Bioethics Discussion Blog: Patient Dignity (Formerly:Patient Modesty): Volume 97

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Wednesday, April 10, 2019

Patient Dignity (Formerly:Patient Modesty): Volume 97



"Not OK" and who decides it's "OK" or "not OK" in a medical professional-patient relationship? Should the final decision be made by the patient (autonomy) or by the medical professional (paternalism).  My view and practice as a physician is that patient informed but autonomous decisions (or informed decisions made by the patient's surrogate, if necessary) should be the determinant state in all patient-medical profession relationships from onset to final actions.  So this view applies to clinical interaction in all stages of medical practice.  In non-clinical relationships (as briefly discussed in Volume 96) the final decisions are more complicated if a clinical relationship had previously been present.

From the onset of this thread topic,  the views presented have clearly held, with examples of patient hurtful contrary professional behavior, that it is the patient who should "be in charge".   What is my opinion is that simply mumbling and grumbling  on this blog thread as to what is "not OK", I fully agree with the attempts by some of our visitors to "move on" to publicize their view for a need for a changes within the medical system to attend to the needs of patients to maintain their dignity beyond maintaining their health and that there are many examples of professional behaviors which are simply "not OK"with them.  ..Maurice.

GRAPHIC: Created by me utilizing the Microsoft Paint Program

59 Comments:

At Wednesday, April 10, 2019 12:08:00 PM, Anonymous JF said...

The way healthcare is paid for by insurance is a deterrent to getting good care. Medical care SHOULD NOT be free. But health insurance is just extra people to be paid and maybe they'll help pay and maybe they won't. Having all different networks forces more of the cost on patients. One of my former coworkers husband had 2 different insurances. One was Medicare , the other something else. But because he chose the wrong insurance to pay his bill they BOTH refused to pay.
Wouldn't it be better to just pay a monthly bill to Medical Care period? Just end overcharging! If somebody doesn't pay their monthly bill and seek care THEN go after them and what they own. Insurance makes all the rules, and in the long run patients are milked to death. I also have a problem with doctors making MORE money when they don't do their job right the first time. Their patients must then return until Doc desides he/she has milked them enough.

 
At Wednesday, April 10, 2019 2:53:00 PM, Blogger Maurice Bernstein, M.D. said...

Continuing on with the occasional physician-patient relationship which needs ethical resolution.. or does it?? When the doctor–patient relationship turns sexual. My question: is this a professional or public issue where standards of behavior of both doctor and patient should be defined? Should this behavior should be considered "OK" or "NOT OK"? Or is this one issue which can arise in the doctor-patient interaction which no public or professional guidance is required and should be considered "off limits" in public or professional discussion considering the dignity of the parties involved? ..Maurice.

 
At Wednesday, April 10, 2019 3:27:00 PM, Anonymous JF said...

I think it should be ok in most circumstances. A lot of people met through work. An inequality would be any relationship where one person earns more than the other.

 
At Wednesday, April 10, 2019 3:28:00 PM, Blogger Unknown said...

JR said:

Thanks, JF. He doesn't want to talk about it as it is way too painful. That is why I vent here so I have others to help me. He, at this time, does not want family or friends to know that he was sexually abused by the prolonged exposure and the questionable alone time the cardiac nurse and the laughing nurse spent alone w/ him when he was drugged and purposely isolated from us. There is more to what he remembers when they were alone w/ him than I have shared here and it is really horrifying. It is hard being the spouse of someone who was sexually abused. I haven't suffered what he has but I still am suffering. He doesn't want to add to mine and I don't want to add to his by making him hear what I have to say. I really cannot imagine what it feels like to be betrayed and violated like he was.

Banterings,

We had always thought of ourselves as being in control of our healthcare needs. However, even if you are in control, all it takes is to have what is termed as an emergency and be drugged w/o consent, and all of that is down the drain. While my I saw doctors, I only chose ones who would respect that I was in charge. My husband also learned over the years to be assertive and be in charge. However, we were living in a dream world because reality of ugly the medical system is reared its monster head and we are left w/ the abuse.

Dr. B.,

It should be defined as an absolute no. If a doctor/nurse has access to someone's information and has examined them intimately or given intimate care, never should they cross the line of being more than a doctor/patient relationship. So that means if a doctor/nurse has treated a patient in a medical encounter, there should never be any type of relationship beyond doctor/patient. The only way that should change is to let the patient see all the doctor/nurse information and naked body so the patient would be on equal footing to make their decision. What is fair for one should be fair for all involved. In fact, since exposing body parts don't matter, than doctors/nurses should have naked pictures so pictures could view what is under the coats and scrubs to make everyone on an equal level. Remember we are told as a patient, being naked w/ these people doesn't matter so let's see if that is true. JR

 
At Wednesday, April 10, 2019 5:52:00 PM, Blogger Biker said...

Sometimes timing is everything. The very recent discussion we had about dignity after death became real vs theoretical for me today, and I drew upon that discussion in helping guide my family. My sister in her 50’s died unexpectedly and unattended without any obvious cause. The coroner’s office determined there was no foul play and chalked it up to undetermined natural causes. Had it been suspicious they’d of ordered an autopsy. To do an autopsy would thus be up to the family if we so chose. As much as we all would like to know what happened, there won’t be an autopsy. My stance was why should she be cut up just to satisfy our curiosity; that we should just let her be and assume it was a heart attack or stroke. It wouldn’t have been the first time people in our family had a stroke or heart attack in their 50’s, she was just alone when it happened and wasn’t able to get help. I’d rather live not knowing than live knowing we prioritized satisfying our curiosity over maintaining her dignity in death.

 
At Wednesday, April 10, 2019 7:25:00 PM, Anonymous Anonymous said...

Hello Biker,

I offer you my sincerest sympathy for the loss of your sister. I also think that your decision for no autopsy is well-thought and commendable.


Reginald

 
At Wednesday, April 10, 2019 7:37:00 PM, Anonymous Anonymous said...

JR said

Biker

So sorry for your loss. JR

 
At Wednesday, April 10, 2019 7:41:00 PM, Anonymous Anonymous said...

Sharp grossmont hospital in San Diego admitted that cameras in their surgical obgyn suites were secretly videotaping patients in various stages of undress, the lawsuit alleges. Why? So they could catch a physician suspected of stealing drugs. What is more important, the privacy of hundreds of patients or proof of a physician stealing medications?

This is in a hospital and yes, hospitals record their patients all the time in various stages of undress neglecting to let these patients know they are being recorded. There is pending limitation regarding this in a class action lawsuit since 2016, you know if male patients were ever recorded it would never be known and there is a most obvious reason why.

Administrators had access to the recording as did many other non-medical staff at that hospital. Who pays for the hospital staff to secretly mount these cameras and record patients, you do. Who pays for staff to sit and review the recorded images, you do. It’s all figured in to the cost of doing business. Next year, that cost will soar above $4 Trillion dollars to buy better cameras to spy on you when you are a patient.

PT

 
At Wednesday, April 10, 2019 10:19:00 PM, Blogger Maurice Bernstein, M.D. said...

Biker, my thoughts now, of course, is for the living including you and your family in this unanticipated loss. I am glad that this blog thread recent topic did helpfully affect your evaluation of the options which potentially was confronting you and your family.

