sometimes the butt of jokes in the media whereas that never happens to women who have had mastectomies. They get empathy. Men get mean spirited jokes.

Healthcare just reflects society at large.

 
At Monday, August 06, 2018 2:34:00 PM, Blogger Maurice Bernstein, M.D. said...

Banterings, you wrote "So why not be brutally honest and just tell them that most will end up being like Dr. Larry Nassar although most of the Dr. Larry Nassars never get caught."

Your suggestion toward my "brutality" would be analogous to my giving each student a pre-tibial pounding with a hammer ("brutally honest") and say "this is what you likely might expect the patient with a pretibial traumatic fracture to experience."

Both would represent what I might call "malignant methods of teaching prognostic education." Of course, there may be some students in my group that turns out later to be "bad apples" but why toss all prematurely into the "bad apple" basket?

..Maurice.

 
At Monday, August 06, 2018 4:57:00 PM, Anonymous Anonymous said...

Biker

I’ve worked at over 20 hospitals in my life and never have I seen a Dermatology or a Urology department in a hospital. From a Urology standpoint urologic procedures are typically performed in surgery for those that require anesthesia. Dermatologists don’t perform surgeries of any kind and I’ve never known or met a Dermatologist.

Typically physician offices will have office managers that hire, manage budgets, troubleshoot etc but they are never over the physicians. At hospitals all physicians typically answer to the CMO ( chief medical officer) or the CEO. Individual departments at hospitals such as the laboratory, respiratory, radiology, bio-med, evs, food service, icu’s and nursing floors, ER, surgery will all have their own directors.

The directors all answer to the COO ( chief operating officer) or the CNO( chief nursing officer), the COO and the CNO answer to the CEO. Now at hospitals some departments will have managers and leads. Additional, hospitals will also have a nurse that works in quality and a nurse or more in risk management. Moreover, many larger hospitals will employ someone in patient relations and all they do is handle patient complaints, business relations and physician recruitment.

I believe the young woman you describe was someone in patient relations. In hospitals that employ someone in patient relations unfortunately this is where all patient complaints start. They have no real power, they just listen to patients who have concerns, however, the complaints if they are a patient care issue are bumped to the quality nurse and if it becomes a legal issue then risk management gets involved. The complaints may end up being sent to the department director if one of his/her employee was unprofessional/ inappropriate and it may end up as well in HR( Human Resources) if the employee is to be reprimanded or terminated.

Hospitals have really cracked down on complaints against physicians and I’ve seen physicians terminated or have their privileges revoked in a heartbeat. Particularly in emergency rooms when many patients complain about PA( physician actors) or physicians are rude to patients. You might think that your complaint has not been heard but I assure you it’s cumulative.

PT

 
At Monday, August 06, 2018 5:07:00 PM, Anonymous Anonymous said...

A.Banterings

The best and worst states for healthcare. I read that article this morning and I thought, how misleading. As if one state is somehow better than another. My thoughts are this, good healthcare is like looking for gold, it’s where you find it.

PT

 
At Monday, August 06, 2018 7:02:00 PM, Blogger Biker in Vermont said...

Thanks PT for your explanation. Not working in healthcare I may be struggling a bit with terminology and perhaps am misusing the word department as it is used in hospitals. Where I go is the 3rd or 4th largest hospital in all of Northern New England and is a teaching hospital. It is a very big deal up here. It has a large Dermatology operation and a large Urology operation. In addition to regular outpatient practices, I know Urology also does the whole range of urologic surgeries and Dermatology does skin cancer surgeries.

When I was ignored by the top doc in dermatology (termed the Section Chief) I went to Patient Relations. They brought the matter to a young woman who (I just looked her up) is the Sr. Practice Mgr for Dermatology, Plastic Surgery, Wound Care, and Thoracic Surgery in the Dept. of Surgery. That's a bit different than back when this all happened when she had a role with urology too. As best I can currently figure, her role is overseeing workflow practices for those areas. Patient Relations worked with her to resolve the situation, though she in turn worked with the Dermatology Section Chief. The resolution involved a policy change and staff training.

Perhaps my struggling with terminology and processes here speaks to just how difficult it is for patients to navigate hospitals when they have a complaint.

 
At Tuesday, August 07, 2018 5:26:00 AM, Blogger A. Banterings said...

Biker,

He is NOT ok with intimate care from anyone. Like me, he avoids healthcare. He has never stayed overnight in a hospital and never been to the ED for anything more than stitches, even then a couple times he took matters in his own hands. I asked him your question, he said if he HAD to, he would require gender concurrent (male in his case) care.

It is interesting that you make such an assumption about him. He is actually quite modest. Just because he is willing to share his body with women that he is attracted to, even if he is promiscuous (by societal standards), that does not mean that he has no modesty OR that all of healthcare has carte blanche access to his body.

This is like making that argument that a prostitute can't be raped. Because he talks about a factual description of his physical being in a humorous pun, it does NOT make him an exhibitionist. Because he talks about it in a matter of fact manner does NOT mean that he is going to show you either.

If you look at the dynamics of a sexual encounter, not only is it consensual, but when the individuals involved are ready to begin the act, BOTH parties undress, there is no bullying. Everyone else from the bar (where they met) do not come into the bedroom to "have a look" either.

He also does not bring this up unless the conversation is going there. The only reason that I am aware of this fact is because we were out at a bar in Philadelphia one time, he was flirting with some women there and the conversation turned to that of a sexual nature. (Interestingly enough, the women turned the conversation sexual.) When they began talking about size, he offered that fact about himself.

In our conversation about your question, he admitted that he has insecurities about his body. He was never the "hot guy" in high school and college (he is actually a good looking man). He said that he has always relied on his personality to attract women. I guess just as when a person goes blind, their other senses enhance (such as hearing). Because he (thought) that he didn't have the looks to compete, he compensated with personality. I will say that he is one of the most genuine and generous person that you will ever meet.


Maurice,

My point is NOT for you to be abusive, my point is simply that despite all you do, you do NOT know how your students end up and you have even speculated that the hidden curriculum undoes all that you have done. So if you were to do nothing, the hidden curriculum would still create the same outcome.




-- Banterings




 
At Tuesday, August 07, 2018 8:23:00 AM, Blogger Maurice Bernstein, M.D. said...

Banterings, yes I do instruct my first year students about the upcoming "hidden curriculum" (I use that descriptive title) where principles of clinical discovery and behavior with patients will be supportive of what we are teaching but warn them that because of pressures of time, money and aberrant superiors, a "curriculum" being presented to them may well be counter to what I and the other first and second year instructors are teaching them in these pre-clinical years. Yes, it is up to the student in these later years of clinical experience with respect to how they accept the behavior of others. But, I do warn them ahead of time. ..Maurice.

 
At Tuesday, August 07, 2018 9:58:00 AM, Blogger Biker in Vermont said...

Banterings, your description of your friend makes the case that the context of exposure matters. It has been brought up many times, but nothing illustrates it better than what you described. Your friend has helped the conversation here by sharing his thoughts.

Context matters.

Our problem as patients is that virtually everyone in healthcare would also say that context matters, except that they view the context of healthcare settings as meaning patients (or at least male patients) set aside the modesty they might otherwise have.

We see context as voluntary (private life) vs involuntary (healthcare settings). They see context as sexual/societal norms (private life) vs non-sexual/non-judgmental (healthcare settings). The two sides are not speaking the same language so to speak.

There is another level of context disconnect as well. Patients differentiate between the many levels of healthcare staff when it comes to intimate exposure/procedure/exams. A man who might be comfortable with a female surgeon operating on him might not be comfortable with an MA or CNA assisting them with a shower. He might be comfortable being examined by a female physician but uncomfortable with her bringing a female chaperone into the room. Conversely the healthcare world does not differentiate between levels in this regard and expects patients to be equally comfortable with the trained-on-the-job MA as with the surgeon.

 
At Tuesday, August 07, 2018 1:29:00 PM, Blogger A. Banterings said...

Biker,

Speaking of context, may I ask about your handle; "Biker in Vermont?"

Is it "Biker" as in "Harley Dude" or as in Tour de France?

I suspect that it is probably Harley. If so, the context is that you would be the type of strong guy that people fear, and you fear nothing (or nothing bothers you).

Yet this stereotype is continually challenged in society that begs us to respect the human dignity of the person. The most recent evolution of this is the GoDaddy GoCentral TV Commercial, 'Biker Mike's Crochet Classes'.

Being that this is advertising, it takes a humorous approach to the subject matter.

I think that one of the most powerful lines come from Shakespeare's "The Merchant of Venice": Act 3, Scene 1. Simply replace the word "Jew" with "patient" and "Christian" with "physician/nurse/provider/etc."


SHYLOCK:
I’ll use it for fish bait. You can’t eat human flesh, but if it feeds nothing else, it’ll feed my revenge. He’s insulted me and cost me half a million ducats. He’s laughed at my losses, made fun of my earnings, humiliated my race, thwarted my deals, turned my friends against me, riled up my enemies—and why? Because I’m a Jew. Doesn’t a Jew have eyes? Doesn’t a Jew have hands, bodily organs, a human shape, five senses, feelings, and passions? Doesn’t a Jew eat the same food, get hurt with the same weapons, get sick with the same diseases, get healed by the same medicine, and warm up in summer and cool off in winter just like a Christian? If you prick us with a pin, don’t we bleed? If you tickle us, don’t we laugh? If you poison us, don’t we die? And if you treat us badly, won’t we try to get revenge? If we’re like you in everything else, we’ll resemble you in that respect. If a Jew offends a Christian, what’s the Christian’s kind and gentle reaction? Revenge. If a Christian offends a Jew, what punishment will he come up with if he follows the Christian example? Of course, the same thing—revenge! I’ll treat you as badly as you Christians taught me to—and you’ll be lucky if I don’t outdo my teachers.






-- Banterings




 
At Tuesday, August 07, 2018 5:06:00 PM, Blogger Biker in Vermont said...

Sorry to disappoint Bantering but the answer is neither. It is biker as in mountain biker. Road biking gets kind of boring after a while. Mountain biking on the other hand requires a combination of strength, skill, and endurance and it never gets boring. My glory days are long gone at this point however. Can't do what I used to do.

I am thus not the strong Harley type guy that some fear but I have been the strong competent type that people have respected and deferred to. Brains and integrity rather than muscle and tattoos.

So while I don't make for a GoDaddy commercial my calm polite but focused style has worked for me. In my dermatology saga this past year coming across as a reasonable person with a legitimate grievance and expectations allowed them to focus on helping me rather than defending themselves against an emotional onslaught which is what I suspect they often get.

 
At Wednesday, August 08, 2018 7:54:00 AM, Blogger Maurice Bernstein, M.D. said...

An interesting recent article in Statnews.com regarding current increasing hospital or health system mergers and affiliations on impairment of physician behavior and safety of patients.

What this means is that the proper ethical behavior criteria of the doctors and staff isn't necessarily preserved when mergers of the systems are allowed to occur. This might make patients' redirection of their caregiver's behavior lost with the mergers and acquisitions---all this making the attempts of our visitors here toward improvements in the medical system behaviors more difficult and uncertain. ..Maurice.

 
At Wednesday, August 08, 2018 10:59:00 AM, Blogger A. Banterings said...

Maurice,

How much additional risk is there?

USC gynecologist Dr. George Tyndall is alleged to have inappropriately touched and photographed patients repeatedly over his nearly 30-year career, despite complaints made about his unprofessional behavior?

...After an investigation, Tyndall was fired last year for inappropriate behavior, according to USC. University officials said the school reached a settlement with the doctor and did not report him to law enforcement or state medical authorities at the time.

The university said it had consulted legal experts and medical professionals to confirm that it wasn't legally obligated to report Tyndall. The university said it subsequently made a report to the California Medical Board on March 9 after Tyndall asked to be reinstated. "In retrospect," USC said it should have filed a complaint with the medical board when Tyndall was terminated...


Actually, Tyndall ONLY was suspended with pay in 2016 retired the next year with a financial payout from USC.

Allegations against Tyndall were made as early as 1990 but USC failed to fully investigate until 2016, and the school also failed to disclose the complaints during an earlier sexual harassment investigation, according to the Department of Education.


To add insult to injury, USC president C. L. Max Nikias agrees to step aside immediately, BUT will continue as a tenured professor and continue as President Emeritus and Life Trustee of the University.

Again, NO accountability in the system.

I guess all those who made complaints (going back to 2000) were labeled as OUTLIERS...




-- Banterings




 
At Wednesday, August 08, 2018 3:12:00 PM, Blogger Biker in Vermont said...

From the Allegations against Tyndal article:

“In fact, USC nurses, chaperones and other staff members were regularly present in the examination rooms, observed the inappropriate sexual molestation, and took no steps to stop it as it occurred,” the complaint says.

To me this is the larger problem in healthcare. There is no avoiding the proverbial bad apples. They are always going to pursue the career paths of their choice, but if their co-workers just look the other way the system is in effect condoning the bad behavior. How many years did Dr. Sparks sexually assault her patients before someone turned her in? How many people knew what the Denver 5 were doing for days before the patient died, yet said nothing? Odds are the actual group was larger than the 5 that got caught.

 
At Wednesday, August 08, 2018 4:19:00 PM, Blogger Maurice Bernstein, M.D. said...

Banterings et al: Banterings in your first
link of your last posting was fully an advertisement by a legal firm for more "customers" in the USC legal issue.
Please avoid direct links to primary advertisements since this blog should not direct readers to frank ads. You can indicate that such companies are active in procuring customers, suggesting that such companies assume that there are many more victims of that USC doctor.. but don't link to the site.
I do want to keep this entire blog without ads (anti-spamming postings here is my other activity as Moderator.) ..Maurice.

 
At Thursday, August 09, 2018 2:10:00 PM, Blogger Maurice Bernstein, M.D. said...

Ah! Finally a mechanism to prevent or get rid of the "bad apples" both students, faculty and the deans themselves at USC Keck School of Medicine.

From the news media of the medical school:
"Kathleen Nelson, MD, clinical professor of pediatrics at the Keck School of Medicine of USC, has been appointed associate dean for leadership and wellness.."

"Nelson will coordinate, oversee and develop efforts in the areas of wellness and leadership for trainees, faculty and staff. She will coordinate her work with other leaders at the Keck School, Keck Medical Center of USC and Children’s Hospital Los Angeles, on programs and initiatives that affect the lives and professional development of the community of individuals that compose the Keck School."

Let's hope this education and supervision of behavior works and prevents entry into my "dirty pond" analogy (Volume 89). ..Maurice.

 
At Thursday, August 09, 2018 4:20:00 PM, Blogger Biker in Vermont said...

Dr. Bernstein, I am guessing you know this Dr. Nelson and are seeing it as a positive development. Sometimes putting new people in positions of authority is what it takes to effect change. Good luck to her.

 
At Thursday, August 09, 2018 4:49:00 PM, Anonymous Anonymous said...

To answer a challenge put forth in Volume 89, sorry, not interested at this point in a 55 word limitation; a succinct presentation is just one tiny facet of what I do as a writing consultant for university and private creative projects I take on. For me, such an exercise is ancient, meaningless - BORING! Permit me to turn this around: the mak’emsick industry uses short, meaningless phrases to hone los sheeples into accepting the nonsensical terms that I and others have exposed as forms of deceit, lying, fraud, etc. Terms such as standard of care, evidence based medicine, unavoidably safe, gender neutral, and those of hospitals that PT has mentioned such as patient dignity, patient respect, ad nauseam. Yet, for the simple minded, one has only to repeat such phrases 3 times and the simple mind believes such nonsense to be true, to be fact, and so forth. I urge all to view “The Bleeding Edge” (it’s on Netflix) which exposes the medical device industry – yep, rotten to the core! One comment I did not agree with (haven’t viewed it all yet) is that pharmaceutical drugs are more rigorously tested than medical devices – we know that’s not true!
Maurice, you stated thusly: “I have something to add which might upset some of my visitors here. Whereas, I will strongly agree that the patient knows a lot more about him/herself than the physician on the first or all the subsequent visits whether in the office or hospital… Nevertheless, no patient excluding an active physician-patient has had the intense and complex education of all the essential details of medical diagnosis and treatment which medical students experience in the first two years of schooling.”
No, I am not upset and I realize most of us have not had the “complex education” (a superb example of an oxymoron!) which med students are exposed to, BUT, some of us, mainly the better educated, are immune to all forms of mental coercion! We smell the rank odor miles away! MEDICAL STUDENTS ARE COMPROMISED THE MOMENT THEY CHOOSE TO ENTER MEDICAL SCHOOL, to use a common term, THEY ARE BRAINWASHED! Let’s face it, the best minds, contrary to industry propaganda, don’t go into medicine! If scientifically inclined, they will choose physics, environmental studies, or the like. And I for one can say that I am FAR better educated in determining truth from falsehood than an entire student body of any medical school! I will make myself perfectly clear: THE INTELLECTUAL CAPACITY TO DETERMINE TRUTH FROM FALSEHOOD TRUMPS THAT NARROW BODY OF KNOWLEDGE THAT MEDICOS SO BOAST OF! The young people entering med schools today don’t appear to have the intellectual ability to determine truth from falsehood, and to a certain degree, these young people are not to blame. They were raised with the “Common Core” curriculum, which was designed to dumb down students and especially to block true critical thinking, as to not question the status quo in the increasingly fascist plutocracy that is the now the state of the nation. The curriculum has been quite successful on both fronts!
One of the main reasons for not choosing a medical career is that many of the best minds would agree with Banterings, that “Medicine is (mostly) infected with power-corrupted sociopaths who have self-exempted themselves from the norms, expectations, and laws of society to protect their deviant subculture… Medicine inveigles society with fluff and window dressing such as the Hippocratic Oath, ETHICS, mimicked emotions such as empathy and compassion, illogical ideologies (such as gender neutral healthcare), and ritualistic, cult-like, pseudo religious ideologies (such as cancer screening).”
I see more yet more coercion/duplicity and so forth in the study “Informed Refusal: Towards a Justice Based Bioethics” and its alarming conclusion, in calling some of us “problem people” or “refusers.” So, we “refusers” are to be guided like sheep to enjoy the dangerous fruit issuing forth from the mak’emsick industry and thus the “trustworthiness of institutions” will be waving like the good ole’American flag!

EO - cont. due to length

 
At Thursday, August 09, 2018 4:52:00 PM, Anonymous Anonymous said...


The battle against informed consent/human rights is making great progress in the land down under! Since it’s at the root of the alarming ill health of especially American and Australian children, and seeing as how the fraud and greed is now being exposed via numerous studies (except from the fascist states of America), let’s see how Big Pharma via its thugs in government is reacting to low income Australian parents who may or may not collect welfare benefits but still believe they are the ultimate guardians of their own children: “Prime Minister Tony Abbott and Social Services Minister Scott Morrison will today announce the historic reforms, which mean parents who fail to immunise [sic] their children will no longer be paid the $200-a-week childcare benefit, the $7500-a-year childcare rebate or the $726 Family Tax Benefit A annual supplement. The combined childcare and welfare payments at risk could amount to up to $30,000 a year for a family with two young children. The changes will come into effect from January 1, 2016.” Here’s the link: https://globalfreedommovement.org/australia-refuse-vaccination-lose-15000-prime-minister-tony-abbott-is-a-moron/

When individuals do not thoroughly investigate a mak’emsick claim whether from Big Pharma, or their shills, physicians and their minions, but refer to such entities or individuals as “experts,” such individuals are committing one of the basic logical fallacies, the appeal to authority. And, since the alarming plutocracy which is overwhelming American politics is not even noticed by los sheeples, jumping on the bandwagon when it comes to medical “experts” and their daily dose of fraud is quite dangerous, for as Albert Einstein warned, “Unthinking respect for authority is the greatest enemy of truth.”

Rigorous studies from around the globe are exposing the ultimate fraud of the vaccine cartel, that their products are not only worthless, but quite dangerous. Japan is suing Merck over the HPV vaccine, Sweden has ended all mandatory vaccinations, people in many countries are marching against mandatory vaccinations, etc. All of this is, of course, deliberately withheld from los sheeples here in the US. I find it particularly disingenuous that physician groups are advocating for stricter gun control laws so as to supposedly protect young people from shooting numerous other young people when it is the pediatricians and their greed, ignorance, and arrogance that has created the alarming spread of mental illness among our youth, especially males who are at much greater risk of harm from vaccines.

Now, when a powerful entity such as Big Pharma/Medical Ops is losing ground to the truth, they at first try to discredit their opponents with pseudo science, and next they attempt to ridicule their opponents via the good ole ad hominem attacks. Both larger entities as well as individual physicians/nurses use a variety of fallacious arguments to bully clients into accepting what these mak’emsick workers deem as necessary: ad ignorantiam, complex question fallacy, false dilemma, appeal to prejudice/bandwagon, circular reasoning/begging the question, argumentum ad passions (a huge favorite of individual providers as well as Big Pharma) and the list goes on and on…


EO cont. due to length

 
At Thursday, August 09, 2018 4:52:00 PM, Blogger Biker in Vermont said...

We have talked about opposite gender chaperones many times. I just learned today that there is a law in VT concerning that for inpatients. Nothing comparable exists for outpatients. From the summary of that law on my local hospital's website:

"Respect for your privacy. This right includes the right to have a person of your own sex present during an exam and the right not to remain disrobed any longer than is required. You have the right to wear your own clothes except when they interfere with your medical care."

I take this to mean that if they try to force a female chaperone on a guy that he can insist they bring in a male instead. Of course this only pertains to inpatients which is not where chaperones are commonly used. Something is better than nothing however.

 
At Thursday, August 09, 2018 4:54:00 PM, Anonymous Anonymous said...


