Bioethics Discussion Blog: Preserving Patient Dignity (Formerly: Patient Modesty):Volume 105

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Saturday, September 14, 2019

Preserving Patient Dignity (Formerly: Patient Modesty):Volume 105



There is no doubt that those writing to this blog thread are "Speaking Up" here but to attempt to meet the goal of the preservation of patient dignity within the medical system, it is necessary for your voices to be heard by your physician and office or clinic staff, your hospital, the boards of healthcare certification and the government.  And you need to gather others who have been, are or will be patients to join in the vocalization of the needed repair and improvement of the medical system.

Yes, feel free to "Speak Up" here but this blog thread is only the beginning, a place to ventilate, discuss and plan but it is necessary to send your words, suggestions and demands OUT to where pressure is applied and there are those who hear you and attention and changes can occur.  ..Maurice.

Graphic: From https://gifer.com/en/HYXa via Google Images

128 Comments:

At Saturday, September 14, 2019 7:49:00 PM, Blogger Maurice Bernstein, M.D. said...

The 4:44 pm posting today on Volume 104 had no pseudonym identification. It was a worthy comment. Hopefully, the writer of that posting will provide some identification here.
Thanks. ..Maurice.

 
At Saturday, September 14, 2019 8:05:00 PM, Anonymous Anonymous said...

NTT


In the last installment you mentioned that “ Many men not wanting to be embarrassed or humiliated will walk away from needed healthcare.” It goes beyond that! State nursing boards state that it’s considered unprofessional sexual behavior when inappropriate draping is applied as well as unnecessary exposure. This is really the crux of the matter, not embarrassment.

What do you call the actions of the Denver 5, as well as other newsworthy behavior. The problem goes beyond simple embarrassment and this is how it needs to be presented. By presenting it as simple embarrassment you are excluding all the criminal behavior that occurs and it is that behavior that needs to be front and center.

PT

 
At Sunday, September 15, 2019 9:59:00 AM, Blogger Maurice Bernstein, M.D. said...

Read this "gripping" article in Medscape: "Violence Against Physicians: What You Can Do". Read all 7 pages and Comments but here is the conclusion within the article.

Conclusion
Violence against healthcare workers is about more than killings or serious injuries, which are relatively rare. The unnoticed problem in many organizations is the minor acts of violence that occur day-in and day-out and wear people down emotionally. These incidents make health-care workers feel vulnerable and can lead to burnout.

There are many ways to deal with this problem. Healthcare workers can learn to protect themselves from serious violence, and employers can let patients know that even minor acts of violence will not be tolerated.

Though I personally don't recall (maybe I ignored) such acts by patients or families described in the article--except I was threatened once by a new male patient that insisted on narcotics prescription to which I refused and I felt I needed help from my staff but fortunately nothing happened and the patient just left.

Yet, if the statistics presented in the article are correct.. professionals have reasons to "speak up" to the public and officials. ..Maurice.

 
At Sunday, September 15, 2019 10:07:00 AM, Anonymous Anonymous said...

One really bad thing about the Denver 5 is the completely inappropriate response from administration regarding it. You have referred to it as 3 weeks of paid vacation. That's exactly what it was.
It's like they're afraid that if they were to FIRE the staff who behaved that way, the remaining staff might get the false idea that they're not allowed to do it. Dr B. It was me that posted that 4:44 post. My phone is trying to force me to print up my full name and I really would be embarrassed for that to happen. JF

 
At Sunday, September 15, 2019 11:43:00 AM, Anonymous Anonymous said...

Maurice


I wouldn’t call the article gripping, OSHA is just another donut loving organization like the Joint Commission. The truth is many patients can be combative and not even know it. Patients with severe head injuries are combative, patients that have overdosed can be combative, coming off meth and even children throwing tantrums. The only reason OSHA has records of these is when healthcare employees want some paid time off because they are LAZY and HATE their jobs.