I have to tell you that over the recent decade, I have repeatedly taken groups of second year medical students to our city's coroner's office to watch a full autopsy but in a large room where many autopsies were going on simultaneously for all present to observe. Yes, all the bodies were of deceased men, women and children, of course all without clothing or covering and being all cut open and organs removed or tissue fluids obtained, it was "quite a sight" but there was no patient or family to observe only me, the students, the pathologists, their helpers and in some cases police officers. My presence there was to be present and monitor and help the very occasional student who felt faint having suffered a vaso-vagal reaction in the midst of this experience.

So that this coroner's environment is not something for some novice to find "pleasant" but also there will be many patients where autopsy is really unnecessary when one considers the deceased patient load and the coroner finding sufficient information in the history not to expect a diagnosis different than the clinical one and there is a family available for consultation. In fact, the office will perform the exam in that case only on the request and fee paid by the family.

In conclusion, based on what you wrote, I have a feeling Biker that your rationale was appropriate. ..Maurice.

 
At Wednesday, April 10, 2019 10:32:00 PM, Blogger Maurice Bernstein, M.D. said...

Ray, erroneously wrote the following to the closed Volume 96. ..Maurice.
PT: Regarding your questions about Gallup, when it conducts U.S. polls, it takes samples of between 500 and 1,500 adults 18 or older and interviews them via randomly chosen land-lines and cell phones after using a technique called random-digit dialing. Contrary to popular opinion, these sample sizes are sufficient for generalizing to U.S. adults if chosen properly. The figures given by Gallup are called point estimates (the single best estimates) of some variable. For example, a Gallup poll in 2018 found that 29% of U.S. adults over 18 answered “yes” to the following question: “Within the past 12 months, have you or a member of your family put off any sort of medical treatment because of the cost you would have to pay?” The 29% is the point estimate. The respondents were not asked about other reasons for delaying health care such as iatrophobia.

The actual statistical analysis was a bit (but not much) more complicated than what I’ve described. Because the Gallup researchers chose a sample of 18+ year-old subjects rather than the entire population of 18 + year-olds, there was sampling error (error due to taking a sample from a population rather than the entire population) to consider. Sampling error is estimated via the square root of P x Q/n where n is the sample size (500); P is the point estimate (.29) while Q is the remainder of the proportion (.71). If a researcher wants to be 95% certain of his findings, s/he has to multiply this formula by (approximately) 2; if s/he wants to be 99.99% certain, s/he must multiply by (approximately) 3. In our case the sampling error is estimated to be 2 x the square root of .29 x .71/500 = 4%. We can say that we are 95% certain that the percent of the U.S. population who answered “yes” to the question was 29 +/- 4% or between 25% and 33%. You can see that as n increases, the sampling error diminishes and as P or Q approach zero (or 1.0), the sampling error diminishes.

The predictive accuracy of Gallup polls as an aggregate is pretty good but it ranks behind some other pollster organizations. However, when you compare Gallup to the organizations with superior accuracy, the percent difference between the former and latter on the same subject is not very great. The question asked by Gallup to determine level of public trust in people who occupy different occupations is: “Please tell me how you would rate the honesty and ethical standards of people in these different fields -- very high, high, average, low or very low?” Ever since nurses were included among the occupations, they have ranked first. Clergy used to rank first; now they rank 8th. They lost considerable ground after all the bad press regarding child sexual abuse. I understand that Gallup does a lot of paid consulting work for businesses, schools, government, etc. But, for PR purposes, it also does a number of polls on its own which results in some financial loss. -- Ray


 
At Thursday, April 11, 2019 5:44:00 AM, Anonymous Anonymous said...

JR said:

PT,

It is my understanding that most procedures are recorded. For instance, they review the recordings of certain procedures in round table discussions. This can be procedures done in the OR or the cath lab. This is the reason why on most consent forms there is a standard phrase about the hospital having the right to film or photo because most procedures are filmed. This is one phrase my husband and I always object to and this one reason we know he was not given true informed consent. He would have objected. He was also drugged and unable to communicate his thoughts. Sedation drugs are not to be used before informed consent is given and hospitals know it but do it anyhow. The law acts as their accomplice. Hospitals know how to "operate" on the fringe of ethical and/or lawful in their pursuit of money and being the "go to" hospital.

I think as far as most polls saying nurses are the most trusted, people have read or seen on tv about priests molesting and teachers having sex with students. There really is not much out there about nurses. More needs to be said about nurses. However, the Catholic church kept the priest abuse secret for many years until it burst out. This is what needs to happen to nurses. To me, doctors are less involved in the actual abuse of patients. They are guilty bc of the staff they are over. But it is difficult to control a bunch of women and doctors are really busy with other things. Flocks of women tend to be petty and vicious especially younger ones. They mellow with age.

As far as there being spectators during an autopsy, I think the family should be notified and given the option to say no. I think the respect of the person should also be observed even in death. If that person would not have wanted to be exposed to a crowd in life, then they should have the same respect in death. I also have issues with autopsy pictures especially of celebrities being released. It is very invasive. I also don't think crime pics should be released and if they are, then whoever did it should be arrested. Their death pics are none of my business. JR

 
At Thursday, April 11, 2019 7:25:00 AM, Anonymous Anonymous said...

Ray

The missing equation is the socioeconomic factor, in other words what neighborhoods were these random calls made. Statistically,the greater the sampling size the smaller the standard error. Nonetheless, I’ve no doubt the poll is a close reflection, troubling as it is , that
people put off seeking healthcare for what they say is a lack of affordability.

Polls seeking public trust are skewed, most people surveyed will have some family member who works in healthcare. The big question is
what benefits are there for these kinds of polls. Polls can be used to measure attitudes or shape public opinion. Is it fair and ethical to say
you can trust your nurse more than you can trust your family Doctor or your clergyman?

PT

 
At Thursday, April 11, 2019 10:01:00 AM, Blogger Maurice Bernstein, M.D. said...

I hope you all can take a few minutes to read this current article in “Public Discourse” with the following address: https://www.thepublicdiscourse.com/2019/04/51161/ arguing against the American Nurses Association draft position statement regarding “Nurses Role When a Patient Requests Aid in Dying” and, of course reading the ANA document itself. However, it seems that the link provided in the “Public Discourse” article does not go directly to the statement itself (and I would appreciate help from our link experts here to discover how to obtain that original ANA statement. ) However, the issue is to give the nurses more freedom in participating in “aid in dying” which the authors of the Public Discourse argues against the ANA and fits with my theme to this Volume: “NOT OK”.
Why I am presenting this resource here is that the authors may be in line with the consensus of my commenters here regarding the virtually “accepted” misbehavior of some nurses and may be folks to contact directly with your understandings and views and they may be helpful in furthering your views. ..Maurice.
Stephen J. Heaney
Stephen J. Heaney is Associate Professor of Philosophy at the University of Saint Thomas in Saint Paul, MN. He has published in The Thomist, The National Catholic Bioethics Quarterly, The Human Life Review, Nova et Vetera, Crisis, Homiletic and Pastoral Review, Touchstone Magazine, Twin Cities newspapers and, of course, Public Discourse on topics in ethics and political philosophy such as abortion, marriage, sexuality, and voting ethics.