I belong to a closed group of parents/relatives of youngsters that have been gravely harmed or killed by vaccines - almost every week, another dead infant, usually 2 – 14 days after a slew of vaccines. Both pediatricians and hospitals are fighting tooth and nail to try and blame these harms/deaths upon ANYTHING ELSE THAN WHAT CAUSED SUCH DESTRUCTION – THE VACCINES THAT PEDIATRICIANS MAKE BANK ON! I’ve already posted the link to what Blue Cross pays physicians to poison the young. And, now, going into the 3rd generation of vaxxed children, some 54% of American children have a serious physical disability (auto immune, severe allergies, asthma, cancer, and this list also goes on…), and yes, autism now affects at least 1 in 36 children. UNAVOIDABLY SAFE TRANSLATES TO HUGE PROFITS FOR BIG PHARMA AND ITS RENT A BOYS, SUCH AS THE CDC, AMA, FDA, PHYSICIANS, AND SO FORTH. Many of the parents I referred to were Pro-Vax before they had to select a coffin for their child! The mak’emsick industry has done a stellar job of not only brainwashing providers but the general public as well! If humanity survives, it will look upon this period of mass poisoning much as modern humans look upon witchcraft and such belief systems.

So, returning briefly to Australia’s new draconian law, we see that the logical fallacy of “argumentum ad baculum” is now being used to keep the mak’emsick industry’s profits rolling right in! This “argument with a cudgel” is used widely in pediatricians’ offices here in the US. Many parents in my closed group report being threatened by their pediatricians if they avoid vaccines for their children; some pediatricians even threaten (and some have) to report them!

I will repeat what Banterings has asked: “Do you still think that the medical education system is not broken?"

Banterings has given us much info on unauthorized PEs, while I focus on the terrorization of parents by pediatricians. I too, would love see a trial of providers for crimes against humanity, and what does one receive for killing/maiming in the name of profit and arrogance? Hmmm… At this point, about as much as the Denver 5 perverts! As Banterings also stated: ALL providers accept accepting their recommendations as an "informed decision," yet there is an interrogation when the patient refuses their recommendations or suggests an alternative (whether it is an accepted alternative or not).” Like parents in my closed group, I basically avoid all medical care unless a matter of life and death! And of course even there one is in grave danger of being harmed or killed – let’s recall that “health” care in the US is now the leading cause of death!

Moving from informed consent to equal rights for male patients I agree with PT, that “Long story short when it’s time for male patients to have a say as far as informed consent and autonomy all paperwork you sign will be null and void.”

I’d like to (almost) end with this from PT: “Let’s face it. I know of no other industry whereby a person pays to be groped, assaulted, molested, raped, inappropriately touched, struck, mocked, gawked, leered, stared, slandered, spyed on, talked about, stolen from, dropped, judged, given a Superbug, wrong medication and death. Even the Mafia has rules and ethics. You pay the hospital who then gets it cut, then pays the Joint Commission, Press Ganey and Big Pharma. These three big companies are getting paid off with your money without doing anything for you. It a systemic corruption that most patients never realize.”
I must agree with Banterings: “That is what these systematic abuses of patients are, crimes against humanity.”

Whether vaccines, senior drugs, discrimination and outright sexual abuse of male clients, these abuses are formulated by the powerful purely for profit and control of los sheeples.

EO cont. due to length

 
At Thursday, August 09, 2018 5:01:00 PM, Anonymous Anonymous said...


The mak’emsick industry is hopelessly corrupted and just these two docs can give some insight: https://healthimpactnews.com/2018/hhs-sued-for-not-upholding-vaccine-safety-testing-mandated-by-law/
http://icandecide.org/government/ICAN-HHS-Stipulated-Order-July-2018.pdf

I’ll conclude with a snippet from my closed group: Merck and the CD have determined that one out of every 912 who received Gardasil in a large study died. Yet, the cervical cancer death rate is 1 out of every 40,000 women per year. In other words, girls are better off not taking the shot because the Gardasil shot kills the girls in greater numbers than the disease it purports to treat.

Informed consent?

https://globalfreedommovement.org/11-golden-rules-of-militant-vaccine-pushers-part-1/
https://globalfreedommovement.org/11-golden-rules-of-militant-vaccine-pushers-part-2/

EO

 
At Thursday, August 09, 2018 8:23:00 PM, Anonymous Anonymous said...

Well let’s see, another one bites the dust. USC president Max Nikias is out of a job for not doing any thing about the complaints regarding Dr Tyndall. Dr Nassar will never get out of prison and those nude posing monkey bar swinging wonders are getting richer by the day. What was the punishment for Dr Twana Sparks when she groped all those men while unconscious. What about all those nurses in that operating room who laughed and never said anything for years.

Many of those patients were poor Hispanic or native Americans, I’ve not heard that they received a dime let alone got any kind of a reward to speak of. I wonder if the patient of the Denver 5 got any kind of an award, if he did it would have to be posthumous, since he was gawked at alive and again after he died. You know Dr Sparks didn’t use a spoon on her poor male patients, she used her hand to slap their genitals.

The victims of Dr Sparks I suppose would not be entitled to an award since they were unconscious, unlike the victims of Dr Nassar they were conscious. I still don’t understand why they got an award. I never got an award or plaque for being treated unprofessional while a patient. Has anyone on this blog ever got an award? Do we have to apply somewhere or online for the award?

PT

 
At Thursday, August 09, 2018 9:07:00 PM, Blogger Maurice Bernstein, M.D. said...

Wow EO: much to swallow and much to digest!
Sorry, the series of separate posts were not published without interruption but the order is set by the time of entry. Nevertheless, there is much to "chew" and "digest". One takeaway is that the medical system has bad people doing bad things for bad reasons. Am I reading the takeaway properly?

With all that EO wrote in mind, I got a visitor today to my blog thread begun in February 2006 titled "Good People Doing Bad Things for Good Reasons".
EO or others may want to contribute a comment to that thread or follow up with a comment of that viewpoint here on "Patient Modesty". ..Maurice.






 
At Thursday, August 09, 2018 9:11:00 PM, Blogger Maurice Bernstein, M.D. said...

If you can't access the link on my previous post try this:
http://bioethicsdiscussion.blogspot.com/2006/02/good-people-doing-bad-things-for-good.html
..Maurice.

 
At Friday, August 10, 2018 1:06:00 AM, Anonymous JF said...

PT, Most people wouldn't seek a reward because they wouldn't want people to know what happened to them in the first place.
Twana Sparks, if she did what she was said to do is a piece of shit and some random stranger ( to her ) should run up to her in a public place and rip her dress off.
Otherwise I don't think your anger at those sexually abused female athletes is justified. Be angry at the female healthcare workers who violate patient modesty. Be angry with male providers who require female staff to be present with his patients are nude.
You seem to think it's not so awful bad if it is a female patient who is victimized.

 
At Friday, August 10, 2018 9:46:00 AM, Blogger A. Banterings said...


My comments will be in bold:


EO,

You state:

...the mak’emsick industry uses short, meaningless phrases to hone los sheeples into accepting the nonsensical terms that I and others have exposed as forms of deceit, lying, fraud, etc. Terms such as standard of care, evidence based medicine, unavoidably safe, gender neutral, and those of hospitals that PT has mentioned such as patient dignity, patient respect, ad nauseam...

Another great example is the "patient responsibilities" listed with the "Patient Bill of Rights." While the Patient Bill of Rights are protected by Federal legislations, providers "TRICK" patients in to believing that in order to get their rights, they have to give something up (patient responsibilities).

...And I for one can say that I am FAR better educated in determining truth from falsehood than an entire student body of any medical school! I will make myself perfectly clear: THE INTELLECTUAL CAPACITY TO DETERMINE TRUTH FROM FALSEHOOD TRUMPS THAT NARROW BODY OF KNOWLEDGE THAT MEDICOS SO BOAST OF! The young people entering med schools today don’t appear to have the intellectual ability to determine truth from falsehood, and to a certain degree, these young people are not to blame...

The Internet has forever changed medicine. Sacred knowledge that was once locked away and guarded in medical libraries is readily available at the world's fingertips.

...THE VACCINES THAT PEDIATRICIANS MAKE BANK ON! I’ve already posted the link to what Blue Cross pays physicians to poison the young. ...UNAVOIDABLY SAFE TRANSLATES TO HUGE PROFITS FOR BIG PHARMA AND ITS RENT A BOYS, SUCH AS THE CDC, AMA, FDA, PHYSICIANS, AND SO FORTH.

Let us not forget that there is absolutely NO LIABILITY to physicians from vaccines. (That is what the Federal Vaccine Court is for.) If I could sell a product that I make a profit from without any liability, I would push to make that mandatory too.

I must agree with Banterings: “That is what these systematic abuses of patients are, crimes against humanity.”

Whether vaccines, senior drugs, discrimination and outright sexual abuse of male clients, these abuses are formulated by the powerful purely for profit and control of los sheeples.


(Thank you for reading and the recognition.) Let us NOT forget the ritualistic intimate cancer screenings of our genitals. Even the bimanual as part of the PE is not recommended .



-- Banterings



 
At Friday, August 10, 2018 11:02:00 AM, Anonymous Anonymous said...

JF


Obviously, most people do considering how many people are coming forward after years and years regarding Dr Nassar and the #Metoo movement. Once this blame engine hits full steam there will be many coming forward regarding Dr Tyndall as well. I don’t think Dr Sparks was one to wear a dress so ripping her dress off in public would be pointless. She should be in a cell across from Dr Nassar, you see and that’s exactly my point.

From the feminist healthcare standpoint you think the only punishment Dr Sparks deserves is to have a article of clothing ripped off of her, that there are double standards for men and women in healthcare who are unprofessional. That only male perps go to prison and women don’t. The nurses on theDenver 5 incident were given 21 days of paid investigative leave, that’s a vacation. There has been much criticism directed at many of the monkey bar wonders as to why didn’t they complain before.

There is much criticism at people, women who come forward years later to make accusations. I have never heard of such a large group of people receiving an award who were supposedly molested, is this new? Why did the Administrators at the hospital in New Mexico where Dr Sparks not step down or get charged. Unless you’ve noticed, female healthcare workers don’t wear dresses anymore, they wear pantsuits and trousers, it’s the new feminist healthcare.

There is much blame to go around particularly with victims and/or so called victims coming out of the woodwork to perpetuate the evil doing, the notion. If you read much of the early complaints about Dr Tyndall, a female nurse complained that she did not approve of Dr Tyndall, that a male should not be a gynecologist at the college. She in fact encouraged many students to complain when they had no complaints about the care they received. There were accusations that he made sexual suggestive comments about his female patients behind the patient’s backs. How often do you think nursesmake these kinds of comments at the nurses station or in their break room.

PT

 
At Friday, August 10, 2018 11:12:00 AM, Blogger Maurice Bernstein, M.D. said...

Banterings, shouldn't the second year medical students be taught and practice the proper performance of a bimanual pelvic exam just as it is a part of the physical exam program at my medical school? Regardless of the statistics regarding universal clinical value of the procedure in view of alternate methods or schedules for disease screening, as long as even one patient in the student's career as a physician needs performance of a bimanual pelvic exam, the student should be aware of the method and patient communication which is necessary for the exam to be of value for diagnosis and patient acceptance of the procedure. However, I have no argument against the proposition and data that manual pelvic exams, based on current studies, are excessively and unnecessarily performed generally in clinical practice. ..Maurice.

 
At Friday, August 10, 2018 11:59:00 AM, Blogger Maurice Bernstein, M.D. said...

For those here who have the time and interest, may I suggest you take a look at "Patient Modesty: Volume 4" which was published 10 years ago. A different set of participants but the same sad stories and worries. And what does comparing the threads from 2008 to now 2018 tell us about what we are dealing with here and what is the prognosis for the future? It appears that over a period of a decade---we are still struggling. What do you think? ..Maurice.

 
At Friday, August 10, 2018 12:32:00 PM, Blogger Biker in Vermont said...

I don't have any expertise as concerns vaccines and can't comment on that. Needless intrusive exams and screenings as has been pointed out need to be done away with. I suspect that in addition to them continuing due to the "we've always done it that way" syndrome, I think part of it comes from these exams being revenue generators.

Every single thing that gets done is billed out. One of the "we've always done it that way" syndrome billing scams is sedation. My last two colonoscopies were done without sedation as was an upper endoscopy and transesophageal echocardiogram TEE). They made the mistake of billing as a separate line item in the summary I got for the TEE a $600 charge for the recovery room that I never used. They probably buried a charge for someone doing a non-existent sedation in one of the other line items. My guess is similar charges are done for all sedations.

My colonoscopies were totally painless and not being sedated meant none of the ladies were able to lift the gown for a gander. I am told this procedure is routinely done w/o sedation in Europe.

The gastroenterologist doing the upper endoscopy agreed with me that needing to be sedated for that procedure is mostly in people's heads, and that he does it all the time w/o sedation in Africa in one of those doctors w/o borders things. It was slightly awkward for a few moments when the tube was inserted, but not a big deal really. Not being sedated meant I kept my pants and underwear on, same as occurred with the TEE.

In all these instances the starting point with most doctors is that the patient must be sedated, that it can't be done otherwise. Except it can.

I have never had a cardiac cath but I suspect that procedure can be done w/o sedation too.

How much money is being generated for hospitals doing unnecessary sedations? They absolutely have the public hoodwinked into thinking it is a necessary part of these procedures. I would add that sedation is not without risk. For some people the amnesia effects are not short term.

I will note that what sent me down the no-sedation road was that those drugs make me ill. Better maintaining my dignity was just a side benefit.

 
At Friday, August 10, 2018 12:54:00 PM, Blogger A. Banterings said...

Maurice,

Why aren't they taught trepanning or how to relieve a woman's hysteria with a vibrator?

I digress...

Again you misinterpret what I say. My point was that when the evidence IS REVIEWED, these humiliating, intimate (usually cancer) exams are more ritual than science. Rituals are designed to keep a power structure.

One of the best descriptions of ritual is ...they developed from behaviors that once had a practical purpose, but gained ritual status after that utility was lost in the mists of time.

In Barry Lyons’ 2005 article, "Discipline and the Arts of Domination: Rituals of Respect in Chimborazo, Ecuador" he examines disciplinary rituals on Ecuadorian haciendas.The deployment of whipping rituals in both religious and labor settings, arguing that the corporal practice of whipping across these social fields was intertwined with cultural and particularly symbolic meanings to produce a “respect complex” which acted not only upon people’s bodies (“coercion”) but also upon their minds (“persuasion”).

Whether in Japan, Europe, or he caste system in India, rituals keep one group in power, and one group subservient to that power.

Michel Foucault has demonstrated this in relation to the monarchy. His most powerful work on the subject (of subjugation) is Discipline & Punish (1975).

Ritual is used to maintain the power of the providers, and keep patients subservient. One of the best examples is the physician's white coat.

Even though our modern system is suppose to be shared decision making (power), physicians still refuse to let go of any power that they have. Physicians still try to live in the ancient paternalistic system.





-- Banterings










 
At Friday, August 10, 2018 6:31:00 PM, Blogger Biker in Vermont said...

Dr. Bernstein, I took a look at Vol. 4 from 10 years ago. For the most part the problems described then remain unresolved but in total the trendlines are looking more bleak for men. The # of men in non-physician roles has increased slightly I think, but the number of female physicians has risen dramatically and female NP's are starting to have a commanding presence in primary care. More women are rising to leadership roles in hospital systems. Women dominate healthcare more now than they did 10 years ago.

Given the extent to which women in healthcare do not see male patients as equal to female patients when it comes to basic respect and dignity matters, the trendline is not good. Maybe there's a question here for your students Dr. Bernstein. Do they think men should have the same same-gender considerations as female patients when it comes to intimate exposure matters?

Political correctness and the #MeToo movement has created an environment in which courts and legislators are even less inclined to go down any "men's rights" path. To do so risks howls of sexism. No one in authority would dare point out the illogic of Women's Health Centers being deemed supportive of women's rights and in the next breath forcing men to have most of their intimate care performed by women also deemed as supportive of women's rights. In the former it is women as patients whose rights must be protected. In the latter it is women as "professional healthcare workers" whose rights must be protected.

Sorry to be so pessimistic, but the big picture doesn't look promising for men. At an individual level we have the ability to demand respect and dignity as we maneuver through the system. It may or may not work in any given instance but outside of advocating for ourselves society is nowhere near ready for men to be the equal of women when it comes to healthcare.

 
At Saturday, August 11, 2018 4:42:00 AM, Anonymous JF said...

This blog is good about teaching how to be accommodated individually. Unfortunately nobody is going to check out this blog until they have had their modesty violated already.
I remember one one of the night time sitcoms ( I don't remember exact words ) but some lady was bragging up a male friend. She said " You're so warm and sweet and kind! You're practically a woman! " It was really funny but why couldn't that be said in real life? Why does it have to be an insult for a man to do something that a woman does?
I don't suggest that guys cry out of humiliation like a girl or woman might, but if multiple men complained about the unethical opposite exposure, things would change.
I can't help but think a huge part of our problem is the number of patients who get a thrill out of it. I know some men MUST get into it because I've heard too many female friends admit to liking a male doc doing their intimate exams.

 
At Saturday, August 11, 2018 9:01:00 PM, Blogger Maurice Bernstein, M.D. said...

Promote patient comfort while making a diagnosis and treating the illness--- this is what I think the profession of medicine is all about. And this is what I teach. Behaviors and actions beyond this represents something else. ..Maurice.

 
At Sunday, August 12, 2018 4:10:00 AM, Blogger Biker in Vermont said...

Dr. Bernstein, yes you are doing your part in the manner in which you teach your students and in your work as an ethicist. This forum gives voice to many and helps patients find their voice.

The primary problem isn't the manner in which physicians themselves do exams or procedures. Where physicians err is with the manner in which they use opposite gender chaperones, scribes and MA's and in the case of urologists in particular it is in only hiring females for things like cystoscopy prep, urodynamic studies and the like. The physician may be a total professional in their personal conduct, but then they ignore the gender issue when they staff their practices and bring others into the room. In a nutshell, physicians buy into the gender neutral mantra for the convenience it offers.

A question for you as an ethicist is why haven't medical ethicists done much as a group when it comes to patient privacy and dignity? Do they collectively just accept that being polite to the patient is all that matters? Or have they and the healthcare system then just choses to ignore them?

 
At Sunday, August 12, 2018 4:11:00 PM, Anonymous Anonymous said...

The are interesting parallels between Dr Sparks and Dr Nassar. Dr Nassar got 1000 years in prison, dosen’t matter the exact number since he will die in prison. Dr Sparks got nothing, not even a day in jail, why? Dr Sparks patients were all unconscious while Dr Nassar’s Patients were alert and oriented. Dr Nassar’s patients were all female and somewhat privileged, at least in the eye of the public. Dr Sparks patients were mostly probably Hispanic and Native American.

It’s been stated that Dr Nassar would insert his fingers into the vagina of his patients. During these examinations I am uncertain if he had staff in the room, however, no one for certain erupted in laughter as those women were groped. On the other hand Dr Sparks would reach into the boxer shorts of her unconscious patients, pull out their penis with her ungloved hand, slap their penis and shout bad boy, bad boy, bad boy, the all female operating room staff erupted in laughter. This kind of behavior went on for years. The head of anesthiology knew about this but then denied it.

In the end Dr Nassar’s patients became millionaires and were given an award. Dr Sparks patients got nothing, additionally, Dr Sparks would write messages on their abdomens. That Michigan University set aside $500 million dollars for the victims of Dr Nassar, yet the Hospital in New Mexico set aside nothing for the victims of Dr Sparks. When you are under anesthesia all operating room staff are supposed to advocate for you, not laugh as you are being groped. The feminist healthcare machine as well as most male physicians have their heads up their asses when it comes to respectful care for the male patient.

Yet, when the feminists in healthcare commit crimes they are not held culpable, no punishment, no jail time. This example perfectly illustrates that. The Denver 5 received no punishment at all although the reports say they were suspended for 21 days. No, they were on paid administrative leave pending the investigation, this is common for HR ( Human Resources) in issues of unprofessional conduct. When they came back to work a letter supposedly was placed in their file. Haha, I’ve gone back in employees HR files and have seen issues mysteriously disappear. Furthermore, when you leave one employer to another the only thing the previous employer can legally state is your title you held, your dates of employment and if you are eligible for rehire.

PT

 
At Sunday, August 12, 2018 5:40:00 PM, Anonymous JF said...

Chaperones,scribes and MA's are used for convenience. Shortly afterwards the providers and their support staff mostly forget about that particular encounter. The patient however( in some cases ) are permanently harmed. I guess it demonstrates who's more important than who!

 
At Sunday, August 12, 2018 7:04:00 PM, Anonymous JF said...

PT, Twana Sparks should be in prison. I completely agree. But doesn't it seem to you that our judicial system works WHEN IT WANTS TO and ONLY when it wants to! It seems that way to me!
I've taken time to look at some of the earlier volumes on this blog. Some of the modesty violations, I would prefer death than to be humiliated that way.
One example was when an accident victim came in and the nurse cut her clothes off while the cops and EMT's hung around to watch. I didn't just want that nurse fired. I wanted her DEAD! The people who hung around to watch, I wanted their eyes poked out! When I talked about Twana needing her dress ripped off I was desiring for her a humiliation that is worse than death.
Our judicial system doesn't care about us! Don't you know that?

 
At Sunday, August 12, 2018 8:44:00 PM, Blogger Maurice Bernstein, M.D. said...

Here is a link http://doctors.ajc.com/doctors_sex_abuse/?ecmp=doctorssexabuse_microsite_nav to a 2017 Atlanta Journal Constitution research study regarding "Doctors and Sex Abuse" in which "A broken system forgives sexually abusive doctors in every state, investigation finds"
This research was out before Nassar and Denver 5 stories publicized but does include Sparks and much more.

An interesting statement in the article:
"The Roman Catholic Church, the military, the Boy Scouts, colleges and universities. They have all withered under the spotlight of sexual misconduct scandals and promised that abuse will no longer be swept under the rug.

The medical profession, however, has never taken on sexual misconduct as a significant priority. And layer upon layer of secrecy makes it nearly impossible for the public, or even the medical community itself, to know the extent of physician sexual abuse."

Hmmn, it does seem that University of Southern California has not as yet "withered" under its sexual misconduct experiences but then any further professional misbehavior or worse is hopefully no longer going to be ignored by that school.
..Maurice.



 
At Sunday, August 12, 2018 9:44:00 PM, Anonymous Anonymous said...