So, they use the excuse that the patient became combative and hit me. Never mind it was accidental, never mind the nurse gave the patient an excessive dose of medicine far above what the physician ordered. Let’s not forget to mention that security is often called for a combative patient, don’t mention the nurse has access to restraints, don’t mention you have Ativan and versed on hand to give combative patients.

These numbers are very very small compared to the hundreds and hundreds of thousands of patients who die each year from medical mistakes. Let’s not forget that many many patients are assaulted, sexually assaulted and abused as well. Healthcare workers can do many things to get 3 weeks of paid time off. They can fake a back injury with employee health, they can view a deceased male’s genitals in a body bag and brag about it, that’s good for 3 weeks of paid time off.

They can bully their fellow coworkers and physicians and be sent to anger management for a week with pay. Ah yes, the art of doing nothing and getting paid for it, continually adding to the ever increasing $4 Trillion dollars in annual healthcare costs. Don’t think for a moment that this is adding to your medical bill, if you do you are wrong, it does!


PT

 
At Sunday, September 15, 2019 12:10:00 PM, Anonymous Anonymous said...

Dr B, I wonder how much of the problem is because of our issue. For sure not all of it is. But if and when it is, it's highly doubtful that any medical staff will admit it. JF

 
At Sunday, September 15, 2019 5:39:00 PM, Blogger Maurice Bernstein, M.D. said...

JF, what I wonder is whether much of the patient misbehavior extending to violence toward those within the medical profession is based recollection of prior upsetting experience as patients, requests or demands by patients which are unaccepted by the profession or anticipation of seriously bad behavior or criminality as written in the news or social media or even in blog threads like ours.

"Speaking up" (educating) by patients may be an important and constructive behavior of patients to the medical system but
"acting up" with degrees of violence, verbal or physical, to individual members of the medical community cannot be acceptable. Or is there defense to such patient behavior?

Can't we all ..."get along" together?

..Maurice.

 
At Monday, September 16, 2019 5:40:00 AM, Blogger Biker said...

Dr. Bernstein, I see the violence in healthcare settings as being multifaceted.

Large numbers of the mentally ill are now living on the streets w/o treatment rather than being institutionalized as had been the case in generations past. These people now just show up, often involuntarily, in ER's.

Drug abuse is rampant, and they too often end up, often involuntarily, in ER's.

Some people may act out as you suggest based on past experiences in the healthcare system.

Society as a whole does not respect authority figures (which healthcare staff traditionally were viewed as) in the manner that used to be the case, and society as a whole has become more stressed and less civil. This plays out in other venues as well, including schools and interactions with police.

 
At Monday, September 16, 2019 1:30:00 PM, Blogger Maurice Bernstein, M.D. said...

Biker, you write "..and society as a whole has become more stressed and less civil." And as this applies to the healthcare profession, there is an expression I would like to enter here which some here would disagree with but I'll state it: "Can't we all get along?"


Let's think of the beneficial changes which can be applied to both groups, medical profession and patients, to resolve the distress obvious on both sides. And let's be honest.. there is distress evident on both sides. ..Maurice.

 
At Monday, September 16, 2019 2:18:00 PM, Blogger NTT said...

Good Evening:

If healthcare showed one iota that they had male patient's backs when it comes to privacy violations, then those men that have had dealings with the system might have a bit more patience. But when NOTHING or a vacation is the punishment for the violation, men have every right to be & should be pissed off at the system.

This article hit the nail on the head & really shows how the American healthcare system has ignored male healthcare for almost 50 years now.

Men’s health in the United States: a national health paradox
https://tandfonline.com/doi/full/10.1080/13685538.2019.1645109

Have a great evening everyone.

Regards,
NTT

 
At Monday, September 16, 2019 4:32:00 PM, Blogger Biker said...

Dr. Bernstein, yes there is stress on all sides. The assembly line industrialization of healthcare no doubt has taken a toll on healthcare staff as well as the patients. At the same time healthcare has become utterly unaffordable for millions that have health insurance, let alone those that don't. Throw in the rest of the stresses modern society and the modern economy has layered upon people and some are going to act out inappropriately. I include in this patients acting out but also healthcare workers who don't afford patients the respect and dignity any person deserves.

