Bioethics Discussion Blog: Patient Dignity (Formerly: Patient Modesty): Volume 93

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Thursday, November 22, 2018

Patient Dignity (Formerly: Patient Modesty): Volume 93







This graphic is my repeat presentation to this thread.  It first appeared here 5 years ago as the graphic on Volume 56 of "Patient Modesty". (Photograph  from U.C.L.A. library website  obtained through Google Images.  )

Now that we are focusing on patient dignity, it would be of interest to compare dignity vs modesty as applied to a patient fully asleep under anesthesia within the operating room.  

Might I suggest that modesty is no longer a matter of ethical concern when the patients body is uncovered but the issue becomes the preservation of dignity. Modesty requires awareness .  Anyone want to discuss this conclusion related to the unconscious but exposed patient? ..Maurice.

82 Comments:

At Thursday, November 22, 2018 8:26:00 AM, Blogger NTT said...

Good Afternoon:

Patient Modesty in Healthcare

There’s an illness that’s moving like wildfire through our medical community.

This illness effects everyone from the CEO down through the rank and file workers. We’ve seen illnesses like this before and they are very very strong however, there is a cure for it.

We have an antibiotic strong enough to kill it in its tracks but because the virus has spread so quickly throughout the medical community, the only way it will be effectively stopped, is if the entire medical community not just here and there to get inoculated.

The illness is bad. Currently, the virus is showing up more everyday within the hallowed walls of our medical institutions. It rears its ugly head more often when dealing with male patients than female patients but it happens to both genders.

The illness I’m talking about is the complete lack of respect of a patient’s dignity (aka modesty), and privacy the medical community has for human beings that present at medical facilities with modesty issues. The two go hand in hand.

The antibiotic we have for the cure of this illness is called Humanity.

If the entire medical community were to take a full dose of the humanity antibiotic, they’d begin to see patients as people first. They wouldn’t be so fast to judgement when they come across a patient wanting to protect their dignity. Patients in turn would not be so defensive when they go for medical attention. Their minds would be more at ease as they wouldn’t have to worry about medical ambushing which currently is rampant within medical institutions. The patient/provider relationship would be allowed to grow rather than fester like an open wound.

So how does the antibiotic work.

In the short-term.

Patients would be greeted with a smile. Workers would introduce themselves and explain what their purpose is and why they are there and ask permission before they do anything.

When patients need attention, the attendant would introduce themselves then escort the person back to a bay or room. Next, they would be respectfully asked to remove all their clothes and put on a johnny gown which would then be handed to them. The attendant would ask if they have any questions. If so, they would answer them to the best of their ability within facility rules. If no questions, the attendant would make sure the area was secured so the patient has privacy for changing then leave the area. When ready to come back & speak with patient, staff would announce themselves and wait for patient to reply saying its okay to enter their space.

Other ways the antibiotic works in the short term are;

Medical institutions would begin to retrain employees by making everyone take a course in patient respect with a required refresher course each year.

Medical and nursing schools would add patient respect courses as a requirement for graduation.

To alleviate male patient embarrassment and humiliation, give men and boys the choice of a male hospitalist when male related intimate issues are at play.

In the long-term.

Medical institutions would ramp up recruitment of men to go to nursing school, graduate, then enter areas in need of male personnel like urology, radiology, oncology, and diagnostic sonography or ultrasonography to name a few.

The booster in the antibiotic is to help the community to find ways (like using male hospitals instead of female personnel), to take care of male related intimate issues if the patient wants same gender care.

Whether one’s personal preference is for either same-gender or opposite-gender medical care, their choice should not only be respected by everyone, but also accommodated by all healthcare providers and their affiliates without question.

The shot of humanity is something our healthcare system is in desperate need of right now so I hope, they will be wise enough to take the antibiotic and cure this sickness once and for all.

Regards,
NTT

 
At Thursday, November 22, 2018 11:20:00 AM, Blogger BJTNT said...

Quote from the referenced article [https://jamanetwork.com/journals/jama/fullarticle/2715597]:
"and the medical community at large do not value trainees enough to stop this harassment."

Is this a clue to cause?

Does the medical community extend dignity and respect to patients - being polite is sufficient. Did these men say their inappropriate comments politely?

Maybe these men learned the culture from their visits to medical institutions and responded accordingly. How is it that sexual expressions to future doctors are bad, but unnecessary sexual exposure of a patient is tolerated without administration action [words only] against it.

How about a follow-up of these men to see what other environments where they found it acceptable to make these comments? It might be interesting.

If the medical community reflected a high-minded environment to the people they serve, patients would respond in kind. Physician, heal thyself.
BJTNT

 
At Thursday, November 22, 2018 12:10:00 PM, Anonymous Anonymous said...

How about the healthcare industry make an assurance, guarantee that you as a male patient won’t be judged, gossiped about, sexualized about nor have a cell phone pic of your genitals taken by a female nurse by the name of Kristen Johnson in upstate New York hospital.

How about the healthcare industry make an assurance, guarantee that during your colonoscopy that the female anesthiologists won’t make comments that “ she wanted to man you up” , make false statements to staff that you have an STD and enter a false diagnosis in your medical chart as was done by Dr. Tiffany Ingram.

How about the healthcare industry make an assurance, guarantee that you as a male patient won’t have a ton of employees in your operating room uninvited taking cell phone pics of your genital injury that occurred at UPMC.

How about the healthcare industry make an assurance, guarantee that you as a male patient won’t be groped and assaulted by an ent physician named Dr Twana Sparks while the entire female operating room staff laughs.

How about the healthcare industry make an assurance that you as a male patient will have privacy, Peace and respectful care after you have died lying in your body bag without 5 nurses peeking at your genitals at a Denver Colorado hospital.

In regards to NTT’s previous post, don’t you think this goes way beyond “ alleviate male patient embarrassment and humiliation.” Better yet how about the healthcare industry make a better attempt at getting nurses to wash their hands. That would save about 100,000 lives each year, don’t you think.

PT

 
At Thursday, November 22, 2018 1:01:00 PM, Blogger Maurice Bernstein, M.D. said...

Thanks for introducing this Volume with a description of pathology and approaches to treatment. Good. However, I wonder what my visitors think about the entry statement I made hoping to clarify one "operative" distinction between "dignity" from "modesty" terms which has been changed in this thread title.

My concept is that "modesty" represents a conscious "awake" awareness of, in our discussion, "our private anatomy" and requires the modest individual to be awake and aware of others who are paying attention to their modesty requirements or defying them. A patient's "dignity" does not require awareness at the moment of "undress" but is a human property that should be assumed as always, permanently, present unless disclosed otherwise by the individual who is the subject of what is occurring at the time.

All healthcare providers must at all times assume that every patient has their own concerns about their bodily appearance to others and this concern is the expression of the "dignity" inherent in every and all patients.

So am I wrong in excluding "modesty" as an issue in an unconscious patient but emphasizing the importance of attention to the patient's human "dignity"? ..Maurice.

 
At Thursday, November 22, 2018 2:33:00 PM, Blogger Maurice Bernstein, M.D. said...

By the way, if visualization of the patient's body can be controversial in terms of "modesty". How about "touching"? Here is a link to a thread started in 2008 with visitor comments titled "A Doctor's Touch" describing the clinical value of touching the patient which may be of interest as we continue "Patient Dignity". ..Maurice.

 
At Friday, November 23, 2018 4:09:00 AM, Blogger Biker said...

While it is correct that patients cannot have modesty concerns while they are anesthetized, they similarly can't have dignity concerns during that period either. However before being anesthetized and after, such concerns can come into play because the patient knows they were naked on the table and that they had no control over whether their exposure was appropriately minimized (what, how long, to who) nor how the staff behaved as concerns the patient's exposure. The unknown in this regard serves to heighten concerns compared to exposure while conscious. Many people don't feel that way but some of us do.

As an aside on the patient misbehavior discussion, at our Thanksgiving gathering yesterday a newly minted 21 year old RN working on a med-surg floor at a local hospital commented on an old man having said something inappropriate to her. She's pretty laid back and wasn't bothered by it but this being her 1st job it was notable to her.

On the touch issue, I'm fine with handshakes, touching my shoulder, or similar normal social interaction type stuff, but I do want healthcare staff to tell me or ask me as appropriate before they touch me for medical exam purposes.

 
At Friday, November 23, 2018 10:18:00 AM, Blogger Maurice Bernstein, M.D. said...

Biker, elements of human dignity are present and should be aware to the medical staff whether or not the patient is fully under general anesthesia.

I can present here an example of professional behavior which I actually observed in the operating room which supports my above statement.

As I recall, it was a 20 year old male who was undergoing a repeat aortic valve replacement. He was already unconscious. His groins were exposed for femoral artery access but immediately after exposure the genitalia were covered. Why was this action promptly carried out? It surely was because the staff was aware of all patients' human dignity even when the human was asleep.

My definition of human dignity is that it is present at all times, awake or asleep. ..Maurice.

 
At Friday, November 23, 2018 11:53:00 AM, Anonymous Anonymous said...

The concept of modesty seems to be a subset of dignity. One has dignity or worth because of his/ her participation in the human race. This human dignity has many components. We have the dignity to make individual choices regarding our associations, our careers, our aspirations, etc. We also have the dignity to choose the way we display our bodies or have them touched by others. This displaying or touching is the modesty component of dignity. Furthermore, our modesty may be conditioned or regulated by our society or culture. What’s considered modest in one society may not be considered modest in another. There’s also the possibility that our views of modesty may not conform to societal views. Additionally, subcultures within our culture may view modesty differently. Ultimately, however, in our current culture in the US, one’s individual view of modesty is pre-eminent. Aside from “decency laws” there is no higher authority than the individual. If the above is true, I, the individual, determine my modesty – how my body will be displayed or touched. My modesty is violated by anyone who acts against my individual modesty determinations. (Admittedly, sometimes these “violations” may occur because others are unaware of my modesty concerns.) Just as I do not lose my individuality when I am asleep, unconscious or anesthetized, I do not lose my modesty concerns in these states. Awake or asleep I still possess those views of how I want to display my body or to have it touched. Isn’t the reason for an Advanced Medical Directive so that I may DIRECT the way in which my body is treated when I am in an altered state of rationality or consciousness? To say that my modesty isn’t violated, if I’m unaware of it, is preposterous. Drugged date rape is a crime because it is a violation of one’s body, one’s modesty and one’s free will WHILE UNCONSCIOUS. The state of consciousness is irrelevant to the crime. The medical community refuses to admit the possibility of modesty violations. The prevailing sentiment seems to be that if the patient is unconscious, his/ her modesty is not violated. This is absurd. No. Just as in the example above, one’s modesty has been violated. Although the “scars” of this violation may not occur due to anesthesia, the violation has still occurred – one’s individual determination of modesty has been transgressed. Assembly-line medicine cannot countenance this individual determination of modesty. It slows down the process. Instead, the subject is ignored. “Leave your modesty at the hospital door”, is the mantra. Ignore modesty and it will go away. Unfortunately, much of society has subscribed to this view. I refuse to embrace this denial.

Reginald

 
At Friday, November 23, 2018 7:27:00 PM, Anonymous Medical Patient Modesty said...

It’s very interesting that Dr. Bernstein’s blog, Doctor’s Touch has a picture of a male doctor kneeling to examine private parts of a woman without looking at them. This was the “compromise” position that introduced men to do first gynecological procedures on women. Before that time, only midwives examined women intimately. I have this very picture on an article I wrote about History of Modern Gynecology.

Misty

 
At Friday, November 23, 2018 9:11:00 PM, Anonymous Anonymous said...

Misty

On your site regarding your illustration “ what to expect during a pelvic exam”, it would be beneficial to readers that female patients can additionally request drapes to cover their inner and outer thighs for more privacy. Many more proactive facilitiesare doing just this to enhance the patient experience.