Maurice

I hope you don’t get the impression, at least from me that it’s only physicians that abuse patients from an unprofessional, sexual point of view. You obviously take a lot of crap on this subject, however, from my experience in healthcare physicians as compared to the rest of the healthcare industry do the least in regards to sexual misbehavior. I’m sure a lot of readers here might be bewildered from this statement and I’m attesting to this based on my many decades of working in the industry. When physicians sexually abuse patients it becomes known rather quickly, it garners much more attention and the mechanisms are there to make these kinds of malfeasance known. Additionally, when the accusations arise ex-patients see opportunities for attention and a potential payout.

In hospital settings most complaints of a sexual nature are kept hush hush by the risk management machine. Hospital staff who have access to unconscious patients have the most opportunity and do so without ever getting caught. Dr Sparks case is a perfect example of this, the operating staff kept the amusement secret for years. One wouldn’t think this would happen in nursing homes but there are hundreds of cases on Propublica.org. For every one case reported in a nursing home thousands go unreported. Nursing homes are not just for the elderly, many young patients reside as well.

PT

 
At Sunday, August 12, 2018 10:40:00 PM, Anonymous Anonymous said...

JF

No, I didn’t know that! What do I know, I’m just another dumb HICK from the desert. I’m just another one of countless male cows herded through our feminist healthcare industry. I pay a considerable amount of money each month just to have that bell around my neck and mooing endlessly. I’m told to be at the Urologist office at 10:30 for my 11:00 appointment, but I’m not seen till 1:00. Guaranteed every single time and I can’t help but wonder is it this way with female gyn patients. I’m always asked the same two questions every single time, are you married or single and where do you work? I just gave you my Cigna gold health insurance card, what else do you need to know?

I’ve yet to have my blood pressure taken properly by these 90 day wonders. I’d like to take the gauge on the sphygmomanometer and place it where the sun dosen’t shine on these people. I once had knee surgery some 30 years ago and while in pre-op the stupid nurse asked me what are the names of all my siblings and what are their occupations? Really, what does that have to do with a left lateral release. I gave you Idiots my Blue Cross insurance card when I scheduled this surgery as well as an emergency contact number. Who asks their patients ridiculous questions like this. When cows are herded through the slaughter house do you think they ever ask the cows,
“ do you have any concerns”?

PT

 
At Monday, August 13, 2018 12:21:00 PM, Anonymous JF said...

PT, Yes the gynecologists keep women waiting. Mostly I have avoided going to them. I took birth control for 2 years in my early 20's but then stopped.
What I was talking about, the judicial system not caring about us, was the huge amounts of time when a healthcare worker is being investigated for abuse and how many years it's allowed to continue.
Many women ( not me ) have complained about abuse, while their abuser just continues to work. I know that Sparks lady wasn't abusing women, but she also didn't abuse you.
You're a little grouchy today! Did your lady cut you off last night?

 
At Monday, August 13, 2018 2:24:00 PM, Anonymous Anonymous said...

JF

This is the problem with the feminist healthcare worker, they make a lot of assumptions.

PT

 
At Monday, August 13, 2018 4:32:00 PM, Anonymous Anonymous said...

Dear readers,
The point I’m attempting to get across loud and clear is that the mak’emsick industry is rapidly becoming a thug for powerful entities that now basically rule our country, and indeed much of the globe. Consider that as a tax payer, some of the taxes paid are for local school districts. Thus, I should be able to enroll my children in said local district without being forced to purchase a product from a for profit, private industry. And these products are not simply school books or the like, but medical products that are injected into the bodies of my children. As I noted before, discrimination against male clients (and of course, much worse, emotional/sexual abuse towards males) is the Indian elephant, whilst forced medical products are the African elephant standing right in the middle of the room.

ANY kind of forced medical procedure is against both domestic and international law, let alone any sort of ethics. Now, whether one believes in vaccines or not, is not the point. The point is that as a human being, part of my inalienable rights is freedom of choice when it comes to medical care. However, as studies around the world now prove, vaccines are not only ineffective, but incredibly dangerous. As worthless, pseudo studies by Big Pharma are quickly being shown to be false and deceptive, the next tactic was to ridicule opponents. However, that tactic is not working very well any longer, as too many children have been gravely harmed or killed, and parents are waking up to the truth about these dangerous products. In Australia, groups of parents are forming their own home schooling and avoiding all vaccines for their children, and of course for themselves as well. I must admit I only was awoken to the truth of THE LONG CON OF VACCINATION when a youngster in my family developed (amongst other harms) brain encephalitis immediately after vaccines, expressed the wish to kill all teachers at his school, and has a ruined life and no future. I only hope someone can care for him after his mother passes, instead of being locked up in some dreadful institution, where of course he will be abused in one way or many ways. But, that’s right, in the US we either imprison our mentally ill, or throw them to the streets!

Returning to the education of medical students, as I said before, they do not have the intellectual ability nor the desire, it would seem, to distinguish truth from falsehood. Indeed, they cannot even understand simple, epidemiological studies which show that death from infectious childhood diseases such as measles, mumps, chicken pox, and so forth were, on the whole, 90-95 % GONE SOME 10 YEARS BEFORE THE ADVENT OF VACCINES, as were diseases that there are no vaccines for, such as Scarlet Fever. Even charts from rent a boy CDC’s website shows this information to be true! What was the main factor in the rapid decline of mortality from childhood diseases – plumbing! Let’s take a city such a pre-plumbed London with millions of humans throwing their bodily wastes onto the streets, that is, basically living among human and animal feces. Add to that the very poor diet of the unwashed masses and presto – simple diseases will kill, as is still seen today in poorer countries. But, as a developed nation, instead of using foreign aid funds to help poor communities build wells for clean water, teach how to grow nutritious food for their area, and so forth, instead we further Big Pharma’s profits by subjecting poor children to untested vaccines, which of course kill many children, but that’s okay, now we can “test” them on millions of developed world children, and make bank without any fear of being sued! ALL children, whether from developed or undeveloped nations, are simply collateral damage; let nothing get in the way of PROFIT!

EO cont. due to length




 
At Monday, August 13, 2018 4:33:00 PM, Anonymous Anonymous said...

One of my “favorites” was a situation some years ago in an African nation whereby all pregnant women in a certain village with injected with a vaccine, which deliberated contained an “extra” ingredient that resulted in most of these women having miscarriages. The result? Objective achieved as the cronies of said Big Pharma thugs moved in to extract the rare metals near the village. One can only surmise that the villagers were so distressed by the avalanche of miscarriages that they consented to having their environment destroyed for a few nickels! This of course, being but one example out of thousands, such as seen with the dreadful abuse of elders here in the US, especially while they are dying such as the example given by PT I believe. This sort of abuse of the elderly and the dying is happening hundreds of times a day across the nation, and like male client abuse, most goes unreported/ undetected. I might even posit that the abuse of our elderly and dying is the worst form of abuse in the mak’emsick industry, but hey, here are future nursing hags of America receiving the foundational training to later abuse all male clients that fall under their salacious “care.”

As a youngster, I had a severe case of Scarlett Fever, and to this day remember hallucinating. But, as I lived with plumbing, clean water, and nutritious food, I survived! We didn’t really run to hospitals in those times as people now seem to do. But, of course, people on the whole are much less healthy than we were in the 50s and 60s; I received only 2 vaccines, one of which was the oral polio of which some 75-80% were contaminated with cancerous monkey kidney cells. This was KNOWN at the time. Gee, not much has changed in this regard!

I don’t have the time to look up credit for this quote, and though it was being used in relation to politics, it is quite pertinent to the mak’emsick industry, especially considering the increasing fascist laws being directed at certain groups, such as school children and certain workers: “Campaigns have long been heavily financed marketing and advertising farces proclaimed by very serious people as being about the ‘will of the people.’ Public relations firms have long shown us that ‘the will of the people’ is for sale and informed consent was lost many years ago, along with a functional educational system that taught critical thinking. It is now a matter of who is able to buy the most media air time and put out the cleverest ads. Campaigns are economic engines all to themselves and media conglomerates depend upon them for profit generation.”

The entire mak’emsick industry seems to be all about the marketing ploys, and getting healthy people to submit to screenings for just about everything! I especially enjoy the ads on the boob tube promoting new drugs; one I recently viewed listed (among a very LONG list) as a possible side effect – now get this – a fatal brain virus! Gee, sign me up for that one, doc!

Please read my next entry as it has to do with the dangerous new “patient rights and patient responsibilities” which as Banterings noted are actually a ploy to negate many human/patient rights. I expect this CRAP to be incorporated at most hospitals not too far in the future.

EO

 
At Monday, August 13, 2018 4:34:00 PM, Anonymous Anonymous said...

Dear Readers,

For the latest assault against human/patient rights let’s look at Penn State Health, which has recently revised its patients’ rights and responsibilities statement. Here’s a snippet: “Penn State Health convened a workshop on the topic, which helped convince hospital administrators to revise the patients’ rights and responsibilities statement. That statement now explicitly prohibits patients from requesting a change of doctors on the basis of the physician’s ethnicity, or religious or sexual identity. Women may still request a female doctor. And doctors who receive discriminatory complaints can switch the patient to another provider if they wish.” Notice that male clients are again IGNORED AS IF THEY DON’T EXIST. No mention if a male client prefers a male doctor! Oh, the poor, poor doctors getting their feelings hurt, being rejected by some patients! Boo hoo all the way to the bank! Go to https://www.statnews.com/2017/10/18/patient-prejudice-wounds-doctors/ for a spectacular read! And as afterthought, as an atheist I would not be comfortable with a rabid religious physician or minion, especially a Christian one as I have experienced great abuse at the hands of several! Funny, isn’t it, for all the hatred between some Christians and Muslims, all cult followers seem to have 2 essential principles in common: My god will smite all my enemies (I guess that includes children and infants, maybe pets as well!), and then he’ll wipe my ass for eternity! With so much in common, it seems the 2 opposing sides should form a new super cult!

Maurice, you seem confident that a new dean will bring a stop to sexual abuse of patients: From the news media of the medical school: "Kathleen Nelson, MD, clinical professor of pediatrics at the Keck School of Medicine of USC, has been appointed associate dean for leadership and wellness.” I cannot share your belief. A female pediatrician will do SQUAT to end discrimination against both young and adult male clients. I bet she still believes in genital exams for all children, and (if still in practice) would not offer young males the opportunity for a male provider or even to refuse genital/anal exams. What’s next, DREs for male teenagers? ( I read of this). Oh, we’ll need 2 females to witness and record! Perhaps a 3rd to hold the penis out of the way for the useless testicular exam. As regular contributors have pointed out many times, part of wellness (indeed, the major part which most Western belief systems still ignore or ridicule) is mental/emotional health, and that does not come when a pediatrician fires parents, bullies parents, and even reports parent to CPS and other groups. Many parents in my closed group report being fired, ignored, ridiculed, screamed at, threatened with being reported, when they refuse vaccines at the Orwellian termed “well child” visit! Maurice, I wonder how you feel about this phenomena which is happening, much as with elderly and male client abuse, hundreds/thousands of times a day at all our fine institutions!

 
At Monday, August 13, 2018 4:39:00 PM, Anonymous Anonymous said...

I must agree with PT, that “The feminist healthcare machine as well as most male physicians have their heads up their asses when it comes to respectful care for the male patient.” Nothing will happen to end discrimination against male clients until a federal law is passed that gives males the same rights that female clients currently enjoy as regards intimate care, and utilize to their benefit! Oh wait, that law was passed a half century ago! So, more laws must be passed that force any institution or practice that accepts any monies from Medicare, Medicaid, etc. to give to male clients the same privileges that females have, that is, choice of gender for any intimate care, exam, procedure, surgery, etc. One does wonder why this has not been addressed and rectified many years, many decades ago, but it falls in line with American culture that males are second class citizens and indeed, one must be “careful” around them as they are inherently violent, sexist creatures that need to be put in their place! Works well for the female nursing hags! And thanks, Mr. Giovagnoli, for your story of the female NP not involved in your care that barged into your ER cubicle demanding to see the erection! She is not an outlier nor atypical! Yes, she was looking for a visual thrill and you foiled her! Good her you!

So, let’s look at some of the moronic notions that female nursing hags (and yes, male physicians as well) promote to keep the status quo a grinding. This from a gentleman that was sexually abused when a preteen: “Mr. Clearwater said males are very reluctant to report sexual abuse because of shame, guilt and fear, ‘especially the fear of being seen as perpetrators, weak, gay etc. And when the perpetrator is a woman there is the fear you won’t be believed or that you shouldn’t complain and you should count yourself lucky,’ he said. ‘People seem to think being a male victim is not as bad as being a female victim and that if the perpetrator is a female the damage isn’t as bad not realising [sic] the psychological damage it can do and especially if that female is a mother… As in many countries males have been seen as perpetrators and not victims and our country is having trouble coming to terms with female perpetrators.’ But surprisingly more men experienced sexual assault by a female (130,600) than at the hands of another man (72,300). Here’s the link:
https://www.news.com.au/lifestyle/real-life/true-stories/men-who-were-sexually-abused-by-women-tell-their-stories/news-story/d41219325

From another article we read that “Overall researchers also found men were more reluctant to report abuse by a woman. ‘The idea that women can be sexually manipulative, dominant, and even violent runs counter to these stereotypes. Yet studies have documented female-perpetrated acts that span a wide spectrum of sexual abuse’ they write. It is something Ms. Stemple feels is one of the reasons it remains widely under-reported. ‘There’s still this perception globally that women aren’t perpetrators of sexual victimisation [sic],’ she said. ‘There’s also this perception that male victims haven’t been harmed, or they welcome it, which is far from true.’ Men report similar or roughly the same mental health outcomes as female victims.” Yet, as clearly seen in American mak’emsick and dumb’emdown institutions, (education – as Orwellian a term as healthcare!) the myth that males are “lucky” to get sexually exploited by a female teacher (let’s call it by its true term –rape) or that ill males when hospitalized or in clinics are happy to have multiple googly eyed females violate their human dignity/modesty, but of course, all females no matter their industry are above and beyond any sort of sexually deviant behavior because we all know that poor little females are all essentially Cinderellas or Mother Teresas, and all are so “professional.” Here’s the link: https://www.news.com.au/lifestyle/real-life/news-life/female-sex-predators-why-there-are-more-of-them-than-you-think/news-story/74506a6c46ee51dbfc8242dc0cc72197

EO cont. due to length


 
At Monday, August 13, 2018 4:41:00 PM, Anonymous Anonymous said...


Another myth promoted by female nursing hags is that women are not visually stimulated by viewing male genitals – this is utter nonsense! How many times have I read (especially on sites like allnurses), that female nurses don’t enjoy viewing naked males. As a red blooded, heterosexual female, I can attest that the hetero females that I know, myself included, enjoy the visual pleasures of naked males. It’s how we’re wired! Recent studies attest to the fact that women are just as visually stimulated as males, but the make’msick industry keeps screaming that penises and elbows are exactly the same! Maybe the Denver 5 (and yes probably there were more hags involved as one writer noted) were interested in the male client’s elbow or enticing eyebrows! Now that’s something to unzip a body bag for!

As Banterings said: “Maybe there's a question here for your students Dr. Bernstein. Do they think men should have the same same-gender considerations as female patients when it comes to intimate exposure matters?” It would be interesting to keep a tally and see how both male and female students respond. More interesting yet, to see how corrupted they become as they become more integrated within the mak’emsick industry.

So, whether a pediatrician threatening the power of the state to bully parents into poisoning their children, or a physician bullying a client into a useless, dangerous screening procedure (let’s not forget that about 42 people die each day just from colonoscopies, this not counting the infections that some overcome and surgeries for perforated colon), or female nursing hags counting c#*^ like the Indians counted coup, all of these mak’emsick workers are HACKING PEOPLE THAT COME TO THEM FOR HELP OR GUIDANCE. “When someone tries to make you afraid, they are abusing you; they are hacking you. They are grabbing your inner workings and turning them toward their own ends.” (Sorry, don’t have the source at hand.)

Luckily I read 2,000 to 3,000 wpm and can cover a lot of material with excellent comprehension, but most Americans don’t have these skills, and rely on all the old, tired, stale, meaningless phrases shouted from the rooftops such as colonoscopies saves lives (kills 3 times as many people as colon cancer), 15-35 year old males MUST have testicles checked or they’ll die from cancer, and so forth onto forever, as PT keeps asking – where does it all end? Good question! Funny, most male providers have stopped doing routine testicle/prostate exams but female providers seem to love them! Hmmm…


EO cont. due to length


 
At Monday, August 13, 2018 4:44:00 PM, Anonymous Anonymous said...


JT, I think that this statement from you does not address what PT was expressing: “I know that Sparks lady wasn't abusing women, but she also didn't abuse you.” That Sparks was routinely sexually abusing unconscious males is a significant problem for all society. If she did that to my SO, there’s be an empty mine shaft with her name on it! One aspect you mentioned some while back was that we have to get private health care companies out of the industry altogether, and yes, they routinely kill clients by not approving certain medical actions, or even ANY medical care so yes, we need universal, single payer health insurance. Better yet, we wouldn’t need any kind of insurance if the industry was not so greedy and duplicitous. As a child, we could visit a physician and afford to pay the bill on spot; for something more serious such as surgery it might take 6-12 months of reasonable payments to pay the bill in full. Much like auto repair, I can afford to purchase a tire for my truck, but for an engine rebuild I turn to my saving account. BUT, I can still afford such work!

Singlehandedly, it is greed that is bringing this once lovely globe to its knees, and the death toll is ringing loud and clear across the continents! If physicians want to regain ANY trust from the non sheeple, they will have to honestly re-examine why they really went into the industry. Without the over sized, indeed ridiculous compensation, it’s a house bet that money is at the top of the list of motivations! Offices getting a little empty? – people like me just don’t go. And, much like ritualistic screening and exam procedures, the annual physical is now being shown to be of little to no value. I had one unwillingly some 11 years ago for an elective, outpatient surgery, and now in my 60s I run 100 pound rescue dogs through the countryside, work out with weights and do pilates/hatha yoga, chop wood/property clean up in triple digit heat, and avoid all Big Pharma poisons. I recently cured a skin cancer (red, bleeding, painful) with cannabis oil and no arrogant physicians trying to bully me about old f%$#@*vaccines or leaving a permanent scar. The cost? Less then $50.00. ‘Nuff said.

EO

 
At Tuesday, August 14, 2018 5:49:00 AM, Anonymous JF said...

EO, I'm JF not JT. I agree with what you said. There wasn't any rational reason for me to put it into PT's face that that Twana Sparks piece of shit didn't sexually abuse him because I also get upset about sexual abuse/modesty violations that didn't happen to me. My problem with PT is it seems like to me, he wants an equal amount of females humiliated. It doesn't matter to him that many of those females didn't or wouldn't humiliate anyone.
It's true that many of the guys humiliated were also innocent but it shouldn't have happened and two wrongs don't make a right. I just wish guys could, for once , take a cue from WOMEN! Are we so unbelievably inferior that you can't follow our lead in ANYTHING?

 
At Tuesday, August 14, 2018 11:57:00 AM, Blogger NTT said...

Good Afternoon Everyone:

I agree with what Biker said back on August 08.

When supporting staff stand there and watch their colleagues abuse patients as far as I'm concerned they are as guilty as the perpetrator doing the abuse.

The healthcare industry is overrun with thrill seekers instead of professionals.

We know the issues. We talk them to death here online. If we want to make a difference for future generations of men and boys we must move this issue out of cyberspace & into the real world where everyone can see yes the healthcare system has a problem and needs fixing.

I've spoken with all my elected officials and told them no help on this issue, no votes from me, my family, and friends come November. It's that simple. If we all did that, they'd have to listen to us.

My grandson got the rude awakening recently when he had to go for a sports physical to play varsity football for his high school.

He wasn't prepared for what he had to endure and he hasn't been the same old kid since that day.

I wish I'd have known he had to get the physical. I could has spoken to his mom first and warned her about letting the school do the physical.

Have a good day.

Regards,
NTT

 
At Tuesday, August 14, 2018 2:19:00 PM, Anonymous Anonymous said...

EO

I’m of the opinion that if Dr Sparks didn’t have to spend 1 day in prison that Dr Nassar should be set free and he should be compensated for every day he has spent in jail. Furthermore, the awards should be rescinded and all monies pain to the monkey bar wonders confiscated.

PT

 
At Tuesday, August 14, 2018 3:18:00 PM, Blogger Biker in Vermont said...

JF, I welcome the input of any female who is supportive of fixing the gender problems in healthcare. That you work in healthcare and are supportive is a rarity. Most women who work in healthcare are dismissive of any privacy/modesty complaint men have, so thank you for seeing these issues as real.

 
At Tuesday, August 14, 2018 9:55:00 PM, Blogger Maurice Bernstein, M.D. said...

Sorry for the delay in posting Comments today. It was my error last week stating that today I would be starting out with my group of first year medical students. That will not begin until next Tuesday. Actually, I was teaching and observing two groups of second year students practicing on each other how to perform a cardio-vascular exam. Yes, the boys had their chest bare for the practice but not the girl students. However, all were taught the importance of attending to the modesty concerns of the patient, yet the need to keep the skin covered what is not being directly examined at the time. If it is necessary to have the breast elevated for chest exam beneath, our course teaches that the female patient should participate by performing that elevation herself.

Yes, I know some of my visitors are of the "demand", as amply written n the past, that the female students should have been as bare chested as their male colleagues. Well, at this point we want all students of both genders to learn cardio-vascular physical exam techniques which are new to them and to make this one and one half hour session with each group of 6 students oriented to such learning and not distracted by any of their personal modesty issues.

We, as instructors of a course have to set realistic-productive immediate goals and proceed in a manner directed to those goals, learning cardio-vascular examination and today and not primarily challenging them to their own physical modesty issues. I and I am sure the other instructor participants followed that primary course directive.

Sorry, based on what my visitors have written in the past, if I again disappoint some of my thread visitors. ..Maurice.
..Maurice.

 
At Wednesday, August 15, 2018 4:32:00 AM, Blogger Biker in Vermont said...