Dianne Marie Johnson
Dianne Marie Johnson received her nursing license in 1972 and recently retired after 44 years of bedside nursing. She worked as an oncology certified nurse in radiation oncology and has extensive experience in coronary care, intensive care and as a “pioneer” nurse in radiology nursing. In 1998 she received her B.A. with double majors in Philosophy and Catholic Studies. In 2006 she received her M. A. in Catholic Studies with emphasis in biomedical ethics from the University of St. Thomas in St Paul, MN. In 2001 she founded Curatio, in part to answer her own longing for integrity between her faith and her work, and in part, to answer Saint John Paul II’s call for re-evangelization of the modern world and to recover the sacred, sacramental vision of the human person in health care. She is married to Reed Johnson and they have three wonderful grown children, 7 grandchildren, and 5 step grandchildren, all who keep her young at heart! She is passionate about helping others develop a closer relationship to Christ in healthcare and currently serves as the Mission Director for Curatio.
Sarah Spangenberg
Sarah is the Outreach Coordinator for the Minnesota Alliance for Ethical Healthcare, a diverse, statewide coalition formed to fight the legalization of assisted suicide in Minnesota. She is currently finishing a graduate degree in Theology from the Saint Paul Seminary School of Divinity in St. Paul, Minnesota.

 
At Thursday, April 11, 2019 10:11:00 AM, Blogger Maurice Bernstein, M.D. said...

Correction: In my piece about regarding the coroner's office, it is the local County and NOT City to where I attended.

By the way, it is my understanding that because most small hospitals do not have autopsy facilities and staff for elective autopsy, nor these days there is not much family interest in having an autopsy performed, mainly cases of potential criminal or unknown cause deaths are required or referred to the coroner for autopsy and diagnosis. ..Maurice.

 
At Thursday, April 11, 2019 1:58:00 PM, Anonymous Anonymous said...

Maurice

The original document can be found on Nursingworld.org,


PT

 
At Thursday, April 11, 2019 5:18:00 PM, Anonymous Anonymous said...

Maurice

Opps, sorry www.nursingworld.org/~4af287/globalassets/docs/...


PT

 
At Thursday, April 11, 2019 7:54:00 PM, Blogger Maurice Bernstein, M.D. said...

PT, I guess your revised address just took us to more "oops". But thanks for the attempt. I do think that presenting the views of patients on this blog to someone like Professor Stephen J. Heaney might be a valuable resource for dissemination of those views to a more widespread audience. ..Maurice.

 
At Thursday, April 11, 2019 8:35:00 PM, Anonymous Anonymous said...

Maurice

I apologize

If you type into Yahoo as a search engine, “ nursingworld.org physician assisted sucide”

The returns will be Euthanasia, assisted sucide and dying- nursingworld.org

Click on it and there it will be

PT

 
At Thursday, April 11, 2019 8:56:00 PM, Blogger Maurice Bernstein, M.D. said...

Ray, you are continuing to write to Volume 96 which is closed for further Comments. Are you typing a Comment on Volume 97 but it is somehow printed out at the end of Volume 96? If you have any info on this which need not be written to the blog, you can e-mail me at doktormo@aol.com. Here is what you wrote this evening and published on 96:


Maurice: Regarding your questions, I cannot answer any of them, although I have some hunches. I searched for research on the subjects but could find nothing. -- Ray


..Maurice.

 
At Thursday, April 11, 2019 10:27:00 PM, Anonymous Ray B. said...

Darn it, Maurice. I did it again -- several times. I'm sorry.

I'll repost here the three I just sent sent out to Volume 96 -- Dang!

Biker: Thanks for a great example of pluralistic ignorance. Actually the concept would apply if your buddies or a goodly number of them believed as you did but said nothing because they believed that you and everyone else thought what you experienced was no big deal. I’ve done the same thing. In a sense, when we do not express what we really believe, we become enablers -- we enable those who would strip us of our dignity. To the extent that pluralistic ignorance prevents us from expressing our outrage, we discourage other like-minded individuals from expressing their outrage.
Thanks, too, for the example of the inappropriate statement made by the nurse. I and nursing students in the early 1990’s found that male patients were more likely than female patients to be subjected to inappropriate comments (usually something about their bodies), although the inappropriate comments made to female patients were more likely to be sexual in nature than they were for male patients.

Misty: I watched your video. It was cutting, acerbic and well deserved. However, I'd like to add one thing to your post. Tell me what you thing. Male providers are more likely to abuse female patients than female providers are to abuse male patients but male patients are more likely to be abused by female providers than female patients are to be abused by male providers. -- Ray

 
At Thursday, April 11, 2019 10:48:00 PM, Anonymous Ray B. said...

PT: If I recall, Gallup uses cluster sampling. I don't think that the socioeconomic status of communities is one of the clusters, though Gallup does use weighted samples and it often breaks down responses according to income of respondents. For example, below is the breakdown of "yes" responses to the question having to do with delaying seeking healthcare because of cost by income. https://news.gallup.com/poll/245486/delaying-care-healthcare-strategy-three-americans.aspx -- Ray

Annual household income
Less than $30,000 31 38
$30,000 to $74,999 23 34
$75,000 or more 15 22

 
At Friday, April 12, 2019 12:19:00 PM, Blogger Maurice Bernstein, M.D. said...

The medical education listserv to which I subscribe is now conversing about the presence of video/audio equipment in patients rooms to record or transmit images and sound for monitoring and teaching those physicians in a residency program. The purpose is very practical in terms of residency education since much of the resident-patient interaction is not observed by monitoring physicians actually being present in the patient's room since, if a physician monitor was present, in person, that might affect the resident-patient spontaneous interaction. And it is that spontaneous interaction which is what observation of the resident should be the basis of the educative monitoring. Should such audio-visual monitoring in each patient room be allowed and to be done by observation at the time in a "video control room" or tape later reviewed. Should all patients be made aware of the possible observation and should all patients sign a release to accept this video-audio observation? HIPAA regulations would likely permit this observation since the physician monitors would be part of the patient's health team. Video in the operating room would also apply as part of the monitored teaching of surgical residents. How all these monitoring tapes are subsequently handled or disposed of is also another matter. So is this all, related to my graphic for this Volume considered by you. the patient gripping your dignity an "OK" or "Not OK"? ..Maurice.

P.S.-By the way.. you should all be pleased that the folks teaching physicians are considering such matters and if and how they should be carried out and attempting to obtain ethical and legal consensus.

 
At Friday, April 12, 2019 3:30:00 PM, Blogger NTT said...

Good Evening:

As far as audio, still picture, or video taping go, the medical community MUST ALWAYS get all patients to sign a release to accept this type of observation.

The request must NOT be hidden within any forms the patient is asked to sign. It should be a separate document.

Only those that want to participate and further the education of a resident will sign on. Those that don't should not be pressured in any way to "go along" with it.

Do this wrong and it could be healthcare's Waterloo.

I suspect the majority will NEVER go along with it because people are at their most vulnerable time when in the hospital and don't want any type of recording device(s) around.

Regards,
NTT

 
At Friday, April 12, 2019 3:33:00 PM, Anonymous Anonymous said...

Hello Dr. Bernstein,

Who will be responsible for turning off the camera after the "teaching moment"? Will these cameras find an "extended" use to "assist" the nursing staff? Why am I thinking that this is a great CYA for the hospital and another loss of privacy for the patient?