Again, thank you for presenting center stage the dilemma men face on KevinMD. Regarding the comment section, of course going in there we knew a few cages would get rattled, it’s always expected. Thank you for advocating on this subject and quite soon I will call on you to present some ideas I have to present this to a much bigger audience.

PT

 
At Friday, November 23, 2018 9:59:00 PM, Blogger Maurice Bernstein, M.D. said...

Actually, Misty, from my point of view as a physician who has over the years performed many many pelvic exams and teach, teamed with gynecologists, second year students how the procedure is carried out, doctors can learn further about female genital pathology by visual inspection than by palpation (touch) alone. Beyond that, what is missing in the picture is visual contact with the head (expression) of the patient. Such periodic, repetitive visual contact, beyond verbal communication is important in the awake patient. I teach students repeatedly to be looking at the face of the patient when palpating any part of the body since often patients will grimace rather than express the discomfort verbally. ..Maurice.

 
At Friday, November 23, 2018 11:32:00 PM, Anonymous Medical Patient Modesty said...

Dr. Bernstein,

My point is that before 1800s male doctors were not allowed to touch or see private parts of women. Before modern medicine was invented, modesty was much more important. Opposite sex intimate medical care did not exist before.

Female midwives before modern medicine was established saw and touched women’s private parts and it was not a problem because they were females.

Look at how this medical student talked about the historic progression of pelvic exams at Male physicians treating Female patients: Issues, Controversies and Gynecology.

Also, check out Shameful Exposure | Early Modern Medicine. This article talks some about male patient modesty.

Modern medicine is gender neutral and has worked to indoctrinate many people to accept that the gender of a medical personnel does not matter and that we should focus on the skills of the doctor/nurse instead of gender.

Misty

 
At Saturday, November 24, 2018 3:50:00 AM, Blogger NTT said...

Good Morning:

Dr. Bernstein in reference your example of the 20 year old patient getting an aortic valve replacement.

If the valve replacement were done today, patient exposure could have been totally avoided had the institution allowed the patient to wear a CovrMedical bilateral medical garment or something similar from another company. The garment gives full access to the femoral arteries in the groin area without exposing the patient's genitalia.

I believe hospitals could directly effect a patients outcome in a positive way by using these types of garments throughout their institutions.

Plus, the institutions that use them would get some good pr out of it via word of mouth from the patients.

So in the end, you have a win win situation. Good for everyone.

Yes the garments cost money but that would be offset by the increase in patient volume.

Regards,
NTT

 
At Saturday, November 24, 2018 5:15:00 PM, Anonymous Anonymous said...

Maurice

I assume you were referring to that 20 year old as undergoing a “ Transcather aortic valve replacement “. My question is, do you think their behavior ( staff) was attributable to your presence? For every one example you refer to as “ professional behavior “ there are 10,000 examples where it is not professional behavior. I’ve found that when staff are NOT under the microscope they tend NOT to care about the patient in regards to the patient’s dignity.

PT

 
At Sunday, November 25, 2018 10:55:00 AM, Blogger Maurice Bernstein, M.D. said...

In the observation I had in the operating room with the 20 year old male, the general genital covering appeared routine, I was at a distance from the table and individual doing the covering never looked at me and appeared to be acting in a routine fashion. Also none of the 2nd year medical student observers my duty to monitor were at the time in the room.

Again, since I never have been a member of an operating room team or frequent observer, I cannot speak for "malpractice" in that environment. Hopefully PT, your ratio of one "good" vs 10,000 "bad behavior" is an over-estimate. Does anyone have an idea of "good" vs "bad" ratios in other occupations or professions including religions? ..Maurice.

 
At Sunday, November 25, 2018 1:41:00 PM, Anonymous Anonymous said...

Re the idea of building an internet site such as Organization for Dignified Patient Care - it’s a great idea. Those who are facing needed medical care, but especially men, need a site where they can access information about their care that they would be hard pressed to find elsewhere, ESPECIALLY INFORMATION REGARDING THE CORRUPT NURSING CULTURE AND THE MAJORITY OF PHYSICIANS WHO IGNORE, I.E., WHO SUPPORT IT BY HAVING ALL FEMALE STAFF! As one contributor said: “They've gotten away with looking for so long they don't want rule changes that might take away their viewing pleasure.” Forcing male customers to accept female hags and others is SO MUCH MORE THAN ABOUT SAVING THEIR OVERPRICED SALARIES! IT IS ABOUT THEIR SEXUAL VIEWING PLEASURE! These hags are hypocrites to the end!

My idea was to create a site where male customers who have been discriminated against by staff, who have been victims of sexual impropriety/sexual abuse can come for ADVICE ON HOW TO REPORT VIOLATIONS. Let’s make it easy for men who have fallen victim to nursing hags (and yes this “skirt” will continue to call an animal an animal – hags and voyeurs apply to a majority of female nurses, techs, aides, etc.). I’m with PT on this – the makemsick hags paint all male customers who desire same gender care as weak or silly, I paint them back appropriately with the same “broad brush” which is the least they deserve! Consider having different sections on the site: one such section can detail how a male customer can issue formal complaints all the way up the food chain. Of course, as states differ, each state would have a separate listing that supplies the path to take to complain, that lists ALL the organizations that one can complain to, the best order to do so in, and might even supply sample letters. Let’s make it easy for men who have been victimized by the voyeuristic skirts to take back their power, and get these hags out of what now passes for “healthcare.”

Of course some will disagree with me when I state unequivocally that another section (or a link to a different site) could be rather a Hall of Shame, where hags such as the Denver 5 and Twana Sparks are publicly exposed, and here men that have followed the advice in the Patient Care site could describe how they were violated, how they succeeded in having nursing hags reprimanded or hopefully having a permanent revocation of nursing license, and LIST THE NAMES OF THE PERPETRATORS. I’m not sure how I ended up on it, but one of my email accounts sends warnings of registered pedophiles who recently have moved into my area. I regularly read the Sheriff’s Calls for info about criminal activity in my rural area.
The site should also detail what discrimination is for male customers, and inform them of how to INSIST ON THEIR RIGHTS TO SAME GENDER CARE – NO EXCUSES BY NURSING HAGS AND SO FORTH, whether in a hospital or clinic environment.

Now, the reason I bring up vaccines is not only because a youngster in my family was ruined by them , and I have some experience trying to teach ELA to such youngsters – OUR SCHOOLS ARE OVERFLOWING WITH THEM - but MANDATORY VACCINATIONS ARE AT THE HEART OF THE BRAVE NEW WORLD WE SEEM TO BE ENTERING IN. The worst, like the youngster I mentioned above, can’t make it in school; they are kept at home or placed in facilities until they are basically thrown to the streets at a certain age, depending on the state or county’s rules. A friend of mine who once worked at such a facility was attacked and almost killed by one such inmate. I recall her gathering some warm coats and blankets several winters back as she had found a few young men released from such a residential facility homeless, living in a desert wash and begging at the side of the road for food.

EO cont.

 
At Sunday, November 25, 2018 1:46:00 PM, Anonymous Anonymous said...

I keep bringing up vaccines because mandatory vaccination for schooling and certain employment IS FASCISM, and those who don’t recognize the wolf at the door will sooner or later be on their hit list. Let’s make it clear – the primary motive of Big Pharma, supported by a coterie of what I can only describe as brain washed morons, i.e., physicians and makemsick workers, is to eventually roll out a schedule of mandatory vaccinations for everyone, child or adult. THE MAJORITY OF A PEDIATRICIANS’ REVENUE – SOME 60-80%, IS DERIVED FROM VACCINATIONS. That is, a majority of their revenue is derived from destroying the immune systems of infants/children. For the uninformed or skeptical, try joining a few groups whose children have been killed/severely harmed by vaccines – these parents will open your eyes! Always more infants dying after their “shots” or children developing severe behavioral and/or physical illnesses after the vaccinations. Try reading the now hundreds of studies coming from anywhere but the USA that details the DECEPTION THAT IS VACCINATION, AND THE MEDICAL OPS THAT SUPPORT SUCH FASCISM. OF COURSE BIG PHARMA LOVES VACCINATIONS – THEY CREATE HUNDREDS OF MILLIONS OF NEW CUSTOMERS WHO HAVE NO IDEA THE MAKEMSICK INDUSTRY HAS DESTROYED THEIR HEALTH. Do you really think you are free here? Try being a physician that orders a medical exemption – these rationally thinking and courageous physicians are hounded and smeared publicly and legally for doing what they should do – protecting the health of children. Now, it probably doesn’t have a snowball’s chance in hell, or male customer’s expectation of having his modesty/dignity respected, but if passed, the bill to remove protection against liability for vaccine death/injury would end most pediatricians’ practices! You should hear what parents of vaccine damaged/killed children call pediatricians!!!

And, for those who haven’t a clue as to what’s really going on with the fascism that passes for “healthcare,” here’s just one example out of thousands that show what the deep state is capable of doing when faced with the truth and this truth of course threatens their ill gotten gains: https://explainlife.com/scientist-jailed-after-discovering-deadly-viruses-are-delivered-through-vaccines-2841/?fbclid=IwAR1exqpN9xfx1zvmt3NTnHcxjuGljwwrw3QI0sIoE7IWD-BJ2cRYRmRxmyw.

EO

 
At Sunday, November 25, 2018 2:09:00 PM, Anonymous Anonymous said...

Maurice

To put everything into a more presentable perspective and taking into account all the hospitals and surgery centers you will have 10,000 surgeries in one state in a single day. I’m just referring to surgeries, discounting all the intensive care units, physician offices, rehab centers, level 1 trauma centers and nursing homes. Surgeries at major hospitals run 24/7 and at outpatient surgery centers are typically 7am till 8 or 9 pm. Major hospitals will have 24 surgical suites that can be booked all day and night, do you really think the staff are going to be nice and treat everyone respectable when it’s just cattle, slabs of meat moving in and out.

PT

 
At Sunday, November 25, 2018 5:42:00 PM, Blogger Maurice Bernstein, M.D. said...

I want everyone here to notice a marked change in the content of views expressed on this blog thread since the title was changed from "Patient Modesty" to "Patient Dignity".
For example, I would have formerly considered EO's presentation of her views of the vaccination issue totally inappropriate to the primary issues involved in modesty concerns of patients and so would not have published it. However, expanding the area of our conversations to the dignity of patients, it makes this thread open to presentation and discussion about these other concerns as "said" to be observed and practiced within the medical profession.

Now, I want all my visitors to know that this entire blog with over 1000 presentations was developed to "discuss" the matter of "bioethics", including the many aspects I considered of possible interest to others.

My question to my visitors and commentators is whether "Patient Dignity" as expanded away from the pure "modesty" (actually specifically "physical modesty") is what is wanted here. Consider that patient dignity can involve many other areas of discussion beyond matters of modesty.

I ask Banterings, who, as I recall, initiated this change in title here, but also I ask the others here, is this now expanded areas of discussion to many other issues is what is wanted for discussion here. The vaccination issue and expanded also to pharmaceutical drug promotion and patient pressuring certainly is appropriately up for discussion and dissection. But is that what our visitors want here.. or should we concentrate on and consider changing medical system behavior on but one issue? Any comments? ..Maurice.

 
At Sunday, November 25, 2018 6:07:00 PM, Blogger Biker said...

Dr. Bernstein, please do not allow this discussion to include vaccines, big pharma, or anything else along those lines. They have nothing to do with patient physical modesty and privacy and the basic human dignity that entails. There are plenty of other places that EO can rant about that. I would also suggest that allowing posters to call all nurses hags or anything else like that is not helpful to the cause. It can only serve to have our legitimate complaints and concerns not be taken seriously by those anonymous readers who might otherwise be sympathetic to the cause. EO can think it all she wants but please don't provide a public platform for it.

Dignity can be a very big topic but let's keep the focus narrowed to the modesty and physical privacy aspects of it.

 
At Sunday, November 25, 2018 6:08:00 PM, Anonymous Anonymous said...