Dr. Bernstein, of course it would deter from the technical aspects of learning if the students were needlessly embarrassed, especially with 1st and 2nd year students. I don't begrudge women receiving same gender care or any other privacy/dignity consideration. I'd just like the same considerations for men. Before they finish medical school however, it would be good for them to have a simulated patient experience that includes genital exposure to opposite gender caregivers. This would not be with their classmates, but rather with the caregiver roles being performed by medical staff they don't know. It could be as simple as a physical with chaperones & MA's observing.

Regretfully the next chapter in women's rights looks to be even more draconian than what we have now. The other day EO made a reference to PennState Health's new Patient's Rights document. I looked it up and this is part of what it included:

"Requests for provider or medical staff changes based on gender will be considered on a case by case basis and only based on extenuating circumstances."

We all know what this means in an arena that prioritizes the hiring of women. Men who want same gender care will have to justify extenuating circumstances. Just being modest will not be enough. Healthcare is still pushing men backwards in order to advance the cause of women.

 
At Wednesday, August 15, 2018 1:45:00 PM, Anonymous JF said...

PT, It's been said that people treat us the way that we've taught them to treat us. You have taught the medical world that your ok with opposite gender intimate care. I don't mean you individually but your gender as a whole.
Sometimes all you have to do to get a certain kind of treatment is just don't refuse that kind it. Girls and women have often FLIPPED OUT about intimate care and often even same gender intimate care also. They just flipped out worse when the care giver was male.
You've become quite bitter about all this, towards women in general. Keep it up and when your laying on your death bed, you'll be saying " cellphones" gasp "the Denver 5" moan #groan...Twana Sparks

 
At Wednesday, August 15, 2018 1:57:00 PM, Blogger Maurice Bernstein, M.D. said...

As always, let's try to keep the discussions here free of ad hominem remarks. The goal of discussion is the subject discussed and not to denigrate the discussers. Your moderator, Maurice.

 
At Wednesday, August 15, 2018 2:01:00 PM, Anonymous JF said...

I don't think nursing home employees fit into the thrill seekers group. Are patients are elderly for the most part. I've only worked one nursing home where we had young people and they were a minority. Also the vast majority of our patients/residents are WOMEN! So we are a different mindset than those clowns who work at hospitals or clinics for sexual gratification reasons. I am upset about opposite gender intimate care. Also I'm upset about same gender intimate care or ANY intimate care that isn't mandatory. Any extra person viewing and doors opened at wrong moments ( without curtains blocking the veiw ) Hopefully I'm not as angry and bitter as PT or irrational as he is about it.

 
At Wednesday, August 15, 2018 2:49:00 PM, Anonymous Anonymous said...

The comments about the PennState Health’s revised patient rights intrigued me so I looked it up. The statement is “In addition, requests for changes of provider or other medical staff based on the provider’s race, ethnicity, religion, sexual orientation or gender identity will not be honored”. Generally “provider” and “medical staff” refer to those independent licensed practitioners, such as MDs, DOs and others on the medical staff (NPs and PAs perhaps, depends on the medical staff bylaws, rules and regs). It does not reflect nurses, MAs, etc.

My decades of experience in health care taught me a couple things: 1) nurses are really great at work arounds. You ask for a nurse of a different GENDER they will try a work around, switch with another nurse of the opposite sex if possible. They are too busy to fight with patients currently, work arounds are easier. 2) physicians get offended by similar requests and are not good at work arounds.

Now, at my institution requests for a nurse, etc. of a different RACE, ethnicity or religion often ended up with me to adjudicate. My response was the same, “I’m sorry Mr./Mrs. Jones that we cannot accommodate your needs in our hospital, but we will work with you and your personal rep to transfer you to another facility that might”.

As many visitors to this site know, there are plenty of court cases on bodily privacy, BFOQ (gender), consent for care, etc. No patient has to consent to any care (of course if they don’t consent they won’t get that care). On the other hand a medical center must be very careful to not run afoul of discrimination laws. They can get into trouble when they start agreeing to modify their care model based on race, ethnicity, religion requests. Gender is one area that all medical centers already have determined they will invoke the BFOQ exception for patients to be entitled to same gender INTIMATE care (e.g., every mammography center is set up this way). Refusal of basic gender request, for intimate care for males when its done for females, could lead to headaches if the patient files discrimination complaints.

So Penn State put out this revised policy in print for their patients. As written it is almost correct. They could run afoul of the gender issue. Requiring a “case by case” review is a barrier to equal care & services, they don’t do that in mammography - they just refuse to hire males for the women and thus they could have legal liability here.

I wrote all of our patient rights for decades - I would have written this differently. - AB in NW

 
At Wednesday, August 15, 2018 5:57:00 PM, Anonymous Anonymous said...

Only about 20% of all abuse cases that occur in nursing homes are reported. 92% of all nursing homes employ at least one convicted
criminal. In 1999 it’s estimated there were 5000 unnecessary deaths in nursing homes. The average annual cost of a nursing care room
will reach $175,000 by 2021. About 30 incidents of aggression can happen towards residents in one 8 hour shift. One out of 4 nursing homes have been cited for a death or serious injury to a resident. In 2005 every nursing home had a major deficiency. Research from 2010
indicates more than half of all nursing home attendees have abused or neglected nursing home residents. Where this all stops nobody knows.

PT

 
At Wednesday, August 15, 2018 9:30:00 PM, Blogger Biker in Vermont said...

Thanks AB for the clarification. Not working in healthcare myself I didn't understand the subtlety of the language and took it to mean all staff. Glad to know that's not the case.

 
At Wednesday, August 15, 2018 10:42:00 PM, Anonymous JF said...

There's a lot wrong with nursing homes but generally speaking, they don't attract staff looking for a sexual thrill. There is a HUGE amount of waste at nursing homes. Lots of borrowing supplies ( borrowed but not returned ) staff sneaking out for cigarette breaks, management is fond of terminating staff as they become eligible for vacation hours and better wages. One problem with that is it treats loyal committed staff like liabilities, another problem is that when there is too many new staff members, accidents are more likely to occur. The quality of work suffers and patients are deprived of care givers that they loved and depended on.
This here isn't about nursing homes but it's something they you've brought up different times. The difference between how Sparks was treated vs how Nassar was treated. You've already voiced your opinion about why you think the outcomes were so different. My opinion is different.
I think it all has to do with money. One article I read about Sparks referred to her as a cash cow. That would be incentive for her hospital to want to keep her around. People can and do justify pretty much anything. Her higher ups probably thought " her victims are unconsciouss, nobody was harmed!"
With Nassar, he targeted the rich and the famous. It's much less safe to do that. His victims could discuss things between themselves.
Sparks's victims, didn't have a community together and were not necessarily wealthy.
I don't know about actual sexual abuse in the medical profession. I just suffered modesty violation but not actual abuse. But if you research into it, women have said that when an investigation of sexual abuse is done, the medical professionals are favored every step of the way. Offenders often just have to use chaperones and leave their doors unlocked while doing an exam. Or sometimes, they are required to go to counseling.

 
At Thursday, August 16, 2018 8:42:00 AM, Anonymous Anonymous said...

Important facts about elder sexual abuse.

70% of reported abuse occurs in nursing homes
Only 30% of elder abuse victims report it to authorities.
The abuser is the primary caregiver 81% of the time.
Nursing homes will be facing funding cuts in light of incidents of elder abuse.

PT

 
At Thursday, August 16, 2018 10:35:00 AM, Blogger A. Banterings said...

PT,

Soon you may have nothing to complain about, India Aims For The World's Biggest Health Care Overhaul.

According to the World Bank, India spends only about 4 percent of its GDP on health care. The U.S., by contrast, spends nearly 17 percent.

Modicare is expected to cost the Indian government less than $2 billion annually. Experts say that's affordable, at least for now. India's economy is currently growing at 7.3 percent, according to the IMF. It's the world's fastest-growing major economy.

"One or two billion dollars is not more than what the Indian government can afford, but these programs have a way of exploding over time...





-- Banterings



 
At Thursday, August 16, 2018 11:15:00 AM, Blogger A. Banterings said...

As to the issue of Penn State Health's new patient rights, these are legislated in federal regulations. I, don't have the link readily available.

(perhaps AB or PT can help with this)

It also does NOT matter what they promise. If they don't like your decisions, they simply banish your family and friends, lie to the police, and declare you mentally incompetent.

Read Escape from the Mayo Clinic: Teen accuses world-famous hospital of 'medical kidnapping'


Everyone involved should be in jail for the rest of their lives!!!




More fraud in healthcare. See how the American Board of Internal Medicine (ABIM) purchase of a $2.3 million 2-bedroom luxury condominium by the ABIM Foundation, a shadow organization of the ABIM, in December of 2007 that came complete with a chauffeur-driven Mercedes S-Class town car, and off-shoring of $6.5 million of our testing fees to the Cayman Islands in the fiscal year 2014.

...and more.


Physicians continue to reject patient centered care and embrace paternalism. Read the latest: Shared Decision-Making Flops for Lung Ca Screening


The blame starts with the medical education. (Maurice, this is NOT directed at you.)

Nationally, nearly one-quarter of second-year medical students reported last year that they “almost never” attended class during their first two, preclinical years, a 5 percent increase from 2015. Read how Medical students are skipping class in droves — and making lectures increasingly obsolete






-- Banterings



 
At Thursday, August 16, 2018 2:47:00 PM, Anonymous Anonymous said...

A. Banterings


Penn’s State Health new patient rights are unenforceble. You can’t force patients to do something they don’t want and you cannot deny a patient care wether they have insurance or not. Th3y have just opened a hugh can of worms.

PT

 
At Thursday, August 16, 2018 7:57:00 PM, Anonymous Anonymous said...

A. Banterings

The medical center in question has a breast center and a labor and delivery suite. One would think that their new patient bill would at one point contradict BFOQ laws. As you know this entire scenario came about with a patient requesting a provider change based on ethnicity of the provider, the patient making the request suffers from dementia. I believe the bill could be challenged if a male patient made a gender request for an intimate procedure. Hospital and medical facilities can set themselves up for a discrimination lawsuit, particularly when it is an established fact that there are no male mammographers employed in that occupation.

PT

 
At Thursday, August 16, 2018 8:04:00 PM, Anonymous JF said...

I can only speak about what I've seen from my past jobs. Sexual abuse has been rare but usually when it occurs, it's another patient doing it. Otherwise I knew of one of our male housekeepers was seen going into patients rooms. He was seen going in a naked ladies room. The lady would rip her brief off as quickly as we put it on her and she was a new patient. We ended up putting long pants over her brief, but before anybody thought to do that Mr Housekeeper was in the room checking her out. One of our young male patients who was alert but couldn't speak, Mr Housekeeper was in his room also. My coworker asked our patient if he was ok with the housekeeper being in his room and he shook his head no. He also looked upset.
We turned it in, and he was terminated a day or two later. A different reason for the termination was given, but the inappropriate attention given to our patients was the real reason.
The other occurrence was a guy came in off the streets and was going into the womens bedrooms. He was seen with his hand up a lady's gown. The nurse came in and he left.
Weeks later he came in again and we told our nurses but they didn't do anything. Me and another aide followed him room to room. My coworker pulled every lady out into the hall. The rest of the staff watched from the nurses station. One aide took his license plate number down. I believe she called the cops but he left and we didn't see him anymore afterwards.

 
At Friday, August 17, 2018 8:24:00 AM, Blogger Maurice Bernstein, M.D. said...

Banterings, in the medical school course teaching how to perform a history and physical exam by first and second year medical student which I have participated, there is rarely an absence (required documented explanation) or non-punctual starttime attendance for classroom discussion or hospital ward patient interaction. Attendance is necessary also in the student's periods of gross anatomical dissection.

From what I understand, in lecture courses, where all students (the entire class) could be in attendance in the auditorium, there are reproductions of lectures available by computer which could be available later and out of the auditorium. I am not aware of further details of attendance issues by students.

..Maurice.

 
At Saturday, August 18, 2018 8:59:00 AM, Blogger Maurice Bernstein, M.D. said...

One word that has been missing in all these discussions is the word "compassion". As defined by Merriam-Webster: "sympathetic consciousness of others' distress together with a desire to alleviate it."

And the "distress" need not be the clinical illness itself but the distress associated with the behavior of others, including the medical system itself, during the process of diagnosis and treatment.

If the healthcare provider's interest is only in time, money, getting something completed and moving on to the next patient then where is the evidence of "compassion"?

Or..on the other hand, should the healthcare provider and patient "suffer together"? For example, pertinent to this blog thread, should the patient's physical modesty be acknowledged and understood by the the healthcare provider?

I am sure that there are some patients, when ill, who are more desirous of a diagnosis and relief of their disorder rather than modesty concerns at the time. And it is the duty of the healthcare provider to demonstrate compassion for their concerns. However, there are others, who write here, include modesty issues within their concerns.

That is why those patients who desire the providers' attention to their physical modesty concerns should "speak up" and inform. And those concerns should be treated as compassionately by the healthcare provider as the physical illness. ..Maurice.

 
At Saturday, August 18, 2018 5:10:00 PM, Blogger Maurice Bernstein, M.D. said...

And here is an example of lack of compassion or worse by Mayo Clinic as published by CNN today. I also put up the link on my blog thread "Refusal to Leave the Hospital: And Now What?". ..Maurice.

 
At Sunday, August 19, 2018 3:25:00 AM, Blogger Dany said...

Dr. Bernstein,

I agree with you that providers should be compassionate about any patient's modesty or dignity concerns. Unfortunately, that compassion often fall shorts of our expectations. When not outright ignored, it is merely lip service.

Is saying "yes, I understand, but..." showing compassion? How about "It must be difficult for you but..."? Acknowledging someone's discomfort is appropriate but if nothing is going to be done to fix it, what's the point?

It's a sad reality to admit but, when opposed gender care (or should I use "non-concurrent" gender care?) becomes an issue, too often it is taken on a very personal level. As if the patient is "challenging" the provider (or their competency, knowledge, or experience). It's as if they take it as a personal affront when in all honesty, it is a matter of comfort.

No use on insisting, attempting to coerce - in essence manipulate - a patient in going through with it if the end result will be a pissed off, and assuredly bitter patient, who now will have lost what little trust they may have. The relationship isn't likely to recover from it. And for what? Prove a point? Promote a political agenda?

Aren't doctors and other health specialists trained to disengage from a toxic patient relationship? Lack of trust (which often stems from discomfort), is a good reason to severe a relationship. Because it is not helpful to maintain it. To claim otherwise is doing a huge disservice to many patients (and I suspect one of the driving factor in instances where patients refuse care).

A more appropriate response should involve acknowledging the patient's discomfort, take that huge chip from the provider's shoulder and see how they can resolve the issue to the patient's satisfaction. They are the ones that matters. Everything else is just... Well, "fluff."

Dany

 
At Sunday, August 19, 2018 1:09:00 PM, Blogger Maurice Bernstein, M.D. said...

NO STUDENT TUITION FOR THE 4 YEAR MEDICAL SCHOOL EDUCATION BEGINNING THIS YEAR AT NEW YORK UNIVERSITY MEDICAL SCHOOL.
Here are the links to the USA Today and NPR current articles on this news:

https://www.usatoday.com/story/news/2018/08/17/nyus-medical-school-just-eliminated-tuition-what-you-need-know/1018021002/

https://www.npr.org/2018/08/17/639467023/nyu-medical-school-says-it-will-offer-free-tuition-to-all-students

So these students will no longer end their 4 years with a 4 x $55,000/year burden.

If this attempt to solve the physician shortage in the United States with more medical schools following NYU as suggested in the articles, what effect might this have on improving the medical system and behavioral issues being discussed on this blog thread? Will starting out as physicians without a financial burden to meet in the upcoming years of practice make their relationship with their individual patient any different? ..Maurice.

 
At Sunday, August 19, 2018 1:17:00 PM, Blogger Maurice Bernstein, M.D. said...

After putting up my last posting, I was also wondering whether the no tuition would allow more students with "minority" backgrounds to finally participate as physicians and would this new influx be constructive and prevent the professional misbehaviors described on this blog thread? ..Maurice.

 
At Sunday, August 19, 2018 2:14:00 PM, Anonymous Anonymous said...

Thanks to the contributor who mentioned the Hennepin Healthcare illegal/unethical use of ketamine via its thugs the EMTs and police officers: “Dr. William Heegaard, the chief medical officer, defended the practice by saying that ketamine is useful for treating people suffering from ‘excited delirium.’ That pseudo-condition — which supposedly manifests as agitation, violent struggles, delirium, and sweating — is not recognized by the American Medical Association or the American Psychological Association, nor is it in the accepted textbooks of illnesses, the DSM (Diagnostic and Statistical Manual of Mental Disorders) and the ICD (International Classification of Diseases).” As articles on this debacle point out, numerous victims had heart attacks or stopped breathing and had to be revived. Now, that’s quite a punishment for something like jaywalking! And that Heegaard CREATED A FALSE MENTAL CONDITION NOT RECOGNZIED BY ABOVE MENTIONED AGENCIES – well, somehow this ugly situation reminds me of the myriad of medical kidnappings happening here in our jolly plutocracy. I wanted to mention the Hennepin debacle and medical kidnapping in my latest diatribe but ran out of steam. I had read brief summaries of the Alyssa Gilderhus and Justina Pelletier cases, but upon reading a longer article re Alyssa’s case (thanks Banterings), even I was shocked at the despicable behavior of the physician in charge of the rehab unit, especially the ugly way he treated her mother. And of course re the kidnapping aspect here we have yet one more case out of zillions of a medico – maybe just call them by a more appropriate term, greedico –using circular reasoning such as religious cults use to justify his immoral and illegal actions: my god is right because he’s god/I’m right because I’m the doctor - and because he’s god he can do anything and it’s right/because I’m the doctor I can do anything and it’s right! The particular manner in which that POS physician treated Alyssa’s mother calls for society to fire this creature, and all minions that acted on his orders, including the nurses acting as prison guards. The physician should lose his license permanently but like doctors that sexually abuse clients and other minions as well we know nothing will happen to safeguard against other clients and their family members being treated, gee, kind of like terrorists or serial murderers! Now, one of most dangerous issues here is that POS going directly against Alyssa’s requests. She is an adult of sound mind and if she wants to transfer to another facility, that is her right. So, Mayo gets a BS evaluation from an in house psychiatrist to declare Alyssa unable to make her own medical decisions and the most dangerous issue is that this POS tried via social workers to have the state or Mayo itself gain custody of Alyssa! This scenario presents an EXTREMELY DANGEROUS SITUATION! So, using circular reasoning, any client can be declared mentally incompetent because the doctor says so! I am reminded of a veteran at a VA facility whose physician declared him mentally ill because he wanted same gender care for a urological procedure! Nice move, little gods in white coats!

Take a look at the myriad of medical kidnappings that occur when parents take dying children off of useless/hastening their death chemotherapy to try alternative methods to save their children. Plenty of this CRAP happening in these fascist states of America. Also, when estranged parents disagree on poisoning their children via vaccinations, the pro-vax parent enlists the aid of the state and mak’emsick thugs to vaccinate children against the other parents’ wishes! So, maybe readers can understand why I keep yelling fascists and thugs all the time! I learned of this via my closed group.

EO cont. due to length

 
At Sunday, August 19, 2018 2:27:00 PM, Anonymous Anonymous said...

Let’s not forget how physicians are complicit in torture such as occurred at Guantanamo Bay and Abu Ghraib and this complicity is still occurring at Black Op facilities not quite near your home! My Army Ranger friend is well acquainted with such facilities and practices. I only wish I could erase memories of some of the horrors he has recounted. Here’s a few links for those that are interested:
http://in-training.org/physician-involvement-cia-torture-8303
https://www.businessinsider.com/doctors-scientists-in-cia-torture-report-2014-12
https://www.thedailybeast.com/rectal-feeding-has-nothing-to-do-with-nutrition-everything-to-do-with-torture?ref=scroll

And here’s a link to medical kidnapping of an infant after he had been harmed by vaccines:
https://vaccineimpact.com/2017/infant-accidentally-vaccinated-with-gardasil-mother-blamed-for-vaccine-injuries-and-baby-medically-kidnapped/

Medical kidnapping of seniors is also a very real threat and the following site is quite comprehensive:
https://medicalkidnap.com/

So, whether infants, adults with mental disabilities, or seniors, we are all at risk for medical kidnapping!

Welcome to 21st century "healthcare"!

I get a similar feeling reading these terrible stories as to one that I have carried since childhood. I went to a private school, but had a friend on my block that attended public school. Now, I wondered why, we’ll call her Ellie, always did all the cooking, cleaning, and yard work at her house and couldn’t play very often. One day I was allowed to meet her parents. They lay on separate beds in a darkened room, and must have been in their late 30s or 40s. However, I wondered why they looked like my great grandparents. When I was a little older, my mother told me they had been medically experimented upon in the camps (Nazi). Ellie’s 4 brothers were slaughtered in the camps, and somehow they had been liberated and found their way to America.

Now, we face similar situations here in the US and our modern day camps are hospitals, senior homes, pediatricians’ offices, and so forth. It’s getting so bad that one needs to stay away from any medical “care” unless absolutely necessary.

EO




 
At Sunday, August 19, 2018 5:42:00 PM, Blogger Biker in Vermont said...

My take on the Mayo situation is that it was a combination of staff egos not liking the mother challenging them and the fact that this young woman represented an almost unlimited billing opportunity. The mother may have been overly demanding but if so, that should have been reason enough to let the girl be transferred to another facility so as to be done with dealing with her. Doing so however would have meant the loss of the revenue the patient represented.

 
At Sunday, August 19, 2018 6:01:00 PM, Blogger Biker in Vermont said...

Dr. Bernstein, I don't see how free tuition would make newly minted physicians more respectful of patient dignity, but it certainly would make becoming a physician more feasible for economically disadvantaged students of any race. My guess is that a subset of those economically disadvantaged kids, the ones who come from rural communities, would return to their hometowns to work. Kids from affluent suburban/urban areas rarely choose to settle in rural small town setting, and the result is the growing shortage of doctors in rural areas. Even then I don't see how those kids from economically disadvantaged families will somehow be more respectful of patient dignity either.

 
At Sunday, August 19, 2018 6:03:00 PM, Blogger A. Banterings said...

