Bioethics Discussion Blog: Patient Modesty: Volume 91

REMINDER: I AM POSTING A NEW TOPIC ABOUT ONCE A WEEK OR PERHAPS TWICE A WEEK. HOWEVER, IF YOU DON'T FIND A NEW TOPIC POSTED, THERE ARE AS OF MARCH 2013 OVER 900 TOPIC THREADS TO WHICH YOU CAN READ AND WRITE COMMENTS. I WILL BE AWARE OF EACH COMMENTARY AND MAY COME BACK WITH A REPLY.

TO FIND A TOPIC OF INTEREST TO YOU ON THIS BLOG, SIMPLY TYPE IN THE NAME OR WORDS RELATED TO THE TOPIC IN THE FIELD IN THE LEFT HAND SIDE AT TOP OF THE PAGE AND THEN CLICK ON “SEARCH BLOG”. WITH WELL OVER 900 TOPICS, MOST ABOUT GENERAL OR SPECIFIC ETHICAL ISSUES BUT NOT NECESSARILY RELATED TO ANY SPECIFIC DATE OR EVENT, YOU SHOULD BE ABLE TO FIND WHAT YOU WANT. IF YOU DON’T PLEASE WRITE TO ME ON THE FEEDBACK THREAD OR BY E-MAIL DoktorMo@aol.com

IMPORTANT REQUEST TO ALL WHO COMMENT ON THIS BLOG: ALL COMMENTERS WHO WISH TO SIGN ON AS ANONYMOUS NEVERTHELESS PLEASE SIGN OFF AT THE END OF YOUR COMMENTS WITH A CONSISTENT PSEUDONYM NAME OR SOME INITIALS TO HELP MAINTAIN CONTINUITY AND NOT REQUIRE RESPONDERS TO LOOK UP THE DATE AND TIME OF THE POSTING TO DEFINE WHICH ANONYMOUS SAID WHAT. Thanks. ..Maurice

FEEDBACK,FEEDBACK,FEEDBACK! WRITE YOUR FEEDBACK ABOUT THIS BLOG, WHAT IS GOOD, POOR AND CONSTRUCTIVE SUGGESTIONS FOR IMPROVEMENT TO THIS FEEDBACK THREAD

Saturday, September 08, 2018

Patient Modesty: Volume 91







There currently is discussion as to exactly or inexactly what is the topic of this thread which has been published Volume after Volume for 13 years.  And whether there is a need to make the title of this thread more appropriate to the content that actually has been already published here. As Moderator, I agree that the discussions and documentations here are far more broad in terms of the patient-medical system relationship than the simple "Patient Modesty" title represents.  The problem is deciding how to express the title of content most appropriately, particularly for the new visitors to this bioethics thread.

I think it is of value to reproduce here the view of a faithful contributor to the blog and this thread whose identification is "Banterings" and my response as presented at the end of Volume 90.  I think it is then important to continue the discussion of the meaning of this thread and the consensus of the contents and ethics meaning of the many posting contributions over the years here.  Banterings last posting follows after my published suggestion for a title.

---------

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?  
..Maurice.
===================================================================

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


===============================================================================================

And now the discussion of a new title continues followed hopefully by further dissection of the status of medical care behavior towards their patients.  ..Maurice.

Graphic: Google Images.




114 Comments:

At Saturday, September 08, 2018 5:38:00 PM, Blogger Maurice Bernstein, M.D. said...

So let me start. I think we should all scan back quickly at the Volumes and then scan quickly at the Comments over the years this blog thread has been published. I have and it is most helpful to gain a better understanding of the arguing slant of what is written here. It has been examples of disrespect by the medical system of an element of patient dignity, specifically not autonomy (inability of a patient to make a decision which is accepted when provided all the facts). I found in this thread that in terms of providing the patient the gender of those individuals attending and observing examinations or procedures, examples are not given in advance. A valid observation but does this represent an insult to the patient's autonomy when a patient enters the procedure (except in critical ER presence) with with the autonomy capacity and opportunity to express in advance their gender requirements. Yet, there are patients who ask about gender attendance in advance or set their anticipated goal as a "cure" of their illness and not any physical modesty issues they bear. Is this an example of the profession's "lack of respect" toward the elements of the patient's fundamental dignity?

What I am trying to do here in this posting is to separate my titled regarding the patient's "expecting respect" from Banterings concluding title starting out with "Medicine's Lack of Respect for Human Dignity.."

As a physician and a teacher of future physicians, I do defend the value that the medical profession provides the patient but I agree with the view set forth in all these Volumes of the need of the medical profession's beneficence and value to their patients must not be lost by any mechanism in which the patient's dignity (including potential modesty) is purposefully ignored.

..Maurice.

 
At Saturday, September 08, 2018 7:11:00 PM, Anonymous Anonymous said...

Delmar Humperdinck lastnamewhatever III is on his front porch and notices that his female neighbor is changing her clothes that he can see into her bedroom window. He walks over to her property and is peeping into her bedroom as she changes. The neighbors across the street sees his actions and calls the police who quite quickly arrive and arrest Delmar for voyeurism. Delmar is arrainged and is charged for a class A misdemeanor and after trial is ordered to spend 12 months in jail and pay a $2300 fine.During this time while incarcerated Delmar loses his job as a meat packer and his home.

In Colorado 5 nurses at a major hospital have peeked at a male patient’s genitals while comatose in an intensive care unit. These nurses were not assigned to his care. After the male patient expired he was placed in a body bag awaiting transport to a morgue when the 5 nurses came to take a final peek at the genitals of the expired patient, opening the body bag. Hospital administration was notified when several of the nurses were overheard talking about what they had done. The police were notified and after conducting an investigation decided to let the hospital deal with the issue. Ultimately, the 5 nurses were placed on administrative leave with pay for 21 days and after returning to work had a report placed in their fil, no terminations.

The laws of voyuerism in every state say that it is equally a crime to remove a the victims clothing to peer at the genitals. Apparently, in the state of Colorado perhaps law enforcement don’t see it that way or perhaps they are just ignorant of the laws. It’s obvious the hospital where this occurred dosen’t respect their patient’s privacy no does it value the frivolous core values that they made up. Had this male patient lived and knew of how he was treated he would be treated as an outlier as well of being accused of having modesty issues then probably told by some hag makem sick female nurse to get a psych eval.

On some blog called patient modesty we have to claw, fight, struggle, scream, yell, be a nuisance, curse, be ridiculed, laughed at all the while being told that’s its our problem because it’s our perception, even on our death bed while taking our last breath. At 4 Trillion dollars where this all stops nobody knows but don’t expect this ever to be viewed in a dignified way or be called dignity. Human beings despite after evolving to stand on two legs with an oposeable thumb will never understand how to treat other Hominids even after years of education.

PT

 
At Saturday, September 08, 2018 9:07:00 PM, Blogger Maurice Bernstein, M.D. said...

I agree.PT, that the lack of respect for human dignity in the medical profession as described in the series of newspaper documentations and examples of personal experienced written here is disconcerting and should be remedied. It is just that unlike Banterings title recommendation that seemingly paints a "starting out" of the medical profession as "lacking respect for human dignity", my title "Patient Modesty, Dignity and Expected Respect by Medicine" is more reflective of what folks have been writing here and not seemingly applying a total lack of respect to the profession. But, it could be that I am misinterpreting what Banterings is implying and he agrees that the medical profession, as described by all the posts over the years, is not some "throw away" but needs repair with regard to matters of patient dignity which includes modesty. ..Maurice.

 
At Saturday, September 08, 2018 9:44:00 PM, Blogger A. Banterings said...

Due to the length and the depth of this post, I must do it in 5 parts.

Part 1



Maurice,

Very good move not changing the title until we finish debating it!

Patient Dignity (Formerly Patient Modesty) show how "modesty" is mo longer the correct term to use (in the same way that non-adherence" replaces non-compliant." We are adding NOTHING else to the original title. It simply updated the "KISS" title used over these 91 volumes.

I was opposed to adding "expecting respect" or anything else. We keep the original title in the current lexicography, while referencing the original title.

The title reflects that the patient is ENTITLED to respect (of what we define as modesty, as a subset of their human dignity), as opposed to the patient begging to be respected.

You state (my comments in bold):


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?

Yes it is expected. This is no more evident than in the fact that 80% to 90% of nurses are female. This is evident in that we are still talking about PEs on anesthetized women WITHOUT consent in the YEAR of 2018. It is evident that no one other than the couple physicians that exposed this abhorrent behavior have ever apologized. In fact, just as is happening here, physicians attempt to justify the behavior by referring to lack of training opportunities and other paternalistic fallacies.

You also continue to hold the position that it is the patients' faults for NOT speaking up. This is blatant VICTIM BLAMING. Just as with the reasons the victims did not come forward with Harvey Weinstein, so to patients face these "NUDGES":

Women are made to feel ashamed for not fighting hard Patients labelled mentally ill

Women are threatened into silence and punished for speaking out patiens threatened with medication/treatment witholding or dismissal

The authorities aren't always helpful The authorities do not understand that these infractions are crimes

...VICTIM BLAMING

One reason people blame a victim is to distance themselves from an unpleasant occurrence and thereby confirm their own invulnerability to the risk. By labeling or accusing the victim, others can see the victim as different from themselves. People reassure themselves by thinking, "Because I am not like her, because I do not do that, this would never happen to me." We need to help people understand that this is not a helpful reaction...




End Part 1


-- Banterings




 
At Saturday, September 08, 2018 9:44:00 PM, Blogger A. Banterings said...


Part 2


This is another way victim blaming commonly occurs in healthcare; saying that if one goes to a teaching facility, they consent to the understanding that students will practice upon them.

Victim blaming exists in modern medicine just as paternalism, the hidden curriculum, and PEs on anesthetized women without consent still do.


Medicine also has a poor track record in respecting human rights:

-(2018) Pelvic Exams On Anesthetized Women Without Consent
-Dr. Larry Nassar
-Dr. Twana Sparks
-CIA made doctors torture suspected terrorists after 9/11, taskforce finds
-Tuskegee syphilis experiment
-Nazi human experimentation
-A surgeon experimented on slave women without anesthesia



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.

Expected respect sounds like the patient is again asking something they are NOT entitled to. It is not EXPECTED either, it is a UNIVERSAL HUMAN RIGHT.

It is something to which you are entitled by virtue of being human. Human rights are based on the principle of respect for the individual. Their fundamental assumption is that each person is a moral and rational being who deserves to be treated with dignity. They are called human rights because they are universal.


...and in this thread:

As a physician and a teacher of future physicians, I do defend the value that the medical profession provides the patient but I agree with the view set forth in all these Volumes of the need of the medical profession's beneficence and value to their patients must not be lost by any mechanism in which the patient's dignity (including potential modesty) is purposefully ignored.

First do no harm...

Postoperative PTSD

Routine Gynecological Procedures Can Cause PTSD

patient refuses life-saving bypass surgery



Getting back to victim blaming, let us look at a recent case in medicine: Larry Nassar Blames His Victims, Says He 'Was Victimized' In Newly Released Videos.



End Part 2


-- Banterings





 
At Saturday, September 08, 2018 9:45:00 PM, Blogger A. Banterings said...



Part 3



When the officer argued that the student complained that Nassar was "massaging her breast," Nassar replied, "It’s the rib cage, you know what I mean?"

"You’re going to be on the chest wall, you move the breast down, you move the breast down to get down to the wall. It’s like giving someone a mammogram almost," he said.

Nassar also argued that he didn’t "get" why the patient’s complaint was coming through at that time.

"Why didn’t she say something if she was, if she was ... if she was feeling violated in any way, shape or form," he says in the video. "There was no communication."


According to Dr. Nassar, the patient (at the time) did NOT speak up.


I will now go back to the the concept of what we describe as "Modesty." This IS a misnomer. Just as the ancient Hebrew language had no word for homosexual, modesty is the BEST term that we can come up with (until now).

We know that human rights are basic rights bestowed by God on human beings.

We also know that one of the basis for ethical decision making (ethics) is religion. Ethics must be based on accepted standards of behavior. For exam­ple, in virtually all societies and cultures it is wrong to kill someone or steal property from someone else. These standards have developed over time and come from a variety of sources including:

The influence of religious writing and interpretations.
The influence of philosophical thought.
The influence of community (societal) values.



Human Rights being endowed by our creator is also present from other sources as well, such as The Declaration of Independence:

We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness.–That to secure these rights, Governments are instituted among Men, deriving their just powers from the consent of the governed…

So these, then, are the foundational principles of our Constitutional Republic:

· Our Rights are unalienable and come from God;
· The purpose of civil government is to protect our God-given Rights;
· Civil government is legitimate only when it operates with our consent; &
· Since the US Constitution is the formal expression of the Will of the People, the federal government operates with our consent only when it obeys the Constitution.






End Part 3


-- Banterings



 
At Saturday, September 08, 2018 9:45:00 PM, Blogger A. Banterings said...


Part 4



So let us tackle the concept that has been labeled "MODESTY" in these past 90 volumes, using an example taken from one of the basis of ethics: religion.

The situation that I speak of is "Adam and Eve's Nakedness."


(At the very least, for those who do not believe in a supreme being, the Bible serves as an anthropological record of human history, and a record of "human ethics".)

So I pose this question, why did Adam and Eve begin covering their nakedness?

The answer in the Bible is NOT modesty, it was knowledge from the tree of life (the apple).



...That Adam and Eve’s discovery of their own nudity occurs after Original Sin has been committed and in their rush to hide and clothe themselves points more concretely to the introduction of shame than it does the relief of ignorance. In other words, our first parents lost the ability to look on the other’s body and see the person and instead began to see only an object. Shame, then becomes a defensive mechanism meant to preserve one’s own intuitive realization of his inherent human dignity...

But after the original sin (and knowledge), man behaved in a modest manner (covering himself) to preserve his relationship with the Creator. Human dignity is meant to protect man's relationship with the creator by external forces. It does this by preserving the concept that thread has called modesty, this thing that Adam and Eve were enlightened with but NEVER named.


CAUTION:

This does NOT suggest that the patient who is accepting of mixed gender care, exposure, unnecessary procedures, etc., is somehow diminishing their relationship with the Creator OR their intrinsic value as a sentient being.

They have chosen to put aside their modesty for a higher purpose. A great example of this in a different situation is the Christian martyrs.

Dignity has been preserved because dignity can NOT be negotiated or given away (by the person), it can only assaulted by others (external forces). Modesty can be set aside or disregarded by the patient (person).




End Part 4


-- Banterings



 
At Saturday, September 08, 2018 9:46:00 PM, Blogger A. Banterings said...

Part 5

CONCLUSION:

Both modesty and dignity protect man's relationship with the Creator (God).

For the atheists (as well as the believer), modesty and dignity (also) protect man's intrinsic value as a sentient being.

Modesty protects man from (himself) sabotaging his (own) relationship with the Creator.

Dignity protects others from sabotaging man's (own) relationship with the Creator.


What this thread has discussed is NOT the patient behaving in an immodest manner in the healthcare system by forcing his nakedness on providers, but it is about taking away man's covering (an infringement of his dignity) against his wishes (by means such as coercion, being "thorough," etc.).