Here's a thought. Ask the patient for permission to have Dr. To Be (even as many as 3 Drs. To Be) sit behind the closed curtain. Attending Dr. could perform his functions and verbalize his actions (now I'll palpate... placing my ….) for Dr. To Be to hear and/or note. Dr. To Be's listening skills would definitely be improved and the patient would behave in an uninhibited fashion having forgotten that Dr. To Be was sitting quietly behind the curtain. Attending and Dr. To Be would then debrief after the encounter. All of this would be done in real time and unedited. Yes, this would not be as efficient as filming for a larger audience; nevertheless, face-time between Dr. and student might be enhanced. They might even find time to discuss the real person that was just encountered. The current mantra of the medical profession seems to be to endorse whatever "enhances the patient experience". Please ask your listserv colleagues, "How do cameras enhance the patient experience now?" Appealing to possible benefits to future physicians does not answer the question. I'll leave the camera cost analysis to others; although, we all know who ultimately pays the bill.


Reginald

 
At Friday, April 12, 2019 4:12:00 PM, Anonymous JF said...

Ray
Which sex abuses the other sex more? According to what we've seen on this blog?
In non medical settings I believe we ( females.) are much more likely to be abused.
In my family there is me and 4 other sisters. ALL of us have been sexually abused. Mostly in childhood. Of my brothers only one has admitted to it and it was a same age girl when they were teens. They were kissing and she suddenly shoved her hand down his pants. One male cousin was sexually abused by his step grandmother when he was 11 and 12.
Otherwise 2 of my brothers have admitted to rape ( although they never used that word ) One brother and 2 of his buddies took turns on a girl who cried and pleaded with them to stop. One of the guys tape recorded her. They were about 15 at the time.
The other brother was in his early 20's and our cousin held down his own girlfriend so my brother and another guy could have their way with her.
I think that in part that is why some female medical staff treats male patients so horribly.
The mindset that men abuse women/ girls, so lets let these male patients pay for it.
It makes no sense though. If there is going to be retaliation target WHO abused you. Not males in general. Not females in general.

 
At Friday, April 12, 2019 4:41:00 PM, Anonymous Anonymous said...

JR said:

This was part of the consent they had my husband sign while still drugged and which he remembers them telling him he didn't need to read it as it was only for billing/insurance purposes.

Consent to Photograph: I consent to procedural or surgical photographs or videos pertaining to my condition or treatment while I am a patient at the hospital.

The form was titled Consent to Medical Treatment/Authorization of Care. They hid this little beauty as medical people do not act for the good of the patient or so we have experienced. This already looks to me like they have the ability to have cameras in patient rooms as this was after his assault & battery procedure. Knowing he was still under the influence, they flat-out lied about the purpose of this form. Of course, it wasn't the first and only lie in their quest to commit as many offenses as they could. As I have said, they already do have that in procedure consent forms so you can bet it is just not being talked about but it actually happens. What about the patient--shouldn't they too have the right to have cameras and video recorded of the procedure and what happens in their room for future legal use or just a record of the event? Fair is fair. Why is it every patient's duty not only to have to pay for medical care but to made sure future healthcare workers get education through them? I say this is an invasion of privacy. What would keep them from filming the patient whenever they pleased to see what is being said? Nothing would as many of them have no conscience, ethics, or morals. I think patients should have the right to refuse health monitors as part of their care. It is just another way sneaky way to educate by dehumanizing patients. JR

 
At Friday, April 12, 2019 5:08:00 PM, Blogger Biker said...

Patients should never be recorded without their knowledge and consent. I am sure most patients would say OK if it was explained to them. Part of the issue is what is being recorded. Even allowing that the hospital in California had good reason to identify who was diverting drugs, that good reason did not extend to it being OK to video patients intimately exposed, nor was it OK to not maintain close control of who had access to those videos.

When seeking to monitor Resident interactions with patients, the same applies. It may serve a useful purpose to monitor the interactions as part of Resident training, but that does not mean it is OK to video patient intimate exposure and possibly be casual in controlling access.

 
At Friday, April 12, 2019 8:42:00 PM, Blogger Maurice Bernstein, M.D. said...

In some hospitals, it is the resident physicians who do all the "work", responsible for the care of many patients.. at all hours and for many hours and this experience in medical education where physician "burnout" begins or actually occurs. I am sure most patients would agree to professional educative supervision of these hard working members of the medical team. The issue is, of course, how should this supervision be carried out with the ultimate benefit for the patient but also for the professional education benefit of the resident.

Every appropriate clinical evaluation and management of every patient should be considered different between patients with the same general diagnosis. With the pressures of diagnosis and care demanded by the system on resident physicians the monitoring of such responsibilities should really apply to each and every patient under resident care. So if " monitoring by means outside a patients room" for one patient should apply to all. ..Maurice.

 
At Friday, April 12, 2019 9:05:00 PM, Blogger Maurice Bernstein, M.D. said...

I want to give you a recent example of the value of observing the behavior of a hospital resident. As I noted in our last Volume, the volunteering physicians at the "free" clinic recently are having patients worked up by hospital residents in our presence. To give you an example of my role as observer and educator in this patient-resident relationship, here is one example. As I sat near by observing the resident taking the patient's medical history, I observed the resident physician, moving her head in a lateral "negative" "no" direction during the act of asking the patient a direct (yes or no) question (example: "have you ever had any discomfort in your chest?") This, of course, is a head motion by the questioner which may suggest to the patient a "no" answer. I watched this occur again and again and at the end of the session when I was alone with the resident, I told her about my observations and she told me she was unaware of her head movement while posing a "yes" or "no" direct question and no prior supervising physician had brought this to her attention but was thankful I did since she didn't intend or want to bias a response by the patient.

Anyway, this is a minor (but could have been major) example of the role of monitoring the behavior and actions of resident physicians in their direct interaction with their patients. ..Maurice.

 
At Friday, April 12, 2019 9:19:00 PM, Blogger Maurice Bernstein, M.D. said...

In keeping with our current topic of discussion, you may be interested to go back to a September 2013 blog topic:

Patient Informed Consent for the Teaching Hospital "Trainee" Care: Informing Realistic Scenarios

which had written and was published by "Bioethics.net" and with visitor responses that followed. ..Maurice.

 
At Saturday, April 13, 2019 10:20:00 AM, Blogger Maurice Bernstein, M.D. said...

Gosh! There is SO MUCH to discuss with regard to the definition and maintenance of patient dignity.. here is another issue to discuss.

What medical errors in diagnosis and/or treatment should be disclosed and explained to the patient and/or family? Does the patient have an ethical right to be notified of any judgment or action error which has occurred and if so..when? As soon as the error has been recognized by the profession or at the conclusion of the professional-patient current management?

Let's get specific. For examples: suppose a hospital nurse accidentally gave the patient another patient's medicine pill, should the nurse await some clinical symptom in response to the error before notifying the patient, assuming the nurse had notified other staff regarding the error?

What do you see as the limits setting attention to patient dignity? Revealing only major medical/surgical errors? Attending to a potentially dying patient in an emergency room? A criminal as a patient? The deceased? Should there be limits set to the definition and response to patient dignity? ..Maurice.

 
At Saturday, April 13, 2019 11:08:00 AM, Anonymous JF said...