Maurice,

You ask, "...Or..on the other hand, should the healthcare provider and patient "suffer together"? For example, pertinent to this blog thread, should the patient's physical modesty be acknowledged and understood by the the healthcare provider?

I am sure that there are some patients, when ill, who are more desirous of a diagnosis and relief of their disorder rather than modesty concerns at the time. And it is the duty of the healthcare provider to demonstrate compassion for their concerns. However, there are others, who write here, include modesty issues within their concerns....


The answer is that your students should take the patient's DIGNITY (I have discussed modesty vs dignity previously) because I have (also) demonstrated (previously) that such a disregard causes adverse side effects such as PTSD. Here is one example: Women’s experiences of gynecological/obstetric procedures can be sufficiently distressing to cause post-traumatic stress disorder (PTSD).

There are many other adverse side effects that are preventable and amount to malpractice (dignity is only one). Propublica did an excellent article, When Harm in the Hospital Follows You Home







-- Banterings





 
At Monday, August 20, 2018 9:54:00 AM, Blogger A. Banterings said...

Here is an interesting parallel that medicine needs to take note of, here


The Pennsylvania Supreme Court released a sweeping grand jury report on sex abuse in the Catholic Church, listing hundreds of accused clergy and detailing 70 years of misconduct and church response across the state.

Note that the grand jury recommended eliminating the statute of limitations for prosecutions, noting that "no piece of legislation can predict the point at which a victim of child sex abuse will find the strength to come forward."

This legislation WILL pass, and it will have grave implications for physicians, especially those in pediatrics.

The cover up (of the church sex scandal) was so heinous, the Pope responded by expressing shame over the Pennsylvania report on abuse.

Note that just as in healthcare, While each church district had its idiosyncrasies, the pattern was pretty much the same. The main thing was not to help children, but to avoid "scandal"....


Maurice,

Expanding on my previous response, your statement:

That is why those patients who desire the providers' attention to their physical modesty concerns should "speak up" and inform. And those concerns should be treated as compassionately by the healthcare provider as the physical illness.

Providers should look at dignity concerns as an underlying illness that may not exhibit symptoms until the condition is stressed. Again, the provider should address this BEFORE the patient speaking up (the patient may be unaware of their right to refuse to undress, request gender concurrent care, etc.), AND a failure to address patient dignity is NEGLIGENT and MALPRACTICE because it may result in preventable side effects such as PTSD.



Gen'rals gathered in their masses,
Just like witches at black masses
Evil minds that plot destruction,
Sorcerer of death's construction
In the fields the bodies burning,
As the war machine keeps turning
Death and hatred to mankind,
Poisoning their brainwashed minds
Oh Lord yeah

Politicians hide themselves away
They only started the war
Why should they go out to fight?
They leave that role for the poor, yeah

Time will tell on their power minds,
Making war just for fun
Treating people just like pawns in chess,
Wait 'till their judgement day comes, yeah

Now in darkness world stops turning,
Ashes where the bodies burning
No more War Pigs have the power,
Hand of God has struck the hour
Day of judgement, God is calling
On their knees the war pigs crawling,
Begging mercies for their sins
Satan, laughing, spreads his wings
Oh Lord yeah


Black Sabbath, War Pigs (from the 1970 album Paranoid)
Songwriters: Michael Butler / Ozzy Osbourne / Tony Iommi / William Ward

Replace "war" with "healthcare" and switch out the people named for different providers...




-- Banterings






 
At Monday, August 20, 2018 10:01:00 AM, Blogger A. Banterings said...

Building on my previous post comparing healthcare abuse to clergy abuse, Houston physician convicted of raping a sedated patient won't get any jail time.

Dr. Shafeeq Sheikh, who was convicted of raping an an acute asthma patient during a night shift when he was a resident at Baylor College of Medicine in 2013, received 10 years probation Friday, Aug. 17, 2018.


Now I need to go and vomit.



-- Banterings




 
At Monday, August 20, 2018 7:05:00 PM, Anonymous JF said...

Biker , More doctors and more medical staff could also mean competition. I would think it should be a different system also though. TV commercials acknowledging the modesty violations and the corrupt billing practices.
I think that that is EXACTLY what could make the difference.

 
At Monday, August 20, 2018 8:06:00 PM, Anonymous Anonymous said...

The FDA has repeatedly sent warnings for years to 73 physicians nationwide over patient care issues yet the medical board has only taken action against one physician. I say that is a very good success rate compared to the State boards of nursing. Top of the Billboard chart it’s always the same song and dance regarding nurses and cna’s. Unreported felony conviction in another state, drug diversion and the all time favorite among them are boundary violations. Apparently, going to work in a hospital is considered a meat market, forget about the notion of gender neutral.

Don’t ever ask a nurse to recite one rule from the nurse practice act, otherwise expect a prolonged blank stare. When my mother was in a nursing home I always brought her gifts and money. She always asked me to bring her small denominations and when I asked her why she said “ so that I can tip the girls when they give me my bath. Apparently, giving them money got her bath sooner. “ &*$#@%*. What? I didn’t tell my mother that the government pays the nursing home well over a hundred grand a year. That it’s a violation to accept monies from a patient when acting as a caregiver in any medical facility.

If you take your loved one in a nursing home pastries or baked goods, they may not be the only ones enjoying the food. There was an article in the paper over the weekend of two cna’s in a nursing home who restrained their patient with duct tape. You have to have a physicians order to apply restraints to a patient and then the order must be renewed daily. One more article of abuse to add to propublica,where it stops nobody knows.

PT

 
At Tuesday, August 21, 2018 4:21:00 AM, Blogger Biker in Vermont said...

JF, though the article about NYU's free tuition mentions the physician shortage, it does not say NYU will be increasing their enrollment. My take is that this move only serves to remove the financial barrier to entry to medical school for economically disadvantaged students.

I should note that as huge as this change is, it is possible that it will prove to be more symbolic than real for the poorest of the applicant pool. NYU is going to attract more applicants than ever now. The very poor will still have had to overcome the barriers to entry to get through a top tier pre-med program somewhere in order to make NYU's cut.

Regardless, I'm not seeing how economically disadvantaged students would somehow be more respectful of patient dignity than more affluent students.

 
At Tuesday, August 21, 2018 5:43:00 AM, Blogger NTT said...

Good Morning:

Banterings, Dr. Shafeeq Sheikh got his sentence from a jury. The only redeeming factor is he has to register as a sex offender for the rest of his pathetic life. His license was revoked by Texas but as soon as the dust settles, we will see him again in yet another state abusing defenseless patients.

Until the public opens their eyes and sees for itself that the medical system can no longer police itself and must have civilian oversight they will continue to hold doctors and nurses in high regard whereby giving them a pass rather than prison.

Regards,
NTT

 
At Tuesday, August 21, 2018 1:02:00 PM, Anonymous JF said...

Biker, I wasn't thinking it would be better because the doctors were once poor. I think it would be better because of more doctors and competition for patients.
The way it is now, we need them more than they need us. Huge numbers avoid care for one reason or another. They don't miss us because they have all the patients they need and then some.
I think rival clinics or rival hospitals who charge appropriately and provide respectful care ( by patient version of respectful ) would make the change. It wouldn't be an automatic though, unless the new staff were taught, right from the start and were a different system.

 
At Wednesday, August 22, 2018 7:58:00 AM, Blogger A. Banterings said...

Here is the latest take on Penn State Health's position on requesting a change of a provider based on the physician’s ethnicity, or religious or sexual identity: it may be MALPRACTICE!!!

In an intriguing study, black patients were far more likely to agree to certain health tests if they discussed them with a black male doctor. Source: NY Times

Read the study here:

The attorneys are going to have a field day with Penn State Health.




-- Banterings



 
At Wednesday, August 22, 2018 9:07:00 PM, Blogger Maurice Bernstein, M.D. said...

I think that patient trust and comfort with their physician is nothing to disregard and is essential to the patient-doctor relationship. If there is racial or religious aspects that a patient requests for their healthcare provider, I think this is just as important as informed consent or dissent in other aspects of medical care and treatment and should be considered and, if the request can't be met, the patient should be so informed and the current providers office help the patient in finding a resource, if possible, to meet the patient's request. Perhaps, cutting out medical school tuition will make a more acceptable pool of physicians for all patient requests.

All of this should suggest to everyone that
the medical profession has more responsibilities to patient (dignity, modesty and respect for views) than purely diagnosis and treatment of disease. ..Maurice.

 
At Thursday, August 23, 2018 3:56:00 PM, Anonymous Anonymous said...

Due a quick simple search on yahoo for women’s hospitals and see how many hits there are. Scientific notation would be best to display the number as these are associated with children as well. I know of no men’s hospital, surgical center etc and in fact everything is done in health care to separate the two. The Urology clinic I went to had two different sides in the waiting room, one side was the prostate center in big letters written across the wall. If you had renal cancer, bladder cancer whatever the diagnosis was you would be seen on that side. The other side were female patients only yet the entire setup was redundant in that the entire clinic employed female nurses/ ma’s.

As you know many mammography clinics give their female patients pink robes as they wait for their mammogram, served food and beverages. If you are a male patient in need of a mammogram due to a possible diagnosis of gynecomastia you will a) be tuned away to another clinic or b) led in a side door to have your mammogram, far removed from the female patients. Men represent only 1 percent of all cases of breast cancer, thus they are considered an oddity and treated as an oddity. Statistically, male patients from age 17-25 years of age represent the vast majority of all level 1 trauma patients but don’t expect any special services.

As a male level 1 trauma patient you will lie there on a gurney fully exposed much longer than any female trauma patient. For some reason unbeknownst to me there will be at least two registration clerks present in the trauma room. All registration clerks that I’ve seen in my life were all female, interestingly it only takes one clerk to register you but for some unexplainable reason there may be 2-3 clerks in one trauma. They know in advance if the trauma patient is a male or female before the patient arrives, they are told beforehand if it is a JohnDoe or a JaneDoe.

I only went to the trauma when I absolutely had too. When I was assigned to trauma and the announcement was made overhead “ trauma team to the emergency room”. I went to do my job there. One time I looked up and there were 40 staff in the trauma room, for 1 patient. It’s ridiculous! There should at most be no more than 6 to 7 staff at most. I’ve heard some nurses say, “ I want to see a good trauma”. I didn’t know there was such a thing. An infant drowned in the family pool, a young man collide head on with a MAC truck and when EMS arrived on scene he was impailed in the grill of the truck and was still alive when entering the trauma room. I wanted to tell the nurse who came into the trauma room not assigned there but “ Just wanted to see a good trauma” are you satisfied now. Was that a good enough trauma for you?

PT

 
At Thursday, August 23, 2018 9:15:00 PM, Blogger Maurice Bernstein, M.D. said...

Anyone want to discuss the presence of TV video crews for a video medical program or "documentary" in the ER? Does every patient have to sign a release, even those behind a semi-closed curtain. Or has such invasion of ERs for TV just a thing of the past? I never thought that behavior was in any way ethical. ..Maurice.

 
At Friday, August 24, 2018 5:31:00 AM, Blogger NTT said...

Good Morning:

Dr. Bernstein, in reference to your TV crews video taping, after the debacle at New York-Presbyterian Hospital 2 years ago, I'm sure most hospitals are making sure patients sign a consent form before any cameras start rolling.

NY Presbyterian had to pay a $2.2 million penalty to federal regulators for allowing television crews to film two patients without their consent. One who was dying, the other who was in significant distress.

Regards,
NTT

 
At Friday, August 24, 2018 2:51:00 PM, Blogger Biker in Vermont said...

That any hospital would have ever thought it was OK to allow film crews (often mixed gender) into ER's to film trauma patients without specific prior consent speaks volumes about how hospitals view patient bodily privacy. Getting the patient's OK afterwards prior to airing an episode was just asking for a major lawsuit to come along. I personally would never consent to being filmed in that manner and would not have settled for them telling me after the fact that it wouldn't be aired. The damage will already have been done by allowing the film crew to film me and to be privy to whatever my medical situation was.

 
At Friday, August 24, 2018 9:29:00 PM, Blogger Maurice Bernstein, M.D. said...

OK.. How about police, fire department and hospital security officers "wandering" around in a hospital emergency room. I am not aware that on any ER admission for examination that patients are given information of the other non-physician, non-nursing staff or are these "regulars" which I described above are intrinsic to an emergency room. Again, this is all in the context of patient privacy, dignity and modesty or do you think that these folks, other than TV video crews don't require acceptance by each ill patient who may be undressed and receiving examination or therapy? ..Maurice.

 
At Saturday, August 25, 2018 3:31:00 AM, Anonymous JF said...

If police,fire department,EMT's and security guards are wandering around, viewing patient nudity- How awful!
Many of us would rather die than be humiliated that way! The hospital employees doing the patient stripping should be the first to be punished, being they're disregard sets the stage. The unnecessary eyes just lingering around to watch need some very real consequences also. My theory is a good horse whipping!

 
At Saturday, August 25, 2018 4:20:00 AM, Blogger Biker in Vermont said...

Dr. Bernstein, if police, fire, and security staff are not there specific to me then they have no business watching me be treated. I realize police sometimes have to accompany suspects but if I am not suspected of a crime then they cannot watch me being treated. By fire staff I assume we mean EMT's and paramedics who might have brought me to the hospital. Once I am turned over to the hospital staff, then they too need to leave. Unless I am thought to be a danger to staff, then hospital security staff also cannot stand there and watch me being treated. I would add I also don't want nurses or other medical staff that are not needed for my treatment watching me either simply because they are curious or have nothing else to do. My treatment is not a peep show. Voyeurs can find another way to get their thrills, and that's what we're talking about, voyeurs.

 
At Saturday, August 25, 2018 1:17:00 PM, Blogger Maurice Bernstein, M.D. said...

It would be interesting to read the knowledge of PT or AB IN NW about the presence of these specific classes of individuals within the active emergency room and whether the patients being treated there, if demonstrating capacity to make decisions, should be informed and allowed to "speak up" regarding their personal acceptance or rejection of being visible (particularly if undressed) to these individuals. My ER experience, as a physician, has over the years been minimal since my patient contact has usually been when the patient was already located in a ward room.

I may be mistaken but I don't think this specific issue has been discussed on "Patient Modesty" and that is why I brought it up for consideration. ..Maurice.

 
At Saturday, August 25, 2018 7:32:00 PM, Anonymous JF said...

On earlier volumes Marjorie Starr and PT talked about ER nurses cutting off patients clothes while police and EMT's hung around to watch.

 
At Sunday, August 26, 2018 4:20:00 PM, Blogger NTT said...

Good Evening:

The ER medical staff has an obligation to protect the privacy and respect the dignity of every patient that comes thru their doors.

All parties not directly related to an individual case have no business being allowed to meander about in the ER and should be told to go or removed.

Regards,
NTT

 
At Sunday, August 26, 2018 6:39:00 PM, Anonymous Anonymous said...

General comments. First, although PT’s description of things happening in hospitals sometimes sounds like hyperbole I generally stay quiet because over the years I too have seen at least one instance of just about everything he has mentioned. Its not rampant, its improbable you as a patient would encounter some of this unethical, unprofessional or illegal behavior, but every large collection of people (employees) has the criminal or the unethical or the nasty members in the group - that is just statistics. Hospitals are no different.

As for trauma bays/rooms/centers, before HIPAA they could be a zoo. Yes, all types came and watched traumas. When HIPAA came along it was a big step forward for patient privacy. In concert with HIPAA we redesigned our trauma area to explicitly set up additional barriers to keep out all but the trauma team and support staff. Card key access, double doors where police would enter before now preventing them, etc. We explicitly banned many of the external people that used to hang around, e.g., police, fire, EMTs, etc. It took years of educating the staff and physicians, the community police, fire, EMTs etc. but eventually the trauma staff took ownership and guarded their space. When I retired a few years ago the trauma area was as private as it was going to get.

Those hospitals that chose to allow filming of ER and Trauma patients before they secured valid written authorization from the patient or their personal representative were very mistaken. I was approached about similar productions at our hospital several times, the argument being other hospitals were doing this, good PR for us, etc. and I always rejected it. Such unauthorized filming does not satisfy HIPAA and CMS regulations and violates bodily privacy case law. Its just not legally defensible and its unethical.

In hospitals there are requests for outside observers in the ED and trauma centers continually. Here I demanded we meet the requirements of HIPAA. I asked the requesting person (usually a physician or nurse) that they define the educational program for the outside health care professionals or persons, the goals, length of training, qualifications to be accepted in the training program, measures of training, etc. In all my years after HIPAA went into effect only one physicians/nurse team ever accepted this absolute requirement and worked with me to set up a bona fide health services training program for outside individuals in the ED (it was for additional community EMT training and was of value).

There is a variation in how hospitals/medical centers approach compliance and the ethics of their operation. I would say there is a wide variation. As patients we must always be mindful of what is appropriate for us and speak up. It helps to have a significant other or personal rep helping with this. fyi - AB in NW

 
At Sunday, August 26, 2018 9:06:00 PM, Anonymous Anonymous said...

Maurice

I’m assuming when you refer to specific classes of individuals in the emergency room as those continuing some function related to patients who were brought to the hospital. Police, firemen, emt’s and helicopter rescue and or perhaps a film crew for a drama television reality show that people just can’t get enough of. Yes, I’ve seen all those people come to the trauma room and is it necessary for the police, men and women to be present and why? Are they going to question the patient, not really when the patient has a GSW to the head, or they have extensive trauma. What about the firemen who hang out in the trauma room after bringing the patient in and giving report to the trauma surgeon? Why do they need to hang out, or ambulance drivers who I’m sure after their 8 or 12 hour shift after hanging out go home, flip on the channel to the first medical reality tv show.

Personally, that should be the first question asked on an employment application, do you watch a lot of medical reality tv shows? I’ve seen the tv crews setting up cameras, equipment and lighting in an emergency room, big time Hipaa violation in that filming will always have extraneous film of patients who Have Not signed a disclaimer etc. Unbeknownst to thousands and thousands of trauma patients in many level 1 facilities that all traumas are filmed. Blame the stupid producers, better yet blame the people who like to sit at home on their big wide sofas, stuff fancy sweet edibles down their major orifice and watch these stupid medical shows all day long.

I’ll tell you that would be the last thing I’d want to do after working 16-20 hours straight at the hospital. Truthfully, I loathe firemen, fire women, ambulance drivers, ambulance chasers, helicopter rescue staff, police who come to the hospital and hang out. It’s been quite a while since I’ve seen a film crew and I forgot initially that I’ve ever seen them in an er but yes, once quite a few years ago. I’m very surprised any CEO of a hospital would agree to such filming, recognition for the hospital or did they just forget that patient’s have a right to privacy.

PT

 
At Monday, August 27, 2018 11:30:00 AM, Blogger A. Banterings said...

AB in NW,

You state:
" First, although PT’s description of things happening in hospitals sometimes sounds like hyperbole I generally stay quiet because over the years I too have seen at least one instance of just about everything he has mentioned. Its not rampant, its improbable you as a patient would encounter some of this unethical, unprofessional or illegal behavior, but every large collection of people (employees) has the criminal or the unethical or the nasty members in the group - that is just statistics. Hospitals are no different..."

I hate to argue, but hospitals ARE different. Because of the nature of medicine, you have a situation where one side holds tremendous power and privilege the other side. Invasions of bodily integrity is expected. As PT said:

"Let’s face it. I know of no other industry whereby a person pays to be groped, assaulted, molested, raped, inappropriately touched, struck, mocked, gawked, leered, stared, slandered, spyed on, talked about, stolen from, dropped, judged, given a Superbug, wrong medication and death..."

That environment is very likely to attract sexual predators, sadists, sociopaths, angels of death, mad scientists (human experimentation), etc. Therefore, the incidence rate of this deviance is higher than other groups. Just look at the Catholic Church; another group that self regulated. Unfortunately there was no justification to intimate exposure there where ther is in medicine.



-- Banterings


 
At Monday, August 27, 2018 5:57:00 PM, Anonymous JF said...

I know of a solution. Tell the people hanging around that they deserve sexual gratification but because of HIPPA they can't watch. Then hand them Penthouse magazine and tell them to leave.

 
At Monday, August 27, 2018 7:00:00 PM, Anonymous JF said...

Banterings, There is SOME reason for some intimate exposure but the majority of that exposure shouldn't be happening at all, or is witnessed by more people than necessary or opposite gender staff is used too often.
The Catholic church perverts, possibly a lot of their deviate behavior may have been medical in nature. Or butt whippings.

 
At Tuesday, August 28, 2018 4:43:00 AM, Blogger Biker in Vermont said...

Thinking about Banterings most recent comment about healthcare offering "access" opportunities for all the wrong reasons, there is probably some truth to it. As society has come to learn, pedophiles found safe harbor and access to children in the priesthood, in orphanages,as coaches, in scouting, and as counselors. The vast majority of people who work in or volunteer in those capacities are not pedophiles of course, but the incidence of pedophiles has probably been greater than in society as a whole.

The question then is does healthcare have a higher rate of voyeurs than does society as a whole? Do some go into the field for that kind of patient access?

I have heard or read many women wanting to work in L&D,NICU,and pediatrics because they want to work with the moms and babies. I know a young woman studying to be a physical therapist because she wants to work with disabled vets. I know a woman who works in hospice so as to minister to the dying. Some like working in the ER for the variety and adrenaline rush it provides. If those who work in healthcare gravitate to the aspect of healthcare that they like, just focusing on the most obvious one, what is it about urology that attracts female nurses and techs? They don't talk about what the passion was that brought them to urology. Just to be clear I am not accusing all urology nurses of being in it for the wrong reasons, but being a urology nurse is far different than being an L&D nurse, so why did they choose one over the other? L&D nurses talk about why they chose L&D, urology nurses don't.

 
At Wednesday, August 29, 2018 6:47:00 AM, Anonymous Anonymous said...