Right now I’m at a loss. Could it be that EO hates female medical staff more than I do? How is that even possible? To begin with, many people suffer from the “ I just can’t fathom that “ syndrome. Until people started seeing video clips of extreme unnecessary police force people assumed that you got what you deserved, but thanks to cell phone technology the truth is finally coming out.

The little dust collector with the three monkeys “ see, hear,speak no evil “. That’s attributable to the “ I just can’t fathom that syndrome”. In many people’s mind that just can’t comprehend, disseminate information and come with an open mind to events they can’t handle, fact is many just can’t handle the truth. The second falsehood is fake information, such as nursing is the most trusted profession. The fake adds that make false promises that you the patient will be treated with the utmost respect.

When are people going to see through the smokescreen Bullshit! To see, admit to yourself is the first step. I’ll give you an example, in the 40’s and 50’s blacks suffered from the same dilemma. Is this a society that is prejudiced against us or this just the way things are supposed to be. There is a Urology clinic in a county called Jeffersonville county Indiana of which is one of many I have been researching lately. It’s interesting but, there are 6 male urologists associated with this clinic and 12 female nurse practitioners, why? You can find the clinic as well as look online and see their pictures along with their bio.

I have read that typically most Urology clinics see about 75% of their patients as male, yet this clinic for reasons beyond me need 12 female nurse quacktitioners. You can accurately assume their medical assistant staff will be all female as well. Let’s flip the roles here. Can you imagine if there were an OB-GYN clinic that had 6 female OB-GYN physicians and 12 male nurse Quacktitioners. Never!

PT

 
At Sunday, November 25, 2018 6:37:00 PM, Anonymous Anonymous said...

Maurice

The main narrative is physical privacy and that has been the primary focus in these discussions yet, I believe to illustrate how deviate the medical community can be other examples have been enlisted just to show how low people stoop in medicine to Fu&k over other hominids.

Medicine is the last industry on the planet to admit this, their mistakes. They come up with stupid oxymoron phrases like “ best practice “ and there are others to stupid to list. It is industry corrupt with greed, unethical behavior and unprofessional conduct with no end in sight. It’s just sickening!

If you notice I reference Hipaa violations along my comments but believe me I could go on and on with examples that would illustrate an absolute disservice to people when they are at their lowest, when illness strikes. I’ll admit it’s a real challenge for me to adhire to the discussions and I’m only doing so because this is the topic and it deserves utmost attention.

When I find a blog that discusses fraud, deciet and corruption in healthcare, billing practices to Medicare, poor medical care to our veterans, violations of the Stark laws, kickback schemes, you can rest assured I have commented on them and will continue to do so.

PT

 
At Sunday, November 25, 2018 8:51:00 PM, Anonymous Anonymous said...

Biker


I don’t know the gender of EO, nor do I care. Personally, I give much credence to posters on this blog who seem to know the just how evil those in healthcare can be. I don’t care how they acquired this knowledge, be it from a combination of patient experiences and/ or working in healthcare. I do give extra credit when they are colorful about it and in this regard I give EO an A.

The definition of HAG by Merrimack-Webster ..an ugly, evil looking woman, a female demon, a hobgoblin.

My question to you Biker is have you ever received care from a female nurse who was evil. Have you ever received what you thought was care from an evil female nurse who tried to harm you? If you have not then you really don’t know what evil is. I don’t really care about those who read this blog and or remain anonymous. To me they are not engaged for whatever reason. If nurses read this blog and don’t learn anything from it or walk away unenlightened they it’s true they are a HAG. I think EO is being rather nice by definition cause there are a number of choice words I could use to describe them.


PT

 
At Sunday, November 25, 2018 9:27:00 PM, Blogger Maurice Bernstein, M.D. said...

But PT et al, what should be the theme of further discussion on this thread? Again, dignity as the named topic opens this thread to a host of issues regarding the interaction between the medical system and the patients. (Please scan through this "Illuminative Evaluation of Dignity in Care" 2012 Thesis by an author from England-- great detailed definition and approaches to resolution of problems.)

And it is my opinion that "moaning and groaning" to each other and the silent visitors does nothing constructive to remedy situations which need to be remedied.

Rather than calling issues "names", shouldn't there be discussions but leading to actions to remedy the situations?

The question should be what and how should further commentary be carried out on this bioethics blog thread? This is important so, as moderator, I know what and how to moderate! ..Maurice.

 
At Monday, November 26, 2018 4:39:00 AM, Blogger Biker said...

PT, having had 2 bladder cancer surgeries, a year's worth of treatments via the penis, 13 years worth of follow-up cystoscopies (every 3 months to start then slowly working its way down to annual ones now), a testicular ultrasound, and vasectomy, and every nurse involved in that care being female except for my most recent two cystoscopies, I have far more experience with female nurses and techs for intimate care than most people. I would not use the word evil or hag to describe any of them, including the two I consider to have been either inappropriate or unprofessional. All of the others did the job they were assigned to do in a professional manner, not doing anything to add to my discomfort or embarrassment. That I still felt uncomfortable or embarrassed and would have preferred male staff is on the system itself and those who make the staffing decisions, not those individual nurses. They didn't do anything wrong.

Anonymous readers do matter in that they can be influenced to change their approach to patient care or conversely to speak up as a patient without their having to jump into the conversation itself. Most of us have been influenced on any number of topics by what we have read without discussing the issues directly with the authors.

In my comprehensive experience in corporate settings and as an appointed and elected small town official (where you have to solve the problems yourself w/o staff), those who can clearly and calmly present the actual problem they are trying to solve are the ones taken more seriously, as are their proposed or requested solutions.

 
At Monday, November 26, 2018 1:01:00 PM, Anonymous Anonymous said...

Biker

The internet is filling over and flooded with articles referring to nurse bullying, violence and incivility. So much so that the Joint Commission as well as other nursing organizations have tried to get involved. When you read these articles they tend to say that patient care is at risk but they really don’t say how. They don’t want to come out and say yes, nurses bully their patients on the internet for if they did that might just compromise their so called standing as the most trusted profession. Anyone that discriminates is evil be it an individual or a group and if an entire organization discriminates then that organization is evil.

You want to be nice to people who discriminate against you? Ask black and Jewish people if nice worked for them when they were discriminated against. Ask them how that is working? Do you think anonymous readers here are going to be engaged, obviously Maurice know the visitors and I don’t think they are looking at this blog from an educational standpoint. I’m not sure how you are going to present problems to people when you don’t have staff. There is a big difference with people in a small town versus 4000 people who work at a major medical center in a large city, it’s comparing apples to oranges.

There is not one of us here who can judge anyone or what they have experienced. We don’t know nor have we walked in the shoes of EO or anyone for that matter. I don’t know what EO has been through and maybe I don’t want to know but obviously it was not good. For all we know maybe EO was at one point nice to providers and found that it did not work. There is a big difference between providers who are not professional towards a patient regarding physical privacy and a provider who not only was not professional but evil and attempted to harm you. You want to know evil, I’ve experienced that.

PT

 
At Monday, November 26, 2018 2:14:00 PM, Blogger Maurice Bernstein, M.D. said...

Whether the writers here are statistical outlier or NOT, I believe there is a real gender medical care problem (disease) at least in the United States (hopefully we will hear from other countries who are coming to this thread)... and the goal I see for this thread is to begin some process to attend to the initiation and augmentation of approaches which will begin and lead to a CURE of this systemic disease.

We read here about the symptoms and course and pathologic basis-- now is time to work towards that cure.

I am sure that all our commentators know lawyers and physicians. A first step is to make an effort to notify them what is being discussed here and have them join this thread with their views and perhaps their professional suggestions of how to proceed.

..Maurice.

 
At Monday, November 26, 2018 4:48:00 PM, Anonymous Anonymous said...

PT, thanks for your support. It is much appreciated, and contributes to healing. Yes, I myself and several family members, as well as a friend, have been both physically and emotionally wounded by the makemsick industry. In addition to grave physical harms, many of us bear quite dreadful, lifelong emotional scars that don’t ever really heal… And I am 100% with you in calling this industry evil. Yes, you are correct that most people cannot begin to comprehend the monster that the medical industry has become. Sure, there are some good providers out there, but, in my experience both personally and professionally, most are the opposite – arrogant, greedy, and reckless – reckless with our very lives!

Now, Biker, as this blog has been running some, what, 12-13 years, did using “nice” language change ANYTHING? ABSOLUTELY NADA! The nursing culture is just as corrupt today, if not more so, as it was 12 years ago. They continue to discriminate across the board against male customers. They continue to practice sexual voyeurism as well as endangering/taking lives with their reckless, selfish behavior and low intelligence. And yes, I am being polite using the term hag, as others terms are much more suitable, but not to this site. One man’s ceiling is another’s man’s floor – what you term a rant is simply one of the ways I write as professional creative writer, and I have over 45 years experience with creative as well as academic writing/editing. One has only to read ProPublica to savor the widespread corruption of all parties in “health” care.

Now, one of my Masters Degrees is in English, and some might think that a “soft” degree. I can assure it is the opposite. Our foundational training is to enable us to discern the truth from falsehood, and this endeavor is one of the most difficult. I have endeavored to show the false narratives – no, let’s call the animal what it is – outright lying by the makemsick industry. They lie about caring about customers, they lie about cancer screenings, they present false statistics, ad infinitum. They lie for profit.

Before you shut down the convo re vaccines, EDUCATE yourself. IT’S ALL ABOUT THE MONEY! Follow the money, as journalists say. Probably everything you think you know about vaccines is just another lie by a greedy, evil industry. Like PT, I use this term deliberately, for it is accurate. Have you had to bury a child after “unavoidably safe” vaccines? I think not. Ernest Fenollosa has given us much truth in this one sentence: “Logic has abused the language which they left to her mercy.” So it is seen in the lies and deceptions put forth by the makemsick industry. Simple jargons for simple sheeple minds is about all that is needed to rule the herd. And as I like to say, an educated sheeple is a dangerous sheeple! For these kinds of sheeples, such as pediatricians, lead the blue collar sheeples down the path of deceit and destruction.

EO cont.

 
At Monday, November 26, 2018 4:54:00 PM, Anonymous Anonymous said...


Now that the gig is just about up, i.e., that many people the world over are seeing the terrible deception, harms – evil - that is the vaccine cartel, the deep state is becoming more aggressive and oppressive. Nothing must stop in their acquisition of yet more profit. Globally Big Pharma has now topped a trillion dollars annually, of which 45% is US business. Note that John Hopkins just put out a statement that they would not treat children or adolescents that are not fully vaccinated. That’s right, if you didn’t allow 70-80 vaccines to be put in your children’s bodies, you are no longer allowed to USE THEIR FACILITIES OF WHICH WE THE TAXPAYERS PAY 100% OF – facilities, personnel, and so forth. So, while I take the discrimination of male customers as a HUGE problem, as a significant evil, I must present it as just one facet of an evil industry. The poisoning of our children surely must rate as the greatest of evils. I’ll repeat just one more time- most contagious diseases were no longer lethal well before the advent of vaccines. Instead, we now have over half of our children with lifelong diseases caused by vaccines! The Orwellian nature of this surely must awaken some of the herd – an authoritarian medical regime that permits no freedom of thought, or of body. Ironic, is it not, that many of the diseases that John Hopkins attempts to treat are from the childhood vaccination schedule, such as, yes, cancer! Autism rates are 1 in 35 in the US, with boys’ rates being 1 in 28. Big Pharma no longer attempts to discover and manufacture useful drugs, instead they have become huge marketing machines who have nearly unlimited control over the main media, medical research (we’ve discussed how a majority of research is false), education, and the makemsick industry. I take something back - the wolf is already in the door. Both educated and uneducated sheeples let it in, and it’s gonna be hell to take back our freedom. Our freedom of body and mind is not only recognized nationally, but internationally, But here, in these fascist states of America, there is no longer any true informed consent.