I've seen nudd people on the TV and it seemed dignified. That's the difference between nude and naked. Last year I went on a family outing where swimming was. A teenage girl went strolling past and I barely noticed her at first. But when she was walking away from us her bottom was completely bare. Nobody, male nor female seemed to notice or care ( except for me )
I told my niece and my niece said " Yes , they do that now , but they're covered in their front."
I have sometimes been able to identify with Dr B when he couldn't understand why it's been such a problem for us , being displayed before unnecessary people.
When I had my gallbladder surgery, I wasn't concerned about modesty at all. I was asked in person if med students could observe and I said yes.
Otherwise, when awake and in good health , I don't undress in front of anybody.

 
At Sunday, April 14, 2019 9:38:00 AM, Anonymous JF said...

I remember on an earlier post I suggested a video recording be used in place of a chaperone to protect patient privacy. Nobody thought it was a good idea. They talked about people having the ability to hack. Maybe it's true. I don't know.
But from more recent posts it's like they are video taping anyway.
In my theory nobody medical could access the recordings. Possibly not even be aware of them. It would be accessible by court order only. After an accusation has been made.
There also needs to be a hidden tape recorder in the break room. Not for just any little wrong thing said or done. But for our issue here to be caught. The offending staff would then be fired. Use a trump up reason ( like what's done already ) that way the staff doesn't realize they're being recorded.

 
At Sunday, April 14, 2019 11:38:00 AM, Blogger NTT said...

Good Afternoon:

Any medical error that directly effects the wellbeing of a patient must without question, be disclosed to said patient by their attending physician as soon as the error is detected.

As far as limits setting attention to patient dignity? There should never be any. Each and every human being no matter who they are or what they may or may not have done, deserves to be treated with utmost respect and dignity.

At times, I'm sure that can be very hard to do but its our ability to show compassion and empathy that sets us apart from all other live things.

Once you start setting levels you take the human aspect out of the equation. Something that must never happen.

Regards,
NTT

 
At Sunday, April 14, 2019 4:21:00 PM, Anonymous Anonymous said...

JR said:

I think it is absurd that when people become and then become patients, it is thought of as being acceptable that in their time of illness and extreme expense they are there to become experiments for ones becoming doctors. While it is true they must learn somewhere, it should not be thought it is an automatic right that every patient is there for educational purposes. The majority of hospitals now state they are a teaching facility. This is not right. Ill people should not have the added burden of being an experiment in learning whether they are exposed or not. However, with being put on displayed naked, it adds stress to some & may impede their recovery. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4377527/ is a great article about patient dignity. As for the cameras, since they cannot act appropriately now, just imagine how they will act if cameras are standard in all patient rooms. As I have said, it would appear that some places use them now as their consent forms has that possibility listed. They would have the ability to listen in on private patient/family conversations and video the patient constantly. What a terrible invasion of privacy.
I also believe there is a difference between being naked and nude. Naked is what the hospital or prison does, nude is like an actress/actor does with consent for money. Many times in hospitals like prisons, it is done by being told to strip and having no choice in whom is present. It is especially upsetting to have this done when drugged or unconscious because you really don't know if they acted appropriately as we have found out. You can never be sure what type you had. This is why it is important that patients have advocates with them at all times and those advocates are not being paid by the medical community as that advocate would not really be your protector. Patients should have the right to photo/video medical encounters too. As we were explaining to my husband's medicare provider other day--because of the abuse he suffered both sexual and otherwise, he will no longer seek hospital treatment as they seem to take great pride in their abuse and/or torture. She offered to find another doctor/hospital (we did that immediately) but she really didn't understand when trust is broken like it was, there is no guarantee that it would not be broken again as we didn't expect it this last time. He is going to stop all the meds and take his chances. He never wanted this procedure and does not want the prescription drug consequences their decision causes. The actions of the medical community and their godlike decrees have major and life altering consequences to its victims but they do not care and will continue to give themselves more power and control over their patient victims. This is the greatest power of modern medicine. The manner in which treatment is delivered has only worsened during the course of years and will only continue as they become more confident in their path of having absolute power and control. Patients are people whose primary purpose is not for medical people to use them for study purposes. They are being paid for a service not the other way around.
Yes, any and all errors should be reported to the patient immediately. It also should be reflected in the medical records however, the EHR are set up so this type of info is not reported and protects only the medical person and not the patient. There is no longer any compassion or empathy shown to patients as least from what I've seen of late. They are just power hungry tyrants who don't realize that the manner in which treatment is delivered is as important or maybe more than the treatment itself. They can have what they term as a successful treatment but the abuse and violations they inflicted in giving the treatment may cause more overall harm to the patient thus making the treatment ineffective. JR

 
At Monday, April 15, 2019 9:36:00 AM, Anonymous Anonymous said...

There is a way to help minimize the lack of respect and dignity shown by the medical staff. At the same time, a way to address the physical proximity issue and also relieve the overwork burden by MDs.

Think of AI as personalized medical care for Generation X, Millennials, and Generation Z [a total of over 215 million potentials in the US]. They are so comfortable with electronic interface, that AI is more comfortable for them than dealing with people [think of two individual in these generations texting each other while in the same room].

Here's a scenario. Patients walk directly into one of the open sound proof booths with available curtains that are under the patient's control. No appointment necessary - no power trip by the receptionist. Not only have the patients avoided the big waiting room, but also the small waiting room [AKA exam room]. The AI voice {natural language processing} greets them and states how can I help you? Eye recognition will validate identity and health insurance. When AI recognizes non-standard English, it will ask patients what language they would like to converse in and accommodates them. For those that prefer, a room monitor would be available to assist.

The patients can present all the symptoms and ask all the questions for as long as they want. Bean counters will eventually impose costs based on time spend. And who doesn't know those who would tell AI their life history [which might be psychologically healthy for them]. AI will refer patients to MDs for cases outside their scope which in time as AI advances won't be that many.

Patients themselves can handle the blood pressure, pulse, temperature, and stething. They can secure the pressure cuff [if unfamiliar both the AI voice and the screen can assist], put the electronic thermometer to their foreheads, stethoscope on chests, and how difficult would it be to design a device so that the stethoscope could be placed on their backs [an advocate or even the room monitor could assist]. That's all the touch labor I have received for years during routine office visits, then again I'm at the disposable age [and male]. Everything else in my recent routine health care involves lab panels that AI is superior at analyzing and prescribing.

The patient's medical history [EHR/EMR] is automatically retained and available to everyone not limited by HIPAA [joke].

Most prescriptions will be available when the patient leaves the booth from a system similar to technology used in warehouses for over 20 years, again with eye recognition. A pharmacist will be available although AI will have time to address all questions during the visit. A printout of prescription and AI directions will be provided. How many patients don't remember everything that the MD tells them? All of this technology is available today.

This AI technology eliminates the lack of respect and dignity served up by current medical community staff plus excellent and consistent medical treatment. The selling point to MDs is that they will no longer be burdened with routine cases. This AI visit replaces what is now known as a routine office visit. Don't you feel sorry for all those poor staffers that no longer will be able to control patients with impunity [and retaliate] during routine appointments?

The technology is available today. It's only a manner of the cultural lag before something like the above happens because it involves cost savings.

BJTNT

 
At Monday, April 15, 2019 10:17:00 AM, Blogger A. Banterings said...