Biker, I think you're giving some healthcare workers more benifit of the doubt than what they have coming.
Have you never known anybody who was a total POS but to some other people they passed off as decent and good?
I've known some people like that. I'm RELATED to a couple of those kinds of people.
Whoever came up with the practice of hospital staff shaving a patient's public hair-THAT WAS DEVIATE! Those patients could shave themselves for the most part. Not sanitary enough? Let the patient wipe themselves with a wipe. There is no pure motives for all female staff working in urology. Or for females to chaperone male intimate exams. Staff shouldn't be wandering in and out when intimate exams are going on either. Sometimes I wish I wouldn't have read some of the stories I have read on this blog! Sometimes I have a hard time living with myself afterwards. When I read about young boys being examined by a doctor and female nurse,at schools, I wanted the school principal, the doctor and his/ her assistant stripped and BEATEN! Or given a choice between being beaten or sent to prison and being registered as pedophiles. If what I have read recently is true , gynecology was INVENTED for the sexual gratification of the male doctors. They had to make it seem mandatory so these guys could make a living as they amused themselves.
Another thing that has bothered me is when doctors have made brothers get intimately examined in front of sisters or vice versa. Some siblings would be ok with that kind of thing. Others absolutely not! Mothers watching their sons get examined. ( or even their daughters ) Fathers watching daughters getting a pelvic against the daughters wishes. All this stuff has an influence. Family relationships are hurt or even destroyed. Since the influence is so much like sexual abuse , some of the patient/victims become deviants ( possibly ) Unexplained anger. But what about the patient/ victims who never abuse other people because of what they've been through? Is it then ok since they don't pass on their pain to other people?

 
At Wednesday, August 29, 2018 10:38:00 AM, Blogger A. Banterings said...

Do to length, I must do this in 4 parts.
Part 1


Maurice,

I want to revisit a suggestion that I had made a while ago, and that is changing the name of this thread to "dignity." You can do something like:

Patient Dignity: Volume 90 (formerly Patient Modesty)

You can even create a separate page to explain the change or put a notice like is here where we post; This System apparently will not allow Comments to exceed 4096 characters...

Your past has shown that you have an open mind about such issues when presented with proof, just as you have accepted that those who post here are NOT the outliers in the system. Now I will present my case for the change.


First let us establish some definitions.


mod·es·ty / ˈmädəstē /
noun Behaviour, manner, or appearance intended to avoid impropriety or indecency.
Source: Oxford Dictionaries


dig·ni·ty / ˈdiɡnədē /
noun The state or quality of being worthy of honour or respect.
Source: Oxford Dictionaries


Human Dignity
The mercurial concept of human dignity features in ethical, legal, and political discourse as a foundational commitment to human value or human status. The source of that value, or the nature of that status, are contested. The normative implications of the concept are also contested, and there are two partially, or even wholly, different deontic conceptions of human dignity implying virtue-based obligations on the one hand, and justice-based rights and principles on the other.
Source: The Internet Encyclopedia of Philosophy (IEP) (ISSN 2161-0002) (peer reviewed)


My original argument (previously) was that referring to the human condition of not wanted to have one's (the patient) body exposed (being naked) as modesty can be construed as the patient is asking for something that they are not entitled to. The phrase that most demonstrates this is You are being too modest."

Dignity on the other hand takes into account the intrinsic value of a human being that makes the person deserving of being treated in an absolute, respectful, and dignified manner that is not open to interpretation or negotiation. To treat one in this manner is often not the easiest option and can be inconvenient.

The basis for human dignity (by non-atheists) is that we are endowed with it by our Creator (God). For Judeo-Christians (such as myself) the concept is furthered in that we believe that we were "created in the image of God."

This was rejected because the thread has been titled "Patient Modesty" and a change would some how create a disconnect. This is nothing more than marketing fluff. I will expand on this.


End Part 1



-- Banterings



 
At Wednesday, August 29, 2018 10:45:00 AM, Blogger A. Banterings said...

Part 2



As a physician and doctor (Latin, an agentive noun of the Latin verb docere 'to teach') Maurice, you teach your patients and students to use correct terminology, especially in regards to human anatomy. Not only does this keep the procedure medical in nature (as opposed to being sexual), but it also denotes the professionalism of the physician (provider) by showing that they are (properly) educated in the correct terminology.

One example of this is the use of the terms anus (the opening at the end of the alimentary canal through which solid waste matter leaves the body.), rectum (the final section of the large intestine, terminating at the anus.), and the colon (the part of the large intestine that extends from the cecum to the rectum).

By using the term modesty instead of dignity, it is making one look less professional and less educated.

The patient can be accused of being too modest.

Modesty is taught to girls at some of the youngest stages of their lives. Modesty as projected by the person (patient) is t different levels. (Read about how New Jersey 'Mormon Prom' Draws Hundreds Of Teens For Celebration Of Modesty.) Modesty is about one choosing to be modest.


Teens were required to sign a pact agreeing to dress and behave modestly, to dance “appropriately” and to abstain from using alcohol or drugs...

The nearly 300 students abandoned several conventional prom practices — including arriving in limousines and wearing expensive outfits. (Organizers encourage attendees to be modest in their spending as well.) Most were dropped off by their parents, and some of the girls swapped or borrowed dresses to keep down the cost...



The problem in healthcare is that providers are taught to respect patient modesty and NOT patient (human) dignity. Let me expand...

An anesthetized patient (technically) has no modesty. (Everybody line up to practice rectal exams on the anesthetized patient.) An anesthetized patient DOES HAVE dignity. The lack of consciousness negates the presence of modesty being practiced, requested, or displayed.

I bet everyone knows where I am going next...


A cadaver has no modesty. An cadaver DOES HAVE dignity.
Increasingly, medical schools are having ceremonies honoring the sacrifice that people made leaving their body to science. This is to humanize the cadavers where traditionally (and still today) the cadavers were de-humanized. This is what happens when medical providers are taught to respect modesty and NOT taught to respect dignity:


...Last month, Stony Brook University Medical Center in Long Island announced it was developing a revised ethics policy after a student posted a photo on Facebook of a classmate posing with a thumbs up next to a cadaver. The State University of New York Upstate Medical University in Syracuse also is updating its ethics curriculum after a former resident posted a snapshot of an exposed brain on Facebook...


Let us also NOT forget the Denver 5...




End Part 2



-- Banterings



 
At Wednesday, August 29, 2018 10:45:00 AM, Blogger A. Banterings said...

Part 3



By using the term modesty instead of dignity, nullifies and disregards the basic intrinsic value that human beings have and deserve being sentient beings and as endowed by our Creator. This is akin to calling a black man "boy."


...One, it's the ultimate sign of disrespect, and is often more offensive than calling them the N-word. For years black men were summarily dismissed and treated with disregard. It was as if their stature was diminished when someone white called them a boy...

Do you remember the images from the sanitation strike that the Rev. Dr. Martin Luther King Jr. was leading in Memphis in 1968? The most striking visual was that of the male protestors wearing signs saying, "I Am A Man!"

There was a reason they were wearing those signs...



This mirrors the profession of medicine. Just as the hidden curriculum, the use of the patient gown, and teaching the term "modesty," helps retain and the paternalistic power that physicians are desperately trying to hold on to. It makes the doctor-patient relationship resemble the parent-child relationship.


For at least 2,500 years, the doctor-patient relationship has resembled the parent-child relationship. The norms of medical ethics, codified in historic documents or perpetuated as informal traditions, encouraged doctors to shield patients from bad news and from general medical knowledge. While Western medical tradition has always included some patient protections, such as informed consent (and its antecedents), doctors have possessed broad powers to withhold treatments that patients desired and, at times, to mislead patients for what they perceived to be the patients’ own good...


Even the term "doctor-patient relationship" attempts to consolidate and preserve physician power br putting the doctor first. I prefer the term "patient-physician relationship" because it puts the patient first, and recognizes the difference between a doctor (PhD) and a physician (medical doctor).


End Part 3



-- Banterings



 
At Wednesday, August 29, 2018 10:46:00 AM, Blogger A. Banterings said...

Part 4


In the evolution of the doctor-patient relationship, such outdated terms are replaced with the correct term. The new terms show a respect for patient (human) dignity. One such example is noncompliance vs. nonadherence. Noncompliance as a term is a slur against patients. Nonadherence has become the (most recent) preferred term to use.


Noncompliance painted a picture of a paternalistic provider mandating the rules of play, while the patient cowered below as a disobedient subordinate. It also implied that the patient did something wrong by breaking the rules and that the actions of the patient ought to be modified to fit the rules, rather than the other way around. On the other hand, non-adherence signified that the patient was a contributing partner in the development of the treatment plan and, further, that he may be justified for not abiding by the terms of his plan.


Many facilities have ordered the term noncompliance with. nonadherence There is a current movement to do away with the term nonadherence (along with noncompliance), because they can interfere with treatment.


Non-adherence used to be called noncompliance, which sounded too paternalistic. Now some experts are shifting to an even less judgmental language of "medication abandonment."


Now let me show how this practical application of the term "dignity" benefits providers.

There is no question that providers' modesty is respected in the healthcare setting (they wear white coats OVER their clothes, where patients remain half-naked wearing only a gown). Now if the profession of medicine was set up to respect patient dignity (human dignity), it would notice and correct the affronts to provider dignity (physician burnout, mental illness, EHR, etc.).

Maurice, I believe that I have made my case with sufficient evidence to back my reasoning.



End Part 4



-- Banterings






 
At Wednesday, August 29, 2018 10:50:00 AM, Anonymous Anonymous said...

www.scrubsmag.com. Search the article “ you know you are a Urology nurse when “

The article says for those whose job involves that area “ down there”

You know you’ve seen more penises than a mohel

And the article goes on


PT

 
At Wednesday, August 29, 2018 6:11:00 PM, Anonymous Anonymous said...

A. Banterings

You bring up an interesting point re: the definition of modesty.

Modesty noun. Behavior, manner or apperance intended to avoid impropriety or indecency.

Now, the definition implies this is a behavior that the patient assumes. But what happens when
the impropriety or indecency is propagated unnecessarily by a nurse, physician etc. In my opinion
this is what this blog is really all about. Yet, by calling the blog modesty removes the negativity,
culpability, turning the tables so we can be labeled outliers. I suggested years ago on this blog
that the word modesty does not encompass the discriminatory, unethical and criminal behavior
so frequently displayed.

Maurice

I think you have displayed considerable insight by allowing this blog to bloom and evolve. This
matter many years ago and even now carries a stigma that often is not talked about by the health
care industry. Little red headed step children have always been beaten and locked in the coat closet
for too long. We don’t intend on running away but rather want to stay and see the healthcare industry
come clean, change their culture, change their hiring practices, admit the wrong doing and turning a
blind eye for soo long. Don’t you think it’s time the name of this blog is changed?

PT

 
At Thursday, August 30, 2018 6:54:00 AM, Blogger Maurice Bernstein, M.D. said...

I certainly agree that after 90 volumes and perhaps 13 years of "Patient Modesty" it may be time, based on increasing consideration of the issue of patient dignity and how such dignity has been impaired by professional or institutional behavior and this subject part of the thread title. Like many ethical subjects there are always two sides to interpretation of the role of patient dignity relative to the goals of medicine.

I found this article "Respect for patients’ dignity in primary health care:
a critical appraisal"

interesting since it tries to present the two sides.

We will be moving on in a while to Volume #91 of this discussion and I agree there should be a change in the title to make the title more fully descriptive of the content of the discussion. What do the others here think about this? ..Maurice.

 
At Thursday, August 30, 2018 9:18:00 AM, Blogger Biker in Vermont said...

I like the word dignity better than modesty in that it can't be used as a negative. The phrase "overly modest" for example when directed at a patient connotes the patient's modesty as being something negative.

An example I had used a year or so ago of my friend who had GBS is another good one. When he went to a rehab center the young woman who was assigned to assess him had him undress, dress, use the toilet, and shower while she observed his capabilities. In response to his embarrassment she said "we don't have any modesty here". She was able to get away with deeming modesty as something negative. She couldn't have gotten away with saying "we don't have dignity here" to a patient that expressed a dignity concern.

Going forward I will try to use the word dignity rather than modesty as appropriate in healthcare settings.

 
At Thursday, August 30, 2018 12:17:00 PM, Blogger A. Banterings said...

PT,

As you stated:

"...But what happens when the impropriety or indecency is propagated unnecessarily by a nurse, physician etc. In my opinion
this is what this blog is really all about. Yet, by calling the blog modesty removes the negativity, culpability, turning the tables so we can be labeled outliers.
"

You are so correct in your assessment of the situation. Using the term dignity prevents from being labeled outliers, AND places the onus on providers to respect the human being.



-- Banterings



 
At Thursday, August 30, 2018 2:02:00 PM, Blogger Maurice Bernstein, M.D. said...

Placing DIGNITY in the title of the thread should we be more specific as to whose DIGNITY? Is this all about "Patient dignity" or aren't we also writing about the apparent dignity or more the loss of dignity of the medical profession and the system itself?
..Maurice.

 
At Friday, August 31, 2018 10:30:00 AM, Blogger A. Banterings said...

Following up on the 4 part argument I made about modesty vs. dignity...

Dignity has 3 definitions, all with subtle nuances.

the state or quality of being worthy of honor or respect. a man of dignity and unbending principle
a composed or serious manner or style. he bowed with great dignity
a sense of pride in oneself; self-respect. it was beneath his dignity to shout

As to the person who acts as he has no dignity; it is important to realize subtle nuances. First off, he is acting in an undignified manner. The lack of dignity is this example is labelling how his actions assail the dignity of those around him and society.

By one having dignity (worth as a human being), one will (should) act in a manner worthy of that dignity. Part of our human dignity is respecting the dignity in others (even if they do not respect others' dignity). This is the second nuance of acting with no dignity.

These definitions all involve the actions of the actor, behaving in a way that elicits respect (or disrespect) of observers. The "state or quality of being worthy of honor or respect" can be achieved by behaving in such a way, for example having good manners (saying please and thank you).

The "state or quality of being worthy of honor or respect" as in human dignity is intrinsic, and can not be given up or taken away, only disregarded and disrespected. In fact, one giving up their dignity can lead to them creating a state of higher dignity beyond intrinsic, human dignity. Think Christian martyrs.

When we speak of patient dignity, we are referring to that intrinsic, human dignity. Patient dignity is a subset of human dignity. Going back to my example, human burial rites going back to prehistoric times recognize intrinsic, human dignity in the manner that the corpse is treated. By contrast, the Nazi concentration camps failed to recognize that intrinsic, human dignity and the corpses were used as manufacturing material (lamp shades, pillows, etc.), as a source of wealth for the riches (possessions) to be mined from the victims, and as refuse to be efficiently disposed of in incinerators and mass graves.

The true horror of the Holocaust was NOT the brutal acts committed, but how the philosophy of the Holocaust ignored that intrinsic, human dignity.

Just as the use of the term "patient modesty" allowed providers to use it against patients (by saying you are being too modest), patient dignity can be used against them by focussing on the dignity derived from the patients own actions (as opposed to the intrinsic, human dignity as a subset of human dignity). Providers may also say that dignity does not apply to (what has been previously called) modesty/exposure issues either from a lack of comprehension of the subject or to confuse the issue (as to deny the patients their full human rights in regards to modesty/exposure issues.

Finally providers run the risk of narcissism by saying "what about my dignity?" As previously stated, surrendering one's own dignity can elevate their dignity and status.

Another risk is the provider "crying the blues" to the patient how the hospital, healthcare system, MOC, etc., tramples their dignity. Due to the power differential, the sick patient can care less. If the system changes to be dignity driven, then that prosperity will spread and the atmosphere will improve for providers as well.




-- Banterings




 
At Friday, August 31, 2018 10:46:00 AM, Blogger Maurice Bernstein, M.D. said...

As an example related to my posting above regarding "loss of dignity of the medical profession and the system itself", how about "Patient Dumping"? ..Maurice.

 
At Friday, August 31, 2018 11:14:00 AM, Blogger A. Banterings said...

Maurice,

When you ask whose DIGNITY, the thread is PATIENTS' dignity. (The thread is named PATIENT modesty now.)

As my previous post warns, this is about the patient. Previously, when dealing with issues of providers, you create new threads (such as Growing Ideal Doctors). We may still touch on provider issues here, but from the patient's perspective, they can care less about the provider when they are sick or injured.



-- Banterings



 
At Friday, August 31, 2018 11:53:00 AM, Anonymous JF said...

I don't know what to say! I don't think medical care should be free but unless the employees are not being paid, it isn't free.
When taxpayers pay the bill, certain taxpayers pay more than their share. Others less than their share and there's a certain number who run to the ER for the lest little thing.

 
At Friday, August 31, 2018 12:42:00 PM, Anonymous Anonymous said...

Maurice

When you refer to “ patient dumping “ that alludes to an entire subject of ethical issues, Emtala laws etc. I think that would be opening up a new can of worms as it would not specifically address the loss of dignity in medical exams and procedures. Many times ex patients accuse hospitals of patient dumping when in reality the patient left ama because they didn’t get the opioids they wanted in the first place. Hospitals are not homeless shelters and you have to have a valid medical reason to admit someone. I could literally go on and on regarding the type of patients who do this.

PT

 
At Friday, August 31, 2018 1:12:00 PM, Anonymous Anonymous said...

And patient dumping is actively employed by physicians at their practices as such happened with my friend who was bullied into 3 genital/prostate exams with numerous voyeurs enjoying the show. I read the letter he received, which, to cover their ass, referred him to a free clinic! Nice! I guess my YELP review frightened them. As it was anonymous, they probably sent out many such dumping letters for males of his age. Now, that scimmer-scammer physician with multiple clinics mostly staffed by online trained female morons, i.e., N quacks and P actors, did not report the N quack hag that abused my friend and was finally fired (after many years) for trash talking about each customer as she slithered out of exam rooms. Of course the greedy b*^#$#* was afraid of HIPAA fines, and instead of acting honorably and REPORTING THE HAG TO THE NURSING BOARD, he simply fired her. I know where she in now abusing, and it won't last too much longer. That physician is equally culpable of her atrocious acts by not reporting her! Just another example out of millions of mak'emsick workers tolling the death bell for their disgusting industry! That physician should also lose his license - permanently!

EO

 
At Friday, August 31, 2018 1:16:00 PM, Anonymous Anonymous said...

PT,

Thanks for your info on trauma 1 care and the remarks by numerous hags on viewing someone’s terrible injury or death: “I’ve heard some nurses say, ‘I want to see a good trauma.’ I didn’t know there was such a thing. An infant drowned in the family pool, a young man collide head on with a MAC truck and when EMS arrived on scene he was impailed in the grill of the truck and was still alive when entering the trauma room. I wanted to tell the nurse who came into the trauma room not assigned there but ‘Just wanted to see a good trauma’ are you satisfied now. Was that a good enough trauma for you?”

This kind of statement from ER nursing hags vividly illustrates their selfish, moronic mind set! Never mind that a family has tragically lost a loved one or that loved one will never be the same, a good trauma is so good to see! As you said, 6-7 mak’emsick workers are all that are needed but you’ve seen 40 people crowding into a trauma room! This brings to mind the Pennsylvania hospital debacle with numerous staff infiltrating an OR to see a genital injury – must be a male customer! (I can longer even use the term client as that term implies respect for said client and professional care. We know this does not apply to males thus from now on I will use customer as it fits right in with being a customer for a hamburger or a new tire or a tattoo! Except we must bear in mind that male customers in other businesses are treated the same as female customers, WITH THE EXCEPTION OF THE MAK’EMSICK INDUSTRY.)

Dignity violations aside (and yes I vote to use the term dignity instead of modesty as it cannot be manipulated by mak’emsick workers), one cannot be too dignified as opposed to being as I’ve heard some hags say “overly modest males,” or “insecure wives.” Hags, we wives, girlfriends, SOs have something to say to you - we are not insecure! We are not afraid that your dumbed down “education” or obese beauty or prurient mind set will somehow make our man fall in love with your low IQ and under arm stink! No worries there!

Back to a trauma 1 room, EVERY person who enters said room does carry a certain risk of infecting the customer. Thus, dignity violations aside, and considering that the globe as a whole is now in a decidedly post antibiotic environment (and thanks, vaccine cartels, for contributing to the dangerous and deadly new forms of what were once ordinary, infectious childhood diseases that cultures with clean water, sewer systems, and adequate nutrition easily overcame and such diseases actually contributed to better health later in life as well) this sort of barging into a trauma room WHERE A MAK’EMSICK WORKER IS NOT ASSIGNED – is this not a HIPAA violation? These workers are not assigned to the trauma case! PT, can you tell us if technically these curious eyeballs could be sued by victim or victim’s family for such a violation? These peepers have no right to know or see anything not assigned to them! I’d make a Vegas house bet that most of the time it’s female nursing hags invading trauma rooms where the victim is male! And, WTF are registration clerks doing in there? The young man impaled on the grill of a truck isn’t going to reach in his pocket and pull out his insurance card or driver’s license. What are they doing there? I’ll make another house bet that the female clerks actually move their obese asses faster than they jog to the soda machine when the trauma victim is male!

As Biker states: “I would add I also don't want nurses or other medical staff that are not needed for my treatment watching me either simply because they are curious or have nothing else to do. My treatment is not a peep show. Voyeurs can find another way to get their thrills, and that's what we're talking about, voyeurs.”

EO cont. due to length


 
At Friday, August 31, 2018 1:19:00 PM, Anonymous Anonymous said...

Thus, I see these registration clerks for a severe trauma as voyeurs. Oh no wait, says the male customer to clerk, my severed leg is over on that other table and my wallet’s in the pants pocket. No, not here, by my unnecessarily exposed genitals, over there. And considering how crowded ERs are today, and how long the wait is – at a friend’s nearest hospital in a fair sized city the average wait time is 12 hours for non life threatening emergencies, WTF are these nursing hags doing running about peeping at the trauma victims? Why are they not helping others who sit in the waiting room for 12 hours with a broken arm or internal bleeding – oh, but their vitals are stable so we can have our peep show and our hugely inflated salary as well! If they don’t like it they can go home! This is our ER! Sorry, no, all “healthcare” is financed by taxpayers, including your inflated salaries and let’s not forget “healthcare” is now the number one cause of death here in our happy plutocracy!

JF you’ve got a good idea: “I know of a solution. Tell the people hanging around that they deserve sexual gratification but because of HIPPA they can't watch. Then hand them Penthouse magazine and tell them to leave.”