Yes we all need to get along. One way is to not make things personal and to give people a chance to resolve an issue rather than getting upset out of the gate. The initial reaction of so many is to flip out instead, though that may be part of the overall societal stress.



 
At Monday, September 16, 2019 5:53:00 PM, Anonymous Anonymous said...

If I were Rick's wife when that piece of &$€£* ripped his cover off of him I MIGHT have beat the stuffings out of her and I would blame HER for it. Not myself. There are instances throughout this blog that can't be blamed on the patient. And the medical staff are to blame.
JF

 
At Tuesday, September 17, 2019 7:55:00 AM, Blogger Maurice Bernstein, M.D. said...

Violence has no place on either side within the medical system. It is not therapeutic nor, in the long run, preventative of clinical disease or personal or systemic misbehavior and may lead to further clinical or social pathology. ..Maurice.

 
At Tuesday, September 17, 2019 8:51:00 AM, Anonymous Anonymous said...

Maurice


Inappropriate draping, unnecessary exposure and sexual misconduct towards a patient are forms of violence too. The healthcare system has long forgot that first do no harm!


PT

 
At Tuesday, September 17, 2019 8:55:00 AM, Blogger Biker said...

JF, Dr. Bernstein is correct. There is no place for violence in medical settings. You can blame the staff all you want but the district attorney will blame you when that staff member you say you might have beat the stuffings out of files charges against you. You are the one that will go to jail, not her.

 
At Tuesday, September 17, 2019 9:55:00 AM, Blogger Maurice Bernstein, M.D. said...

PT, inappropriate draping or undraping and what might be considered in the general term "sexual misconduct" are all terms related to the anatomic area of the body needed to be inspected or attended to. Yes, a nurse exposing a patient's penis in preparation for the physician to perform an ophthalmology exam for vision symptoms can be called "inappropriate" or worse BUT unexplained eye pain, sensitivity to light and purulent discharge from one or both eyes which is clinically unexplained may warrant subsequent uncovering of a penis, covered during the eye exam, for examination for signs of gonorrhea. It all depends on the clinical situation and the attention to patient dignity. ..Maurice.

 
At Tuesday, September 17, 2019 2:16:00 PM, Anonymous Medical Patient Modesty said...

Hi everyone,

I wanted to share something with you all that you all may not have really thought about. I am not sure if Dr. Bernstein has thought about this before either.

I recently found out that it may not always be the medical professional who are at fault for violating your wishes for modesty.

Are you aware that if you give your child Power of Authority that she/he could decide what happens to your modesty if you were placed in a nursing home or you were in a coma?

Here are some possible scenarios:

1.) Let’s say that an elderly woman who has dementia is placed in a nursing home and she has expressed in the past she did not want any male nurses or aides to do intimate things to her such as assisting her with bathing. Her daughter who has Power of Authority feels differently and does not think modesty is important so she said it is okay for her to have male caregivers to assist her with intimate procedures. Other family members have spoken up and shared that she cannot have male care givers for intimate procedures, but the nursing home said that it is the Power of Authority’s decision.

2.) Let’s say that a man who has expressed that he does not want female nurses to catheterize him and that when urinary catheterization is required that only male nurses can do the catheters. Let’s say that he went into a coma for a while and his older son who has Power of Authority has decided that it does not matter and that female nurses can do anything to him. The daughter has spoken up and shared how her dad feels about female nurses and requested that they only allow male nurses to catheterize him. The hospital said it’s the son’s decision since he has Power of Authority.

I’d like to hear how you all would respond to those scenarios. Do any of you have a child who has power of authority over your healthcare?

Misty

 
At Tuesday, September 17, 2019 3:16:00 PM, Blogger NTT said...