I believe that I have successfully demonstrated why the title should be Patient Dignity (Formerly Patient Modesty) (and NOTHING else).

The main points that make "dignity the preferred term are:

-- Modesty is something that the patient asks for (because it is NOT a right), and they can ask for too much (being too modest).

-- Dignity IS a human right.

-- This is a form of victim blaming. (This risks ire from the #MeToo movement.)

-- Modesty is the means that the patient protects his intrinsic value as a sentient being from himself.

-- Dignity is the means that the patient's intrinsic value as a sentient being is protected from others (external forces).

-- This thread deals the patient's dignity (intrinsic value as a sentient being) being assaulted by external forces (providers) and NOT from themselves.




-- Banterings

 
At Saturday, September 08, 2018 11:46:00 PM, Blogger A. Banterings said...

Maurice,

As a rebuttal to your response to PT,

I believe that this is rampant in the industry, I point to my previous 5-part post: This is no more evident than in the fact that 80% to 90% of nurses are female. This is evident in that we are still talking about PEs on anesthetized women WITHOUT consent in the YEAR of 2018.

I would argue that your proposed title,"Patient Modesty, Dignity and Expected Respect by Medicine:Volume 91" implies that the healthcare industry does NOT respect the patient. If abuse was not rampant in the industry, then we would NOT be discussing "expected respect," instead we world be talking about the "given respect."

What I am trying to do here in this posting is to separate my titled regarding the patient's "expecting respect" from Banterings concluding title starting out with "Medicine's Lack of Respect for Human Dignity.."


So is the subject of the thread what percentage of medicine as a whole disrespects human dignity OR the experiences of those disrespected by medicine?

If indeed we were all outliers (who post here), to say that we are outliers is an affront to our dignity as well. What if someone said to all of Harvey Weinstein's victims that he was an outlier AND MOST female actresses are not abused in such a manner by the majority of producers somehow suppose to remedy their pain and trauma?

Does this fact negate all that the #MeToo movement is attempting to accomplish? Should we forego new regulation to protect actors because he was an outlier?

This is a furthering of victim blaming.

Using the outlier response to the Weinstein victims would make that person an enabler.

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. Source: Volume 90

If we are looking to title the topic of this thread, then "Medicine's Lack of Respect for Human Dignity and Patient Modesty" is appropriate for the title. Almost 100% of the examples given and discussed here deal with "Medicine's Lack of Respect for Human Dignity and Patient Modesty".

Does the thread talk about the patient protecting providers from the patient (modesty) OR the patient needing to be protected from providers (dignity)?

For the record, the profession can be saved (by putting patients in control).






-- Banterings



 
At Sunday, September 09, 2018 8:20:00 AM, Blogger NTT said...

Good Morning:

Changing the name on the blog is a good thing. It might bring more medical people into the conversation.

I am beginning to wonder if our problem with the medical community would begin to get resolved if we fixed the problem we have with Washington.

I recently read an article from December 2017 called Why men don’t care about the health care debate.

https://www.statnews.com/2017/12/20/men-health-care-debate/comment-page-1/#comment-1267742

Everybody knows men die sooner than women.

The medical community says men don’t take as good care of themselves as they should or as women do.

I believe that’s part of the reason their culture teaches them they don’t need to respect a man’s dignity and privacy because he doesn’t respect himself well enough to take better care of himself.

One of the reasons men do not take better care of themselves is, the federal government makes it a lot costlier for men than women.

Take the Affordable Care Act (ACA).

As part of ACA, women receive a large number of gender-based services that in turn, personalize their health insurance for them and that then provides a strong incentive for them to buy coverage.

At the same time under ACA, there are no gender-based services for men so there is less incentive to buy health insurance. Instead, males pay fines and penalties.

So, our own government is in effect punishing men for a program that fails to provide for their basic needs.

These are our ELECTED officials that we sent to Washington that are doing this to us.

Rather than listen to their constituents, they listened to the lobbyists.

The entire male (not female), population of the United States that is part of the ACA program, is being denied basic no-cost preventative care on a daily basis while at the same time they are offering the services to females.

That people, is DISCRIMINATION.

Males deserve the same chance that out female counterparts have to live a long and healthy life.

Our federal government in tandem with the healthcare industry is seeing to it that it never happens.

It time for men to take a stand.

We need to DEMAND equality and the immediate removal of gender-based discrimination in the entire healthcare system so fathers, their sons, and grandsons have the same chance at a long and healthy life as mothers, daughters, and their granddaughters currently have.

It’s time men went after their representatives in Washington. If they want to stay there they need to get this fixed NOW or they can forget about join back there next January.

This has gone on long enough. It’s time to fight back as being quiet will only hurt more men.

Regards,
NTT

 
At Sunday, September 09, 2018 9:38:00 AM, Blogger A. Banterings said...

I want to expand on the abstract concept modesty but more accurately dignity.

Another abstract example is the "F" word.

To expand on this, I will use another similar situation, & that is the cartoon, "The Smurfs". The word "smurf"The Smurf lexicon is quite unique & rather advanced linguistically.

A (more) contemporary cartoon Rick & Morty, also uses a similar lexicon "Squanch".

This concept is based on ancient, primitive, & (even) modern lexicons.

Maya has a number of meanings, most of which are nouns but many of which are abstracted concepts. It can refer alternately to the illusion of existence, the temporality of the material, the deity that both shrouds us from the truth & frees us into it, or a bunch of other wacky things. Maybe the broadest possible translation is "not that", where "that" means "what is real".

Let me use "smurf" to illustrate this in the context of healthcare:

I am not going to let that smurfing doctor stick his finger in my smurf with three medical smurf practicing on me.

While we know what I am conveying, but the phrase, "The Smurf that smurfed smurf", gets a little more dicey.

Try yourself with the Smurfilator! (Translate English to Smurf).

One reason that has been cited for discontinuing to teach Latin in high schools is, because one cannot say "Drive the car to the gas station" in Latin.

Some primitive languages do not have words for "ownership" of possessions because they live in a communal setting. In this type of culture, an airplane would be metaphorically described as a bird. In a previous example, I cited the ancient Hebrew language having no word for homosexual, so the Bible metaphorically describes it as "man laying with man."

Abetter example of the abstract respect for modesty/dignity discussed, the Judeo-Christian concept of "love" has been extensively written about. The Bible mentions different kinds of love.

There is God's love for us, the love we have for God, the (erotic) love of our spouse, the love of our children, & the command of Christ to "love our neighbor" to name a few. Modern day has expanded the concept to love our job or love our pet.

Love, like dignity is endowed in (& taught to) us by our Creator

We are dealing with an abstract concept, & there is no one word to describe it. Previously that word was modesty, now dignity is a much BETTER term. Expanding the title, such as by stating the obvious (expecting respect), will only take the focus off the (abstract) subject.

Note that it is much easier to describe the antithesis of dignity, words such as "naked," "abuse," & "lack of respect" are easier to visualize as opposed to that of dignity.


-- Banterings

 
At Sunday, September 09, 2018 10:26:00 AM, Blogger Biker in Vermont said...

It seems the general agreement is that within healthcare modesty is assumed for female patients and deemed a negative when expressed by male patients. This reflects societal norms. The classic examples of this are female prison guards (and even female staff in juvenile detention centers) have full access to undressed males whereas the opposite does not occur. It is as well readily evident in female reporters having full access to male locker rooms whereas the opposite does not occur. That healthcare follows societal norms should thus not surprise anyone.

As already discussed, dignity cannot be turned into a negative in the manner that modesty is for males. The problem men and boys face is that within healthcare there is not a working definition of what dignity actually means. The definitions used are sufficiently vague that every healthcare worker can read whatever they want into it. Every hospital and medical practice and every person who works in healthcare maintains that they respect patient dignity.

To the extent it is defined at all, gender is never part of the definition. That is the core issue. "Dignity" does not have a staff gender aspect to it when applied to male patients. Dignity is instead just the mechanics of draping, pulling the curtain, acting with confidence, maintaining a proper gameface etc. You see it every time the issue surfaces on AllNurses or in articles & discussions elsewhere. Female staff from top to bottom take offense when men want same-gender care for intimate matters.

So, dignity in the title of the thread makes sense, but we here for whom dignity contains a gender component are speaking a different language than is used throughout the healthcare system.

 
At Sunday, September 09, 2018 10:31:00 AM, Blogger Maurice Bernstein, M.D. said...

Thanks to Banterings, PT and NTT who have initiated discussion of this important decision with regard to the question: "What the hell are we talking about?"

And just to let you know, the entire introductory portion, including graphic, of each new blog thread (and of course currently "Patient Modesty" is the most frequent) is reproduced on the "blog" section of Bioethics.net http://www.bioethics.net/2018/09/patient-modesty-volume-91/ which is the internet publication of American Journal of Bioethics and a link is provided to come directly to my blog thread to read the Comments. What I am getting at is that providing the professional ethicists and physicians who read that journal website an entry point to read fully and contribute their understanding of the issues here. These professionals may be in our audience but I personally urge them to contribute their views even anonymously as our "regulars" have.

I appreciate PT and "AB in NW" who have had direct professional participation in the medical system and who have expressed their interpretation of what is being written here and their own views..but..I would like more input by more of those directly involved in the "goods" and "bads" in the medical practice of the medical-healthcare profession. ..Maurice.

 
At Sunday, September 09, 2018 10:51:00 AM, Blogger Maurice Bernstein, M.D. said...

Oops! I left Biker out of my "thanks" first sentence because I wasn't aware his posting as I was writing. So also, thanks to Biker. ..Maurice.

 
At Sunday, September 09, 2018 11:13:00 AM, Blogger A. Banterings said...

Maurice,

I am sure that there are others who have posted recently and in the past that work on the inside as well, they just do not wish to publicize it and risk being recognized and jeopardize their livelihood.



-- Banterings

 
At Sunday, September 09, 2018 4:47:00 PM, Blogger NTT said...

Dignity What is it

Dignity is our inherent value and worth as human beings.

Everyone is born with it.

Inside, we all want to be treated like we have value.

Treating male patients as though they had NO value. That my friends, is what the medical community is getting away with.

The culture that exists within the community teaches healthcare workers that men have no value therefore they have no dignity to respect so, go about your jobs in a dignified and respectful manner (because healthcare workers have dignity), and if there are any problems, the system will deal with them on a case by case basis.

Part of the reason they treat men with no dignity is they see the federal government doing it by way of discriminating against male healthcare services. They figure if the government can do it why not them too.

PT once said that the medical community needs a Starbuck’s moment. I totally agree. The boobs in Washington that are willfully discriminating against men could also use the same kind of moment.

Every person in the healthcare industry from the CEO’s to the peons should be required to take classes in dignity and respect of their fellow human beings.

They can try, but unless you allow them, they can never take your dignity from you. We each have as much value as anyone else. Do NOT let anyone tell you different.

If a healthcare worker is not respecting your dignity and protecting your privacy, then it’s time to SPEAK UP and tell them you aren’t having any part of their “non-professional” behavior.

Do it for yourself and do it for your children.

They can’t be allowed to walk all over men anymore.

We are all equal.

Equal pay for equal work and equal healthcare services for ALL not just for some.

Regards,
NTT

 
At Sunday, September 09, 2018 9:32:00 PM, Blogger Maurice Bernstein, M.D. said...

I think it IS time for the patient community throughout the United States and the world become therapeutic and make a concerted effort to heal the illness of their medical systems from the top of the system and down.
NTT has provided a summery of some approaches to therapy. And there is no doubt in my mind now after these 13 years of this thread of personal experiences but also news publicized disclosures that a system illness exists and it needs to be treated. And its up to the patients and prospective patients (which means all of us) to provide that necessary therapy.

You know, one should consider that the medical system has not recognized that they have an illness as symptomatic to their patient population in different ways as potentially harmful as some of the patients' own illnesses they should be treating. I see that harm to be characterized as interfering with the initiation, proper prompt patient diagnosis and patient treatment as a result of the medical system and some individual provider's ignorance and misbehavior.

So now is the time to start the therapy. I agree it is appropriate to start at the "top" including the federal and state government rules, laws and oversight but also systems and medical organizations and facilities below them including individual medical care providers.

The patients should be active and follow the "Me too" movement. Extend public and system awareness beyond "workplace sexual harassment of women" to medical system inattention or worse to the dignity and modesty of their own patients of both or "other" genders.

Look, its great that a lot of words and documentation has been placed on these Volumes regarding this issue but what is being done here to change the medical system behavior is virtually minuscule at the most and as I have said in Volumes long passed, what is needed is an organized approach to document the disease and order the treatment needed to be applied to the medical system. ..Maurice.

 
At Monday, September 10, 2018 10:16:00 AM, Blogger A. Banterings said...

Maurice,

The #MeToo movement is NOT about the C suite changing the system, it is grass roots. It is changing a name from "modesty" to "dignity" because it can be construed as victim blaming.

Healthcare is going to be changed by lawsuits from abused patients.

Question: Why the PEs on anesthetized patients in 2018?

Answer: Because they can (Michael Foucault) AND because there is NO cost (or it is profitable) to the profession (Archie Banterings).



I also want to get back to the title being Patient Dignity (Formerly Patient Modesty) (and NOTHING else). After hearing more details about CBS's Moonves, I began to think about the title. What would a blog about the abuses in the entertainment industry be called? "Entertainer Modesty, Dignity and Expected Respect by the Entertainment Employees"?

The #MeToo movement would ask, "Why is 'expected respect' like a benefit like health insurance?" "Is this something out of the ordinary, something to be bargained for, or something that is not normally present in ANY industry?"

Saying "expected respect" is saying that "I hope it is there." It also implies that it is NOT MANDATORY, or that it can be NEGOTIATED.

Human dignity can NOT be negotiated and is MANDATORY. Infractions of human dignity (and other human rights) are CRIMES AGAINST HUMANITY.

Keeping "Formerly Patient Modesty" as a permanent part of the title preserves the context of the thread.

Let me put it another way: If Spanish became the predominant language spoken, and we were to change the title to the most up-to-date and acceptable language, we would call the thread Modestia Paciente.

We would NOT be calling it Paciente modestia, dignidad y respeto esperado por la medicina (Patient Modesty, Dignity and Expected Respect by Medicine).




-- Banterings




 
At Monday, September 10, 2018 10:28:00 AM, Blogger A. Banterings said...

One of the assertions that I have made is that the profession of medicine has historically, continually, and to this day lacking a moral conscious and doing what is best for itself. The latest example is PEs on anesthetized women in 2018.

I am going to link another article that shows the ethics of the profession throughout history:


A History of Human Guinea Pigs



-- Banterings


 
At Monday, September 10, 2018 1:31:00 PM, Blogger Biker in Vermont said...

Healthcare does not consider female staff performing or observing intimate care for male patients to be dignity violations. Dignified care includes proper draping, pulling the curtain, proper communication, being polite etc., but gender is not a dignity consideration when it is female staff-male patient.

This is consistent with societal norms. Men exposing themselves to women without permission is a major violation of societal norms. Women voluntarily observing exposed males, with or without their permission, is not.