Maurice,

HIPAA says that if there are ANY pics or video taken by the facility, then they become part of the medical record.

I wonder how many facility include the video for monitoring residents, teaching purposes, security, etc. as part of the medical record.

Here is some resources:

HIPAA - Photographing, Video Recording, Audio Recording, and Other
Imaging of Patients, Visitors and Workforce Members

HIPAA Restricts Some Photography, but Not All

Some states have additional protections beyond HIPAA:


The Consequences for Violating Patient Privacy in California?




-- Banterings




 
At Monday, April 15, 2019 12:17:00 PM, Anonymous Ray B. said...

Maurice: You wrote, “Should such audio-visual monitoring in each patient room be allowed and to be done by observation at the time in a 'video control room' or tape later reviewed. Should all patients be made aware of the possible observation and should all patients sign a release to accept this video-audio observation? HIPAA regulations would likely permit this observation since the physician monitors would be part of the patient's health team.”

Here’s a general rule of thumb: If healthcare providers wish to do something to patients that is not essential to their health or healthcare, then those providers must secure the informed consent of the patients. As for HIPAA, it is not the best source for determining what constitutes ethical behavior. After all, it allows commercial film crews to be defined as business associates (which the law never intended) and, hence, to film patients in ERs who are deemed by physicians to be unable to give consent and have no legal representatives available to do so. The AMA considers this decision to violate its Code of Medical Ethics; I find it to be ethically reprehensible and indefensible. -- Ray

 
At Monday, April 15, 2019 1:41:00 PM, Anonymous Ray B. said...

BJTNT: Interesting futuristic piece you wrote. As I read it, I thought, “Although, technically, this could happen in my lifetime, it won’t. If implemented today, it would make a lot of jobs in healthcare obsolete and would cut into corporate profits.
Your use of “cultural lag” was quite apropos. Cultural lag is both a theoretical concept and a theory. The theory was first introduced by William Ogburn in the 1920’s. The concept itself refers to a phenomenon whereby the non-material culture of a people (e.g., beliefs, values, norms, practices) lags behind the material culture (e.g., technology). The theory is that societies and their constituent parts experience disruption due to cultural lag. The nature of society is to gradually accommodate to the lag until, in a sense, the non-material culture catches up to the material culture. Disruption can take the form of increasing deviant behavior as we may now be experiencing in its many forms in healthcare. -- Ray


 
At Monday, April 15, 2019 3:31:00 PM, Anonymous JF said...

JR
I have so many doubts that our victory over our issue will come from anybody law abiding.
I'm more inclined to think it would come from motorcycle gangsters. The office or hospital humiliates the wrong guy? Of course Mr Macho Man wouldn't be straight with his biker buddies about the reason for his upset. He'd probably make up a bogus excuse for the retaliation that he plans.

 
At Monday, April 15, 2019 5:40:00 PM, Anonymous Anonymous said...

JR said:

I can tell you from experience that too many medical facilities including the one from hell, do not follow the law, regulations, and policies of HIPAA or really anything governing PHI. They are above the law and the law allows them to get away with it. I am sure there are two sets of medical records: one that they give when requested by outside entities such as patients and one that use for their own purpose. I believe systems like the Epic will allow this. As I have stated, we recently have encountered hospitals in normal, non-procedure consent forms having photos/filming mentioned in them. If it is mentioned and asked for patient signature for acknowledgement, you can bet there is a reason. I also know that many ORs use recordings to have round table discussions about procedures. This is covered by the procedure consent form. As I said, one dr.'s office said they didn't have filming in their exam rms but the consent wanted signature for it. They said w/o signature no dr. visit. I said w/ signature and nowhere to disagree, it would be a he said/she said matter where my husband would come out the loser so we walked even though no intimate contact would have been done. It is the principle they can do whatever and get away with it. They know the rules and how to operate and sedate the rules as well as people. It seems to be a game to them.

JF,

I am afraid that something that you described may happen. I hope not as the patients there for treatment don't deserve to be hurt anymore than they are by being there and being abused and violated by the medical staff.
What is being described here in this blog really resembles a prison-like setting for patients. Patients must strip on command. Patients can be put on display for and touched by any stranger the medical people desires. Patients can be videotaped and/or audio taped at any time or all the time. The medical people have total control over what happens to them when in their prison facility (except prisoners have more rights than patients on this). Patient's sleep periods, menus, and mealtimes are controlled by the hospital. Visitation may be allowed or not and may be recorded. There is no recourse for crimes committed against a patient (prisoners do have civil liberty guarantees while patients have no recourse). Some patients are confined to certain areas as are prisoners. Isn't modern medicine the greatest thing ever that it has actually progressed backwards to make people who have the misfortune of being ill treated worse than an actual criminal? Medicine should be very proud of themselves. Hopefully, each and every one will have the opportunity to become a victim of their own doing or one of their family members. That would be the greatest justice to me is that they are allowed to become victimized by the same system they use to victimize the common person. That is fate! JR

 
At Monday, April 15, 2019 8:40:00 PM, Blogger Maurice Bernstein, M.D. said...

Thanks to all for your recent Comments. There is so much intricacy to parse out if one wants to come to some conclusion. Perhaps that is why the medical system is not meeting the standards being set here. Or is "intricacy" not the correct excuse?

By the way, has anyone noted, we are missing further input by "AB in NW"? Hopefully, all is well in NW. ..Maurice.

 
At Tuesday, April 16, 2019 6:36:00 AM, Anonymous Anonymous said...

JR said:

It is really not all that complicated. I believe the medical community view us as pieces on a chess game or to be more precise, pawns. Pawns are thought of as being the weakest pieces but in reality, losing one without a well thought plan can mean losing the whole game. This is what the medical community is doing in reality--losing the whole game. Knowing how to treat your pawns is what separates an expert chess player from the novice. The medical community is too full of its self-importance to realize this piece of information. They are willing to lose because they think the king is the most important piece. They seem to have the misconception the only thing that matters is they make and follow through with the treatment of their choosing and not taking into consideration the treatment ultimately affects the patient for the rest of their life. Medical people are too defensive and get too offended when patients have opinions or want respect. However, most medical people want respect from others delivering services to them. I would imagine most medical people want a polite, attentive server who delivers their steak rare instead of medium even after the server warns them that eating rare steak is unsafe. I wonder how they would feel if a mechanic said they needed new brake pads on their BMW and couldn't reach the dr. and went ahead and did it anyhow because the mechanic felt the worn pads were too unsafe as well as having a leaky power steering pump so he replace the whole steering system? Outrage and a refusal to pay would probably be the result. However, they never consider that patients have the same right as the medical community is only a service provider too. We are the bosses and they are only the method in which a service is delivered. The service should be delivered with respect, explanation, and only with consent. The medical community should not be making this concept so difficult. It is what they expect in other aspects of their lives so why is it so difficult for them to see that patients have the same right. Fate, will someday make them patients too and I am sure they will want to have a say bc at that time, some wet behind the ears medical provider will remind them they are not a dr./nurse but merely a patient.