Bear in mind that our society has already entered the second phase of fascism, and medical ops is their willing servant in pursuit of control and profit. I know evil when I smell it, and the rank odor emanating from the makemsick industry stinks to high heaven of it! Recall, first they came for the gypsies, then the Jews, who’s next? Perhaps tear gassing starving children at our borders? Oh, that’s happening today! Now for those who deem that control of their own body is their inherent right, I say – the makemsick industry is the primary thug of the global medical cartel, and I approach with eyes wide open.

Thank you Maurice, for having an open mind. It a rare thing indeed in today’s makemsick industry.

EO

 
At Monday, November 26, 2018 8:54:00 PM, Blogger Maurice Bernstein, M.D. said...

EO, so do think the real solution to the "makemsick industry" behavior is behavioral control through change in the political system in the United States for devising laws and the legal system for seeing that the laws are followed?

Are we (USA) alone on the planet in this whole medical system misbehavior or worse? My concern is exactly why I want to encourage the visitors here from other countries to voice their experiences within where they live.

Banterings.. where are you in this patient dignity? I miss your postings. You have not written as yet to our Volume 93. I hope you are in good health and not facing the medical system issues that are being discussed here. ..Maurice.

 
At Tuesday, November 27, 2018 4:48:00 AM, Blogger Biker said...

EO wrote: Now, Biker, as this blog has been running some, what, 12-13 years, did using “nice” language change ANYTHING? ABSOLUTELY NADA!

In my case I only began speaking up a 2-3 years ago as a result of finding my voice here on this forum. Prior to that I was the typical guy that simply "manned up" and made believe it didn't bother me. Since then speaking calmly and clearly has been very effective.

I have been assigned male staff upon request and w/o being hassled by the female schedulers for my last 2 cystoscopies, 4 times now for 3 different types of procedures where sedation is deemed mandatory I have had those procedures w/o sedation, I was allowed to keep my pants and underwear on for an upper endoscopy and a T.E.E., both procedures for which having nothing on but a gown is standard protocol, and when I had a little dust up with Dermatology over not wanting a female scribe and LPN in the room for my exam, Patient Relations went to bat for me and effected a policy change in large part because of the manner in which I presented my complaint. I overheard the Patient Relations person essentially portraying me as credible, rational, and reasonable in my expectations of no female observers during my full skin exam.

So, yes, being nice has proven to be a very effective way to cause change in the delivery of my healthcare. In the corporate world and in the public sector where for 40 years I was the one in charge those who came to me ranting and calling people names have gotten nothing more than a smile, nod of my head, and an opportunity to vent. Rarely did I take their complaints seriously because they came across as people for whom no solution would be acceptable. Those who came to me in a calm rational manner got my attention and I'd do my best to find a win-win solution.

For broad changes that everyone might benefit from we need laws passed or a major court case. Until such point I will continue doing as I have done and yielding the benefits of more respectful and dignified healthcare such as I have achieved these past few years. In the case of dermatology, the policy change I caused to happen benefits other men who may also express concern over female observers. In urology my requests are giving them positive feedback that hiring a couple male nurses was a good move on their part. That perhaps will help other men. Having procedures done w/o sedation or any ill effects occurring has surely also taught the staff involved that maybe sedation shouldn't be quite as mandatory as it is. These things have ripple effects.

 
At Tuesday, November 27, 2018 2:21:00 PM, Blogger NTT said...

Good Evening My Friends

We’re here on this blog for those men and women that have had their dignity stripped away from them by a healthcare system that has lost its humanity to show them they are not alone.

We that have had dealings with the system have diagnosed the problem and are now seeking a cure for the virus.

Its going to take everybody working together towards the end goal of pushing this issue out into a public forum where the healthcare community can neither hide from the issue or bury it anymore.

As bad as they are and as angry as we get at them, we cannot let our guard down. If we want to be taken seriously by the medical community, we will have to play the nice game or, they will just look at us and say they’re a bunch of outliers that we can ignore.

Like Biker, I believe its going to take a lawsuit or congressional intervention to make the kind of changes we are looking for.

But that’s not going to happen until we get this issue out into the public’s eye where they like us, can see there is a problem that needs to be addressed. Once people really know what’s going on, they will call for change.

You can’t tell me that we have the know how to send a probe 54 million miles to another planet and make a spot on landing, but we don’t have the know how to fix problems here at home.

We have the know-how. We just have to find the will to use it.

As far as, are we the only country with healthcare issues, I would say no. The difference between our system and other country's from what I've been reading is other countries are working on the issues to correct what's wrong for the sake of their patients.

We here in America are just letting BIG BUSINESS make the rules instead of "the people".

For instance, I read in a journal the other day about a study done on urodynamics for prostate surgery.

They actually took the time to ask the patients their views and they got personal.

What they found out was men had apprehension, discomfort, and embarrassment. and, were not happy with the inadequate amount of information given about what would happen during and after the test. Many were embarrassed during the test due to lack of info.

Better privacy was another issue. Too many people in the room and just like here nobody introduced themselves to the patient and said why they were there.

So you see, we aren't alone.

Difference is, based on what the guys said, changes are to be made system wide to make the testing more tolerable.

You wouldn't see that here without a congressional mandate or court order.

So, chins up, chests out as we march on for a cure.

Regards,
NTT

 
At Tuesday, November 27, 2018 3:11:00 PM, Blogger Maurice Bernstein, M.D. said...

Let's get started: How about my visitors writing about this medical system misbehavior, amply described in these Volumes, to their US senator or congressperson and posting their response to be read by the visitors here. There has been much political concern disseminated in the media from politicians about financially protecting patients with established diagnoses. Now, how about views from the legislators regarding gender mistreatment by the medical system as described here? ..Maurice.

 
At Thursday, November 29, 2018 2:28:00 PM, Blogger A. Banterings said...

Maurice et al,

Forgive me as I have some issues with family and work are taking up all my time.

As to the issue of vaccination, I believe the vaccination issue is relevant. Forced vaccinations are a violation of one's bodily integrity just as modesty issues. Even if this thread was titled (only) "Patient Modesty" the vaccination issue has relevance.

I believe that other issues (such as criminal activities) furthers the lack of concern for the humanity of patients that infects healthcare. These issues are sociopathic and systematic.

I hope to be back to more in-depth posting soon.


-- Banterings


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

Since this thread has been expanded to Patient Dignity and with the issue of vaccination being started as a matter of personal autonomy, part of ones dignity.. how about quarantine for communicable diseases, most commonly tuberculosis?

First read the AMA Code of Medical Ethics regarding "Ethical Use of Quarantine and Isolation".

Like vaccination for infectious disease can one argue that quarantine for infectious disease is also a "violation of one's bodily integrity"? Can personal human dignity of any person be violated for a "common social good"?

If so, can anyone see a "common social good" in the way patient modesty is handled throughout the medical profession? For example, would there be less opportunity for obtaining "the best management and cure of disease for all patients" if the medical system was compelled to follow many of the "gender equality" requests brought to this thread?

Like "anti-vaccination" or "anti-quarantine" for maintaining the individual's dignity, could an "anti-gender" attitude by patients have a societal harm?

..Maurice.

 
At Friday, November 30, 2018 5:12:00 AM, Blogger Biker said...

Modesty based physical privacy is in a class of its own with no commonality with the vaccine controversy or any other extension of what some might want to place under the dignity heading. Can an argument be made that these other things are dignity issues? Sure, but all it does is divert attention from the specific issue of gender equity in the delivery of healthcare. It just serves to water down the discussion.

My wanting the same bodily privacy dignity considerations routinely provided to women has nothing to do with vaccines or hospital billing practices or the medical profession's self-governance, nor the newest addition to the list, quarantines. When I am asking for a male nurse or sonographer I really don't care about the rest of those issues. If gender based physical modesty/privacy weren't an issue all to itself it wouldn't have been singled out under B.F.O.Q.

Please let's not water this down.

 
At Friday, November 30, 2018 7:24:00 AM, Anonymous Anonymous said...

My husband had a heart attack in August. The 1st hospital didn't record him telling them he experienced bad side effects w/ painkillers. On transfer by helicopter, unknown to him they gave him 100mcg Fentanyl in addition to the 4mg of morphine given at hospital. He said he felt he was having an out of body experience. When he arrived at the hosp. that could handle heart patients, they immediately stripped him, put his things in a pink trash bag, and left him exposed to all including the registration woman. he is a prostate cancer survivor and wears pads and he was thoroughly humiliated but so drugged he couldn't voice it. He was exposed for a good 30 minutes. He was shivering uncontrollably. He was in a room w/ 4 females. His blood pressure dropped from the cold and the drugs (this is what he had told the other hosp.). After the procedure, there is no note of where he was but again he was left exposed and when they wheeled him out his gown was around his neck. Upon transfer to his room, (they wouldn't let me in there) they again left him exposed. The incompetent nurse could not get the equipment hooked up so the room was full of other people. Again, she left him exposed in front of them and made him use the urinal in front of them. This would not have happen if he was a female. The doctor who removed the sheaths also did not cover him up the next morning. A total lack of respect. He is very leery about more medical intervention because of this total lack of respect. Although exposure is sometimes needed, it should be done in a limited basis w/ only those necessary to the procedure.
I think that periodically all medical staff should have to be practiced upon so they know how it feels. If nudity is no problem, then they should have no problem for their co-workers to practice on them. My husband feels violated. Also, it took them over 2 hours for me to see him and then only because my son finally stopped one coming out of a door. We found out she had just come out of my husband's room and was laughing hysterically and couldn't speak for laughing. His memory is spotty and he doesn't know what was going on but we both are very upset about this. What was going on that 2 females nurses alone w/ a drugged man that would cause such hysterical laughter? He no longer wants females involved with his care if he is to have it. JR

 
At Friday, November 30, 2018 10:09:00 AM, Blogger Maurice Bernstein, M.D. said...

Welcome JR with your disturbing story.

I hear Banterings and I hear Biker.

I want the visitors here to know that I am not against the idea of resuming the thread dealing with strictly patient physical modesty as has been the main topic throughout all these 93 Volumes--but there is no reason why I can't start a continuing thread on patient dignity which can cover issues more broadly than physical modesty. It is true that I have had separate thread titles in the past years dealing with some specific aspects of patient dignity and these are still being read but generally not written to.

There obviously appears to be multiple areas within the medical system's activities which patients have considered as infringement on what property they own--their individual dignity. And these concerns are worthy of discussing in a thread name separate from patient modesty.

I would tend to agree with Biker that we shouldn't get off track but instead we should set aside the patient modesty matter as a separate topic which has been the main concern of participants over these past 13 years of postings. The goal with regard to patient modesty is to provide specific changes in the medical system and behavior.

Yes, personally unwanted vaccination pressuring or demands and many other examples of possible dignity infringement by government or the medical system itself is worthy of discussion but within a separately titled thread.

Banterings (who initiated the modesty title change) and all the other readers and participants what do you think about resuming "Patient Modesty" Volume 94 and beginning "Patient Dignity" as the simple single title, Volume 3?

Why am I writing all this? It is because I see in the 13 years of the writings primarily on patient modesty and the misbehavior or worse in this regard a topic that now needs active approaches to change the system and not diluted with other aspects of human dignity which may need other approaches for change. Does anyone agree with my suggestions regarding the threads? ..Maurice.

 
At Friday, November 30, 2018 1:11:00 PM, Blogger NTT said...

Good Afternoon:

USA Today & the Milwaukee Journal Sentinel have done an nice story on how doctors surrender their license in one state rather than suspension or worse then move to another state abd pick up where they left off.

He removed the wrong body parts twice. And he's still a doctor.

https://eu.jsonline.com/story/news/investigations/2018/11/30/doctor-good-record-might-have-troubled-history-given-up-medical-license-elsewhere/2048657002/

Regards,
NTT

 
At Friday, November 30, 2018 2:20:00 PM, Blogger A. Banterings said...

Maurice,

We have discussed such things as supporting that medicine "does not know any better." I do not think that such topics become the focus of the thread, but are allowed to support that modesty violations simply occur because medicine "does not know any better."