This is the way it has long worked in society at large. It is OK for girls to help bath their younger brothers but the opposite is not generally allowed. Decades ago it was OK for female school staff to wander into swim classes to speak with the coach or for mom's & sisters to observe swim classes at the YMCA when boys swimming in the buff was mandatory, and permission was not needed from the boys. Had those boys gone to a swimming hole however where women or girls were present, they'd of gotten in lots of trouble for exposing themselves. The difference is males imposing their nudity on females (unacceptable) vs females voluntarily viewing exposed males (acceptable). This is the female prison guard in the shower area and the female reporter in the locker room scenario. It is the female police officer in the ER.

What happens in healthcare is totally consistent with accepted mores in society. This is why men who want same gender intimate care are looked askance at in healthcare settings. The female staff are voluntarily treating or observing the exposed male patient, hence there is nothing wrong with it from their perspective.

Dignity is a better word than modesty, but healthcare staff is 100% convinced that they already respect the dignity of male patients. The task here is changing the working definition of dignity in healthcare settings more than it is demanding we be treated in a dignified manner.

 
At Monday, September 10, 2018 2:37:00 PM, Anonymous Anonymous said...

I find I must cast my vote for Banterings’ view of how the mak’emsick industry treats customers and thus cast my 2 cents for the title, “Medicine’s Lack of Respect for Human Dignity and Patient Modesty.” That this title is appropriate can be seen against a larger canvass of human behavior, for as PT has stated, “Human beings despite after evolving to stand on two legs with an opposable thumb will never understand how to treat other Hominids even after years of education.” As one looks around the globe today, one can see that ALL societies are in a state of collapse, and of course the US mak’emsick industry is a superb micro example of such collapse. Now, physiological collapse occurs as a result of psychological collapse, which is readily seen in all facets of these fascist states of america (doesn’t deserve a capital letter) and is especially clear in the “healthcare” arena. For instance, as PT has noted, a hospital can purchase a 3 million $ MRI machine and spend big bucks on providing kosher and halal meals, but hiring a few male nurses for male patients – it seems to be about as difficult as navigating the black hole at the center of this galaxy!

Furthermore, I’d like to introduce another noun for the title – male modesty – for the feminazi takeoever of the mak’emsick industry readily grants respect of dignity/modesty for the female customer (not in all cases such as is seen in PEs on anesthetized females, but a few thousand female violations as seen against the hundreds of millions of violations against the male client is what needs exposure), but deliberately discriminates against male customers, and such discrimination is found everywhere – private medical offices, larger clinics, and of course hospitals. For instance, that a urology clinic would have 100% female nurses/MAs vividly illustrates the foundational lack of respect for the dignity of all males. From the get go, the male customer is not afforded any informed consent or respect for modesty/dignity choices but is forced to, as one male client has expressed it, “leave my dignity at the door.”

I always rather wondered why “male modesty” was not foremost in the title of this blog?! At this point, seeing how all mak’emsick female workers are given a free pass to discriminate against and sexually abuse male customers, I don’t give a s*^# about all the pampered, perfumed, powdered p*#@* females who access “healthcare” demanding that their dignity be respected. Couldn’t care less – no, less than that – I despise groups of females who band together for their “rights.” I guess I avoid gaggles of females because inevitably these gaggles turn into coven of b*%#^^# as seen in the medical arena and in K-8 “education” as well.

For, I’m with PT here. Open the prison doors, and let out all the Larry Nassars, free of fines and restrictions upon their licenses. If the Twana Sparks, Tiffany Inghams, and millions of mak’emsick nursing hags such as the Denver 5 get off scott free to continue abusing, then ALL male medicos imprisoned or fined for client abuse should be set free to continue abusing, such as ALL MAK’EMSICK FEMALE WORKERS ARE FREE TO CONTINUE ABUSING. I do enjoy terms such as “monkey bar wonders,” and agree that NO FEMALES ARE ENTITLED TO ONE NICKEL OF COMPENSATION UNTIL, AS FAR AS POSSIBLE, ALL MALE CUSTOMERS STILL LIVING ARE COMPENSATED FOR THEIR ABUSE AT THE HANDS OF FEMALE MEDICAL HAGS, NO MATTER THEIR POSITION.

EO cont.

 
At Monday, September 10, 2018 2:41:00 PM, Anonymous Anonymous said...

Re Tiffany Ingham: US colonoscopy clinics (and mostly female nursing hags at such) pooh pooh the idea of patient dignity/modesty, telling clients that ask for colonoscopy shorts or all male teams for male clients, that “you’ll have a gown and a blanket.” Yeah, and we know that gown and blanket will be lifted up in a New York second for a peek at MALE genitals or removed altogether! WTH was the MA in the Ingham case doing while she practiced her voyeuristic mind set and examined and commented on the client’s penis? No tube going in that end!!!

Here’s all the punishment this obviously criminally minded female received from the Virginia Board of Medicine: “Ingham, Tiffany M., M.D. 0101-233633 Mount Dora, FL 5/11/16 Reprimand; license subject to terms and conditions based on inappropriate statements made during a procedure while administering anesthesia to the patient.” That Ingham made statements such as this, “After five minutes of talking to you in pre-op, I wanted to punch you in the face and man you up a little bit,” readily illustrates her mental instability and her absolute lack of morals or ethics. This one statement alone shows Inghams’ total unsuitability to practice medicine! She is one vicious, mean broad! And falsifying charts, well, ‘nuff said!

And here’s the doing business as usual BS white wash from the American Society of Anesthesiologists: “The American Society of Anesthesiologists® (ASA®) was very disappointed to learn of the serious allegations against physician anesthesiologist Tiffany M. Ingham, M.D., who recently was sued for medical malpractice and defamation for making comments about a patient during a colonoscopy in Reston, Va. Dr. Ingham is not a member of ASA.

The Society promotes the highest levels of professionalism and patient care and advocates that all physician anesthesiologists follow its Guidelines for Ethical Practice of Anesthesiology which require that members provide medical care with compassion and respect for the dignity of the patients.”

“Compassion and respect for the dignity of patients” - sound familiar? It’s the same BS meaningless platitudes that hospitals and providers spout at every turn of the client abuse highway! Per usual, it seems the creature Ingham is still practicing, but now in Florida.

Here’s EO’s title which I realize no one else would prefer: Mak’emsick Industry’s Discrimination and Abuse of Male Clients, or, How the Feminazi Gaggles Voyeur and Dishonor Male Customers.

EO


 
At Monday, September 10, 2018 2:55:00 PM, Anonymous Anonymous said...

Let me add to comments Biker has mentioned. According to state nursing boards it is considered sexual misconduct for nurses to leave patients unnecessarily exposed, ie improperly draped. What!!! Female nurses have been doing this to their male patients for the last 50 years. I’ve only noticed these new rules on state boards of nursing websites within the last 6 years and I can’t help but wonder are these new rules put in place so they can make sure the influx of male nurses into the field don’t do to female patients what female nurses have been doing to their male patients. Why all of a sudden are there these rules put in place? There can be no other explanation for this but nursing boards I’m sure have different standards depending on the gender of the nurse. Just take a look at the Denver 5 and the Penn state hospital and you see what I’m talking about. If you still have doubts this issue extends to physicians. Dr Twana Sparks compared to Dr Nassar. I rest my case.

PT

 
At Monday, September 10, 2018 5:00:00 PM, Blogger NTT said...

Good Evening Everyone:

Dignity in Healthcare

Observing all patient’s dignity and privacy is essential for establishing a working relationship between provider and patient. It is also is critical for maintaining the patient’s well-being. Many harmful consequences including but not limited to the destruction of the patient/provider relationship will ensue if the patient’s dignity is not observed.

While investigating many different articles, I found that medical institutions outside the United States take this subject much more serious than those here in the states.

Biker has hit the nail on the head about the main issue. On the healthcare side gender is not a dignity consideration when it is female staff-male patient.

Ask just about anybody in healthcare and they will tell you America has a patient-centered healthcare system.

If we truly are a patient-centered system, then it wouldn’t it be reasonable to think that the views of what the patient considers what makes up dignity to them, trump whatever the healthcare definition might be.

If that’s the case, the healthcare system needs a Starbuck moment to consider the huge culture shift that must occur.

This issue could be resolved in two steps.

1. Whenever a person requires medical attention they are asked do they require same gender care. Or just let your personal physician know so it gets into your record.

2. facilities do staff allocations to adjust for gender specific events on any given day.

By asking one time it will go into the patients permanent record that they require same gender care so going forward if the patient returns, they know right away they need specific people.

Regards,
NTT

 
At Monday, September 10, 2018 7:57:00 PM, Anonymous Anonymous said...

In the decade that I’ve been following and posting on this blog some things that I have mentioned were not always believed or accepted and as a result I have only posted issues that were maybe not always evident. For example, there are no male mammographers and that female trauma nurses always let their male patients lie nude longer than really needs too. It is at this time that I am going to give a bigger picture of the more common privacy violations that occur in hospitals.

Definition of flashing: Female nurses open up their male patients gowns to expose the patient’s genitals when other female staff enter the male patients’s room. Location, neuro icu, micu, any intensive care unit whereby male patients are comatose by barb induced comas. This unnecessary exposure in the 70’s was done in the presence of candy stripers. It is done today in many icu’s.

Curtains in addition to glass sliding doors are present in every intensive care unit, yet curtains are primarily for patient privacy and the glass doors are to keep noise out, however the glass doors usually open with the exception of isolation patients. Every intensive care unit employs a unit secretary and every unit secretary is female. They are non medically trained! They answer phones and take messages yet I’ve seen every one deliberately enter the closed curtain patient rooms, stick their heads in when patients are getting intimate care, baths etc, when the patients are young males.

Respiratory techs are about 75-80% female yet many are conjoined at the hip. They can’t go into a patient’s room that is on a vent to adjust the peep ( respirator settings) without the other. There is absolutely no reason they need to adjust the peep and record the respirator settings when the curtains are closed and they Knowwhen patients are being bathed.

Radiology techs, particularly female x-ray techs are also co-joined at the hip. It takes two of them to push a portable x-ray machine and they will often show up in 3’s just for one trauma. Female registration clerks are conjoined at the hip like respiratory and x-ray in that it takes two and three of them to stand in the trauma bay to register one trauma patient.

Speech pathologists are all female, I’ve never seen a male one ever. I’ve never been able to figure out why a female speech pathologist needs to be present in the icu of a Young male patient that is intubated and on a respirator. The patient has an NG tube(nasogastric) that is on tube feedings. She is most likely there to get flashed.

I’ve never been able to figure out why the hospital dietitian, they are all females too needs to be in a young male patient’s room that is intubated with an NG tube on tube feedings, closed head injury. There is no valid reason for her to be in the room. Who you ask are the most professional people ( staff) in my opinion that work in hospitals? House keeping that’s who.

PT

 
At Monday, September 10, 2018 9:56:00 PM, Blogger Maurice Bernstein, M.D. said...

I am reading! I am reading! This is just the discussion I wanted for clarification regarding a change of title. I just wish that we can get some additional but currently active members of the medical care "team" to join the conversation. (I do appreciate those here who have identified themselves with a history of prior attachment.) PLEASE, PLEASE.. provide the entry to this blog thread to others who are actively employed in the medical profession to input their responses (anonymously, as usual). I would like to read contra-arguments, if that is what they will be, about the views already expressed.

“Do unto others as you would have them do unto you.” is a statement of understanding the matter of dignity of others as well as ones self and should be behind every medical misbehavior that PT and others have documented here. Failure to follow this ancient biblical expression is clearly a sign of personal loss of dignity.

No doubt: the word "dignity" needs to be part of the new thread title. ..Maurice.

 
At Tuesday, September 11, 2018 4:29:00 AM, Blogger Biker in Vermont said...

Yesterday I did a post, with examples, talking about societal norms being that men cannot expose themselves to women but women can voluntarily view exposed men with or without their permission. This is how it is in healthcare and in society at large.

There is one huge exception to that societal norm that is of interest. The Federal Govt.'s rules for observed urine tests for drugs requires that observers be of the same gender as the person being observed. No exceptions. This is the rule for the D.o.T for truck drivers and for SAMSHA for other federal agency required observed drug tests. The Feds gave men the same protections as women.

However those protections do not extend to non-Federal jurisdictions. Private employer, State & Local police, court, and Halfway House mandated observed drug tests do not mandate same gender observers. Women more or less universally receive same gender observers but it is fairly common for men to have female observers. I believe that when men have challenged this courts have ruled that women can observe men's drug tests. To add some context to this, here is the definition of how it is done (from D.o.T. regs):

i) As the observer, you must request the employee to raise his or her shirt, blouse, or dress/skirt, as appropriate, above the waist; and lower clothing and underpants to show you, by turning around, that they do not have a prosthetic device. After you have determined that the employee does not have such a device, you may permit the employee to return clothing to its proper position for observed urination.

(j) As the observer, you must watch the employee urinate into the collection container. Specifically, you are to watch the urine go from the employee's body into the collection container.

 
At Tuesday, September 11, 2018 9:18:00 AM, Anonymous JF said...

EO, You and PT have got it all wrong. Don't blame the female patients banding together for rights. They are part of the solution, not the problem.
The people you should be angry with are the female medical staff violating make dignity AND THE MALE DOCTORS AND MALE STAFF REQUIRING FEMALE STAFF TO BE PRESENT! Like Dr B said to, I glossed over some of the earlier volumes. If I hadn't seen it in an earlier post I would think you were a man. Would it be helpful towards male dignity being accommodated for you to be humiliated in a medical setting?

 
At Tuesday, September 11, 2018 9:59:00 AM, Blogger Maurice Bernstein, M.D. said...

JF, I am in no way criticizing your expression "..I would think you are a man" but want to initiate another thought for discussion: would it be more appropriate to use the term "male" rather than "man"? Do you think that the word "man" in an oral or written expression already sets a definition to that gender which includes all that is "manly" and the "manly aspects of his dignity" which includes the idea that physical modesty is not part of that assigned dignity? It's just how the term "man" paints a picture of behavior. Whereas,would the use of the biologic term "male" lead to the same assumptions as the term "man"? I want to suggest for discussion that it wouldn't. I don't think the same distinction exists between "woman" and "female". Does my theory regarding societal assumptions between "man/male" and contrasting with "woman/female" have any support here? ..Maurice.

 
At Tuesday, September 11, 2018 10:48:00 AM, Anonymous JF said...

I don't get what you mean. I'm all for male dignity being respected. I think a large portion of the exposure shouldn't be happening anyway. I think though, instead of being angry when females demand respect, these exact same females should go to bat for patient dignity PERIOD! We're not your enemies. The medical staff is , when it comes to dignified care. I see zero benifit from Larry Nassar being released from prison. That would be a backward step. A step forward would be Twana Sparks prosecuted or very publicly humiliated.

 
At Tuesday, September 11, 2018 11:05:00 AM, Anonymous JF said...

Do unto others as you would have them do unto you! Could it be that they ARE? Maybe these females that violate male dignity are the same females who get sexually excited when a male doctor does intimate exams on them. Maybe the male doctors who have female staff present when his patients are exposed would like it being done to him.

 
At Tuesday, September 11, 2018 1:23:00 PM, Blogger NTT said...