Dr. B.,


I see you mention the free clinic but how many rich patients are subjected to the student exam situation? Does having money exclude this learning on patients? It seems to me that only the poor and us middle class people are subjected to the medical teaching aspect? How many celebrities have a roomful of students and teachers practicing on them? How many celebrities get special consideration in protecting them from unnecessary exposure both bodily and medical records? Certainly the medical community is discriminative in its deliverance of medical care. I know there have been uproars when a celebrity's privacy has been invaded while hospitalized but for ordinary people there is basically no action taken. JR

 
At Tuesday, April 16, 2019 9:57:00 AM, Blogger A. Banterings said...

Maurice,

The answer is simple, and I have espoused it ad nauseum:

Power corrupts; absolute power corrupts absolutely.

Just look at the abuses that occur when there is a group that has absolute power:

- prisons: Abu Greib, Gitmo
- cults
- dictatorships, totalitarian regimes
- Feudalism
- slavery

You have to look no farther than how slaves were treated in our country. The slaves were dehumanized and used at the whims of the masters.

I am sure that Ray can expand on this line of thought...

Thankfully society is slowly stripping medicine of their medieval guild powers and subjugating the profession. The pendulum is swinging the other way. The profession will suffer the way that patients have. Turnabout is fair play...



-- Banterings



 
At Tuesday, April 16, 2019 1:05:00 PM, Anonymous Ray B. said...

JF: You write, “Which sex abuses the other sex more? According to what we've seen on this blog? In non medical settings I believe we (females.) are much more likely to be abused.”
I would not quibble with your observation, JF. All three sources of data – official statistics, self-reported studies, and victimization studies – suggest that men are more likely to abuse women than women are to abuse men. Men are also more likely than women to abuse men. The same patterns exist in the case of sexual abuse.

However, in healthcare settings, per se, one may find that male patients are more likely to be abused by female providers than female patients are to be abused by male providers, primarily because female providers are in the numerical majority. On the other hand, male providers may be more likely to abuse female patients than female providers are to abuse male patients. As an illustration, imagine that a hospital has 100 female providers and 20 male providers who treat 200 male patients and 200 female patients. All 20 male providers abuse as many female patients. Fifty female providers abuse as many male patients. The rate at which male providers abuse female patients, then, is 100% while the rate at which female providers abuse male patients is 50%. Yet, the risk of female patients being abused by male providers is 10% while the risk of male patients being abused by female providers is 25%.

I have not come across reports about research on the interaction effects of patients’ sex and providers’ sex on the likelihood of abuse in healthcare settings so can only hypothesize what the outcome of research would be based primarily on anecdotal evidence of the sort accessible in this blog. -- Ray

 
At Tuesday, April 16, 2019 2:12:00 PM, Blogger Maurice Bernstein, M.D. said...

JR, there are major teaching hospitals which are part of medical schools, minor teaching hospitals with affiliation to medical schools but the hospital is not part of a medical school itself and hospitals without teaching students or residents. University of Southern California Keck School of Medicine in Los Angeles, where I have taught first and second year medical students past 30 years and where I completed my residency, has Los Angeles County-Keck School of Medicine as it's major teaching hospital. The hospital is across a street from the medical school campus. In addition, the school has its private hospital unrelated to the County a block away. The medical school and its students and residents participate in the learning process in both hospitals.

You may be interested in this article: Navigating Hospitals:Teaching Hospital vs non-teaching, Does it Matter?

Banterings, do you look at the medical system as political, a political entity? If not, then as a form of a business attending primarily its own self-interest? ..Maurice.




 
At Tuesday, April 16, 2019 3:58:00 PM, Anonymous JF said...

JR
I didn't mean a shoot out in the hospitals or clinics. That possibly wouldn't bring any kind of victory over our issue because in all likelihood it would be covered up WHY the shooter did what he did.
These people can't be touched on their own turf. Individuals ? A different story!

 
At Wednesday, April 17, 2019 4:23:00 AM, Anonymous Anonymous said...

JR said:

Dr. B.,

I think you might have misunderstood what I intended. It seems to me that the difference in how healthcare is also evidenced by celebrities/wealthy people not having to have medical students examine them like we do. Also, their privacy is better guarded and when there is an incident, action is taken. Money and fame makes a difference. Also, at least here in Indiana, there are very few community hospitals left. They have been swallowed by the big 4 in central Indiana. Elsewhere, in Indiana, other chain hospitals are doing the same. All of them in their so called consent forms, clearly state they are a teaching hospital but don't specify what type of teaching hospital. They say if you don't want to be used as a teaching object then go elsewhere but there is no elsewhere. They have made sure of that. I believe common people are given any choice but the celebrities/wealthy people are. Community hospitals used to be the place for respectful treatment because those who worked there were part of the community but now they merely are part of a corporation who doesn't care as there are always more patients to make money from if one becomes dissatisfied. Certainly, hospitals are a business. They certainly attend to their own self-interest and they are also a political entity but not in the traditional sense as they have a huge lobbying presence and thus control legislation that affects them. They are like politicians in that they say one thing but do another thing. They act as if they are doing good but in reality are only self-serving. There may be some who truly want to do good and treat patients w/ respect & dignity but they get lost in the crowd of control and money seekers. JR

 
At Wednesday, April 17, 2019 9:07:00 AM, Blogger Maurice Bernstein, M.D. said...

JR, supporting the possibility of inequality of medical diagnosis and treatment based on patient's insurance coverage is supported by this article in Medical Bag based on a current article in the JAMA Internal Medicine. Researchers examined the discharge, transfer, and admission rates of patients presenting to the emergency department with common pulmonary conditions and analyzed that rate against their health insurance status. Hospitals that had both an emergency department and intensive care capabilities and patients who were diagnosed with acute pulmonary diseases such as pneumonia, chronic obstructive pulmonary disease, and asthma were included in this study.
... ...
Hospital transfers occurred in 1.6% of uninsured patients, 1.3% of Medicaid covered patients, and 1.2% of privately insured patients, which meant both uninsured patients (adjusted OR, 2.41; 95% CI, 2.08-2.79) and Medicaid covered patients (adjusted OR, 1.19; 95% CI, 1.05-1.33) were more frequently transferred than privately insured patients. Hospital discharges occurred in 88.8% of uninsured patients, 80.2% of Medicaid covered patients, and 78.5% of privately insured patients, which meant uninsured patients (OR, 1.66; 95% CI, 1.57-1.76) were more likely to be discharged.

My take: Further studies may support the idea that these days the medical system is oriented to $$$ rather than patient's immediate care of their symptoms and illness. ..Maurice.

 
At Wednesday, April 17, 2019 4:26:00 PM, Anonymous Anonymous said...

Dr. B.,

I don't know about other states but the people I know of who have the Indiana Medicaid-HIP-have fewer issues than people w/ regular insurance. Also, the elderly on Medicaid have fewer restrictions than those on medicare and private ins.
It seems to me that the health system is rigged against older people. The Service UnExcellence Director told me that as a man getting older my husband should become use to having his control taken away and being exposed as he was going to have more and more medical encounters as he aged. She said everyone should suck it up and get used to it. I think that older American males are especially abused by the system. Older women are not too far behind. This country has an attitude of disrespect for the elderly. There was an article on Medpage today about how the elderly suicide rate has increased. With the attitude of Service Excellence, it is no wonder why older people would rather die than be treated so abusive and feel so violated. However, there is a difference in how the wealthy, famous are treated an average people like my husband are treated. Money does indeed talk as well as publicity. No one cares if the average person is abused especially if that person has private insurance and/or Medicare. JR

 
At Thursday, April 18, 2019 12:54:00 PM, Anonymous JF said...