As moderator and (we) as posters must focus on the modesty aspect. Supporting material (such as vaccines and quarantine) may be presented, AND (as when the thread was only titled "Patient Modesty") a seperate thread may be spun off if that topic so warrants it.


-- Banterings



 
At Friday, November 30, 2018 2:28:00 PM, Blogger Maurice Bernstein, M.D. said...

NTT, "ugh!"
This documentation piece shows the intrinsic deficiency within a system to keep control of the medical system. Discouraging for those of us who want to improve the medical system.
This is an example of a physician's actions to maintain self-dignity is destroying the dignity of the medical board of another state. As repeatedly noted in previous Volumes, we must include changes in the state and federal agencies if we want to make changes in the medical system below them. Again, "ugh!" ..Maurice.

 
At Friday, November 30, 2018 3:08:00 PM, Anonymous JF said...

I wanna write to my senator about our topic. It's Marc Rubio but I couldn't pull up his mailing address from Google. I don't have a good attention span. I might ask one of my nurses to get it for me or a coworker but first I thought maybe somebody here might know it.
Otherwise I wanted you all to know that the Adventist Health system is in violation of the Seventh Day Adventist Church but very possibly they are unaware of the fact.
I was a member of the Adventist church for 14 years before I learned what Ellen White said about the opposite gender intimidate care issue.
I'd like to mention that our church has been accused of making Ellen White into a god. We don't but we acknowledge her as " more than a prophet" In chapter 6 of Daughters of God Mrs. White wrote It is not the will of God that men attend to the delicate needs of women and lady physicians should utterly refuse to look upon the secret parts of men. Very much evil has resulted from the practice of men treating women and women treating men. It is a practice according to human devising and not according to Gods plan. Ellen White also said that if men attended to men and women attended to women, a door that Satan desires to enter is closed to him. All this was written like in 1911 and thereabouts. And one reason a lot of Adventists don't know is because Ellen White wrote more than 40 books,5000 articles and 50,000 manuscript pages.

 
At Friday, November 30, 2018 4:42:00 PM, Anonymous Anonymous said...

In response to JR, help your husband regain some control by filing complaints appropriately. The Hospital your husband was mistreated at is licensed by the State, is certified by CMS, and has nurses who must follow nursing regs as well as state and federal regs.

You could complain to the State hospital licensing agency - found at the Dept. of Health Services in your state. Here is an example of regs in my state, Washington, about treating patients with respect and not abusing them (of which your husband was a victim on both counts).

WAC 246-320-141
Patient rights and organizational ethics.
The purpose of this section is to improve patient care and outcomes by respecting every patient and maintaining ethical relationships with the public.
Hospitals must:
(1) Adopt and implement policies and procedures that define each patient's right to:
(a) Be treated and cared for with dignity and respect;
(b) Confidentiality, privacy, security, complaint resolution, spiritual care, and communication. If communication restrictions are necessary for patient care and safety, the hospital must document and explain the restrictions to the patient and family;
(c) Be protected from abuse and neglect;
(d) Access protective services;
(e) Complain about their care and treatment without fear of retribution or denial of care;

But worse, here are portions of my states regs on SEXUAL MISCONDUCT (every State has similar regs). There was ZERO reason to leave your husbands genitals exposed (he wasn’t given a foley catheter it sounds like so ZERO reason to uncover his genitals, even to access the femoral arteries). That is either very poor training for those nurses or intentional actions by them. Regardless, complaints about sexual misconduct should be filed with your State’s Board of Nursing, the Hospital, and the Licensing agency. Tell them the story you posted here. Until men start complaining about sexual misconduct these behaviors won’t change.

WAC 246-840-740
Sexual misconduct prohibited.
Sexual misconduct. A nurse or nursing technician shall not engage, or attempt to engage, in sexual misconduct with a current patient, client, or key party, inside or outside the health care setting. Sexual misconduct shall constitute grounds for disciplinary action. Sexual misconduct includes, but is not limited to:

(b) Touching the breasts, genitals, anus, or any sexualized body part except as consistent with accepted standards of practice for examination, diagnosis, and treatment and within the nurse or nursing technician's scope of practice;

(f) Not allowing a patient or client privacy to dress or undress except as may be necessary in emergencies or custodial situations;
(g) Not providing the patient or client a gown or draping except as may be necessary in emergencies;

(i) Removing patient or client's clothing or gown or draping without consent, emergent medical necessity or being in a custodial setting;

(q) Making statements regarding the patient, client, or key party's body, appearance, sexual history, or sexual orientation for other than legitimate health care purposes;
(r) Any behavior including any verbal or physical contact which may reasonably be interpreted as sexually demeaning, humiliating, embarrassing, threatening, or harming a patient, client or key party;
(s) Photographing or filming the body or any body part or pose of a patient, client, or key party, for other than legitimate health care purposes or at the request of and for the benefit of, the patient, client, or key party; …

-AB in NW.

 
At Friday, November 30, 2018 5:57:00 PM, Anonymous Anonymous said...

I don’t think everyone should get their panties in a knot for worrying over issues that are not physical related privacy posted on this blog. You know the medical community certainly won’t and they will even look for an excuse to diminish their behavior and their pathetic horrible mistakes as they routinely screw over the lives of other people.

Case in point. A nurse killed a patient by giving them the wrong medication, vecuronium instead of versed. The news report listed vecuronium as a drug that is used in lethal injections. The posts on Allnurses were of the position that it was wrong by the news agencies to note that this compound is used in lethal injections. Never mind the idiotic mistake made by the nurse, never mind this happened to a patient the day after Christmas, never mind what the family went through, never mind the unfortunate death the patient experienced.

Just blame the news agency for letting the public know that this drug is used in lethal injections. Have I ever mentioned how much I despise the medical community, have I mentioned how much I hate nurses. Would you like to know how many fatal mistakes nurses make each year administering medicines to patients.

PT

 
At Friday, November 30, 2018 6:33:00 PM, Anonymous Anonymous said...

Let’s talk more about this issue of dignity and physical privacy. Which is worse, being treated in an undignified fashion in the hospital, being given vercuronium by mistake and dying in an undignified fashion or simply refusing to seek care like many men do and then dying from the disease process. I’m a little confused why a physician would prescribe versed for claustrophobia regarding this patient, Ativan is the first appropriate choice since Ativan is used to treat anexiety. Versed seems like overkill for a patient verbalizing that they has claustrophobia.

Nurses spend a lot of time on their cell phones, facebook and chatting at the nurses station about patients and their families. They get upset when they have to get up from the chair their buttocks have been glued to for the last hour and give a patient medication. They want to complete the task as fast as they can so they can return to their chair while the glue is still warm. Such is the sisterhood of nursing, ever complaining about their assignments, the number of patients they have etc. The perpetual bullying, violence towards their coworkers, patients and physicians.

Men avoid healthcare for many many reasons, one of them is to stay away from evil hags for fear of incompetence. Mistreating patients in regards to respectful care and physical privacy is not just unprofessional behavior, it’s not just sexual impropriety, it’s not just discrimination, call it what it is additionally, incompetence.

PT

 
At Friday, November 30, 2018 9:05:00 PM, Blogger Maurice Bernstein, M.D. said...

AB in NW, does the extensive state regs which you described in Washington State and hopefully in all states apply only to hospitals or also in every physician's office? How are the institutions actively monitored to verify compliance? Or do the states simply await complaints from patients, family or other observers? I suspect the answer is "the latter". ..Maurice.

 
At Friday, November 30, 2018 9:24:00 PM, Blogger Maurice Bernstein, M.D. said...

You know, I was thinking a bit further with regard to my last posting. I once experienced a "new patient" enter my office simply asking me to prescribe a narcotic without providing any further history or to have a physical exam. When I explained my "no" response to his request, he got up and left my office. I then instantly assumed he was from the State screening me for my behavior regarding a narcotic request. There was nothing in this "patient's" appearance or behavior to suggest any other possibility.

In this regard, then, why can't the state arrange to have "pseudo-patients" randomly enter hospitals to provide a limited monitoring of the state regulations you describe? The airlines carry "pseudo-passengers" to maintain safety, why not "pseudo-patients" in hospitals? ..Maurice.

 
At Saturday, December 01, 2018 1:57:00 AM, Blogger NTT said...

Good Morning Friends:

JF, Rubio has a senate webpage that has a link to send him email. Everybody in congress has one as I've been using the links to send letters to many of them. So far with just canned responses.

Here's the link to Rubio's page.
https://www.rubio.senate.gov/public/

Regards,
NTT

 
At Saturday, December 01, 2018 8:06:00 AM, Anonymous Anonymous said...

Dr. Bernstein,

The sexual misconduct regs I posted apply to all licensed nurses and nursing techs practicing (licensed) in the State of WA. That is, whether it’s a hospital, assisted living facility, clinic, ambulatory surgery center, diagnostic imaging center, etc. These are statutes under the “nursing” section of the Administrative Codes. Every state I’ve looked at has similar that would apply to nurses, wherever they practice. That is, nurses and their aides have a responsibility to treat each patient with dignity, maintain their bodily privacy, and not abuse and demean patients. Leaving patients exposed endlessly for no urgent/proper medical reason violates these laws.

These regs apply to ALL genders, not just for protecting females. Unfortunately there seems to be a pervasive medical myth, not evidence based, that one doesn’t need to provide proper draping and bodily privacy for male patients, nor similar “modesty” accommodations to male patients that are provided to female patients. Such discrimination is inconsistent with state and federal laws. - AB in NW

 
At Saturday, December 01, 2018 8:21:00 AM, Blogger Biker said...

Dr. Bernstein, pseudo-patients could work for checking on inappropriate dispensing of drugs, but how do you do this with exams or procedures requiring intimate exposure? Certainly there would be people willing to subject themselves to that; no different really than people being willing to be patient actors in medical schools. The issue is how does a pseudo-patient present so as to get their clothes forcibly removed in an ER or get a catheter or be scheduled for a testicular ultrasound or some other intimate procedure?

I still think we'd see healthcare staff (all levels, physician down to medical asst) be much more respectful of patient modesty/privacy/dignity if before they were allowed to work in a healthcare setting they had to have an intimate exam by opposite gender staff, and with extra staff in the room. Then and only then would they understand what it is like to be a patient in the way we discuss here. Most 20 something young women entering the healthcare workforce have never been a patient in that manner. Most never will and as a result will never understand the difference between being polite and being respectful nor the difference between convenience and necessity.

 
At Saturday, December 01, 2018 9:57:00 AM, Blogger Maurice Bernstein, M.D. said...

Biker, I offered the suggestion of "limited monitoring" of staff behavior by the State. There are many less dramatic repetitive staff-patient communication and behaviors of the staff to patients that could be signals of the potential for worse actions or ignorance. Yes, staff preparing a patient in the ER for a physician examination or how the nurse behaves in applying a bed-pan to a patient or closing curtains surrounding the hospital bed. There are many other possible actions or procedures which could provide insight to the investigator "pseudo-patient" about a staff's ignorance or defiance of rules. ..Maurice.

 
At Saturday, December 01, 2018 11:53:00 AM, Anonymous Anonymous said...

AB in NW

Those regs you posted do not apply to medical assistants and who exclusively employs medical assistants, physicians offices. State boards of nursing regulate nurses that are nurse practitioners, registered nurses, licensed practical nurses and certified nursing assistants. It’s always seemed redundant to me why state nursing boards do not regulate medical assistants. There are many medical assistants who practice outside the scope of their license and who present themselves as nurses which in some states is a crime.

Secret shoppers or pseudo-patients would be worthless in evaluating the services of any medical facility due to the liability and what would the point of it be anyway? Medical facilities across the country pay millions of dollars for Press Ganey to survey YOU the patient when they want to and the complaints are not acted upon regardless. The money paid to Press Ganey by the way comes out of you medical bill. I’m going to say with absolute certainty that about 98% of all nurses have no idea about the regulations you posted, nor can they recite 2 regulations from the nurse practice act.