Good Afternoon:

Personally I feel that due to the embarrassment factor, many men never tell their girlfriends & spouses what really goes on during a male specific intimate exam, test, or procedure.

Maybe if more women knew what their men are being put thru for no reason, they'd stand with them and make the objection LOUD ENOUGH to be heard.

Regards,
NTT

 
At Tuesday, September 11, 2018 2:28:00 PM, Blogger Maurice Bernstein, M.D. said...

JF, to clarify, I was not commenting about your understanding of the gender of EO. I was simply using your statement to open a discussion as to whether "man" implies something different with respect to attributed dignity issues than if one uses the word "male" instead. When the expression "men are..." is used, does this bring up different concepts to the average listener or reader than if one starts with "males are.."
Again, is there a significant behavioral or other (including elements of dignity) difference in the minds of most people between what characterizes a "man" from a "male". Is it more understandable to most people to consider men to be considered "less physically modest" as an example compared to considering the same concept in a "male"? Remember, there does appear a difference between "man" and "male" which is characterized by the common cultural expression: "Man up!". ..Maurice.

 
At Tuesday, September 11, 2018 2:49:00 PM, Blogger A. Banterings said...

Here is a 2012 study about allowing medical students perform exams on patients. Note that intimate exams were most frequently refused and gender affected refusal rates.

Would you consent to being examined by a medical student? Western Australian general public survey



-- Banterings


 
At Tuesday, September 11, 2018 7:51:00 PM, Anonymous Anonymous said...

Female patients never ever banded together for anything. They never marched, never partook in a riot or any of the above. It was the female nurses who made steps to ensure that when they are patients they will Not be treated the way they treat their male patients. I consider every female nurse to be a hypocrite of the highest order who receives a mammogram, delivering their baby in an L&D suite, seeks a female gynecologist etc. they know full well what the gender of the care giver they seek.

PT

 
At Tuesday, September 11, 2018 10:26:00 PM, Anonymous JF said...

Never marched, no. But many females bulked about intimate care. Cried about it. Complainted to parents as kids and to their guys as adults. Parents made workers aware. Men were defensive. They plain ol got on the medical worlds NERVES! It was easier to accommodate than to put up with the annoying behaviors. I'm not sure why you're stuck on the male mammogram thing. A pelvic is much more private than breasts are and most women have been to male gyno's. Those male gyno's also do breast exams.

 
At Wednesday, September 12, 2018 8:01:00 AM, Anonymous Anonymous said...

Hello,

Suggestions for blog title:

"Promoting Modesty/ Dignity in Health Care"

or

"Advocating (or Advocates) For Modesty/ Dignity in Health Care".

Reginald

 
At Wednesday, September 12, 2018 9:19:00 AM, Blogger Biker in Vermont said...

My guess is that to a large extent healthcare did not purposely take steps to advantage female patients but rather just did it automatically as an extension of societal mores that saw females as universally being modest and needing their privacy protected.

Regardless, healthcare is trending towards being even more female-centric. I believe I read that females are currently 1/3 of practicing physicians and with 50% of medical students being female, in another generation half of all physicians will be female.

We currently see a steady stream of articles on KevinMD by a female physician or medical student outraged that women are not already 50% of the dept chairs at medical schools and in hospitals. While there is nothing wrong wanting to achieve that level of success, what is telling is the argument used almost every time that women are 50% of the population and should have equal representation. That women command 90% of nursing and tech jobs is OK with them too because medicine is gender neutral when that gets raised in the conversation. They don't see men as needing equal representation below the physician level.

It boils down to young female physicians and medical students see medicine as sexist anywhere that women are not 50% represented while at the same time seeing men as sexist if they dare complain about nursing and allied fields being 90% female.

It should be noted that when we add NP's and PA's to the "provider" mix, women are already well above the 1/3 level used in discussions that only count physicians. When physician ranks achieve 50/50 parity, "providers" will be overwhelmingly female given the flood of female NP's and PA's entering the market and functioning as if they were physicians.

The extent to which young female physicians and medical students only express concern for female staff and female patients does not bode well for male patients.

 
At Wednesday, September 12, 2018 10:47:00 AM, Blogger A. Banterings said...

I must do this in 2 parts:

Biker et al,

I will tell you exactly where discrimination against men in healthcare comes from, and that is from the McCarthy era attitudes of the Federal judicial system (IRONICALLY) from rulings on Title VII of the Civil Rights Act of 1964 (which is suppose to prevent discrimination based on sex (gender).


...Civil Rights laws that prohibit discrimination, particularly in employment, based
on race, color, religion, gender/sex, national origin, age, disability, or other protected categories.
However, embodied in these laws is an exception whereby discrimination based on otherwise
protected characteristics may be legal because the very nature of the job requires such characteristics...

...(the) explicate this exceptional doctrine, called the bona fide
occupational qualification (BFOQ) defense...

...The BFOQ health-care cases, at times called the “therapeutic” exception” (Healy v.
Southwood Psychiatric Hospital, 1996, pp. 169-70; Martin, 2012-2013; Wilhelm, 2007; Lidge,
2005, pp. 169-170)

Source: The Bona Fide Occupational Qualification (BFOQ) Defense in Employment Discrimination: A Narrow and Limited Justification Exception


The patient right to privacy:

Patients have common law privacy rights that may deserve protection."
"One who intentionally intrudes, physically or otherwise, upon
the solitude or seclusion of another or his private affairs or concerns, is
subject to liability to the other for invasion of his privacy, if the intrusion
would be highly offensive to a reasonable person." Invasion of privacy
by intrusion requires an invasion of "something secret, secluded or private
pertaining to the plaintiff."3 Patients also have a common law right
to be free from actual or threatened offensive bodily contact. The Second
Restatement of Torts provides that someone who "acts intending to
cause a[n] . ..offensive contact with [a] person . .. or an imminent
apprehension of such a contact" is liable for assault if he causes his victim
to fear an offensive contact." That person is liable for battery as well
if he also causes the contact. Courts have readily found that viewing or
touching a naked person constitutes an invasion of privacy,86 an assault
or a battery.

Source: Equal Employment and Third Party Privacy Interests: An Analytical Framework for Reconciling Competing Rights

End Part 1


-- Banterings


 
At Wednesday, September 12, 2018 10:47:00 AM, Blogger A. Banterings said...


Part 2


In Backus, a male nurse applied to work in the labor and delivery
section of the hospital's obstetrics and gynecology department. The hospital
refused his request on the ground that "the hospital 'did not employ
male R.N.'s in the OB-GYN positions because of the concern of our female
patients for privacy and personal dignity which make it impossible
for a male employee to perform the duties of this position effectively.'"...

...Between the lines of the opinion, however, lurks another form of discrimination
that the court neither examined nor justified--discrimination
against male obstetrics nurses as compared with female nurses providing
intimate services to male patients in other departments. ...

...When Title VII was enacted, widely held social norms and
stereotypes prevented women from working if they had small children at
home,' prohibited women from lifting heavy weights or working late
hours, prevented women from tending bar and banned pregnant
teachers from the classroom."' By explicitly recognizing the relevance
of social norms regarding privacy, the expanded bfoq defense invites
courts to reinstate unfounded stereotypical notions of appropriate male
and female jobs as a legitimate basis for hiring decisions. In fact, one
article has already suggested that the privacy cases provide a basis for
generally expanding the scope of the bfoq defense to accommodate
"broadly shared social norm[s]."'...


...For the past century, nurses have been predominantly
female' and doctors predominantly male. Historically, female
nurses and male doctors have treated patients of both sexes.
Community standards regarding intimate viewing or touching of one sex
by the other reflect this historical fact-female nurses may treat male
patients and male doctors may treat female patients, but male nurses
may not treat female patients.

Source: Equal Employment and Third Party Privacy Interests: An Analytical Framework for Reconciling Competing Rights


Here is the rub:

The current approach further conflicts with another of Title VII's basic
goals because it expressly maintains the status quo. Intimate contact
between an employee and a patient of the opposite sex is acceptable when
the public is accustomed to it-when females fill their traditional role as
nurses and males fill their traditional role as doctors, police officers and
prison guards. Privacy interests are asserted and prevail when men or
women attempt to break into the traditionally segregated professions.

Source: Equal Employment and Third Party Privacy Interests: An Analytical Framework for Reconciling Competing Rights

In short, if the
hospital wishes to protect the privacy interests of one class of patients, it
must provide the same level of protection to all patients to ensure equal
employment opportunity.

Source: Hays v. Potlatch Forests, Inc., 465 F.2d 1081 (8th Cir. 1972)



-- Banterings




 
At Wednesday, September 12, 2018 11:42:00 AM, Blogger A. Banterings said...

Let me expand on my previous 2 posts:

Today gender roles have changed. We have working moms with stay at home dads. Men are acknowledged as being sensitive.

Much of this has been the result of feminism.

Indeed,reverse discrimination has occurred. This is evident in healthcare as per our discussions.

To see the extent that feminism has oppressed males, look at some views that feminists have of males. Feminist Andrea Dworkin strongly implies that "all heterosexual sex is rape" in her 1987 book, "Intercourse". Radical feminist Catherine MacKinnon's work strongly implies that ALL men are rapists.

Many men take the position that feminism has created women who are abusive and evil. Psychology Today article, Why Modern Feminism Is Illogical, Unnecessary, and Evil.

Misandry, meaning hatred of men has become problematic in our society today. Note how Psychology Today labels the phrase "be a man" (man up) as misandry.

in the late 1960s and 1970s, feminism sewed the seeds for modern day misandry. In popular culture, this is best represented by Nurse Ratched (character in One Flew Over the Cuckoo's Nest), who represents the oppressive mechanization, dehumanization, and emasculation of modern society—in Bromden’s words, "the Combine".

As modern day gender rolls have changed, what society has had previously as acceptable is changing.

None of the articles mention the right of the patient to refuse. As a consumer, they have the right to refuse any provider for any reason or no reason. Title VII only requires that EMPLOYERS hire and assign employees (providers) irregardless of gender. Title VII does NOT impose on patients that they accept a provider.



-- Banterings






 
At Wednesday, September 12, 2018 12:28:00 PM, Anonymous JF said...

I think there should be stricter rules about if and when there is gonna be exposer,any unnecessary staff shouldn't be present. Patients should be informed in advance. Most of the exposure shouldn't be happening in the first place.
Glossing through the volumes, I tried to comment but my phone deleted some of my comments. RG had once asked if he could wear a pair of boxer shorts backwards for a colonoscopy and was told no. I was wondering if maybe asking might have been his mistake. Maybe he should have told them instead. He partly won though when he was allowed to wear a jockstrap.
Patients should also possibly tape record staff reactions so if and when they ridicule patients for their modesty, they can be made accountable and won't be able to lie their way out of what they have said.

 
At Wednesday, September 12, 2018 12:38:00 PM, Blogger Maurice Bernstein, M.D. said...

Great presentation Banterings!! But now what?? Does the nondiscrimination policy in the Affordable Care Act Section 1557 (description published by National Woman's Health Center April 2018) is still in effect under Trump? If so, my reading is that applies to all genders (including men). I think the approach for change, if not including the issues discussed here, should be through the political system. I am sure that those male Senators and Representatives have in their parties, members who are have the views which have been a virtual consensus on this blog thread. ..Maurice.

 
At Wednesday, September 12, 2018 2:47:00 PM, Blogger A. Banterings said...

Maurice,

That is why I said that Title VII rulings were based on McCarthy era attitudes. The ACA is a reflection of that change in attitude from society. These laws take in to account and force that change.

Example: Court Rules That Transgender Patient Tortured By Doctors Is Protected Under Obamacare

Now what?

We get lawyers and sue them for everything they have.

That will change.


-- Banterings

 
At Wednesday, September 12, 2018 8:23:00 PM, Blogger Maurice Bernstein, M.D. said...

By the way, I don't think I ever mentioned on this thread another way to "speak up" to a part of a hospital's current functioning which may lead to some changes in that hospital's behavior toward patients. And that is for the patient to request an ethics committee consultation. For more about the potential responsibility and function of a hospital ethic committee, read the thread with Comments there on the topic "Should the Role of a Hospital Ethics Committee be that of a Patient's Advocate?"
As a current hospital ethics committee member and former chairperson of ethics committees of two hospitals I understand the current function of such committees related to issues (certainly related to patient dignity is one). Read the thread and responses and return and give your view here. I think this may add something to our general discussion here.

..Maurice.

 
At Thursday, September 13, 2018 7:54:00 AM, Blogger A. Banterings said...

Maurice,

As AM pointed out, we have the American values of individualism and autonomy (which is the basis of the foundation of our country). In recent time, the medical ethical principle of justice has been "bastardized" to justify socialist views that have crept into liberal politics (the basis of the ACA).

If we go back to the foundation of medical ethics, Hippocratic Oath (c. 400 BC), we find that the duty of the physician is to the patient as an individual. There is no mention of society (other than not sharing medical knowledge with society).

The basis of ethics developed over time and come from a variety of sources (mainly):

-The influence of religious writing and interpretations.
-The influence of philosophical thought.
- The influence of community (societal) values.



The American values of individualism and autonomy are largely ignored by medicine, until recently. This manifested itself in paternalism.

Paternalism has been justified by the principle of beneficence. Ethically, the American values of individualism and autonomy trump beneficence. Our society recognizes the right of the individual to make bad choices. This is most evident in the gun control debate: the US Constitution guarantees freedom, it does not guarantee SAFETY.

Society had enough with the paternalistic COUNTERCULTURE of medicine, hence the move to patient centered care. If medicine was a truly ethical profession, we would not have had a shift to patient centered care, Dr. Joseph Mengele, Tuskegee, Justina Pelletier and Alyssa Gilderhus, or PEs on anesthetized women without consent in 2018.

Medical ethics (in practice) is just a means to confuse the patient and justify paternalism.



-- Banterings







 
At Thursday, September 13, 2018 12:31:00 PM, Blogger BJTNT said...

The following four refer to the same article:

The basis of ethics developed over time and come from a variety of sources (mainly):

-The influence of religious writing and interpretations.
-The influence of philosophical thought.
- The influence of community (societal) values.

Not to mention the following typo [2102]:

Blog posted by Steven Mintz, aka Ethics Sage, on April 12, 21

BJTNT

 
At Thursday, September 13, 2018 2:51:00 PM, Blogger NTT said...

Good Afternoon:

Banterings, you are saying;

“In short, if the hospital wishes to protect the privacy interests of one class of patients, it must provide the same level of protection to all patients to ensure equal employment opportunity.”

Correct me if I’m wrong.

Medical institutions that hire females in Mammography, & L&D to care for their female patients, must by law, hire or reallocate male personnel to areas such as urology to protect the privacy and care for male patients that want them or they’re in violation of the BFOQ hiring exception.

1. What if they’re not using the exception to do the hiring? They just tell the court we’re hiring females because there are no males available.

2. Where would one find out if someone is using a BFOQ exception to do the hiring? I wouldn’t expect them to just tell anyone who calls & asks.

Getting lawyers & suing the pants off everyone sounds like a good idea but, I don’t think any lawyer will take up the cause anytime soon due to the time, effort, and cost it will take.