Good evening:

Misty, people should always talk to the individual they are giving medical power of attorney to so that their wishes are followed. That all they can do.

Regards,
NTT

 
At Tuesday, September 17, 2019 3:52:00 PM, Anonymous Anonymous said...

Biker. I guess I don't need to concern myself about Rick because I'm NOT his wife. You are correct that if I assaulted that scumbag I would be changed not her because the patients are the least important people in those kind of encounters.
People on this blog continue to say that a court case won is the key to getting things changed. I only partly agree because it's been strategically seen to that that won't happen. Lawyers won't take the cases.
I don't think our issue will ever get anywhere if we just play by the rules and lawmakers who don't listen to us make the rules. Without some criminal retaliations things will continue. Abused patients will do without Healthcare. So what if Rick was deeply humiliated. The medical assistant wanted to play a prank. He felt suicidal? He's expendable!
The moral of the story is attack these people OFF of their turf. On their turf, they're untouchable. JF

 
At Tuesday, September 17, 2019 5:00:00 PM, Blogger Maurice Bernstein, M.D. said...

NTT is correct. The decision by the patient's surrogate when the patient has no capacity to communicate directly based on the facts provided by the physician is, if known by the surrogate, the previous views or decisions by the patient. The surrogate "speaks" for the patient's known personal interests and prior views and decisions. If the surrogate is not aware of those "interests" then the surrogate and physician's decision is based on what they consider most patients would consider as one in their "best interest". That is why, if the gender of those about to or currently attending the patient has been previously told to the surrogate as unacceptable, that view must be presented to the medical team by the surrogate. If gender of those who may be treating the patient is of importance to the patient, the patient should have previously specifically informed the surrogate of that view. ..Maurice.

 
At Tuesday, September 17, 2019 5:34:00 PM, Anonymous Anonymous said...

Maurice


In actuality, babies are most at risk for conjunctivitis caused by STDs when an infant is born to a mother untreated with chlamydia or gonorrhea. I would find it concerning that it takes an ophthalmology nurse to expose a patient’s penis based on the physician’s clinical findings.

The ophthalmologist would most likely refer the patient to their PCP for follow up physical exam, blood and urine tests. There, I fixed it for you. Besides, I seriously doubt any opthalmologist is going to perform genital exams but to be fair to both genders, if the clinician suspects an STD in a female patient do you really think an ophthalmologist is going to keep an exam table with stirrups and a vaginal speculum.

PT

 
At Tuesday, September 17, 2019 5:49:00 PM, Blogger Maurice Bernstein, M.D. said...

PT, it need not be an ophthalmologist who starts the examination of the eyes. We teach the students and are expected ourselves as internal medicine or generalists to attempt to take a history of eye symptoms and examine the eyes and consider a differential diagnosis and yes refer the patient to ophthalmologist as necessary. However, if on taking an appropriate general medical history, GC is suspected, certainly the genital exam and testing is also appropriate by the internist. ..Maurice.

 
At Tuesday, September 17, 2019 6:43:00 PM, Anonymous Anonymous said...

Maurice said


“ PT, it need not be an ophthalmologist who starts the examination of the eyes “. I agree and it need not be the opthalmologist’s nurse who starts the physical exam of the patient’s penis.


PT

 
At Tuesday, September 17, 2019 8:36:00 PM, Blogger Maurice Bernstein, M.D. said...

PT: Full agreement!


Again, I want to welcome all those visitors to this blog thread whom I know from the StatCounter program are joining us here. But rather than just look at what has been written, I really would encourage the visitors to provide their insight into the topic here.

Please don't feel intimidated by the majority (virtually all) the views of medical system "corruption" described here. It certainly is possible that there are some visitors who have been repeatedly satisfied with their attention and care and autonomy by the medical system. If that is your experience and judgment, please take a bit of time and express it here. What has been your interaction with the medical system and degree of satisfaction and how the stories of "badness" or worse by some (too many?) are affecting your own personal experience with the medical system.