And Biker you’re right that urology nurses never talk about why they zeroed in on that particular branch! Let’s face it, most do so for sexual thrills. And PT I read the scrubsmag on urology nurses and of course it’s the customary nasty verbiage of seeing more penises than a mohel (or prostitute, don’t nurses have cute little cards that say so?). Let’s turn the sexes around as we have done with intimate exams and are we hearing male nurses say, “I see more clitorises than a female circumciser in Pakistan!” Yep, they have parties for these kinds of “events” as my Ranger friend has attended some, and only the ugly females are circumcised and turned into lifelong household drudges/slaves as no one will marry them. In full view of guests, no anesthetic, but fresh goat meat! A banging good time for all! Reminds one of 2 nursing hags and 2 “trainees” catheterizing a young, good looking male customer; they only need 1 hag for an old guy! Hmmm…

Lastly, I had a loved one killed by an angry driver almost 4 decades ago and I can assure all that the pain doesn’t go away, one lives with it and copes as best as one can. Yeah, I’m an atheist but as the daughter of a physicist I can say that this universe has numerous dimensions and I’m looking forward to seeing my dear friend in a kinder one down the line. Recall that energy is neither created nor destroyed, it simply changes form. The thought of voyeurs viewing his unsuccessful resuscitation would be the straw on this camel’s back (I don’t allow myself to dwell on it), and in those days I’m sure dozens were barging in to see the “good trauma” of an already deceased handsome young man in his twenties with dreadful injuries lying trauma naked! Another banging good show!

And Maurice, you bring up a great point re dignity. It’s not just customer dignity we’re speaking of, any one with in depth knowledge of or one whose dignity has been violated by the mak’emsick industry would agree that “aren't we also writing about the apparent dignity or more the loss of dignity of the medical profession and the system itself?” The mak’emsick industry is tolling its own death bell, yet with the dreadful changes coming to this small globe won’t be here too much longer anywho! For the more stalwart souls, try researching the intersection of anthropomorphic climate change and geo engineering. That cup of hot chocolate will never be as comforting as before…

EO

 
At Friday, August 31, 2018 2:11:00 PM, Blogger Maurice Bernstein, M.D. said...

How about the title: "Patient Dignity and the Practice of Medicine" or something to that effect? Isn't that what has been discussed here all these years?

EO, thanks for revealing your female gender. I think it is important to all visitors here and myself to know the gender from which the Comment writers express their views. It gives to the reader a constructive understanding of what was written since after all that has been written on this blog thread--I do believe that gender (either biologic or other) and gender concerns should be considered. If there is disagreement about my view, I would encourage discussion here. ..Maurice.

 
At Saturday, September 01, 2018 3:25:00 AM, Blogger Biker in Vermont said...

Dr. Bernstein, while my 1st thinking was simply Patient Dignity, adding "and the Practice of Medicine" might serve to encourage more participation from those who work in healthcare. It signals them that they play a role in maintaining patient dignity. Yes everyone's websites say they do that, but it seems in reality those who work in healthcare rarely think about the patient's dignity and their role in maintaining it. Their platitudes never amount to more than being polite as all that is necessary.

 
At Saturday, September 01, 2018 9:02:00 AM, Blogger NTT said...

Good Afternoon:

If the American healthcare industry put as much effort into solving the patient dignity and privacy in healthcare issue as they do in making their obscene profits, we wouldn't be having these discussions.

Regards,
NTT

 
At Saturday, September 01, 2018 12:25:00 PM, Anonymous Anonymous said...

In Arizona and a few other states there are hospital chains that are called Dignity health and Honor health. These basically are a catch phrase that really imply respect your health, make sure you maintain your health insurance and honor your health, just make sure that one of every 5 dollars that you spend flows into our pockets. Now in 1977 the amount of money people spent on bubble gum in this country was enough to financially create the voyager probe spacecraft from scratch to launch.

The concept of patient dignity and respectful care are just as obscure in healthcare as are the mission statement and core values, shelved somewhere in the twilight zone where Rod Serling couldn’t even find. I’m convinced that no amount of money, not even every dollar spent on every stick of bubble gum in this country for the last fifty years could help promote or change a culture that has existed for soo long, yet from the monies spent in 1977 for bubble gum that little probe is still flying sending back information and slowly but surely getting close to another star. Wouldn’t it be great if our healthcare system with the 100 Trillion dollars that’s flowed into its coffers over the last 50 years that they would have recognized some solution that maybe just maybe they too could reach for the stars, not likely.

PT

 
At Saturday, September 01, 2018 5:18:00 PM, Blogger Biker in Vermont said...

There is a current active thread on AllNurses about enticing more men into nursing. At about 100 comments already, there is not a single one that speaks to whether more men in nursing would be a good thing for patients in general or male patients specifically. That the discussion hasn't been framed in terms of patient impact is very telling.

https://allnurses.com/general-nursing-discussion/bringing-in-the-1172565.html

 
At Saturday, September 01, 2018 9:28:00 PM, Blogger Maurice Bernstein, M.D. said...

I scanned the allnurses.com article comments and I agree with Biker, I couldn't find any mention regarding the value of male nurses for attendance to the patient modesty issue of male patients. It seems that what is discussed on our thread about the male modesty issues might be interpreted as verifying that the nursing profession looks at our "complainers" as statistical outliers and motivation for more male nurses is based on $$$$$$ and less work for the female nurses. VERY INTERESTING!! ..Maurice.

 
At Saturday, September 01, 2018 11:30:00 PM, Anonymous Anonymous said...

The predominant comments made by female nurses regarding enticing more men into nursing is so that they can call on male nurses to do the heavy lifting and turning. If this is indeed the only reason then should that validate the assumption that male nurses are paid more, not to mention that according to them all male nurses are gay. Thus you have two complaints thus far by female nurses who complain about the 5% of male nurses there are, a) all male nurses are paid more than them b) all male nurses are gay. These are complaints against all male nurses committed by the feminist healthcare regime to help keep men from choosing nursing, if you can’t legally keep men from applying then complain about their salaries or call them gay and then just assume they are stupid and say they are only good for lifting help.

I’ll remind everyone again that the healthcare industry has done something truly amazing in the annals of equal employment and that is to ensure that mammographers and L&D are exclusively female at the same time basically infiltrating every Urology clinic in the country with female nurses and ma’s. People often talk about BFOQ but the reality is no female patients ever complained to hospitals about wanting a female tech to do their mammogram, they didn’t have to. When mammography was first introduced in the 60’s the only facilities that could afford an x-ray mammo machine was the hospitals. It was then that only female techs were selected from radiology to transition and learn mammography, thus BFOQ was never called into question by a female patient.

Fiurthermore, if you look into these flourishing off-campus mammography centers take another look at the radiologists who not only read the mammograms but also do breast biopsies and breast localizations, female. Currently, about half of all radiologists are female and predominantly those radiologists who take further training to do breast locs and biopsies are female. If you are a female patient employing the services of a mammography center you will be assured 100% of the time a female will perform your mammogram. Should your mammogram be positive for a mass needing more intervention. Rest assured if you require a breast biopsy, a female radiologist will be there to perform that as well.

PT

 
At Sunday, September 02, 2018 2:45:00 AM, Blogger NTT said...

Good Morning:

The nursing field (notice I don't call it a profession as there is nothing professional about them), lost it's humanity years ago.

It's all about making things easier on themselves, making sure their female patients are taken care of properly, and the almighty dollar.

Male patients are just poor old slobs to be humiliated any way they can.

Men need a national voice but the healthcare industry has paid everyone off to keep quiet.

Regards,
NTT

 
At Sunday, September 02, 2018 10:08:00 AM, Anonymous JF said...

PT, That is because women and girls have behaved obnoxiously and got on their nerves and got our way ( more than guys have ) Don't limit yourself to being obnoxious on this blog. Get on thier nerves and cause them to have some nervous breakdowns.

 
At Sunday, September 02, 2018 10:36:00 AM, Blogger Maurice Bernstein, M.D. said...

How about changing the title of this thread to "Patient Dignity in Medical Practice" with, in the next few Volumes an added "Formerly Patient Modesty"? The addition would be to prevent "Patient Modesty" title of our thread to be abruptly removed from search engines. ..Maurice.

 
At Sunday, September 02, 2018 1:16:00 PM, Blogger Maurice Bernstein, M.D. said...

Is this what you want to read from all nursing publications? (SCRUBS July 2013) ..Maurice.


HOW TO MAINTAIN EACH PATIENT'S DIGNITY

We often forget there is a human being on the other side of the bedside. While we stand there and spout off the appropriate education and implement the required interventions, we sometimes forget there is an actual human being listening.

Some nurses have an overwhelming knowledge base and the sharpest skills, but fail to treat their fellow humans like people. No matter what kind of nurse you are or aspire to be, please be sure to maintain each patient’s dignity. Here are five tips to help you:

Be careful how you touch them

Whether pressed for time or nervous because it’s a first time skill, pay attention to how you touch them. Be gentle and be mindful. Gentle pressure goes a long way–not to mention having warm hands.

Be conscious of their feelings

Just because you’re not afraid doesn’t mean they aren’t. Just because you’ve done this a thousand times doesn’t mean they have. Treat every interaction like it was your (and their) first time.

Don’t make them feel embarrassed

No matter how you feel, no matter what you may want to say, no matter how you may want to act, do not make yourself feel more comfortable at their expense.
Your body language will speak louder than any words will. No matter how comical they may act, do not smirk or smile. Embarrassment will get you nowhere.

Always cover them up

While equipment malfunction is important to troubleshoot, please remember that the patient’s birthday suit is hidden under their gown for a reason. If at all possible, find a towel, find a blanket, find something to keep that birthday suit hidden.

Give them privacy–always

There is a very good reason every bed is surrounded by a curtain. It’s your job to make sure that curtain is used. For some strange reason, health care professionals of all walks of life tend to forget that curtain exists.


While some of my suggestions may seem ordinary or even basic, I promise you that no patient will care how much you know. He or she will, however, care how much you care.

 
At Sunday, September 02, 2018 1:41:00 PM, Anonymous Anonymous said...

Maurice


Yes, that article is from scrubsmag.com, the same publication that presented “ you know you are a Urology nurse when “ , you’ve seen more penises than a mohel. Now, the article you presented if you will notice has no comments in the comment section. That is no one has bothered to even read it.

This article from scrubsmag.com has a number of interesting comment in the comment section.
www.scrubsmag.com/I-dont-want-a-male-nurse-taking-care-of-me/...

Thus if a female patient states that I don’t want a male nurse taking care of me, would the male nurse state

1) Sorry, all we employ are male nurses at this facility
2) You do not have anything I haven’t already seen
3) I suggest you seek care at another facility
4) I will go find a female nurse for you
5) Smirk and sneer and walk out of the room


What would the interaction be if the roles were reversed? I can tell you that it would be 1,2,3,5

PT

 
At Sunday, September 02, 2018 2:11:00 PM, Blogger Biker in Vermont said...

Yes, Dr. Bernstein, that is what I want to see more of. I do not blame the individual female nurse, tech, MA etc for being assigned to me for some intimate exposure procedure. They're just there to do what they were told to do. My beef is with the system that doesn't hire males or seek to assign or make available male staff for intimate exposure matters.

That said, the individual female nurse, tech, MA etc is fully responsible for how she goes about doing her job. There would be fewer complaints if they did things in the manner noted in the article.

Your new title and side note is good. Thanks much for all that you do.

 
At Sunday, September 02, 2018 3:57:00 PM, Blogger NTT said...

Good Evening All:

There's no comments to the article because they only follow those suggestions for their female patients.

For males it's get it done as quickly and humiliating as possible.

Federal mandates or lawsuits is the only way right now to even bring someone from the medical community to the table & open a dialogue on this subject.

Regards,
NTT

 
At Sunday, September 02, 2018 6:24:00 PM, Blogger Maurice Bernstein, M.D. said...

Considering Federal Mandates, here is the most recent (2012) document from the Department of Health and Human Services I could find regarding physical privacy as applied to Medicare and Medicaid for hospitalized patients. Anyone find a more recent declaration? ..Maurice.

DEPARTMENT OF HEALTH & HUMAN SERVICES
We are taking this opportunity to clarify our guidance for the hospital requirements governing patient privacy and medical record confidentiality at 42 CFR §482.13(c)(1), §482.13(d)(1) and §482.24(b)(3).
DATE: March 2, 2012 TO: State Survey Agency Directors FROM: Director Survey and Certification Group SUBJECT: Hospital Patient Privacy
Physical Privacy
“The right to personal privacy” includes at a minimum, that patients have physical privacy to the extent consistent with their care needs during personal hygiene activities (e.g., toileting, bathing, dressing), during medical/nursing treatments, and when requested as appropriate. People not involved in the care of the patient should not be present without his/her consent while he/she is being examined or treated. If an individual requires assistance during toileting, bathing, and other personal hygiene activities, staff should assist, giving utmost attention to the individual’s need for privacy. Privacy should be afforded when the MD/DO or other staff visits the patient to discuss clinical care issues or conduct any examination or treatment. However, audio/video monitoring (does not include recording) of patients in medical-surgical or intensive-care type units would not be considered violating the patient’s privacy, as long as there exists a clinical need, the patient/patient’s representative is aware of the monitoring and the monitors or speakers are located so that the monitor screens are not readily visible or where speakers are not readily audible to visitors or the public. Video recording of patients undergoing medical treatment requires the consent of the patient or his/her representative. A patient’s right to privacy may also be limited in situations where a person must be continuously observed to ensure his or her safety, such as when a patient is simultaneously restrained and in seclusion to manage violent or self-destructive behavior or when the patient is under suicide precautions.


 
At Monday, September 03, 2018 11:46:00 AM, Blogger Maurice Bernstein, M.D. said...

You know, on researching Google Images for a graphic for the next Volume, I found from the displays a word which we have omitted in the new thread title: RESPECT. Dignity alone is not sufficient. The dignity is characteristic of an individual but that dignity must be respected by others to fulfill its personal value. And those currently writing here are demanding such respect by others in the medical system.

So how about a title for this continuing thread:
"Patient Dignity and Respect in Medical Practice" ?

..Maurice.

 
At Monday, September 03, 2018 1:28:00 PM, Blogger Biker in Vermont said...

Adding respect to the title works. Our problem as patients is that every healthcare organization and healthcare employee says they respect patient dignity. The problem is they get to define it w/o caring what the patient thinks. For most they think all that is necessary is being polite.

On the Medicare physical privacy definition you posted, I wonder how many who work in ER's and OR's have ever read it.

 
At Monday, September 03, 2018 4:32:00 PM, Blogger Maurice Bernstein, M.D. said...

Thanks Biker for confirmation of my thread title but on further thought I wondered FROM whom are we requesting RESPECT? Are we implying that the respect should be coming from the patient who bears the dignity? Or would it be better to clarify the source of the respect we are writing about to use the title "Patient Dignity and its Respect by Medical Practice"?

Of course, patients should also have the duty of respecting "medical practice" in all of the profession's own burdens and skillful patient benefits, right? But, really the orientation of this thread from the onset was about examples of the lack of respect by the medical practice toward the patients themselves and presumably that orientation would be still the main direction to follow, right?

Therefore, wouldn't "Patient Dignity and its Respect by Medical Practice"be more in keeping with what is being written here?

OR should we define the issue of "respect" by using the word "Disrespect"? I think it would be better to use the word "Respect" so that a Comment could also include personal examples or published examples of "respect" toward the elements of "patient dignity" which is actually the goal we are all, hopefully, attempting to have set. ..Maurice.

 
At Monday, September 03, 2018 8:39:00 PM, Blogger Maurice Bernstein, M.D. said...

PLEASE, those who visit here but haven't yet contributed to the discussion, please write your comment about my above suggestion regarding thread name change. It won't take long and you can end your comment with an unused pseudonym or initials. Thanks. ..Maurice.

 
At Monday, September 03, 2018 9:09:00 PM, Anonymous Anonymous said...

Maurice

Yes, patient dignity and it’s respect by medical practice


PT

 
At Tuesday, September 04, 2018 4:13:00 AM, Blogger Biker in Vermont said...

Dr. Bernstein, your latest tweak of the proposed name change adds clarity. Thanks for thinking it through.

 
At Tuesday, September 04, 2018 5:46:00 AM, Blogger NTT said...

Good Morning:

Dr. Bernstein.

"Patient Dignity and Respect in Medical Practice" or "Patient Dignity and Respect in Healthcare" works for me.

Thanks for all you do for us sir.

Regards,
NTT

 
At Tuesday, September 04, 2018 6:48:00 AM, Blogger BJTNT said...

"Patient Dignity and its Respect by Medical Practice" is an appropriate and a good title.
BJTNT

 
At Tuesday, September 04, 2018 8:36:00 AM, Blogger A. Banterings said...

Maurice, et al,

Titling the thread Patient Dignity and the Practice of Medicine, Patient Dignity in Medical Practice, etc., is redundant. Because we refer to the individuals as "patients," it is understood that they are in the healthcare system.

Calling it Patient Dignity and Respect in Medical Practice is also misleading, because (similar to the modesty vs. dignity debate) it assumes that the healthcare iIS respecting patient dignity. A more accurate proposed name name would be Patient Dignity and LACK OF Respect in Medical Practice.

What we are attempting to do is SIMPLY replace an outdated, inaccurate term that is defamatory with a modern, more accurate term. It is the same way that providers now use nonadherent in place of noncompliant.

To add anything else may have the appearance of either "sour grapes" by healthcare in that the term dignity puts the onus on the profession of medicine as opposed to the patient asking for something (the respect of their modesty), that the subject is trying to be obscured by adding in other topics, OR that providers are attempting to hijack the topic to turn it around about their working conditions.

The working title for these first 90 volumes has been quite effective, evidence that it has lasted so long. It also adheres to the KISS principle, which also has helped keep it alive.

Calling it Patient Dignity (Formerly Patient Modesty), retains the simplicity of the name, links the new name to the old, shows the respect for science (by recognizing both advancement and the correct term to use), and conveys that this is about the intimate exposure of patients.

The paper that started this thread was titled "Naked," a term that providers are vehemently taught to avoid. Instead they use the term unclothed (because giving a patient a gown negates this term. Naked implies shame, embarrassment, and power differential. Unclothed is sterile, something that one reads about in textbooks.

Again Maurice, I appeal to you as a scientist, ethicist, and a human being to do the correct thing and title the thread Patient Dignity (Formerly Patient Modesty).




-- Banterings

 
At Tuesday, September 04, 2018 9:42:00 AM, Blogger Maurice Bernstein, M.D. said...

Banterings, obviously a more simple title "Patient Dignity (Formally Patient Modesty) may be, by that simplicity more specific to the property of the patient. But isn't "respect by medical practice" set a specificity with regard to the professional system which is so directly involved in patient diagnosis and treatment.

For example, "Patient Dignity" which represents "dignity" a human's property which should be part of every human and observed and attended to by all classes of "others" besides the medical profession.
For example, shouldn't a patient's dignity in all respects be understood and followed by all who interact with a patient: family, occupations interacting with a patient, law, government as examples? But this thread is not talking about these interactors. To me.. from the onset of this thread which followed the NEJM article "Naked" by Atui Gawande. M.D., the direction of the concerns have always been the medical profession as the object.

Banterings, sure if discussion here included equal attention to the examples of "others" interacting with patients noted above then your more simple title would be appropriate. But it seems, that throughout the 90 Volumes, the orientation to toward those who are involved directly in the professional job of the practice of medicine in all of their various presence and participation.

Blog thread titles are important since they are involved in computer searches by possible visitors. I am glad we have had the comments on this topic by Banterings and the above others. But based on Bantering's suggestion and my argument, I would like to see a bit more conversation before finalization. This posting is 164 for this Volume 90 and I feel "safe" (from previous system breakdown) to continue with another 20 or so Comments before having to move on to Volume 91. ..Maurice.


 
At Tuesday, September 04, 2018 9:49:00 AM, Anonymous JF said...

The word violations used to be in the title

 
At Tuesday, September 04, 2018 9:58:00 AM, Blogger NTT said...

Good Afternoon:

Since we're still tossing names around, how about "Dignity and Respect of Patients by Medicine" or "Dignity and Respect of Patients by Healthcare".

Regards,
NTT

 
At Tuesday, September 04, 2018 10:53:00 AM, Blogger A. Banterings said...

Maurice,

Yes, "respect by medical practice" is implied, but it does NOT always, and more often than not. This is evident in your change of position from those who post here being outliers to (possibly) you being the outlier.

Banterings, sure if discussion here included equal attention to the examples of "others" interacting with patients noted above then your more simple title would be appropriate.

I would expect that beyond the most obvious (being healthcare interactions), that you would title THOSE threads more descriptively (Patient Dignity; treated poorly by family...).

I also question that if this change beyond a simple 2 word title is necessary to clarify that this thread deals with patient interaction within the healthcare system, WHY was it NOT made at an earlier time?

As for search engines, they look at content as well at titles.

The old title "Patient Modesty" survived this long, so why would "Patient Dignity (formerly Patient Modesty)" also NOT survive?




-- Banterings




 
At Wednesday, September 05, 2018 8:41:00 AM, Blogger A. Banterings said...

I know that this thread has taken a turn to titling the thread :"patient Dignity," but in keeping with the ongoing theme of the thread, here is a 2018 study examining patients' attitudes at a urology clinic:

Patient Perceptions of Chaperones During Intimate Exams and Procedures in Urology Clinic

What is conspicuously absent from the study was if patients did NOT want a chaperone. I suspect that the study was skewed in that the clinic where the study was done had a mandatory chaperone policy. This means that those who do NOT want a chaperone present would go to another clinic.

These are just the preferences of those willing to accept a chaperone.

What is telling about preference for a chaperone is the small number that actually WANTED one present vs those who either did not care or did not want one present.




-- Banterings




 
At Wednesday, September 05, 2018 10:40:00 AM, Blogger Maurice Bernstein, M.D. said...