What might be a better way that could yield results would be a writing campaign.

Also, another way would be if those with facebook accounts can show without a doubt they are discriminating and how they are doing it, put it out on social media & get more everyday people talking about it. Let other men out there know, they’re not alone & can speak up. Or maybe something like #PatientDignity on twitter.

Any campaign has to acknowledge that there are men that prefer opposite gender care and that is their right & this isn’t about taking that right away from them. I get that a lot when talking about same gender care to other guys. We need to avoid looking like we want all guys to have same gender care regardless.

If the buffoons in congress along with maybe the Dept. of Health & Human Svcs. were to get letters from men from all over the country showing them in writing how healthcare discriminates against men and telling them we want changes or congress can start looking for new jobs maybe, we can make people sit up & listen.

If the medical community is circumventing hiring practices at the cost of male patients, the public has a right to know & demand congress for transparency on the entire community.

We have a duty to ourselves, or dads, granddads, sons, and grandsons to put an end to this crap here and now so no one has to go thru this nightmare ever again.

Let’s start talking, until we lose our voices and writing, until our fingers hurt.

Time to be the guys that said here and now enough is enough. Change the laws or move out of the way for those that can & will.

Regards,
NTT

 
At Thursday, September 13, 2018 10:00:00 PM, Blogger A. Banterings said...

NTT,

What the 1950s era of judicial thought is saying is that women are the weaker sex, so they need special protection (especially id G&O and L&D). Traditionally, men and women accept care (including intimate care) from male physicians and female nurses, therefore because society GENERALLY accepts care from same and opposite sexes, therefore nondiscrimination in employment is a greater good personal dignity and autonomy by patient choice of the gender of providers.

It could be argued that such conduct is not tortious because conflicting
social goals favoring equal employment opportunity for men outweigh
patients' common law privacy rights.94 Patients' inconsistent preferences
regarding treatment by opposite sex health professionals95 may suggest
that their concern for privacy is not very strong. Alternatively, their
preferences, although grounded in traditional role expectations, may
nonetheless be strong and entitled to protection. Case law reveals that
although hospitals assert patients' privacy rights in equal employment
cases, patients who litigate complaints regarding intimate viewing or
touching associated with health care invariably complain about the professional
status of the actor, not the actor's sex. 96 The absence of litigation
by patients regarding the sex of their health practitioner may mean
that medical personnel ordinarily respect privacy objections to treatment
or it may mean that patients are not litigious regarding their privacy
rights. 97 If so, the absence of complaints proves nothing regarding the
legitimacy of patient privacy concerns. Alternatively, it may mean that
patients do not object to treatment by medical personnel of the opposite
sex as long as they are qualified professionals.98 If so, the concern for
patient privacy is unfounded.


(Source: Equal Employment and Third Party Privacy Interests: An Analytical Framework for Reconciling Competing Rights)


An older but still valid case law authority is the federal district court decision of Fesel v.
Masonic Home of Delaware, Inc. (1978) where the court upheld precluding a male nurse’s aide
from working in a retirement home where 22 of the 30 guests were female. The court based its
decision sustaining the BFOQ on the testimony of several residents and an expert witness who
persuaded the court that many of the female residents would not consent to be taken care of by a
male (Fesel v. Masonic Home of Delaware, Inc., 1978, p. 1353). Accordingly, the court
concluded that the employer had a factual belief that the hiring of male nurse’s aides would
undermine the essence of its business (Fesel v. Masonic Home of Delaware, Inc., 1978, p. 1353).
Another case illustration is the Third Circuit Court of Appeals case of Healy v. Southwood
Psychiatric Hospital (1996), where the court upheld a BFOQ assigning only females as childcare
specialists positions for female children because women were better role models for girls and
because it would be easier for a child who had been sexually abused to discuss her problems with
a female healthcare worker (pp. 132-33). The court explained that the “therapeutic mission” of
the employer necessitated the gender-based assignments and thus the BFOQ (Healy v.
Southwood Psychiatric Hospital (1996, p.133)...

(Source: The Bona Fide Occupational Qualification (BFOQ) Defense in Employment Discrimination: A Narrow and Limited Justification Exception


Still, patients do not have to accept opposite sex care. There are consumer laws that protect patients.




-- Banterings



 
At Friday, September 14, 2018 4:37:00 AM, Blogger Biker in Vermont said...

I don't understand on what basis a court would rule in favor of any man who wanted same gender intimate care in a hospital setting.

Courts have consistently ruled against men who have made privacy based complaints in prison and halfway house type settings. Courts ruled in favor of allowing women in men's locker rooms. My understanding is that teenage boys in juvenile detention type settings cannot even demand same gender supervision dressing & showering. That section 1557 of the ACA that Dr. Bernstein noted is mostly speaking to protecting the interests of women and transgenders.

Though schools allow kids to get sports physicals at their own doctor's office, boys that don't have insurance or the means to do private pay do not have the right to demand same-gender staffing for their genital exams that will be done by staffing the schools provide, usually a female NP & female MA is my guess.

DOT direct observation urine sampling is the only place I am aware of that guarantees men same gender staffing.

In theory a lawsuit could change things but how would a case get built to actually convince a court that males are the equal of females when it comes to intimate privacy?

 
At Friday, September 14, 2018 5:31:00 AM, Anonymous JF said...

I tried to post last night but my phone just wouldn't cooperate. This is in response to something NTT said.
NTT said something about suing the pants off of doctors/medical staff but that likely no one would take the case. So they pretty much rules out just hiring a lawyer.
Maybe then we should actually financially help someone become a lawyer who will agree to help us with this issue.
Preferably someone who has put time and money into becoming a lawyer , but is in real danger of not being able to because of money. He/she would need to have the ability to argue well. A LOT of what has been said on this blog, has been well said. I realize that males have it worse, but it's not just males who are humiliated. Plus we women can make testimony about the harm husbands and fathers.

 
At Friday, September 14, 2018 9:37:00 AM, Blogger A. Banterings said...

NTT, JF, et al,

What we need to do is lay out the means as which patients can bring legal action over violations of dignity. The problem with most applicant attorneys is that they are use to the routine. If a surgeon leaves his watch in you, that is malpractice.

We have to teach them how violations of dignity lead to PTSD, anxiety, avoidance of care, etc. Lawyers (like most of the public) probably accept less than dignified medical care as a fact of life, unaware that they have options. Of course, being a liability attorney, they are guaranteed VIP treatment.

This guide would also serve as a model for PREVENTION of dignity violations for facilities and providers who want to do the right thing.

Anyone who wants to contribute can contact Maurice for my email, or get it from my blogger profile.

What I need most are legal foundations to allow patients to pursue these violations either civilly OR criminally.

The first example I just gave is PTSD as a adverse side effect.

Once we have created this publication, I will get it in the hands of the appropriate lawyers.



-- Banterings



 
At Friday, September 14, 2018 10:10:00 AM, Blogger A. Banterings said...

Now for my weekly round up of how healthcare supports patient dignity:

Employee Sues Hospital ‘Taking Photographs Of Her Naked’

Hospital Fires Medics Twerking Beside Naked Unconscious Patient

Interestingly enough, in this article it is stated:

In the operating room, particularly, law, ethics and concern for patient are important considerations of the operating team. Online Journal of Health Ethics mentions that the problems of apathy, carelessness and indifference in the operating room may prove to be a larger barrier to achievement of sound ethical practices in the operating room.


An oldie (2006) but goodie (from the UK): Patients tell naked truth about mixed-sex wards

Late-night Santa Cruz hospital discharge of nearly-naked homeless man riles community

FIVE HOSPITAL EMPLOYEES FIRED AFTER DANCING AROUND NAKED PATIENT [VIDEO]

Finally, here is a really GREAT solution!!!

ALL PROVIDERS SHOULD BE NAKED IN HOSPITAL SETTINGS FOR INFECTION CONTROL!

Not just the ER, but EVERYWHERE!

It is OK, after all they are trained to deal with a naked, nonsexual manner.

How surgeons can stop the spread of germs by operating NAKED instead of wearing surgical gowns

This is MODERN SCIENCE, from 2017.




-- Banterings






 
At Friday, September 14, 2018 3:40:00 PM, Anonymous JF said...

I'm still stuck on the idea of us helping somebody become a lawyer for the purpose of advocating our cause.
The laws are in place already , but humiliated people generally just go away with their tails between their legs which makes it easy to victimize us.
Our lawyer could start out railing against unethical billing practices. A lot of people would show up for something like that. It also is a valid concern and needs adjusting.
Once people assemble to listen and to have their turn to speak, it could be asked of the ladies if they know of men who adamantly refuse healthcare. Not just men of course but I think you know where this is leading. To sue for not having male nurses and male CNA's it would need to be proved that the males were applying for the job and being turned away.

 
At Friday, September 14, 2018 4:41:00 PM, Blogger NTT said...

Good evening.

From General Surgery News.

In the OR, a Cell Phone Attached to the Hip Is the Norm.

https://www.generalsurgerynews.com/In-the-News/Article/08-18/In-the-OR-a-Cell-Phone-Attached-to-the-Hip-Is-the-Norm/52377?sub=E84CB45B51C22A9B27C8E433A02ADCC95C914BC5C69C616EF17E26D8DFB&enl=true

Regards,
NTT

 
At Friday, September 14, 2018 9:43:00 PM, Anonymous Anonymous said...

NTT

The article from general surgery news is incorrect, misleading and a downright lie. Cell phones are not on the hips of staff, the cell phones are in their hands while the patient is being prepped, during surgery etc. At outpatient surgery centers I’ve seen three people at once with their cell phones while patients are being exposed and prepped. Nobody wears them on their hips, you really can’t with those scrubs, the cell phones are in their pockets.

Now, I can just hear the pundits discounting everything that’s being said and on this blog. Pundits don’t like to be discounted because it makes them appear unprofessional. They don’t like being told to put their phones away and they don’t like to be called out for being unprofessional. Do you think the medical community searches on the internet for instances like the Denver 5 and how many people outside of a small town in New Mexico have ever heard of Dr Sparks.

The thought aspect of the probability of unprofessional behavior far outweigh any concerns of any modesty issues people have. It is the fear that you will be treated unprofessionally and unethically but a) not knowing how to deal with it and b) knowing the probability is rather high. This is what I find disturbing is that those who work in hospitals, directors and administrators simply turn a blind eye to it all. Nurses dont complain about it unless they have absolutely something to gain when they drive that knife deep into the back of another nurse. It’s called nurse bullying, not advocating for the patient.

They all wear that killer clown smile but just under the surface resides someone that hates their job, someone who is very judge mental of patients and will only advocate from a privacy standpoint for female patients. It extremely disturbing that when the article about Dr Sparks was posted on allnurses some of the bloggers thought it was a joke, yet the news about Dr Nassar broke the man was guilty from the getgo. You don’t have to be a rocket scientist to see through the lies and the hate and how it’s filtered, the discrimination.

PT

 
At Friday, September 14, 2018 9:58:00 PM, Blogger Maurice Bernstein, M.D. said...

Of interest relative to the discussions here is a current rather detailed paper regarding the use of smartphones in a hospital environment. ..Maurice.

 
At Saturday, September 15, 2018 3:16:00 AM, Blogger NTT said...

Good Morning Ladies & Gentlemen:

PT I agree with you on the phone.

I've been writing the buffoons in congress that the phones must be taken out of the hands of all healthcare workers during their shift. If healthcare employers what communication available to employees they should supply camera-less cellphones or Motorola radios.

It's time that the needs of the patient start taking front & center stage in healthcare.

Camera phones are detrimental to the safety of all patients therefore, they should be banned in all medical facilities in the country.

Stay safe & have a great weekend all.

Regards,
NTT

 
At Saturday, September 15, 2018 2:14:00 PM, Anonymous Anonymous said...

The practice of radiology involves intimate exams/procedures of course. Here is a very easy to read set of policies regarding intimate exams and chaperones by the UK Society of Radiography (applies to the practice of radiology in the NHS). I would urge all to read each section (Intimate exams, Chaperones, Students).

You will learn that in the UK you can have your rad provider(s) of the gender you feel comfortable with, you can have a chaperone of the same gender if you wish, and you can reschedule, without judgement if the gender you request is not available, you will be informed about students & their gender and of course can refuse.

So it seems the UK is WAY ahead of the US in this regard. That is, by comparison the US medical system artificially constrains services by gender, and adheres to a discriminatory system.

https://www.sor.org/learning/document-library/intimate-examinations-and-chaperone-policy/1-introduction-0

Also this document, like so many in the US, mentions “‘Intimate examinations can be embarrassing or distressing for patients”. So why does the US medical industry, including most private physician offices, refuse to address this for patients?

fyi. — AB in NW

 
At Saturday, September 15, 2018 4:17:00 PM, Anonymous Anonymous said...

AB in NW

Here are the exams in Medical imaging that would be considered intimate

MRI———-None

Ultrasound ————-Breast, Scrotal

CT——————rectal contrast if requested by provider, Fine needle guidance under Cat Scan for pelvic region

Nuclear medicine—— Treadmill Stress cardiogram for chest lead placement

X-Ray———-Barium enema, Voiding cysto urethrogram, cystogram

The rectal contrast given during a Barium enema and the rectal contrast during a CT (if requested by provider) can be inserted by yourself.

A Cystogram and a voiding cysto urethrogram require a Foley catheter. The foley is placed by the radiology nurse which is always a female, therefore request a male nurse from the ER for placement.

Of course, the UK is far ahead of the US in progressive thinking, however, here in the US we spend $4 Trillion and it’s increasing every year, where it stops nobody knows.

PT

 
At Saturday, September 15, 2018 10:12:00 PM, Blogger Maurice Bernstein, M.D. said...

Shouldn't in all cases of "intimate" exam or procedure, it should be the patient's (him or herself), if possible, always weigh the emotional impact of the intimacy with the potential personal medical benefit of what is being carried out? Can a potential high benefit temper any feelings of indignity even if one cannot obtain the comfortable gender of the individual performing the clinical action? Or is a patient'a modesty within dignity so absolute and fixed that it would trump any potential beneficence (producing a clinical "good") for the final clinical outcome?

Another way of asking: is a person's dignity permanently set and not related at all to the patient's potential personally beneficial outcome being attempted to be achieved by those who are attending the patient> Can the patient's definition of "dignity" be modifiable related to circumstance? Or should patient dignity and modesty be considered under all circumstances as a "fixed" component of each human? ..Maurice.

 
At Sunday, September 16, 2018 8:22:00 AM, Anonymous Anonymous said...

Maurice

You have posed this question before yet most of the time it’s applicable to only one gender. I’m sure to many it’s not worth it as I’m referring to those who refuse to seek treatment at all and that is one of healthcare’s biggest failures. Advocacy starts at the front door and advocacy should never be limited to just one gender. I fall into that group who basically will refuse to seek treatment until perhaps it’s too late to seek treatment at all. Every patient is given a treatment option and with that it’s assumed that standards of care will be followed but as far as genders are concerned that is where it ends. Your questions assume this is a perfect world and on the assumption that all patients Will be treated professionally and ethically. When those go out the window there is no barometer that’s going to give you the answers.