Please contribute your own experiences and I am confident that your view will be worthy of productive discussion as has been the views presented here over the years. Don't be afraid.. please contribute your views. You may find support.

To our "regulars", isn't what I just wrote here reasonable and could be of value toward further constructive discussion? ..Maurice.

 
At Tuesday, September 17, 2019 8:44:00 PM, Blogger Maurice Bernstein, M.D. said...

Oops! I should have concluded my above request to our "hidden" visitors with the words of the GIF graphic of this Volume: ..so "SPEAK UP". ..Maurice.

 
At Wednesday, September 18, 2019 4:53:00 AM, Blogger Biker said...

Dr. Bernstein, the other voices that I would most like to have join the discussion are female healthcare workers. More specifically I would like to hear explanations for the disconnect between when they are the patient and they are the provider. I find it disingenuous when they say medicine is gender neutral and that there is nothing sexual about healthcare when they are dealing with intimate exposure matters with male patients and then turn around and insist upon female staff for themselves when it comes to mammograms, urodynamics, inpatient showering, catheters, L&D etc, and even then wanting it to be at facilities and practices other than where they work.

In the vein of watch what they do (same gender for themselves), not what they say (gender neutral, nothing sexual about healthcare when dealing with male patients), I err on the side of taking my cues from what they do.


So, I invite any female that works in any direct patient capacity in healthcare to tell me why my interpretation is wrong.

 
At Wednesday, September 18, 2019 8:29:00 AM, Blogger A. Banterings said...

Maurice,

PT beat me to the punch. Urinalysis is the best test to confirm gonorrhea.

For most people, the thought of getting gonorrhea urine test or chlamydia urine test is a lot less intimidating than the thought of needing a physical exam...

...You will provide a urine sample, that you collect yourself, to the doctor.


Note:
This article acknowledges the physical and mental discomfort of the physical exam and the (outdated) swab method, and the fact that people rather forego these tests even at the cost f their health.


An ophthalmologist would NEVER perform a genital exam when urinalysis is so much less invasive. Doing this (even by a physician examining the eyes) would show a COMPLETE LACK OF COMMON SENSE. It may be quick and easy (for the physician), but the psychological harms to the patient far outweigh ANY CONVENIENCE.

If the patient was asymptomatic in the genital area, the physical exam would be inconclusive. The patient may also only have the infection in the eyes (this is possible although I will not go in to the mechanics of this). So the correct procedure for ANY physician, if is suspected is to culture the purulent discharge of the eyes FIRST, then order a urinalysis to test for gonorrhea.

To go straight for the genital exam fails to take into account the risk to the patient for psychological harms and risk to the physician for legal harms. Many psychologists have claimed that genital exams were appropriate for monitoring side effects of medication or as part of a physical exam, yet the juries did not see it that way.

This is just further proof that the profession of medicine lacks common sense and ignores societal norms and mores.





-- Banterings











 
At Wednesday, September 18, 2019 9:05:00 AM, Blogger Maurice Bernstein, M.D. said...

Biker, I would be more interested in reading why "any female that works in any direct capacity in healthcare" supports your comment and give their opinion why your your interpretation is NOT wrong but is valid. ..Maurice.

 
At Wednesday, September 18, 2019 9:42:00 AM, Anonymous Anonymous said...

Dr B,
A woman who attends to nude/naked males? She isn't going to admit to wrong motives. Do you think she's going to admit to any wrong motives? How many people do?
I don't consider myself the same caliber. I don't attend to naked males my age. ( very rarely )
PT has seen a lot more naked men than I have. I just attend to the same men over and over. Mostly bedridden and confused. In a 30 year time period the number has grown but I guarantee you more males have had erections from PT seeing them then me just because he's seem many many more.
I guess I was just running off at the mouth about saying I would have assulted Rick's medical assistant. I haven't assulted anybody in a lot of years. That being said I stick to my story that her actions are much more abusive than would be a patient or patients spouse who would assult her.
It's just the people over us claim the right to decide for us who sees patient naked bodies. For how long. How many people and what gender.
The motive for war criminals and medical workers? Are they the same?
Some are but they're not wearing signs around their necks. Maybe if a recording device where to be hidden in the break room or wherever they congregate to chat. I'm sorry. I'm feeling bent out of shape. Not at anybody particular on this blog. I'm just feeling my slave status compared to lawmakers and people who rule over us. JF

 
At Wednesday, September 18, 2019 10:09:00 AM, Blogger NTT said...