As far as female staff making derogatory sexual comments about their male patients, I’ve heard just about all you can imagine. They have to verbalize it to other staff. If the nursing industry is so professional and the most trusted profession then why would you need those regs in the first place. Don’t you think the choice of a career would be to advocate for the ill and that it would be a calling, that at some point during coursework ethics training you have to have a presence of mind.

WAC 246-840-740 q) Making statements regarding the patient,client,or key party’s body,appearance ,sexual history,or sexual orientation for other than legitimate health care reasons. This one is probably abused the most.

PT

 
At Sunday, December 02, 2018 7:11:00 AM, Anonymous Anonymous said...

I believe that any medical staff member should not be allowed to carry a cell phone on their person that is capable of taking photos/video. The old and the drugged are especially vulnerable to misconduct by medical staff. The cath lab is not exactly sterile as they allowed in the helicopter crew and did the "shave" on the table so there is no reason that an advocate for the patient such as a wife or husband cannot be present to make sure there is no misconduct or abuse. I am mature enough to know to stay out of their way. My husband was present during my emergency C-section where my guts were laid on top of me and I was fine and he didn't interfere. The secret atmosphere that we allow medical procedures to have is the biggest part of the problem. If everything was transparent then I think many of the issues would resolve themselves. The idea that they used Versed is to me, unethical. If you are given painkillers and a general numbing agent then why is Versed necessary to wipe out the pain of the procedure? It is used in my opinion to wipe out your memory of their actions for their convenience. I don't feel it is anyone's decision to decide what memories I keep and what memories are erased. That sounds like a war crime to me. If Versed is consent to then the person should have a right to have an advocate of their choice present. If they are indeed doing no harm then why not? In most ORs there is an observation room behind glass so why can't your advocate be in there? Transparency solves many issues. Why can't a family member be present when they transfer someone from recovery to their room? What is the big secret? Most adults especially if they are told to keep out of the way will respect it. Medical staff are human and many times people forget that and make them demigods. They are sexual beings too and don't necessarily leave that at the door. Having an advocate present is just sense. JR

 
At Sunday, December 02, 2018 11:23:00 AM, Blogger Biker said...

JR, I am convinced that versed and the other amnesiacs used are primarily a convenience tool for the staff and a billing mechanism for the hospital.

First on the billing, on one of my procedures that I refused versed for a T.E.E.(transesophageal echocardiogram), they billed $600 for use of the recovery room. I had to go round after round with them to remove that charge from the bill being I never went to a recovery room because I had nothing to recover from. I imagine many hospitals also bill separately for administering the versed as well.

More importantly if a T.E.E. and upper endoscopy which I also had w/o sedation are simply a tad awkward but not in the least painful and if colonoscopies are neither awkward nor painful, I cannot see what medical benefit the patient receives from being sedated with an amnesiac. It my case it makes me ill which is a big negative instead. This is why I am convinced its purpose is simply staff convenience.

Part of that staff convenience is not going through extra steps to keep the patient covered when its easier to leave them exposed. For the T.E.E. and upper endoscopy I kept my pants on vs wearing only a gown. For the colonoscopies (did it twice this way), not being sedated meant I was assured of being kept covered 100% of the time.

I would add that the secrecy aspect you note extends to the verbal and/or written instructions and literature patients receive or can find on the internet themselves. They invariably gloss over privacy and exposure issues if they get mentioned at all. The dermatology office doesn't tell the patient scheduling their 1st full skin exam that a scribe and asst will be there observing. The Cath Lab doesn't tell the patient who will shave them (if they even get told they'll be shaved) and whether or not they'll be exposed at any point in time. Urodynamics testing is grossly privacy-invasive but male patients are not told that it'll be 2 women doing the test, similar to men being sent for testicular ultrasounds without being told it'll be a woman doing the procedure. This not informing the patient is pervasive throughout.

 
At Monday, December 03, 2018 3:44:00 AM, Blogger NTT said...

JR, the public, has no clue that many benzodiazepine sedatives like midazolam (aka versed amongst other names) & non-benzodiazepine sedatives like zolpidem cause anterograde amnesia. These drugs are the doctors & nurse’s best friends because it allows them to do what they want & not get caught because without an advocate there for your protection, you’ll never know what they did & who was there when they did it.

There is hard evidence that the amnesiac effects of the drugs can & do last far longer than they anyone predicted. Especially in older adults. Some people’s memories are screwed up for the rest of their lives.

I agree with Biker that it’s a convenience for the medical staff so they keep it at the ready & freely use it without regard to the patient.

As part of any healthcare reform, better patient laws must be enacted for the following.

Whenever gender specific intimate care of any type comes into play regardless of gender, the patient must be asked beforehand if they prefer same gender care givers. If they do, the facility must (with the exception of emergency care), provide them before proceeding with the task at hand. Violation of this basic human right, will result in immediate termination of employment of all offenders involved.

Take the cell phones with cameras out of the hands of all healthcare workers during working hours. Hospitals should provide communications to keep in contact with staff during working hours.

Anyone caught with a camera phone on their person during their shift gets an automatic one-week suspension without pay regardless of title. Get caught a second time, its automatic termination.

Next is the use of benzodiazepines. Due to the effects of the drugs on people’s memories, if the hospital insists on using them, then patients must have a patient advocate of their choice with them at all times the drugs are in use on the patient. With their advocate with them the provider will inform the patient & their advocate that the drugs are being used & what effect they will have on them. The advocate cannot be a hospital employee.

When a patient is asked to get an exam, test, or, procedure, the healthcare provider asking will provide their patient with a full & accurate account of what it is that they are asking their patient to go through. Too many patients are being blindsided by the industry which leads to poor patient/provider relationships.

Ladies & gentlemen, the American healthcare system has had things their way far too long & we the patient are the ones paying the price. For example, the article in USA Today shows how their system protects the doctors at the patient’s expense by allowing them to surrender their license in one state then just go to another state & pick up where they left off. Nurses that violate patients do the same thing & get away with it.

The inmates are running the institutions. We don’t need nor do we want these kinds of individuals taking care of our citizens. Its time to purge the system of the pervs, voyeurs, & all the others that do wrong by the patient.

In any patient centered healthcare system, it’s the needs of the patient, not what’s convenient for the healthcare worker or institution that takes center stage.

Let’s remove their veil of secrecy once & for all.

Of the people. By the people. For the people. That is what a reformed American healthcare system must be about. Not give me your money & leave any ideas of dignity, pride, & respect at the door or just stay away.

Only after the patient’s rights are secured will we take a look at what can be done to lighten the burden on medical staff. Not before.

If these are the kind of things you want to see from your healthcare system then ladies & gentlemen its time to put that iced tea &/or beer down, get off that couch, & contact your state & federal representatives, family, & friends & let them know “YOU MEAN BUSINESS”. Things must change.

SPEAK NOW. LOUD AND CLEAR. Or forever hold your peace.

Regards,
NTT

 
At Monday, December 03, 2018 6:14:00 AM, Anonymous Anonymous said...

Biker,
I agree. Versed is used for their convenience. My husband was not told about it. The stuff you found on the Internet glosses over what really happens in a cath. lab. He went through hypnosis to regain some of his memories. At the end of the session when he came out of it, he was emotionally upset. It was a terrible experience. The hospital he was transferred from noted that he had a "husband". We have to wonder that since he was transferred to a large Catholic hospital that they might have been less considerate of him for this reason? By the way, his spouse is female. This same hospital treated me horribly by not letting me see him before the procedure even I was there. I also was not able to see him for 3 hours after the procedure except a glance in the hallway. I was supposed to have able to see him within 30 minutes but it took 3 hours.
You're right. The cath. lab doesn't tell who shaves them. He remembers being told they were shaving him. In his drugged state, he remembers thinking why but was unable to voice it. The OR reports of the past listed more details but they have secrets down to a science now. He really didn't need to be shaved. The cath. lab is really not sterile as they let in the air ambulance crew and did the shave on the table. They didn't allow him to undress either although he was able to do so. I wasn't shaved for my C-section and nothing bad happened. I think this is just a routine they use to create submission and power.
They say the pain med and Versed are for the patient's good. However, after the procedure he remembers them telling him they were stitching devices to him and it would hurt. Hurt it did. At that time, they didn't care about the pain so their story of how they do this for patients not to feel pain is not true. They didn't even numb the area.

He had told the other hospital that he didn't want painkillers due to sensitivity but they failed to note that and by the time he was at the other hospital, he was drugged out of his mind.

In his health directive, he has listed what he will allow and what he won't. There is an app. you can put on your phone so it is always w/ you. I mostly go everywhere w/ him so I can once again turn into a tigress if needed. I have come out of retirement to protect him from this medical system that discriminates against men. They would never do to women what they do to men. I was once told by an urologist that he didn't like women like me. I told him to get used to it because women knew how to stand up against doctors and it was my hope that men too would learn how to stand up for their rights. I was defending my husband at the time. JR

 
At Tuesday, December 04, 2018 10:52:00 AM, Blogger Maurice Bernstein, M.D. said...

Another aspect of the provider-patient gender relationship, which I don't recall being specifically discussed here is about the LGBTQ status of the patient (and even that of the healthcare provider).

Does anyone consider it insulting for a for a physician or nurse, male or female, to ask their patient their sexual orientation as part of history taking? Shouldn't that history information be pertinent and essential for managing certain aspects of medical treatment and nursing for that patient? For example a transgender male who has residual female breast tissue be cautioned to maintain breast screening for cancer? How about prostate cancer in a transgender female who may still have an intact prostate?. Here is the link for a presentation of the overall management of a transgender's health: "Transgender Health"

This all begins with worthy communication between parties. And what about the personal gender of the provider (physician, nurse, tech, etc.) Would you say that also should be part of the initial conversation between provider and patient? But, do you see this "gender disclosure" of both parties a necessary part of a "honest" and "beneficial" part of the provider-patient relationship? ..Maurice.

 
At Tuesday, December 04, 2018 2:10:00 PM, Blogger Biker said...

Dr. Bernstein, as you note there are legitimate reasons for some physicians or other staff to be aware that a patient is transgender, but rather than ask all patients, I suggest transgenders be the one to communicate that info to their providers when it is pertinent to the care being received. Transgenders are such a small % of the population that it would be overkill to ask every patient this question.

Concerning lesbians and gays, I say it is none of the physician's business unless the patient chooses to share it. Same goes for lesbian or gay healthcare staff. It is none of the patient's business. As a patient I really don't care whether they are or aren't.

 
At Tuesday, December 04, 2018 7:29:00 PM, Anonymous JF said...

Biker, Maybe YOU don't care, but some patients do. Especially when it comes to intimate care.

 
At Tuesday, December 04, 2018 8:41:00 PM, Blogger Maurice Bernstein, M.D. said...

Biker et al, we DO teach first year medical students to include a Sexual History in their detailing of the Past History as in sub-category PERSONAL HISTORY:

H- Home, living situation and relationships
E- Education, employment
A- Activities, typical day, exercise, hobbies, sleep habits
D-Drugs (illicit, tobacco, alcohol)
S-Sexual history
S-suicidal or depressed (current or past)
S-spiritual history

Is any of the categories SO PERSONAL and SO UNNECESSARY TO ASK that these sub-categories of the patient's life as to warrant omission?

The patient is not threatened by the student to respond to any of the categories but will explain to the patient why the answers are important as a physician develops a complete medical history.

..Maurice.

 
At Tuesday, December 04, 2018 8:57:00 PM, Anonymous Anonymous said...

Last year Press Ganey earned between $100-500 million and yet their worthless efforts have defined just how worthless your opinions are to the hospital where you received care. Notice they tell all their patients “you might get a survey” but that not all do. Probability tells you that the more statistical data you recieve the more accurate the evaluation. How many times have you heard each year how nursing is the most trusted profession and that we are expected to place our full trust in them.