PT

 
At Sunday, September 16, 2018 11:48:00 AM, Blogger Maurice Bernstein, M.D. said...

PT, I may be repeating this issue because I have never heard it before in my own internal medicine practice. As I stated from the very beginning of this thread I have never had a response by any of my patients regarding modesty issues either related to my practice or to the experiences in disorder diagnosis and treatment by previous physicians. Never. Never. And that is why I started calling those who were telling their stories of modesty distress here statistical outliers.
I have modified that view after further reading over the years and acknowledging the news stories (stories which should upset all potential patients).

Yes, patients have complained of timing, costs, discomforts of therapy and other experiences going on at the time but never physical modesty issues. I have explained to female patients about the presence of a female chaperone during pelvic exam and I don't recall any upset or rejection.

So here I was in 2005 with the published article by Dr. Gawande oriented primarily about the female modesty in medicine in other cultures and how they were managed and the need for rules in our Western culture. So the responses to my blog thread "Patient Modesty" was an unusual educational experience even though I was regularly teaching students the need to attend to patient concerns regarding modesty, the stories here were still very surprising.

Anyway, that is my rationale for my persistence of trying to put the patient into a position of participation in the decision of personal emotions from modesty vs diagnosis and curing of the disease.
..Maurice.

 
At Sunday, September 16, 2018 12:52:00 PM, Blogger NTT said...

Good Afternoon Everyone:

AB in NW spoke about "Intimate examinations can be embarrassing or distressing for patients”. So why does the US medical industry, including most private physician offices, refuse to address this for patients?"

They won't address it because it will cost them money which they don't want taken out of their pockets.

Also, earlier in the blog Biker spoke about how "Courts have consistently ruled against men"

He is definitely correct. The criminal justice system in this country needs to go back to school & learn what "Equal Protection Under The Law" really means.

Our male children are still being violated every day in this country by female teachers. Unless it happens in Texas, the female predator gets off with probation.

If it happens in Texas, they do it right & put the woman away in prison where they belong.

The courts need to wake up and start treating both sexes equally on these types of issues.

One way to wake them up is prosecutors and judges are elected officials. If they aren't going to treat the sexes equally, maybe they don't need to be in office.

Your vote is a powerful tool one can use to derail the train & reshape the future.

Think about it.

Regards,
NTT

 
At Sunday, September 16, 2018 4:40:00 PM, Anonymous JF said...

Dr B, It's not possible for a woman to give birth and leave her undershorts on , but huge amounts of intimate care shouldn't be happening at all.
Another huge amount that DOES need done could and should be done with less people seeing and attending. Some the patient could do for themselves.
There is one certain thing that EO said that I agree with. Modesty violations are sexual abuse. That being said I know it would never hold up in court. I also acknowledge that many times their is no sexual motivation on the healthcare givers part.
I remember my grandmother talking about when my grandfather was having dentures made , he was made to completely undress and he really didn't want to. It was in front a a female.
How was that ok? It WASN'T. That's how!

 
At Sunday, September 16, 2018 6:14:00 PM, Anonymous Anonymous said...

Dr. Bernstein said “I have never had a response by any of my patients regarding modesty issues…” & “I have explained to female patients about the presence of a female chaperone during pelvic exams & I don’t recall any upset or rejection”.

How about the situation males encounter almost universally, one (or more) of the opposite gender in attendance for the intimate exam? Did you, Dr. B, ever employ a male MA, nurse or use male staff as a chaperone and do a pelvic exam with yourself & the male chaperone in attendance? (as an aside, if not, why not?) How about adding a third male in the room observing (maybe another MA, or nurse or a medical student?)

That is the situation that many males face and I suspect MANY patients of either gender would find a level of uncomfortableness & modesty when confronted with two or more of the gender not expected in attendance & just watching their intimate exam. Remember, the patient willingly chooses the gender of their physician. They had no issue with you being a male, they made the appointment with YOU. So you’ve selected already for those comfortable with YOU. But what about when you bring in more people to watch of a gender that they don’t expect?

An extension is the patient who is comfortable with their physicians gender but than gets referred for intimate tests in the office, by staff they do not know, nor know the gender of, nor know how many will be in attendance at this intimate test. Again, that happens to male patients frequently - rarely are female patients “ambushed” by a room full of male staff for an intimate exam/test by the design in the US medical system.

In addition, this line of thinking that you never saw it so it must be an outlier is faulty and has no statistical basis. Think about the “MeToo” movement that ONLY RECENTLY began. Women who were assaulted years ago, could not speak up or complain for years, are now telling their stories. For any single provider to conclude there were no issues because they weren’t acknowledged at the moment of the intimate exam/test is foolish. Medicine must be better than this. — AB in NW

 
At Sunday, September 16, 2018 6:51:00 PM, Anonymous JF said...

Because they are getting enough of what they want and need WITHOUT addressing this issue for parents.

 
At Sunday, September 16, 2018 7:35:00 PM, Anonymous Anonymous said...

What AB in NW has described is only chapter one of many chapters male patient’s face once they enter the health care arena. It seems that people are figuring ways of presenting themselves into the exam room with the physician and the patient. I’ve seen the physician’s secretary, medical assistant barge in. It probably would not be cool but I’d like to say “ thanks for invading my privacy, now get the fu&k out.”. Now you have scribes in the equation which in my opinion considering voice recognition transcription makes absolutely no financial sense. What would happen if during a Pap smear,on-gyn exam or breast a male walked in on the exam. I can you you exactly what would happen, that female patient would no longer return.

PT

 
At Sunday, September 16, 2018 8:33:00 PM, Blogger Maurice Bernstein, M.D. said...

To alleged "AB in NW" posting: I never had a male nurse or male staff and thus never had a male chaperone or any male in the room when performing a pelvic exam. I never had any "shadowers" during a male or female genital exam or others in the room during history taking or physical exam. I retired from active medical practice 18 years ago. I do see a few patients a month in a "free clinic". I do have a male interpreter assigned because of non-English speaking Hispanic patients as the main population of the clinic. However, he will leave and I will obtain a female interpreter if the patient desires.

By the way, I really would appreciate more regular commenters to sign in via Blogger.com similar to JF and Biker et al. This will help the reader verify the validity of the author. ..Maurice.

 
At Sunday, September 16, 2018 9:04:00 PM, Blogger Maurice Bernstein, M.D. said...

Now back to the supporting of the use of "dignity" in the revised title of this blog thread.

I read an article in the American Journal of Bioethics 13(8) 2013 titled "Treating Patients as Persons: A Capabilities Approach to Support Delivery of Person-Centered Care"
This article supports the concept of looking at patients not as a disease or a target of treatment but as a human with multifaceted components of "dignity" and each and every one of these facets must be understood and accepted.

From the article:
If health services and staff are to recognize and cultivate patients’ capabilities to experience inclusion in the community of ethically significant human beings, they must bestow on them the status of people who matter. This will involve interacting with them in ways that signal they are valued and given due consideration (not, for example, left unacknowledged in waiting rooms or on hospital beds, and, in Kantian terms, not treated as means to policy or service ends). This requirement can obviously be associated with the notion of respect that features strongly in many existing definitions and discussions of person-centered care.


My impression is that in the height of managing numbers of patients, there is a behavior of potentially everyone involved in care and treatment and even administration to look at each patient as a disease to be treated and matters of patient dignity is, in keeping with "goals", is overlooked or frankly ignored. And this is the way patient modesty becomes a trivial issue and a hindrance to satisfactory completion of those diagnostic and therapeutic goals and the moving on to the next patient. I agree that these days the medical system's attention to patient dignity is more easily overlooked than in the past since other goals are more pressing. And this, as suggested in the article, must be reconsidered and reversed. ..Maurice.

 
At Sunday, September 16, 2018 10:17:00 PM, Anonymous JF said...

I heard of a guy accidentally walking in on a woman getting a pelvic exam. He told his doctor about it afterwards and his doctor laughed.

 
At Monday, September 17, 2018 2:14:00 AM, Anonymous Anonymous said...

Maurice

It is your impression based on managing numbers of patients? That has never been my perception. In that regards how due you factor in the unprofessional behavior such as Dr. Sparks or the Denver 5. Apparently, they were not busy enough managing numbers of patients otherwise they would not have spent so much time being unprofessional.

PT

 
At Monday, September 17, 2018 11:25:00 AM, Blogger A. Banterings said...

I must do this in 2 parts:

Maurice,

In regards to your statement:

As I stated from the very beginning of this thread I have never had a response by any of my patients regarding modesty issues either related to my practice or to the experiences in disorder diagnosis and treatment by previous physicians.


If you came to me as a client, this is exactly how I would handle it. I do not expect you to answer the questions (publicly), but feel free to only if you are comfortable doing so. Some questions you are NOT going to be able to answer immediately (even if you wanted to). This is NOT intended to be judgmental of you, your practice, or your skills as a physician. This is to aide you in seeing that you may not realize that you have unknowingly) experienced this. If you would like to pursue this line of thought with me privately (for your own edification), feel free to contact me offline. (Everything will be in the strictest confidence.)

First, let me ask about your practice.

- Were you the sole physician or was it a group?
- How many people were at the practice and what were their roles?

What was the profile of your practice?

- Was the practice known to handle special or difficult cases?
- Was there a waiting list to become a patient?
- Was there something special such as admitting privileges/affiliation with a certain hospital or network, OR some other special notoriety?
- Was there something unique about the services or range of services offered?
- What was the demographic make up of the patients? Was there some unique common traits (such as referrals from friends or colleagues)?

This is meant to give me some insight as to the trade offs people are willing to make. It is NOT really a a trade off of dignity for care, it is a matter of trust. If one has great trust in a physician, then although there may be some embarrassment, they feel safe, even in that embarrassment. When people are untrusting OR even neutral (no opinion) in their trust, they feel MORE vulnerable and MORE embarrassed.

To have those concerns swept aside with "there is no modesty here," "this is how we have always done things," or "I am a professional," OR to insist on those procedures (including justifying it as necessary), does NOTHING to build trust, it actually will erode trust.

Next, I will ask about intimate exams.

- Were intimate exams mandatory as part of an annual physical exam (so the practice can cover all organ systems for a full reimbursement)?
- Were patients pressured into them (such as we can't refill your anxiety meds because you have not had your annual exam or annual pelvic exam)?
- Did any patients ever refuse these exams?
- How were patients who refused treated (were they dismissed because they APPEARED not interested in maintaining their health)?
- Did the practice require PEs for oral contraceptives?
- What was the procedure for an annual exam (history while patient fully dressed, gowns utilized, patients only in underwear or naked, etc.)?
- Were there ever any "old school" patients that preferred (or at least didn't mind) being naked for the entire exam?
- What was the policy for new patients (was a comprehensive PE required)?



-- Banterings




 
At Monday, September 17, 2018 11:26:00 AM, Blogger A. Banterings said...

Part 2


The next important issue is others in the exam room.

- What was the chaperone policy and how was it used?
- What instances provided for someone other than the physician and patient to be the only people in the exam room?
- Who were the others in the exam room?
- How was it discussed (if it even was) with the patient about others in the exam room?

Please note that 18 years ago there were VERY DIFFERENT practices in healthcare in terms of respecting patient dignity, This is NOT a critique of how the practice addressed patient dignity, but simply truthfully explaining SOPs.

Finally, here is the tell; Did the practice ever follow up with patients who left the practice or never returned? Take all the patients who left the practice and this would need be stratified and cross referenced by:

- Those who never returned after a first appointment.
- Those who left within a year of a first appointment.
- Those who never returned after an intimate exam/procedure.
- Gender of provider and gender of patient.
- Those with some notice or reason of leaving the practice given or received and those who gave no notice or reason.


Just as seen with Athena Health [Some male patients may prefer male doctors, research shows" (athenaInsight)
], patients did NOT give explicit reason of gender or dignity, but it was interpreted in the trend in patients who did not return after a first appointment.

Athena Health has further recognized the issue of additional people in the exam room. [Why male patients may not want medical chaperones" (athenaInsight)]

If you ever had a patient express ANY DISCOMFORT about an intimate exam/procedure, that may be an unrecognized disclosure. Saying "is this necessary," "do we really have to do this," etc., especially for preventive exams is VERY TELLING of discomfort. Just because a patient allowed a procedure/exam, did NOT speak up about it, and returned does NOT mean that it was NOT traumatic for them or it did NOT cause permanent damage.

What this DOES mean is that the provider or staff may NOT have recognized the patient's complaint.



-- Banterings






 
At Monday, September 17, 2018 8:41:00 PM, Blogger Maurice Bernstein, M.D. said...

Banterings, a host of interesting but also questions of value in the evaluation of any office doctor-patient relationship. I can't answer all your questions, in part because I don't remember... having completing office practice 28 years ago and clinic practice 18 years ago. I can tell you that pelvic exams were never routine as part of a general physical exam and as I previously noted only female chaperones were utilized. On male patients, no one in the exam room beyond me and the male patient. This was true in both private and clinic practice. I always informed patients before genital exam but was anticipatory to explain and attentive of any discomfort which the patient expressed.

I don't recall any impaired relationship with a patient or family and I never experienced a law suit in all my over 25 years of practice.

I always looked at patients as humans and not as a disease and that has continued in my teaching of first and second year medical students.

Times with increased patient load have changed in active medical practice and it does appear what has been written here and in the literature that some changes have been "hurtful" in various ways to more patients than I was aware of when I was in active practice. ..Maurice.

 
At Tuesday, September 18, 2018 9:46:00 AM, Anonymous JF said...

In all fairness, not all intimate care is traumatizing for everybody. Sometimes I have breezed through it and wasn't upset. I'm reasonably sure the same is true for many others. Even an extra staff person being in the room isn't upsetting to me so long as I'm not being exposed to her. That being said I don't buy for one second that she is their for my benifit. My benifit doesn't factor in at all unless I have been asked. That has never happened though.

 
At Tuesday, September 18, 2018 1:23:00 PM, Blogger A. Banterings said...

Due to length, I must do this in 3 parts:

Maurice,

Not having any lawsuits in 25 years of practice is testament to the humanity that you brought to your practice. I like your style. My primary is "old school" like you, and that is why I have chosen him as my primary. He has never pushed any intimate exam, but offered a couple. The only one that he ever did was at MY request. Never any coercion either, therefore I would never feel violated with him.

I imagine that you are very much like him, and not having had any lawsuits, and you "old school" style, I find it plausible that your patients never experienced dignity violations with you.

I reread your first paragraph and disagree with you that patient autonomy IS an issue with patient dignity. Just as with all services, patients can choose the level of care they wish to receive. Cell phones are a great example; do you want the 10Gb a month plan or the unlimited? Women may choose a separate provider for gynecological care. Then we have all the specialists. There is no reason that a patient (sans a genital complaint) EVER needs a genital exam.

Even in the ED in emergent situations, a patient's wishes can be respected. The case of Brian Persaud and NY Presbyterian Hospital show this with the PR (rectal exam). When examined, the science (in TRAUMA) found that it did more harm than good. Situations where the providers had to "wrestle" the patient to perform (potentially doing more harm if the patient indeed has a spinal injury), it should have been a no-brainer for people who remind the public of how educated they are...