And now before we actually start changing the title of this thread to include "dignity" and to exclude "patient modesty" in medicine, I just looked back at my earlier threads on this blog (year 2005) that deal with human dignity (beyond the issue of "death with dignity") and I wonder whether all these years and volumes of "Patient Modesty" really come down to the issue of the patient's emotional reaction to their own physical modesty or the implied effect of actions on the physical modesty of others and the general concept of dignity is something else.

Here are the addresses of each of the 4 threads specifically on "dignity". Should we re-think changing this blog thread title? Isn't the essential discomfort and anger simply that of the medical system's inattention or disregard to the individual patient's physical modesty? ..Maurice.

"More on Human Dignity"
1: http://bioethicsdiscussion.blogspot.com/2005/12/more-on-human-dignity-1.html

2:
http://bioethicsdiscussion.blogspot.com/2005/12/more-on-human-dignity-2.html

3:
http://bioethicsdiscussion.blogspot.com/2005/12/more-on-human-dignity-3.html

4:
http://bioethicsdiscussion.blogspot.com/2005/12/more-on-human-dignity-4.html







 
At Wednesday, September 05, 2018 11:48:00 AM, Blogger Biker in Vermont said...

Dr. Bernstein, the problem with "modesty" rather than "dignity" is that the healthcare system almost universally say they respect patient dignity while being quick to dismiss male patients who express a modesty concern as either being an "outlier" or being "overly modest". While what constitutes respecting patient dignity is a somewhat elusive definition typically not much more than being polite, the definition never includes anything about staff gender when it comes to male patients. I suppose it is just convenient for them to not think staff gender has anything to do with respecting patient dignity.

If anything the situation is getting worse. Women who elect all-female care are celebrated as empowered whereas men who don't want female care for intimate matters are deemed sexist. Somehow gender has to become part of the dignity discussion.

 
At Wednesday, September 05, 2018 2:22:00 PM, Blogger A. Banterings said...

Maurice,

What we are discussing here, (mainly) is the abstract concept of a patient being exposed in the healthcare setting and how healthcare responds. It stems from discussion over NEJM article "Naked" by Atui Gawande. M.D..

For example, the ancient Hebrew language had no word for homosexual, yet homosexuality existed and was described in other ways such as metaphors (man lay with man).

Modesty seems to come closest, but fails because this concept presents as the patient asking for too much (being too modest, we have no modesty around here). A more accurate term is ABUSE, but alas, medicine does not like this term.

You state:

And now before we actually start changing the title of this thread to include "dignity" and to exclude "patient modesty" in medicine,...

The abstract concept best described (up to this point), which has been labeled as modesty, IS a SUBSET of HUMAN (patient) DIGNITY.

We are not excluding this concept of (what was formerly called) modesty, we are describing it better. The description puts the onus on medicine AND allows for those that disregard a patient's dignity to be labelled as deviant. With the archaic term of modesty, it allowed the concept of "we have no modesty around here" to be business as usual.

It is human nature (for the most part) to try and take the "easy way out." Too often the easy way is not the (morally) right OR just way to do things. The poem, "The Road Not Taken" by Robert Frost illustrates this. Jesus Christ invites his followers to take up their own cross, and follow in His footsteps. These illustrate that the correct way is usually the hardest.

Once the cat is out of the bag, medicine can not stick to its archaic ways. Just look at what happened with paternalism.



-- Banterings



 
At Thursday, September 06, 2018 7:51:00 AM, Anonymous Anonymous said...

With all due respect to those who participate in this forum, these days it is all about search engines and how your title stacks up when searched. Please stick with "modesty" as opposed to "dignity". When it comes to exposure in a medical setting, modesty would be the more common thought in mind. Can we now move on please?

Ed T.

 
At Thursday, September 06, 2018 11:49:00 AM, Blogger Maurice Bernstein, M.D. said...

Ed T, thanks for your view and I would appreciate comments from others who hold or reject your view.

I do want to emphasize to all, that focusing on the many different expressions of personal dignity, even defined "patient dignity" does, in fact, deviate from the ongoing basic personal modesty issues that have provided content to this thread all these years. It has been basically the physical modesty of the patient's inherent dignity which virtually all the discussions here has been directed. Of course, expression and attack on the physical modesty of a patient requires a conscious and aware patient. To have unprofessional behavior and behavior shown primarily to deny any patients potential modesty performed on an unconscious patient is an attack on every or any patient's inherent dignity.

Because the expression "Patient Dignity" is so much more than "Patient Modesty", I would tend to avoid defining what has been the ongoing topic here using the broader description "dignity". Yet, Banterings and everyone can still extend the conversation into other attacks by the medical profession on the patients' dignity itself.

Let's have a bit more conversation regarding the change of title after we have looked back at previous Volumes and see if the discussions were more of a generalized "dignity" or of examples of specific attacks on physical modesty. ..Maurice.

 
At Thursday, September 06, 2018 11:50:00 AM, Blogger A. Banterings said...

Biker,

Here is the problem with focussing on gender, due to the large percentage of women in healthcare, all male care may be logistically impossible at a facility. Gender is MOST definitely part of dignity, just a little down the ladder. This is how dignity addresses an intimate situation:

■ Provider take a self assessment if the intimate procedure is ABSOLUTELY necessary, ALL OPTIONS (including treating without doing the procedure/exam).

■ The proposed procedure and all options explained to the patient, they are allowed to choose.

■ If the patient rejects the provider's proposed treatment, a discussion can occur, but the patient's wishes MUST ULTIMATELY BE RESPECTED. The issue of gender concurrent care may be addressed here.

■ Dismissing a patient for rejecting the provider's proposed treatment IS a form of bullying. Being "thorough" may be more about making the provider feel comfortable rather than the patient. Here are 2 examples:

A 15 yr old boy is refusing the genital exam for high school by his physician (gender unimportant, he is just NOT having his bodily integrity violated). The physician threatens to either not sign the school form or dismiss him as a patient.

Commentary: Regularly pediatricians omit the genital exam, especially at the request of the patient. This is more about the physician being comfortable than the patient. (Reference: Medscape Connect

A 65 year old patient with back pain is requesting an MRI. Physician refuses.

Commentary: Even though MRIs over overused, that does not preclude the physician examining on a case-by-case basis (even if unwarranted). Further, MRI is best at detecting (possible) arthritis.


■ Once an agreed upon procedure is chosen, the provider explains in detail. Alterations are made to the proposed procedure to make the patient as comfortable as possible. Again, the patient's wishes MUST ULTIMATELY BE RESPECTED. The issue of gender concurrent care may be addressed here.

■ The modifications may be made "on the fly." Again, the patient's wishes MUST ULTIMATELY BE RESPECTED.


Notice that dignity does not say anything about the patient appropriately draped. All that is in the proposed procedure. That is not set in stone. That can be changed.


-- Banterings

 
At Thursday, September 06, 2018 12:55:00 PM, Blogger A. Banterings said...

Maurice,

Are you proposing "Patient Physical Modesty?

Again, that can be dismissed as the patient being too modest. "Patient Dignity (formerly Patient Modesty)" will still bring the search engines to this blog and thread, reflects an enlightened understanding of the subject matter, AND it is the CORRECT term to use.

You can NOT escape the fact that what is discussed here is more about patient dignity rather than patient modesty.

I would accept "Patient Modesty (Patient Dignity)".

Keeping the title "Patient Modesty" denies the existence of patient dignity. This is essentially how physicians are trained: dehumanize the person.

You can do something like "Modesty Issues under Patient Dignity", "Patient Dignity and Modesty Issues".




-- Banterings



 
At Thursday, September 06, 2018 2:03:00 PM, Blogger Maurice Bernstein, M.D. said...

Banterings, I am still open to suggestions. My main goal is that the title of the thread, if it properly should be changed from that which I have used all these 13 years should still reflect to visitors the main emphasis of what is being discussed here.

If we are discussing primarily "Patient Dignity" then here is one description of the expression/definition from Nurs Midwifery Stud. 2015 Mar; 4(1): e22809.
Published online 2015 Mar 20.:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4377527/



Dignity is fundamental to the well-being of every individual in all societies. It is a basic human right for all, and health care organizations should pay special attention to this universal need. Meaning of dignity remains complex and unclear because it is a multidimensional concept. The word originates from two Latin words ‘dignitus’ which means merit and ‘dignus’ meaning worth. The concept of dignity has four defining attributes including respect, autonomy, empowerment, and communication ( Griffin-Heslin VL. An analysis of the concept dignity. Accid Emerg Nurs. 2005;13(4):251–7) As Griffin and Vanessa reported, each of the four attributes in turn consists of several dimensions. Respect includes self-respect, respect for others, respect for peoples’ privacy, confidentiality and self-belief and belief in others. Autonomy includes having choice, giving choice, making decisions, being able to make decisions, competence, rights, needs, and independence. Empowerment includes a feeling of being important and valuable, self-esteem, self-worth, modesty and pride. Communication might be verbal or nonverbal and also includes explaining and understanding information, feeling comfort and giving time to the audience.


..Maurice.

 
At Thursday, September 06, 2018 2:42:00 PM, Anonymous JF said...

I agree with what you just said. Much intimate care could just be skipped and a lot of care is avoided because of intimate care being pushed on patients.

 
At Thursday, September 06, 2018 4:14:00 PM, Anonymous Anonymous said...

Realize the trait of “modesty” is only manifested IF the provider and/or institution has rigid preconceived policies, beliefs and practices on delivering their health care that do not contemplate “modesty”, patient centered care, and/or equitable treatment of each gender. As most know every institution providing breast mammography screening and diagnostic tests only hire and train female techs and medical assistants for these intimate breast services (male rad techs and male MAs are equally qualified for this work). Many medical institutions only hire female nurses, medical assistants, and techs to work in female patient intimate care units or clinics. Most private physician offices only hire female MAs. And literally thousands (almost 10,000 last time I counted) of female only “women’s imaging centers” and “women’s health clinics” have been created by the US healthcare system to explicitly address female “modesty”.

Certainly not every medical office, center or hospital can always accommodate every female “modesty” issue but there is at least a factor of almost 1000 better chance that female modesty issues can be accommodated upon demand than male “modesty” issues can be accommodated in much of America. This is by design of the American medical system and physicians.

So as I’ve said before, “modesty” isn’t the big issue here. Discrimination is the issue. How can medical professionals defend not providing similar accommodations & services to their male patients that their female patients receive so readily? The excuse there are not enough males in medicine is absurd. Nursing schools have classes graduating in excess of 15% males, some approaching 20%. Every male out of medical assistant school training should have a dozen job offers waiting (alas it seems to be just the opposite). About one third of rad techs are male. So discrimination is tacitly present in the health care field - medicine is NOT gender neutral.

For that reason a more accurate blog title would be “Patient Modesty, Dignity, & Equitable provision of intimate care”— AB in NW

 
At Thursday, September 06, 2018 5:40:00 PM, Blogger Biker in Vermont said...

Bantering, I agree that there are other aspects to dignity beyond gender. The medical world is aware of those other aspects and it seems the trend is increasingly explaining options and listening to requests. At least that's been my experience for the most part these past couple years. Much less patriarchal than it used to be. Gender aspects of dignity however continues to be ignored when it comes to male patients.

Being polite, pulling the curtain, asking for permission before touching me etc are all good things and contribute towards making the interaction dignified, but there are some things that just cannot be made dignified when performed by opposite gender staff. One simple example that come to mind is assisting a patient with showering. There is nothing a female staff member could possibly do that would make it dignified for me as a patient. Another example would be a urodynamics study. Both are just so privacy-invasive that even if female staff were the politest people in the world, kept observers out etc, it is still not going to be respecting my dignity. Yet the medical world would say with total certainty that my dignity was well respected. Sometimes just being polite is not enough.

 
At Thursday, September 06, 2018 8:24:00 PM, Blogger A. Banterings said...

Maurice,

Moreover, the amount and type of observation and touching necessary for the delivery of medical treatment (the actual intrusion of the patient's bodily integrity) remains the same regardless of the sex of the medical personnel providing the treatment. 
The core values have been variously described as "autonomy . . . over the intimacies of personal identity the right to be self-determining" respect for "individual dignity," "human dignity," or "individuality" and the "right of personhood." Moreover, because control over one's body is a fundamental prerequisite to all forms of autonomy, privacy also refers to control over this basic manifestation of selfhood
Source: Privacy and the Sex BFOQ: An Immodest Proposal



-- Banterings


 
At Thursday, September 06, 2018 8:26:00 PM, Blogger A. Banterings said...

I do this in 2 parts:


From my blog:

Using the term "patient modesty" implies that the patient is asking for consideration that is exorbitant, burdensome, cumbersome, and unreasonable. Modesty is something that the healthcare system will hand out at their convenience after checking that your expectation level falls within normal parameters (set by the healthcare system).

Modesty implies more than your fair share. When we describe someone as being "modest" in their form of dress, it is implied that they are going beyond the norm. A modest skirt comes to the ankles when everyone else is wearing mini skirts. Just as in healthcare, an extreme clothing example would be the Muslim hijab.

The healthcare system justifies blaming the patient for modesty issues. "What is wrong with you, why are you not like everyone else who is normal?" This leads to the solution (you should) "just get over it." Modesty can be traded off for necessity.

Patient Modesty in respect to Patient Dignity justifies the patient's chosen level of modesty (needs) and requires the provider to meet those needs. Using the term "Patient Modesty," while technically correct, connotates something that may be deemed unreasonable.

Dignity is an innate right. By the fact that you are a human being, you carry with you human dignity with you. Dignity affords a certain level of ethical treatment defined by the outcome, NOT the input.

By that I mean that today the healthcare system has sheets for draping, curtains to block accidentally open doors, and same gender providers (the input). The healthcare system uses drapes, curtains, and same gender providers where feasible and when available (the output).

The Hierarchy of Dignity in reference to the healthcare system.

Human Rights ==> Are "commonly understood as inalienable fundamental rights to which a person is inherently entitled simply because she or he is a human being."[2] Human rights are thus conceived as universal (applicable everywhere) and egalitarian (the same for everyone).
Dignity ==> The innate right to be valued and receive ethical treatment.
Human Dignity ==> The ethical treatment of human beings. Human Dignity is a subset (specific type) of Dignity, AND a specific Human Right.
Patient Dignity ==> The ethical treatment of human (medical) patients. Patient Dignity is a subset (aspect) of Human Dignity.
Patient Modesty ==> The right to ethical treatment of the patient to determine the parameters (usually dealing with body exposure) that they are comfortable with. The parameters of exposure can include level of exposure, gender of those exposed to, when exposure is necessary. Patient Modesty is a subset (aspect) of Patient Dignity.
Gender Preference ==> The preference of the gender of the provider. Gender Preference is a subset (aspect) of Patient Modesty.

Self-Determination is a Human Right, defined as the process by which a person controls their own life.
Human Dignity allows for there being different levels of trust. Self-Determination allows the individual to assign levels of trust. A person, group of people, organization, etc. can raise or lower the level of trust a person has in them. (Businesses call it advertising.)



Source: Patient Dignity 04: "Patient Dignity," "Human Dignity," and "Patient Modesty"


-- Banterings


 
At Thursday, September 06, 2018 8:27:00 PM, Blogger A. Banterings said...

Part 2


Patient Dignity is no different. An individual patient may place a higher level of trust in a provider, thus increasing the comfort level and reducing the requirements for patient modesty. A good provider, that builds a relationship with a patient builds trust and may lower the patients needs of modesty.

A provider like New York Presbyterian Hospital reduces trust (as in the 2003 forced rectal exam of Brian Persaud), thus patients may require higher levels of patient modesty from NYP.

Negotiations are allowed. Coercion is NOT allowed.
Coercion is defined as the to use force or intimidation to gain compliance.
Coercion is contrary to Self-Determination because the individual is not making choices freely and without duress.

Coercion would be: I will drop you as a patient because you are not complying with me by fact that I am the doctor. To do that, it will cost some large, arbitrary amount. You know catheters come in sizes from small to "fist." So by refusing a DRE, you are refusing all care, so I will let you die.

Negotiation would be: Let's first talk about your expectations... There is an alternative procedure, but your insurance only covers it as out-of-network. There is an alternative procedure, but the outcomes are not as good. To have all male providers, we have to schedule that 3 months from now, I can do it in office today, but my nurse is female.

There is a fine line between coercion and negotiation. It comes down to the factual accounting of the penalties or rewards between the choices. If to provide for a all male procedure, a male provider (nurse) for the procedures is brought in from the outside, the all male procedure is subject to the schedule (comes in once a month) of the "outside" male provider, and the all male procedure schedule is booked 3 months out: negotiation.

If the difference between the penalties and rewards is arbitrary (and sometimes exorbitant), it is coercion. You don't want to do this today with a female, then you have to wait 6 months. (Thinking: the schedule isn't full, but the time frame in long enough and inconvenient enough to FORCE you to comply with my wishes.)


Source: Patient Dignity 04: "Patient Dignity," "Human Dignity," and "Patient Modesty"




-- Banterings


 
At Thursday, September 06, 2018 8:45:00 PM, Blogger A. Banterings said...

Maurice,

In your heart, as a human being, an ethicist, and a scientist, you know that I am right. The physician, however, because the manner the training is instilled refuses to accept this reality.

It is the same way that the physician said that we were outliers, then the scientist said, although I never experienced it, I cannot deny it happens (regularly). Finally the human being and the ethicist said, I may be the outlier.

Again, the human being and the ethicist knows that what I propose is correct and keeping patient modesty denies the patient's dignity.

In the same way that I have created a new reality for you, I feel that you are fishing for an excuse to keep the paternalistic reality that you (and the profession) are clinging to.

When no one rushes to your position with a defensible argument, you keep fishing, exploring 10+ year old threads, and offering alternative proposals.

Please live up to the expectations of the a human being, ethicist, and scientist that you are, show respect for human dignity by acknowledging it in healthcare, and change the title of the thread t respect human dignity.

The truth is absolute, and no amount of debate will change that.




-- Banterings

 
At Friday, September 07, 2018 2:45:00 PM, Anonymous Anonymous said...

Maurice

I want to add on to what AB in NW mentioned regarding medical institutions that seem to hire a high percentage of female staff and that is just a small part of the problem. The bigger part of the picture is how the female staff treat their male patients and it is this that a large segment of those blogging here as well as perhaps even you and many in healthcare don’t appreciate. It’s been my impression from what I’ve seen in intensive care units, neuro step down units, floor patients as well many medical procedures and trauma, that male patients are often deliberately left unnecessarily exposed. More often than not the patients are unable to advocate for themselves and are completely unaware that this is how they are treated. You never see female patients treated like this ever, I assure you this problem is industry wide and just speaks volumes to the extent that discrimination and unethical behavior run rampant. Furthermore, in the 25 or so hospitals that I’ve worked at never have I heard of any of those hospitals ever having a medical ethicist on board let alone a “ medical ethics committee. Show me one ethics committee for nurses on line or at any hospital for that matter. There is no such thing as a an ethics residiency program, at least I’ve never heard of one. What guiding ethics principle do nurses have or as a rule to go by? None!

PT

 
At Friday, September 07, 2018 9:42:00 PM, Blogger Maurice Bernstein, M.D. said...

How about:
"Patient Modesty, Dignity and Expected Respect by Medicine:Volume 91"

???

Isn't this precisely what is the theme presented over and over here?

We are at over 180 Comments for this Volume and I think we must move on.

Quickly confirm or dismiss my (as Moderator) attempt to widen the initial descriptive title for all the new visitors who come here looking for, well, "Intra-communal interest". What "intra-communal interest"? Well, those of us in the social community who need medical diagnosis and treatment in one form or another.

"Patient Modesty, Dignity and Expected Respect by Medicine:Volume 91"

..Maurice.

 
At Friday, September 07, 2018 11:43:00 PM, Blogger A. Banterings said...

Maurice,

Again you are making it look like the patient is (now) asking for 2 things they are not entitled to. Not only are they too modest, now they are "expecting respect."

...how dare you expect to be treated with respect? If you come to a teaching hospital, it is understood that you will be treated like a warm cadaver. Students will line up to practice their "probing" skills on you...

This is "victim blaming," plain and simple. In this era of the #MeToo movement, the last thing that one would want to do is victim blaming.

If we want to be brutally honest, then title the thread exactly what it is:


Medicine's Lack of Respect for Human Dignity and Patient Modesty



-- Banterings



 
At Saturday, September 08, 2018 2:56:00 AM, Blogger Biker in Vermont said...

I'm OK with that title.

 
At Saturday, September 08, 2018 8:15:00 AM, Blogger Maurice Bernstein, M.D. said...

Banterings, I fully understand your title "Medicine's Lack of Respect for Human Dignity and Patient Modesty" but is such a title really fair for the entire medical profession which in a way this title implies? Isn't what is being written here something that is more EXPECTED of the profession and not implying or seemingly implying in a title itself a conclusion to introduce the subject being discussed within, that there is already a universal "lack of respect" in that profession's behavior?

Look..my approach to the defining of what has been written here all these years is based on the visitor's personal experience or published facts there is apparent "lack of respect". Banterings, rather than taking a "brutally honest" approach to a profession which contains bad behavior as well as I think a whole lot of good and patient worthy good behavior, shouldn't we NOT set the title and imply a final conclusion but keep it open so that folks like Biker who have had some valuable experiences as a patient can feel comfortable to express their "good" experiences as well as the troublesome? That is why I consider "Patient Modesty, Dignity and Expected Respect by Medicine" a better title.

Look, there is no urgency to change the title simply for Volume 91 since I think this current discussion of title and meaning by our contributors is a worthy education for the other visitors.
I do feel an urgency with over 180 postings here to move on to the next Volume and continue this discussion there, trying to define in the opening title what it is that our visitors are trying to express. I agree to a change in title and this discussion of what we are writing about here is of value and should be further discussed to provide a more representative title of what is being written here and not some conclusion.

We all agree in the concept that there truly is "Patient Modesty". But obviously there is more within the content of the discussion in these Volumes and it is appropriate to include that in the title.

We must now move on to Volume 91. ..Maurice.




 
At Saturday, September 08, 2018 9:57:00 AM, Blogger Maurice Bernstein, M.D. said...

NO FURTHER COMMENTS WILL BE PUBLISHED ON VOLUME 90. COMMENTS CAN CONTINUE ON VOLUME 91.

 

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