Why do we need to know all the regs that AB in nw posted, answer is we don’t. How would you the patient know those even exist, most all nurses don’t. Why do we have State nursing boards and why is it that every 3 months they post pages and pages of nurses that have been reprimanded. Is it that they have to be transparent, to show that those who work for the boards are doing their job, but to what end. Who does it benefit? In many states the nursing board will not show the general public what nurses are reprimanded, why? Is it an embarrassment to the nursing industry or to the board itself?

AB in nw posted those regs to demonstrate that you the patient should be treated with dignity and respect by showing you those regs.Yet don’t you think it’s the hospitals, medical facilities responsibility to let you know those regs exist. If they let you know those regs exist that would cast doubt that you could trust anyone in the nursing industry. So, knowing what the regs are, how is that supposed to help you the consumer patient? Those regs are about as worthless as core values in that very very few know they exist. The same can be said of the nurse practice act, who can recite any of it.

It just seems to me that there is very little information provided to the consumer patients to make good informed consent when there is much information out there that says how little you can trust the medical facilities. One way I like to point out healthcare’s dysfunction is by comparing it to other industries. Now, not only have physicians been told to do no harm, but now they are being told to do no financial harm. No, you should blame all the nurse quacktitioners and physician actors for not having the required clinical skills and just ordering very expensive tests.

PT

 
At Tuesday, December 04, 2018 9:05:00 PM, Anonymous Anonymous said...

Folks


I have seen many patients of the LGBTQ community treated very badly once it’s known by staff. It’s sickening! Furthermore, patients who suffer from hermaphroditism are treated worse and they don’t even fall into the LGBTQ community.Figure that one out, they are treated like circus freaks. Finally, if you are a male patient presenting to the emergency room with an object lodged in your rectum I assure you the entire hospital staff will be aware of you in short order.

PT

 
At Tuesday, December 04, 2018 10:41:00 PM, Anonymous JF said...

PT, I would think that would be a HIPPA violation. I know it's probably true though. Where I come from a doctor had to go to a hospital because his wife superglued his genitalia together while he slept. He wouldn't go to the hospital where he worked but he still didn't go far enough. It was known by everybody and their brother in no time.

 
At Wednesday, December 05, 2018 3:29:00 AM, Anonymous Anonymous said...

I do not follow this website every day so
I am late in finding out about JR's allegations when her husband was in the hospital. Reading her various posts though I did not get the impression that either she or her husband complained. They definitely should and it seems almost a guarantee that if they did at least something would be done about this. In their case there were numerous witnesses to back up the story whereas I was out all by my lonesome. I still think that somebody associated with this site should write a book about all of this.


PA

 
At Wednesday, December 05, 2018 4:14:00 AM, Blogger Biker said...

Dr. Bernstein, all of those questions may be pertinent to the physician for purposes of their better understanding the whole person. I get that part, and agree it could be a good thing if it helps the physician see the patient as a real person.

For some patients however the fear of being judged and receiving lesser care is real. Others who may trust their physician may be concerned about confidentiality, especially on sexual orientation or history matters or concerning mental health. No longer can patients tell their doctor anything in confidence. It goes in the electronic record and it'll be there in perpetuity for the myriad of healthcare staff who don't need that info but who the system gives it to anyway. It'll also be there increasingly for govt. entities with non-healthcare agendas for whom weaponizing health records is a means to achieve their ends.

The system itself is working against the interests of all concerned.

 
At Wednesday, December 05, 2018 4:43:00 AM, Blogger Biker said...

This LGBT issue reminds me of a question I've thought of a few times in the past but never posed. Are there regional differences in the US concerning the issues we discuss? The US is far from being a monolithic culture. I've been places down South and in the Southwest that are so culturally different than New England that it doesn't even feel like I'm in the same country.

The LGBT issue that prompted me finally asking the question is just one example, but gays have lived in the open here for so long that it is not a big deal. The culture of Northern New England is live and let live and most people don't care about such things. If the LGBT community is being abused in the healthcare system here based on their orientation it is not anything I've ever heard about from the gays & lesbians I've known. We just had a transgender woman run as the Democrat candidate for governor and neither she nor the general public made that an issue in the campaign. It only seemed to be an issue for people in other parts of the country. She lost to a popular Republican incumbent in this otherwise Bernie-friendly State, and nobody pointed to her transgender status as a reason for her loss.

Coming back to the general topic of modesty/privacy/dignity, is it possible that there are regional differences? Or differences between urban/suburban areas and rural/small town areas?

 
At Wednesday, December 05, 2018 7:13:00 AM, Anonymous Anonymous said...

PT is right. Staff, nurses, etc. have VERY LITTLE knowledge of the regs and their own responsibilities under their licenses. They receive little to zero training on much of this material. Sadly they rely on word of mouth and "urban myths". I think that makes it all the MORE valuable to complain about violations you experience from these folks.

On a related matter, for those of you that access medical care at HOSPITAL based physician offices, hospital based clinics, hospital based imaging centers and the hospital itself there are federal regulations that must be met by these entities and those regs apply to EVERY patient (not just Medicare & Medicaid patients). Each hospital, to receive federal payments, must be certified as meeting these requirements. Many hospitals use the Joint Commission to achieve this certification. Certification involves an unannounced inspection periodically. Some have a direct survey by the government (which is always done by the State licensing agency under arrangement with the Centers for Medicare and Medicaid Services, CMS). These certification surveys happen on average every three years. Failure to be certified means NO PAYMENT for Medicare and Medicaid patients and ultimately the closure of the hospital/medical center.

Attached is a link where you can see the list of regs that are required (they are called the Hospital Conditions of Participation and they have associated Interpretive Guidelines that outline their intent and how they will be surveyed).

https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/som107ap_a_hospitals.pdf

Some relevant standards from that document:

§482.13 Condition of Participation: Patient's Rights
“A hospital must protect and promote each patient’s rights.”

§482.13(c)(1) - The patient has the right to personal privacy.
“The right to personal privacy” includes at a minimum, that patients have PHYSICAL PRIVACY to the extent consistent with their care needs during personal hygiene activities (e.g., toileting, bathing, dressing), during MEDICAL/NURSING treatments, and when requested as appropriate.
People not involved in the care of the patient should not be present without his/her consent while he/she is being examined or treated. If an individual requires assistance during toileting, bathing, and other personal hygiene activities, staff should assist, giving utmost attention to the individual’s need for privacy. Privacy should be afforded when the MD/DO or other staff visits the patient to discuss clinical care issues or conduct any examination or treatment.”

§482.13(c)(2) - The patient has the right to receive care in a safe setting.
“The intention of this requirement is to specify that each patient receives care in an environment that a reasonable person would consider to be safe. For example, hospital staff should follow current standards of practice for patient environmental safety, infection control, and security. The hospital must protect vulnerable patients, including newborns and children. Additionally, this standard is intended to provide protection for the patient’s EMOTIONAL HEALTH and safety as well as his/her physical safety. RESPECT, DIGNITY and COMFORT would also be components of an emotionally safe environment. “

§482.13(c)(3) - The patient has the right to be free from all forms of ABUSE or HARASSMENT.

So, for example, those patients that are intentionally left naked/exposed for no justifiable medical reason, not given the decency of draping nor physical privacy, are being abused and violating the federal standards above. This is why I’ve stated complaints to the licensing agency, Boards, and, if the Joint Commission is the certifying entity, to the JC, should include the words like “abuse”, “sexual abuse”, “felt threatened, uncomfortable”, “unnecessary exposure”, "intimidating", etc.

If you don’t complain the behavior continues. Complain. AB in NW

 
At Wednesday, December 05, 2018 1:24:00 PM, Blogger Maurice Bernstein, M.D. said...

PA, I am not sure that the book written by a participant here would be as effective in the short run. I do agree with AB in NW that formal complaints to the Joint Commission has the potential of being more effective. However, I also believe based, on previous postings that PT would promptly, disagree with my advice regarding the JC.

Biker, I fully agree that the electronic record which I never had available (not concocted or required) so thus not part of my past active medical practice and currently my participation in a "free clinic" for the poor and those patients who are not eligible for governmental support..hooray--all notes are written by hand! (the only handicap is being able to read all other physician's handwritten notes.)

Finally, acceptability of a patient for the doctor to ask and write responses about any personal details of the patient's history is strictly related to relationship and understanding with the patient's physician and specifically whether the patient understands the value of such documentation as part of the beneficial professional action to cure. "To cure": isn't that the ideal goal of all patient-doctor interactions. ..Maurice.

 
At Wednesday, December 05, 2018 2:28:00 PM, Blogger Biker said...

Thanks AB in NW, I didn't realize there were standards that clear and specific. That is encouraging and helpful. To what extent do the regulatory agencies expect patients to have first pursued their complaints directly with the hospitals?

Dr. Bernstein, if for example a patient is meeting with a physician for the 1st time for a routine physical, I suspect that it is not clear to the patient how the physician knowing the patient's sexual orientation or history is pertinent to the physical they are about to receive. The other thing is that it isn't the doctor taking the history but rather a Medical Asst. At least that's been my experience in recent years. When the doctor comes in they may ask some follow-up questions to probe deeper on an issue and they will ask additional questions as they perform the physical, but all of the lifestyle questions, meds being taken, past medical issues & surgeries etc is covered by the MA beforehand, the MA of course just following a script and keying in whatever the answers are.

 
At Wednesday, December 05, 2018 5:23:00 PM, Anonymous Anonymous said...

Maurice

Twice I have made complaints to the Joint Commission regarding my care at a hospital and twice after making the complaints online I have received some ridiculous number that is best described in scientific notation. Never recieved a follow up from the Joint Commission, responses Nada. Having worked in management at hospitals I have on many occasions escorted the Joint Commission through hospitals from department to department as they looked for infractions. Most of these people are clueless and could not inspect their way out of a cardboard box.

What benefit is there to make a complaint to such an organization when you don’t get a response to your complaint. Hospitals are inspected once every third year and I assure you it’s never the same people that visit. The Joint Commission is not the venue for patients to bring complaints to, a) the Joint Commission does not have the manpower. They don’t have a base in every state, their field inspectors are flown out to inspect the facilities. b) The Joint Commission only insects hospitals for their processes, fire drills, fire exits, fire extinguishers, evacuation plans, you get my drift. c) if you want to score well with the Joint Commission on the day of the visit supply them with lots of coffee and donuts.d) The Joint Commission does not have regulatory power, they cannot shut down a hospital.

d) Passing their inspections is like getting the seal of good housekeeping. e) They are a for profit organization, hospitals pay them a sizable sum to inspect their facilities. f) Hospitals are not required to have their facility inspected by the Joint Commission, it’s a voluntary program. g) You will never see a physicians office volunteer for Joint Commission inspections. The Joint Commission is a line that sounds important dosen’t it, well it’s not. It’s just a name.

A patient at a hospital in Tennessee was given a fatal dose of vecuronium instead of versed. The mixup occurred when the nurse typed in the letters VE in the Pyxis and when the Pyxis opened the drawer that’s what she got and gave the patient. While in the pet scanner the patient died, a horrible death I will say, unmonitored. This facility was Joint Commission approved recently, before this incidence, Whoops, ill say their process is broken big time, HUH. You would think the Joint Commission would ask “ why is Vecuronium, a compound used in lethal injection stored in a Pyxis! In patient care areas?

One would think only Anesthiologists would have direct access to a drug like this. Did the Joint Commission fly their inspectors out to this facility, that’s a big NO. But I’ll say that the last Joint Commission inspectors who inspected this facility should have their Ass/Asses in a sling. You can’t brib CMS and the state with donuts!

PT

 
At Wednesday, December 05, 2018 5:47:00 PM, Anonymous Anonymous said...