Maurice, you are an outlier then.

I actually feel bad because I think how could a physician NOT have experienced this (which is so pervasive in healthcare today).


Healthcare has become so synonymous with dehumanization, I could not recognize a humanistic provider. For that, I sincerely apologize.

The problem today is how healthcare is delivered. Healthcare has been industrialized. What is produced is no longer the work of artisans, but of assembly lines. That is true of the automobile industry, farming (agriculture), and (even) art is assembly lined (think lithographs of paintings or concrete yard statues).

I remember a time when a primary would do sutures (stitches), blood draws, inoculations, and the like in their office.

The film, Modern Times (Charles Chaplin, 1936) was one of the early exposes on how industrialization dehumanizes. An even earlier herald of this was Metropolis (1927).

"Metropolis" and "Modern Times" are both among the 45 films on the 1995 Vatican film list published by the Pontifical Council for Social Communications in honor of the centenary of the motion picture.



-- Banterings


End part 1

 
At Tuesday, September 18, 2018 1:24:00 PM, Blogger A. Banterings said...

Part 2

Note: this is an excellent article referenced. It is however ironic that this ethical think tank is associated with Carnegie who brought us the AMA.


In a world in which economic factors are given priority over ethical considerations in decision-making, humans lose their dignity. Economic forces, left unchecked by ethics, dehumanize through a strange inversion: economic entities gain autonomy while humans lose theirs. Corporations become people while people become reduced to only their economic roles as workers, consumers, or investors...

...More complex are dehumanizing practices that may aid care. Diagnosis and treatment might necessitate “mechanization”—breaking the body into organs and systems. Scaling back empathy can diminish staff stress and burnout. Even moral disengagement can be adaptive. From giving a shot to slicing into the flesh to perform surgery, medical care often requires inflicting pain or invading the boundaries of the body in violation of deeply held human taboos. And patients may die after even the best of care. For the professional, guilt could be paralyzing.

Still, the authors argue, dehumanization is useful only in “specific contexts,” such as acute care. Waytz says, “Dehumanization’s functionality varies wildly across specialities from pediatrics to orthopedic surgery, so future research is needed to determine when dehumanization is most prevalent and most detrimental.” In the meantime, the authors offer numerous humanizing fixes: Call patients by name, not numbers; discourage labeling people as diseases; personalize hospital rounds and pre-surgical preparation; eliminate opaque surgical masks; affix photos to CT scans and biopsies. Include patients in care planning. Let them choose their gowns—and design those gowns so they’re no so humiliating. Increase physician diversity and hire people with good social skills. And, for med schools, perhaps most radical: Eliminate the “white-coat ceremony” when graduates don the mufti of the elect...



Dehumanization is endemic in medicine:

"Anyone who has been admitted into a hospital or undergone a procedure, even if cared for in the most appropriate way, can feel as though they were treated like an animal or object," says Harvard University psychologist and physician Omar Sultan Haque. Health care workers enter their professions to help people; research shows that empathic, humane care improves outcomes. Yet dehumanization is endemic.


The defacto article about dehumanization in medicine is Dehumanization in Medicine Causes, Solutions, and Functions

...The control and power afforded to doctors in this relationship constitute a major determinant of dehumanization—mastery—which can then facilitate dehumanization of patients (Lammers & Gast, 2010; Lammers & Stapel, 2011)...


-- Banterings


End part 2

 
At Tuesday, September 18, 2018 1:24:00 PM, Blogger A. Banterings said...

Part 3

Finally, the paper Dehumanization in Medicine Causes, Solutions, and Functions supports my assertion that medical school "kills the conscience" and creates sociopaths:

...Recent research on the brain functioning of medical professionals sheds light on these matters. Specifically, two experiments have examined the neuroscientific basis of pain empathy in physicians versus nonphysicians (Cheng et al., 2007; Decety, Yang, & Cheng, 2010). Physicians who practice acupuncture (as well as matched nonphysician controls) underwent functional magnetic resonance imaging (fMRI) while watching videos of needles being inserted into another person’s body parts, as well as videos of the same areas being touched by a cotton bud (Cheng et al., 2007). Physicians showed significantly less activation in brain areas involved in empathy for pain (anterior cingulate cortex, anterior insular cortex, periaqueductal gray) than did nonphysicians...

This finding raised further questions about the nature of physicians’ empathy. Perceiving pain in others typically involves two steps. First, people engage in emotional sharing of another person’s pain and then cognitively reappraise this emotion (Decety, 2011; Fan & Han, 2008; Han, Fan, & Mao, 2008)...

Physicians’ decreased empathy for pain has multiple causes that likely stem from medical training itself... Specifically, by dampening pain empathy, one also dampens feelings of unpleasantness that arise from perceiving others’ pain...

During medical school, students report being the most empathic during the first 2 years of school, but report empathy declines as soon as significant patient contact occurs in the 3rd year of training, persisting for the final clinical year of school (Hojat et al., 2009). A systematic review of 18 longitudinal and cross-sectional studies on changes in empathy over time in medical students and residents demonstrated that empathy decreases as education and training increases, especially as training becomes clinical and requires more direct patient interaction (Neumann et al., 2011). This reduction of empathy likely directly contributes to increased dehumanization...

...Countless medical procedures, such as administering foul-tasting medicine, proctology examinations, or open-heart surgery, necessarily involve inflicting pain... This sort of moral disengagement, “the disengagement of moral self-sanctions from inhumane conduct” (Bandura, 1999, p. 193), often serves either to justify past or prospective harm... Dehumanization that involves viewing others as incapable of fully experiencing joy, pain, and desire makes it easier to hurt them without causing feelings of personal distress.



Note that some solutions include:

Finally, an additional solution to the dehumanization that results from moral disengagement is simply to decrease psychological distance between doctors and patients. This can be done through alterations in dressing practices for patients, which not only personify them, but also make them appear psychologically closer and more worthy of moral concern. Almost universally, patients in hospitals are dressed in gowns and smocks that barely cover private parts and humiliate and degrade in other ways (such as being covered with little pink flowers). In the Stanford Prison Experiment, forcing people to wear humiliating and degrading clothing, including actual hospital smocks and gowns, led others to brutalize them (Haney, Banks, & Zimbardo, 1973). Clothing that simplifies physical examinations need not also humiliate people who are at their most vulnerable and also allow observers to morally disengage from them.



-- Banterings

 
At Tuesday, September 18, 2018 3:04:00 PM, Anonymous Anonymous said...

A. Banterings


Once while working in trauma a female nurse said, “ if I’m ever brought in here make sure I’m covered up “. Yet, she only covered her female patients, true story. Go Figure! I’m convinced the only way we are going to effect change is through affecting the bottom line, their pocket book. Medicare re-imbursement through patient satisfaction scores is currently in its infancy.

A) Not all patients recieve a survey
B) The hospital chooses who to be surveyed
C) Derelict questions are posed.

The government loves people’s ideas on how to save it ie( taxpayers monies), therefore I suggest they create the surveys, take it away from the hospitals and start asking proper questions.

PT

 
At Tuesday, September 18, 2018 7:37:00 PM, Anonymous JF said...

My best friend was ambushed by a group of med students with her first baby. She said there were about 15 of them. I don't know if she was exaggerating or not. I also don't know how many were male or how many where female. It's been 30 plus years now.

 
At Tuesday, September 18, 2018 10:03:00 PM, Anonymous JF said...

PT, Why couldn't you have left an anonymous note turning her in?

 
At Wednesday, September 19, 2018 1:47:00 AM, Anonymous JF said...

I wonder about the expensive art work displayed at hospitals. Is it donated by private citizens or groups, or is that from the taxpayers or patients. I'm not trying to be insulting. I really don't know.

 
At Wednesday, September 19, 2018 8:44:00 AM, Blogger Maurice Bernstein, M.D. said...

OK..let's get down to the "nitty gritty" of patient autonomy and maintenance of patient dignity vs patient safety. These questions were recently asked on a bioethics listserv to which I subscribe.



Can patients who are identified as fall risks refuse bed alarms (designed to alert staff when patient leaves bed unassisted)?

Can patients who are identified as fall risks refuse to be accompanied by (or within arm’s reach of) staff while in the bathroom?
Note: a significant number of falls that occur at our center occur when patients are alone in the bathroom.


Where does patient autonomy end? ..Maurice.

 
At Wednesday, September 19, 2018 9:07:00 AM, Blogger BJTNT said...

Provide same-gender staff to fall risk patients in the bathroom before you question patients for refusing assistance. And, heaven forbid, that the administration might invest in training staff how to handle these patients.
BJTNT

 
At Wednesday, September 19, 2018 9:47:00 AM, Blogger Biker in Vermont said...

With rights come responsibilities. It is not a one way street.

On the 1st fall risk question posed I say it is reasonable to have a bed alarm to alert staff. It does not pose an undue burden upon the patient. The staff can't be expected to carry the liability should the patient fall because there wasn't a bed alarm, and for sure the patient and their family will blame the staff and the hospital in the ensuing lawsuit claiming due diligence wasn't used to protect the patient from falls.

On the 2nd question posed, again it is reasonable to require assistance getting to and from the bathroom for the same reasons just noted, but in this case providing same gender staff assistance upon request is also a reasonable expectation on the part of the patient. Getting patients to and from the bathroom is not an emergency situation and hospitals should make provision for patient privacy in this regard. If this isn't about human dignity what is.


 
At Wednesday, September 19, 2018 10:59:00 AM, Anonymous Anonymous said...

Maurice


Patient safety and patient dignity are for the most part separable with just a few exceptions in the realm of our concerns on the blog. First, as you know the patient needs to be mentally competent to make informed decisions about their care. Additionally, the patient must be informed of the risks and be given sufficient information about their health condition. A number of steps can be taken to minimize the risks of falls within any facility, a) keeping beds at their lowest position b)patients at all times have access to their call lights c) bed alarms when patients attempt to get out of bed d) provide socks that have gripping pads at the bottom e) yellow wrist bands that designate fall risk as well as signs on the door and hart designated as a fall risk f) commodes placed in the room and the curtain drawn.g) hire male staff for male patients who refuse to have females next to them in the commode.

Now, I could go on a rant that might never end but just suffice it to say I’ve seen many patients that were

A) Not given a call button
B) nurses never respond to the call button
C) bed ridden patients lying in excrementand urine for 2 days.
D) patients restrained WITHOUT a physicians order
E) no fall risk precautions taken at all for mentally incompetent patients

Therefore, I’m not going to entertain at this point any excuse at all for the sad pathetic reason medical staff
will do anything they can to perpetuate the dehumanization of all patients they are being PAID to provide respectful
care. Can we move on!

PT

 
At Wednesday, September 19, 2018 3:36:00 PM, Blogger NTT said...

Good Evening:

I'm with biker on your question Dr. Bernstein.

I see no issue providing the bed alarm. If they need to use the bathroom the provider should provide same gender caregivers to help the patient without them having to ask.

Regards,
NTT

 
At Wednesday, September 19, 2018 3:59:00 PM, Blogger Maurice Bernstein, M.D. said...

PT, before we "move on", I wanted to reproduce here a response within that bioethics listserv discussion, currently in progress, from a female physician-ethicist whose words may support your views.


This brings to mind other “hospital policies” that patients sometimes (try to) refuse.



For instance, when an outpatient is referred to the ER our institution requires that they be accompanied by a nurse or medical assistant. Sometimes they require use of a wheelchair, presumably on the assumption that if someone is sick enough to be sent to the ER they can’t walk independently. Which makes you wonder about the folks driving themselves there….



What if a competent patient refuses either accompaniment or a wheelchair?


Our staff would try to force them to accept. Yet patients can refuse the referral to the ER itself!

Which brings me to the analogy point –> If a competent inpatient can demand discharge itself, why would we compel them to accept a bed alarm, a low-fat diet, accompaniment to the bathroom, vital signs at 3 a.m., an IV machine that beeps when it’s empty, or anything else that might keep them from sleeping, eating or defecating with dignity?


I think many of these rules, while intended mostly for patient safety, are also meant to reduce the risk of liability for a bad outcome, and that is why they face pressure for compliance.


So there! PT, your views are supported! ..Maurice.

 
At Wednesday, September 19, 2018 5:20:00 PM, Anonymous Anonymous said...

Maurice

It’s no surprise now that managing hospital noise is now being measured against HCAHPS scores. Don’t get me wrong, I’ve seen more than my share of obnoxious patients who are manipulative, abusive of healthcare services. I’ve also seen more than my share of patients who were abused by the healthcare system including myself and along that regard I can’t blame many patients who AMA and had a good reason for doing so. Ive also seen far too many patients who were discharged prematurely and/or given a superbug which is now why if an illness was not managed properly at discharge than readmission is free.

BTW, my initials PT are the abbreviation for Patient. I am above all an advocate and voice for the patient. I’m not on this blog for my own personal benefit but simply to try and change a service that has become very indifferent to patient care. There is much blame to be shared both by the patients who seek a service as well as those who deliver it. In the end we have to keep our eye on the big picture and stay reminded of why we are here, those goals seem to have gotten blurred. I believe in the starfish assumption which is, a bunch of starfish are washed up on the shore. You can’t save them all but, if you can save one starfish or make a difference for just one starfish.

PT

 
At Wednesday, September 19, 2018 6:00:00 PM, Anonymous JF said...

Dr B, The fall risk might be a little more risky, depending on how alert the patient is. Most risks though patients should be allowed to sign something releasing the hospital from liability

 
At Wednesday, September 19, 2018 6:25:00 PM, Blogger A. Banterings said...

Maurice et al,

I want to bring up the latest story that supports my assertion that medical school kills conscience: Doctor, Girlfriend Charged With Drugging, Raping Women; Hundreds Of Victims Possible.

It got me thinking, and the research that I did found that serial sexual predator/rapists with 10-20 victims is considered staggering numbers by law enforcement. Harvey Weinstein is considered an outlier. Very rarely are there offenders that have such incredibly high numbers.

Now, law enforcement are now saying that Dr. Grant Robicheaux and Cerissa Riley may have as many as 1000 victims based on videos on their cell phones.

I thought about physician serial sexual predator/rapists regularrly have hundreds of victims. Some that come to mind are:

Dr. William Ayers
Dr. Earl Bradley
Dr. Nikita Levy
Dr. Larry Nassar
Dr. Twana Sparks
Dr. George Tyndall,
Dr. George Reardon
Dr. David V. Gierlus
Dr. Binh Minh Chung
Dr. Mark E. Walden
(Identical twins) Dr. Mark and Dr. Scott Blankenburg
Dr. Thomas Allen Tyma
Dr. Michael Roy Sharpe
Dr. Arthur Nilon Tallant

— Banterings







 
At Wednesday, September 19, 2018 6:34:00 PM, Anonymous JF said...

PT, I don't know how you can say what you did about saving just one starfish. You are for male patients dignity rights and ONLY male patients dignity rights. Towards female patients, you want an equal number of females humiliated.

 
At Wednesday, September 19, 2018 9:26:00 PM, Anonymous Anonymous said...

JF

I never mentioned in my last post that all the Starfish I’m trying to save are all male did I? Female Starfish are already advocated for and sometimes just sometimes to get the train headed on the right side of the tracks you have to steer it on the wrong side of the tracks.