Elderly are ABSOLUTELY milked by the system. I have also seen elderly who are actively dying be prescribed 15 sheets of meds that they won't live to use. But they'll be charged fof tbose meds.
I have always worked at nursing homes as a CNA and in recent years I've been a med tech for assisted living.
I have a theory that elderly , once they can no longer be financially raped, will be put to sleep.

 
At Thursday, April 18, 2019 1:29:00 PM, Anonymous Medical Patient Modesty said...

Ray: I believe many male patients are sexually abused by female medical personnel. Male patients are much less likely than female patients to speak up when they are abused. I believe that this is why we do not hear much about male patients being abused. I’ve heard many accounts of female nurses making fun of male patients’ genitals while they are under anesthesia. Men tend to suppress their feelings. Male patients are less likely to be believed than female patients.

For everyone: I wanted to let you all know we have put up a new video, Surgery and Your Modesty . It is 39 minutes long. I think every patient should listen to this video before they have surgery. We talk about both male and female patients in this video. You will notice there is a part about men going to urologists in this video.

Misty

 
At Thursday, April 18, 2019 1:56:00 PM, Blogger BJTNT said...

Recently I received a Press Ganey survey from my hospital stay for a hip replacement. My stay was so lacking in integrity in several cases that it would influence my giving poor scores in every dept. I have decided not to complete the survey. I'm still so pissed off that my responses would not be fair.

Besides I suspect my health care was so typical of the medical community culture that the hospital administrators would say to each other "What's the problem? That was business per usual."

In the comments section, I could describe the most egregious failure. I have no stomach to do this because I think it's a waste of time. And if a form letter response was the reply that would really irritate me.

BJTNT

 
At Thursday, April 18, 2019 2:31:00 PM, Blogger Maurice Bernstein, M.D. said...



Besucher aus Berlin, was halten Sie von den Themen, die hier diskutiert werden
Und wie wird die Lebenserfahrung und Würde in Ihrem Land behandelt?
..Maurice.

 
At Thursday, April 18, 2019 2:55:00 PM, Anonymous JF said...

?

 
At Thursday, April 18, 2019 3:37:00 PM, Anonymous Anonymous said...

JR said:

JF,

I have long thought what you said about once the old are no longer useful. My husband was a vibrant, productive 67 yr old man before he was hospitalized. They treated him as if he was a naughty child missing part of his brains which is really funny bc they have drs. on staff older than him who still treat patients. Seems to be a different standard there?

He went in one man and came out a man who no longer has a smile on his face. They made sure they took that away. No, he's not depressed about the heart attack as he is a cancer survivor so a heart attack was not really the worst that has happened as far as illnesses. However, it was the standard of care that was the defining difference--the demoralizing, dehumanizing, abusiveness, uncompassionate, controlling, etc. Is the treatment still successful if they ultimately force the patient to never seek treatment again because of their actions? Is the treatment successful if it was done against the will of the patient?

Misty,

We are going to do our best to get his story out there. As much as he doesn't want others to know about how they abused him, he feels it has to be done. As long as men don't speak up and tell their stories, this type of thing will still happen. They count and thrive on silence. I have been doing research into how they are taught to provide patient care. Everything I have found and noted, says patient privacy is of upmost importance. Keep them covered and don't expose them unnecessarily. So what goes wrong between the time they are taught to when they actually are practicing their craft? Why does it go wrong and why are they okay with what they do? I guess they aren't smart enough to know the means doesn't justify the end? Or maybe they are too high on their pedestal of self-importance to realize how their actions actually cause more harm than good?

Dr. B.,

I have been thinking about cameras being used to in OR and patient rooms. Not as you might or have suggested but as a means of documenting patient care standards. The recordings would serve as a memo of care so the patient could view the entire event(s) and decide if their standard of care was acceptable. It could be sent directly to the patient's phone for monitoring or storage or wherever the patient wanted. The videos would help staff be aware that mistreating patients would be monitored more closely so they wouldn't be as likely to do it and get away with it. These videos should have audio too. In a patient room, the patient once not sedated could operate the controls so any contact w/ medical staff could be recorded. These recordings would also protect the staff if any issues arose that they weren't guilty of committing. These recordings would also serve as evidence in malpractice for one party or another. JR

 
At Thursday, April 18, 2019 7:59:00 PM, Anonymous Anonymous said...

A female writer for MensHealth magazine obviously thought it funny to write an article about a man who bought a stool from an
IKEA store. The man purchased the stool so he could sit under his shower. The stool had perforated holes in it and as the man was taking a shower one of his testicles became caught in the hole of the stool. Of course anything about men’s health becomes funny especially if
written by a female. I suspect if there is another sinking of the Titanic a lot more women will drown.

PT

 
At Thursday, April 18, 2019 9:24:00 PM, Blogger Maurice Bernstein, M.D. said...

JF, "?"

Well, I am trying to get the visitors from other countries who are identified as landing on our blog thread to contribute their experience and their country's views of their medical system and how it is the same or different than what is described here.
In this case, the visitor was from Berlin Germany and had our thread translated into German and hopefully Google translator program which I used will present my offer to communicate, if the viewer returns.

As I have indicated previously, I think viewpoints from other countries will provide important insight for all of us.

Has any of our current contributors had experiences in other countries?

..Maurice.

 
At Friday, April 19, 2019 6:51:00 AM, Blogger NTT said...

Good Morning:

I don’t believe most men and women went into nursing school predisposed to embarrassing and humiliating their patients. I believe nursing schools try teaching dignity and respect of all patients.

I see the change coming after they graduate & are hired at their first “real” position.

Now they are in the “real world”. No more mannequins to test proficiency on. Now its real people.

I believe the change in their attitudes comes from the people that have been in the system for years and now will be guiding these new recruits. They were taught the ropes by their teachers now they will pass on the good and the bad to these new recruits.

As I see it, the area to place the blame for patient abuse is all levels of management within a doctor’s office, clinic, imaging center, outpatient surgical center, and hospital. These people know it’s going on and do nothing to stop it.

Senior management may not know it’s happening because supervisors and department mangers keep it contained knowing if it got any higher, heads would roll including their own.

They also know they can get away with it with the men due to the male stereotype. They know probably 98% of men will never open their mouths out of fear of being made fun of.

The only way as I see it to clean up this mess once and for all, it for men to say “you’re not going to abuse me and get away with it anymore”.

If you’re a man or boy and a healthcare worker makes you feel uncomfortable, embarrasses or humiliates you, you have an obligation to get names of the individuals involved, make sure your facts are straight, then report it to senior management of the facility and all regulatory state and federal bodies that can act on your behalf to take corrective action.

I know its very embarrassing to air your “dirty laundry” in public but until the authorities, and the public are made aware that bad things are happening to patients, NOTHING WILL CHANGE. Senior management needs to know these things are happening right under their noses in their facilities and if its not corrected, it could cost them money.

Men have to bury the stigma attached to talking about the way they are treated if we are to change the healthcare system.

Guys, we don’t deserve to be abused and it’s time we did something about out for ourselves and our male offspring.

Regards,
NTT

 

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