Maurice

Did I mention that the cost of the Joint Commission as well the cost of Press Ganey is figured into every patient’s hospital bill. I have mentioned that not all patients will recieve a survey from Press Ganey, that decision is made based on the hospitals decision to send you one. Why would the hospital allow you a dissatisfied patient to recieve a survey, a survey that could reflect negatively on the hospitals HCAP scores which could affect Medicare reimbursement.

If the Joint Commission is such a regulatory agency which it is not, wouldn’t you think they would be transparent and share, post, investigate, corroborate and/or allow CMS to review complaints from patients. CMS knows how flawed and corrupt Press Ganey is, just review online the 7 things you didn’t know about Press Ganey. But, don’t let all the medical complainers distract you from the real truth, medical staff hate the idea, concept that they are being evaluated, but yet, they know it’s a big scam.

PT

 
At Friday, December 07, 2018 6:56:00 AM, Anonymous Anonymous said...

Yes, we have complained. However, the hospital said that nothing wrong had been done and that is the end of it. So we are taking legal action. We have filed HIPAA complaints, submitted complaints to the attorney general, and to the nursing board. All are still under review. We recently had to have his insurance company get involved because they have charge for a private room that he was never in on the first night. We had tried for months to get a response from the hospital but none until the insurance got involved. My husband was afraid to complain while he was in the hospital. All he wanted to do is to get all. At that time, he thought he had lost his mind because we did not know about the drugs. Once he was out and safely at home, we made the complaints. This is a religious hospital and basically their customer service rep sent a letter saying, "Too bad for you." Once we got a copy of his medical records, we were able to see many more things that were done that shouldn't have been. I am glad we did not complain before we got the records because that might have allowed them to change them.

On another matter, this same hospital asked my husband 3 times what sexuality he thought of himself as being. They also would ask what gender he preferred to have sex with. I told him he should have ask them because their private preferences also should be known too. However, he would be too chicken to but I would. They also asked him if he was sexually or verbally abused at 3a when he was just out of the procedure room. I think we should be able to ask or test for drugs and alcohol before they are allowed to give care. Some of the actions of one nurse could perhaps be explained. JR

 
At Friday, December 07, 2018 3:14:00 PM, Blogger A. Banterings said...

Maurice,

Here is an excellent Medscape November, 2018 article titled: Why Do Patients Withhold Information?

The problem is that medicine has granted itself too much power.

-- It is OK for us to have patients undressed (and remain exposed) at our whim.
-- Paternalism.
-- It is an emergency, consent does not matter.
-- We need to know your complete history, if not to diagnose what is wrong with you, but for anticipatory guidance.
-- etc...

It is time to do away with the term patient. We are healthcare clients (just like the way of the financial industry). It is time for the patient to decide what level of service they want to receive.

It is also time for providers to do their jobs and begin practicing a little customer service.

Companies that practice customer service have better working conditions. Starbucks Coffee has tuition reimbursement and Amazon raised their minimum (starting) wage for all U.S. employees to $15 per hour. Read about 12 companies wWith the most luxurious employee perks.

Note that these companies have strong commitments to customer service and the "customer experience."

As I said before, the job of medicine will not get better unless medicine hands over power to the patient.



-- Banterings


















 
At Friday, December 07, 2018 9:39:00 PM, Blogger Maurice Bernstein, M.D. said...

I wrote the following to a bioethics listserv to which I subscribe:


Here is a topic brought up on my bioethics blog which I don't recall having been discussed here. In these days now where paternalism is "gone" and autonomy is going "full throttle" (or is it?), shouldn't we now be called and treated as "clients" or should we persist in being called "patients"??


I will summarize here the responses, if any, of the ethicists (physicians and lawyers and philosophers) who participate on the listserv. ..Maurice.

 
At Saturday, December 08, 2018 12:11:00 PM, Blogger Maurice Bernstein, M.D. said...

An ethicist suggested using the term "customers" for "clients". Another non-physician ethicist wrote the following:

There are plenty of healthcare settings in which I have wished that patients got even a fraction of the respect they get at the local Costco.

A "Customer" is someone with the power of the purse - - which patients rarely have, except within their deductible/cost-sharing. But even that deductible brings limited freedom, since the insurer or employer decides which providers are "preferred," and changes that list every year. A Customer not only chooses what to buy (which patients sometimes can, sometimes cannot do), but is able to hold the seller accountable (eg, return the product for a refund), which patients can't often do w/o the help of a lawyer.

So "patient" is not necessarily an honorific term. And "customer" is not necessarily derogatory.


A physician-ethicist followed with the following:


Patients, not customers or clients. The difference is in degree of autonomy. If autonomy in medical practice is going "full throttle" then it's time to apply the brakes and get back to shared decision-making.

As healthcare providers our first responsibility is to our patients but our job also includes being responsible stewards of medical resources ("distributive justice" in ethics-speak). I help my patients choose among reasonable options. It's my decision what those options are. Customers and clients are not restricted in that way.


Finally, another physician-ethicist agreed with the last comment:


“clients” suggests service provision on demand. Definitely understand the push-pull, but > 50% of a doctor’s duty is always to elements beyond any one given patient’s preference: guided by voluminous ethics & law, available evidence, resource management, and broader societal concerns. There is actually quite frequently some misalignment, however slight, between a particular patient’s preference and all the other factors. The physician has to navigate the space in between using her independent judgment. That’s unlike any client/customer relationship.


And so what would your agreement or rebuttal be for the above views? ..Maurice.

 
At Saturday, December 08, 2018 3:21:00 PM, Blogger NTT said...

Good Evening All:

If this story about a doctor at New York-Presbyterian Hospital pans out to be true, just more reason for public oversight of every hospital in this country.

Hospital won’t name doc who allegedly molested 17-year-old female teen.

https://nypost.com/2018/12/07/hospital-wont-name-doc-who-allegedly-molested-teen-suit/

Hospital many yet again be trying to protect one of their own and bury this story.

Why else would they not tell the teens mom who the doc was or that it was someone impersonating a doc and they don't know who it was.

It's about TRANSPARENCY.

No mention of law enforcement involvement either.

Regards,
NTT

 
At Saturday, December 08, 2018 6:37:00 PM, Blogger Maurice Bernstein, M.D. said...

If physicians and the medical profession would accept the concept of the individual who comes to them, one way or another, should be considered "as a client" and not simply "a patient", there might be less of the behaviors (misbehaviors) of the profession which has been amply described on this blog thread.

One reason, the subjects of the medical system are not "clients" is because the sick individuals are subjected to the limitations of primarily "others paying for the services needed: health insurance, private organizational or governmental". This lack of self-responsibility for payment appears to be in stark contrast with what is the situation for those needing or requesting dental care from the dental profession. Payment often comes directly from the individual needing the dental care and so that individual has by this financial autonomy greater voice in what and how things are done by the professional. They are dental clients setting their role and power before and perhaps while they become a dental patient.
A brief article on this viewpoint can be found at this dental practice education website: http://www.speareducation.com/spear-review/2012/09/the-difference-between-a-client-and-a-patient

How do my visitors here compare the two professions and their behavior based on the concept of "client" vs "non-client--only a patient." ..Maurice.

 
At Sunday, December 09, 2018 7:42:00 AM, Blogger Biker said...

Dr. Bernstein, I am a customer when I am buying standardized goods and services be it at the grocery store, a new vehicle at a dealership, my phone service, or the guy changing the oil on my car.

I am a client when I am buying a specialized service or unique goods in which, with my input as to what I want, that person or business uses their expertise to perform that service or create those goods. This is the guy that tends my flower beds, the realtor or lawyer handling a transaction for me, or the woman that I'm hiring to do a painting of my property.

I am a patient anytime I am in the medical system. There are both standardized and specialized aspects to healthcare but being a patient is not the same as being a customer or client in the sense that I describe above. I can't quite come up with the words here but being a patient is literally presenting my body for examination or some procedure to be performed on it deemed necessary for the maintenance of my health or even the preservation of my life. Being a patient is far more personal and one is far more vulnerable than when we are a customer or client.

There are of course many fine points that could be argued and exceptions to the rule found but generally speaking I see no need to change the terminology.

 
At Sunday, December 09, 2018 10:39:00 AM, Anonymous Anonymous said...

Hello
I am a longtime follower and have contributed both positive and negative experiences here. I have one of each to contribute.
My primary physician has recently modernized the office. I have to admit I see the benefit of him having the comprehensive digital records for my care and medications at his fingertips. The downside is that they send in a female staff member to update and dictate all the new information and findings. I was not 100% comfortable with her being there but I could see the benefit of recording all the data. Being there for the exam would be another matter. My Dr follows the same procedure every time. When he reached the part of the exam requiring exposure I was about to say something. Before I could the assistant packed up and left before the exam began. I felt very respected that she left on her own before the exam without having to say a word. I was pleased with the experience and told the office health management organization so.

Fast forward to my vasectomy a week ago, different doctor/office. The urologist did the whole prep and procedure on his own, no unnecessary office staff (all female of course) in the room, which was good. Midway through the procedure some random female staff member just comes barging in. I somewhat stunned by it look at her and ask "What the hell?" She just looks at me for a moment and says "Don't mind me, I just need to get a few supplies." and proceeds to rummage through the cabinets. I was incensed but at the same time not surprised. How ^%$# disrespectful can you possibly get? I find it hard to believe that this room had the only source of whatever she needed and that it was so critical that she could not *&^% wait until I was done. I am still fuming and the management body for this office will hear about it as well. One good thing is that most offices now want patient surveys and there is at least one avenue to be heard.
Mike

 
At Sunday, December 09, 2018 1:08:00 PM, Blogger Biker said...

Mike, my guess is that female staff member saw you earlier in the waiting room or in transit to the procedure room and pegged you for a closer look when she knew you'd be exposed during that procedure. When you complain she'll act all innocent and say she didn't know you were in there, but her reaction having not been one of shock that you were there exposed and immediate apology indicates it was a contrived entry into the room. Sometimes people think they are not as obvious as they are.

 
At Sunday, December 09, 2018 1:53:00 PM, Anonymous Anonymous said...

This is from the oath of Hippocrates, dated around 2,400 years ago.

I will respect the privacy of my patients. It is the earliest expression of medical ethics in the western world. It is in fact still used today by the AMA code of ethics. First do no harm was coined in the 17th century. Here we are some 2,400 years later, no we are not carving these promises on stone tablets but rather these are solemn promises made supposedly by countless providers who can’t make up their minds.

Should we call these people clients, no customers, let’s call them patients and back and forth. It dosen’t matter what they call us, today healthcare in this country is well over $4 Trillion dollars and next year it will be $5 Trillion, that you can count on. Nursing supposedly has their own code of ethics but it’s ok, they don’t know what it is. They can’t even recite two regs from the nurse practice act. What do they call their patients, honey, sweetly, dearie, darling. That’s because they are too stupid and too lazy to look at your arm band to see what your name is.

Florence Nightingale has been dead for 108 years but it dosen’t matter, only 50 years after her death female nurses saw it ok to assault their male patients with a steel spoon if they had an erection, 250 years after “first do no harm was coined” and mentioned countlessly in nursing schools in this country. The moral of the story is that it dosen’t matter who the figures were that helped shape modern medicine nor does it matter how long ago they died. They might as well be fictional characters in a storybook, the term patient, client, customer just refers to an ever growing price tag.

PT

 
At Monday, December 10, 2018 3:23:00 AM, Blogger NTT said...

Good Morning Everyone:

Biker I agree with you, Mike was marked by the staff to "be checked out".

Looks like we have to hold their hands yet again.

Time for medical facilities and doctor's offices be required to post A sign on the door.

WITH PATIENT
DO NOT DISTURB
DO NOT! ENTER

Unless the doctor calls an emergency if anyone violates the room when the sign is hanging or lit, they should be fired on the spot for violating the patient's right to privacy.

After a few voyeurs are fired, word will spread and it should slow down the perverts then stop.

If doc doesn't fire employee include that tidbit in your complaint to state officials.

As AB in NW says, you want change, you gotta complain. It's the ONLY way this crap with end.

Regards,
NTT

 

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