PT

 
At Thursday, September 20, 2018 1:37:00 PM, Anonymous JF said...

PT, I think a high profile wrongful death lawsuit would be beneficial. With it a huge protest. Males wearing blue uniforms. Females wearing pink uniforms , wearing masks, maybe. Of the victims face. Some not wearing masks but carrying a sign saying I am a male CNA/male nurse. I have applied to this hospital x amount of times and turned away. Other signs could say I haven't saught care for 20 years because of dignity violations. Another sign saying Healthcare trades dollars for mens lives. People. Males and females carrying signs saying my father/ husband/ brother sister aunt...is dead because of modesty violations. Another sign. Let patients decide what is dignified care instead of staff. " This hospital is a humiliation factory for male patients!" Somebody, or several somebody's carrying a sign saying " nurse cut off all my clothes while EMT's and police hung around to watch" Ambush practiced at this hospital. The harm I received at the hospital is .... There's a lot of things the signs could say. Maybe some signs could say "Male patients 10 times more to be humiliated in this hospital than female patients!"
All that being said, don't make it an all male issue. It isn't. Just more instances of it. Our gender loves your gender. And no, I'm not referring to the healthcare workers who enjoy humiliating males ( and sometimes females ) I think we should TEAM UP!

 
At Friday, September 21, 2018 6:28:00 AM, Blogger Biker in Vermont said...

Coming back to a recent discussion about DRE's, I just had my 1st ever annual physical with a female provider. This is a PA who replaced the male PA who left the practice. Given I already have an established cardiologist, urologist, gastroenterologist, and dermatologist, I see my primary care provider as a gatekeeper of sorts who monitors and addresses the basics and does referrals as needed. On that basis and knowing that at my age physicals are fairly perfunctory, I figured letting her do my "Welcome to Medicare" exam was OK. I've as well been happy with her having been attentive to matters I have brought up and am thus comfortable with her serving as my PCP.

At the very end of the exam (which I remained fully dressed for except for unbuttoning and lifting my shirt) she asked if I wanted a DRE. I said I'll pass on that, and added that my understanding was that routine DRE's aren't recommended any more. She said they are imprecise as a diagnostic tool but are offered. She didn't push the DRE at all and was fine with me declining it.

My urologist does not do them automatically each visit and so should he say he wants to do one I will consent to it with him.

 
At Friday, September 21, 2018 11:19:00 AM, Blogger A. Banterings said...

This is the problem with medicine, they have self-exempted themselves from the laws and expectations of society, AND society bought the lie.

Texas doctor will not serve jail time for raping patient in her hospital room in 2013
FILED UNDERTEXAS AT AUG 19


Under patient dignity, here is how medicine really feels about patients: https://www.hhs.gov/about/news/2018/09/20/unauthorized-disclosure-patients-protected-health-information-during-abc-filming.html

Note that the settlements and corrections are not an admission of fault.

We are just warm cadavers.



-- Banterings


 
At Friday, September 21, 2018 4:15:00 PM, Anonymous JF said...

How do some of these people escape being murdered?

 
At Saturday, September 22, 2018 4:14:00 PM, Blogger Biker in Vermont said...

Concerning the filming settlements that Bantering posted, businesses never admit guilt when they reach settlements with the feds. There is nothing unique in that regard in these cases. To admit guilt opens them up to many other lawsuits. The govt's interest is only in changing behavior going forward.

What strikes me most about the filming w/o prior patient consent was the thinking that it's OK being the segment wouldn't be aired if the patient doesn't consent. That misses the point entirely that film crews were privy to intimately exposed patients and that a permanent record was made of that exposure via the film. I doubt all copies are destroyed when a patient doesn't consent no matter what they may say to the contrary.

The other thing is them thinking the pixelating of genitals and breasts protects the patient's privacy. Again, there was a film crew present w/o pixelation, additional staff will have viewed the original footage during the editing and pixelating processes, and an original copy will be kept somewhere until such point as it is hacked and then it'll be everywhere.

That hospitals miss all this speaks to why they are so lax with patient physical privacy. They just don't care.

 
At Saturday, September 22, 2018 9:50:00 PM, Blogger Maurice Bernstein, M.D. said...

We are at the 100 Comment mark and let's get back to the initial topic of this Volume: consideration of revising the thread name.
Banterings has suggested "Patient Dignity (Formerly "Patient Modesty").

Does everyone agree that such a title would not open this thread up to a host of issues presented some of which are beyond what is usually being considered here?

For example should we consider dignity of humans in a more general sense or more in the context of the profession of medicine? Does using the word in the title "patient" focus on a consideration of specific dignity aspects?

Is my concern unfounded about how others would interpret the title and perhaps be disappointed in what they are reading here?
It seems to me that what has been written over the years here is patient modesty as a specific element within patient dignity and now we may be broadening the discussion to elements not necessarily directly related to physical modesty itself.

Perhaps, with all the aspects of medical practice beyond simple physical modesty of the patient, the title should be expanded.
..Maurice.

 
At Sunday, September 23, 2018 6:55:00 AM, Blogger Biker in Vermont said...

Dr. Bernstein, I am not looking to broaden the scope of this discussion to include anything beyond patient modesty and the ways in which it is violated within the healthcare system. If using the word dignity rather than modesty makes it harder to dismiss us as having issues or being outliers, then dignity is the preferred word.

However using the word dignity is no panacea in that every hospital and medical practice already says they respect and protect patient dignity. They just never define how it is they do that. Even without a specific definition, it is well established that staff gender is not considered a factor in respecting and protecting patient dignity when the patient is a male.

We as well know that despite hospital statements saying patient dignity is respected, even when there are egregious violations (Dr. Sparks, the Denver 5, the OR "circus" at the Univ. of Pittsburgh Medical Center last year where a crowd gathered to photograph and ogle some guy with a genital injury), there is rarely any substantive punishment for the violators. It thus begs the question what do they mean when they say they respect and protect patient dignity. How bad would the violation have to be for someone to actually get fired?

People do get fired for HIPAA violations but not for even gross violations of male patient intimate privacy such as the examples noted above.

So, I don't want to expand the scope of the discussion to include other aspects of dignity or the healthcare system in general. I am OK with any wording that keeps the focus on bodily privacy/modesty/dignity.

 
At Sunday, September 23, 2018 7:41:00 AM, Blogger Maurice Bernstein, M.D. said...

Biker et al: how about setting a goal for the preservation of patient modesty since there is no argument now that the quality "patient modesty" already exists along with its documented violations. A suggested title might be "Preservation of Patient Modesty". This approach to a title might be better since it will include not only a description of how patient modesty has been handled in the past but how it can be "preserved" in and for the future. ..Maurice.

 
At Sunday, September 23, 2018 4:13:00 PM, Anonymous Anonymous said...

Maurice

Unfortunately, the title is not descriptive to reflect sexual misconduct in all regards. Remember that state boards of nursing consider it sexual misconduct when patients are left inappropriately draped ( unnecessarily exposed), nor does it reflect the aspect of molestation as in the Dr Sparks cases. The very word modesty has a connotation, implies that it is a state of individual perception, rather a state of mind void of any wrong doing by those that have observed. Thus the definition of modesty wether inherent with voyeurism in the medical application seems to render those inappropriately viewing incupable, this is the problem I have with the title of this blog.

PT

 
At Sunday, September 23, 2018 5:01:00 PM, Blogger Maurice Bernstein, M.D. said...

Just to let you know that I am also becoming made aware of the terrible one sided ("professional" side) illustrated aspects of what goes on in the medical-surgical profession. Please go to this current BBC video (after a brief commercial) which the female medical photographer describes in that video her valuable but "nauseating" (my word) occupation (with examples) and yet I couldn't find one comment about how her photography was affecting the photographed patient or family. The emotional effect description is only one-sided (hers)! Go to the BBC site and see what I am writing about. ..Maurice.

 
At Sunday, September 23, 2018 6:15:00 PM, Anonymous JF said...

How about Educating Medical about patient dignity

 
At Sunday, September 23, 2018 7:27:00 PM, Anonymous Anonymous said...

Maurice

She should be wearing a surgical mask, infection control should be talking to her after this video. Secondly, if she can’t handle the heat she should get out of the kitchen. “ oh look at me, see what I do everyday! Next she will be wearing scrubs at your local Starbucks. “ I hope these patients have offered her permission for the photographs and just because these is no identifying patient information dosen’t mean it’s not a Hipaa violation. Photographs do little for medical education but everything for legal reasons. Way back in the day when I worked in a morgue I despised detectives who would come and take pictures of murder victims. This was when PPE ( personal protective equipment) was not readily recognized, the idiot would ask “ why are you wearing gloves? “. Folks, it’s not worth giving an explanation to some idiots.

PT

 
At Sunday, September 23, 2018 8:00:00 PM, Blogger Maurice Bernstein, M.D. said...

PT, no HIPAA in Great Britain but as I understand some similar requirements. ..Maurice.

 
At Sunday, September 23, 2018 9:03:00 PM, Anonymous JF said...

Or patients life threatening devastating failure to receive dignified healthcare.

 
At Monday, September 24, 2018 8:50:00 AM, Blogger A. Banterings said...

This is how patients need to fight back: If in a facility's web page, marketing material, Patient Bill of Rights, etc., it states "...we will preserve the patient's dignity...," then patients that have their dignity violated need to bring lawsuits for breach of contract.

It is an "implied contract" that the patient's dignity will be preserved and respected. The proof is that based on those written materials, the patient had that expectation.

Consent forms are contracts of adhesion, and advertising material (as an implied contract) creates a conflict in consent form (contract of adhesion). Conflicts in the terms, ambiguity, or unclear provisions are interpreted in favor of the party who did not prepare the contract (the patient).

There is also the question of whether the makers of these contracts, which are entered into freely and without coercion by the customer or client, should be allowed to evade liability for unfair contracts.

Once an attorney is successful with the first lawsuit, then they will all hop on board. hen it starts costing money, healthcare will finally change.



-- Banterings

 
At Monday, September 24, 2018 11:06:00 AM, Blogger Biker in Vermont said...

Banterings, in an adhesion contract within healthcare settings, would not a court apply what the healthcare industry generally accepts as the meaning of "dignity" under what are considered standards of care? I would think any court would be leery of going down the path of each patient getting to decide what dignity entails. My guess is that the incident being litigated would have to be far outside those commonly accepted (by the healthcare industry) standards of care. Those standards of care do not currently include anything about gender when it pertains to male patients.

My guess is that successful lawsuit would be based on a claim of discrimination instead.

 
At Monday, September 24, 2018 3:07:00 PM, Anonymous JF said...

I was thinking of a staff meeting arranged by patients and/of patients advocates. The title of the staff meeting is respecting patient dignity. First speaker allows staff to know of the humiliation of patients, and inform staff that the stereotype of males having no modesty is wrong and a huge deterrent to males seeking healthcare. Then staff is introduced to male nurses and male CNA's who testify " I have applied to this hospital x amount of times in a x amount of time.
Patients, male and female testify of having been unnecessarily exposed or exposed to too many people. Family members in some cases. People in hallways. Too many staffers... The amount of time healthcare has been avoided because of preventable humiliation. Then a lawyer takes the stage informing hospital/clinic that males are protected under law same as female patients and this facility is in violation. Then a recording is played of the workers in their breakroom talking about male patients in an unprofessional manner. Lastly the lawyer makes hospital aware that they are the defendant of a million dollar lawsuit for a wrongful death lawsuit. A patient/patients dying because of avoiding healthcare because of dignity violations.

 
At Monday, September 24, 2018 8:19:00 PM, Anonymous Anonymous said...

Biker in Vermont, A. Banterings

It would seem that would be a logical direction from a legal perspective, however, nothing about limits of patient exposure, behavior are mentioned in standards of care. The limits of exposure and behavior are set by the state boards of nursing and if it involves a physician that would be directed to the respective state medical board. If you recall the operating room case regarding a genital injury at a Penn. hospital this was self reported by the hospital to the state health and human services. If an incident like this happens a hospital must self-report, they can end up in big trouble if they don’t. Additionally, the hospital must show that they have taken steps of corrective action otherwise face fines and action by the state.

Few patients realize that making a complaint directly to the dept of health and human services gets the hospitals attention very quickly and will prompt an immediate investigation by administrative staff. Each state has this regulatory agency, you have to find it online and there you will find a complaint form. As you see the donut seeking Joint Commission people have NO regulatory power, they think they do but their seal of approval amounts to no more than Martha Stewarts’s seal of approval on the boxes of donuts they so desperately love to eat.

PT

 
At Tuesday, September 25, 2018 8:31:00 AM, Blogger A. Banterings said...

Biker, PT, et al,

The standard of care is not set in stone. It would be incumbent upon the plaintiff to demonstrate that what is considered "business as usual" is a violation of dignity. That can be done easily.

The first step is to show that the profession of medicine is out of touch with reality and the expectations of society. Just look at the recent

history of of performing pelvic exams on anesthetized women without consent, and it is still occurring in 2018.

Despite widespread condemnation of the practice, performing pelvic exams on unconscious women for medical training, without explicit consent, is legal in 45 states.

All one needs to prove this point are expert witnesses to testify to justification of the practice.

The next piece of proof is the UN's reports of the Report of the Special Rapporteur on torture and other cruel, inhuman or degrading treatment or punishment, Juan E. Méndez. Another useful source is The human rights of intersex people: addressing harmful practices and rhetoric of change.

In addition to the physical and emotional problems that can be caused by surgical
intervention, many intersex individuals suffer lasting psychological effects as a result of
repeated genital examinations in childhood. “Repeated examination of the genitalia,
including medical photography, may be experienced as deeply shaming. … Medical
interventions and negative sexual experiences may have fostered symptoms of
posttraumatic stress disorder and referral to a qualified mental health professional may be
indicated.”
42 While some genital exams are deemed necessary for diagnosis or
monitoring of medical conditions, others are done without specific indication, sometimes
to satisfy provider curiosity or for purposes of training providers.43 Complications and
follow-up of genital surgery can make additional exams necessary.
A leading patient advocacy group has likened such procedures to child sexual abuse
(CSA):

Children with intersex conditions are subjected to repeated genital traumas
which are kept secret both within the family and in the culture surrounding it. . . .
These children experience their treatment as a form of sexual abuse, and view
their parents as having betrayed them by colluding with the medical professionals
who injured them. As in CSA, the psychological sequelae of these treatments
include depression, suicidal attempts, failure to form intimate bonds, sexual
dysfunction, body image disturbance and dissociative patterns.44

(Source: MEDICAL TREATMENT OF PEOPLE WITH INTERSEX CONDITIONS AS TORTURE AND CRUEL, INHUMAN, OR DEGRADING TREATMENT OR PUNISHMENT


At the very least, there is grounds for malpractice for not recognizing the potential psychological side effects of such treatment.





-- Banterings





 
At Tuesday, September 25, 2018 9:06:00 AM, Blogger A. Banterings said...

PT,

The US will no longer be wasting the most on healthcare. See 'Modicare': India's PM promises free health care for half a billion.



-- Banterings


 

Post a Comment

<< Home