Good Afternoon:

I agree with Biker on the female healthcare workers. His interpretation is spot on but you'll NEVER hear a female healthcare worker agree with it unless they are retired or no longer in the field.

Gender neutral is one of the many myths that needs to be exposed for the farce it is.

Regards,
NTT

 
At Wednesday, September 18, 2019 10:27:00 AM, Anonymous Anonymous said...

JF


Let me correct you, I’m male. For many years I worked in hospital administration. There, I fixed it for you.


PT

 
At Wednesday, September 18, 2019 12:58:00 PM, Anonymous Anonymous said...

JF


Since you are our resident bedpanologist I’ve a few questions. Cable TV. Can nursing home residents enjoy cable TV? When I become a nursing home resident I’m hoping for some luxurious bed and bath products. Additionally, as far as gastronomical delights go I have developed a taste for mackerel. Would that be something I can enjoy while a resident in a nursing home? You mentioned erection and I’m assuming you meant penile erections. I’m only familiar with my own erection and I suppose that’s a good thing, thank you.

You said “ I don’t attend to naked males my age (very rarely). I just attend to the same men over and over. Mostly bedridden and confused. In a 30 year time frame the number has grown. “ Considering the resident demographics across nursing homes are you suggesting to us that you rarely provide care to patients your age or younger or do you prefer not to care for those patients.

PT

 
At Wednesday, September 18, 2019 1:59:00 PM, Anonymous Anonymous said...

PT. I know you're male. I never said anything different. JF

 
At Wednesday, September 18, 2019 3:53:00 PM, Anonymous Anonymous said...

PT. Most of our patients are ELDERLY. Occasionally there will be a younger patient but it doesn't happen often. I have taken care of those younger guys also but there hasn't been a lot of them. We're for sure not the crowd who show up to work for sexual gratification reasons. And instead of calling me Ms Bedpan just call me ASS WIPE. I'm sure that term was named after us. JF

 
At Wednesday, September 18, 2019 4:00:00 PM, Anonymous Anonymous said...

JF

Ok, I will do that in the future, Ms ASS WIPER.


PT

 
At Wednesday, September 18, 2019 4:35:00 PM, Blogger Biker said...

Dr. Bernstein wrote: "Biker, I would be more interested in reading why "any female that works in any direct capacity in healthcare" supports your comment and give their opinion why your your interpretation is NOT wrong but is valid. ..Maurice."

If such a person exists then yes I'd love to hear from them. My supposition is that virtually all female healthcare workers maintain the gender neutral/purely clinical mantra (what they say) is not in conflict with their personal "no males" demands (what they do). I can't see how that's possible, but yet they seem to be in both places at the same time. If they say they are not, then I'd like them to tell me how it is I am wrong.

 
At Wednesday, September 18, 2019 5:48:00 PM, Anonymous Anonymous said...

Biker


Very excellent commentary, I’ve wondered the same thing. They seem to masquerade around in scrub pants pretending to be of the gender neutral variety although, the giveaway was the sexy nurse, Betty Boop scribbling on their scrub tops. Thanks to the news media that leaked many examples of their adventures in unprofessional criminal behavior we know better. The manipulation of employment positions all the while discriminating against men in the job market and at the same time behaving in the most unprofessional manner against said gender while patients. How long do we have to juxtapose these examples to illustrate just how evil the healthcare industry is?


PT

 
At Thursday, September 19, 2019 8:23:00 AM, Blogger A. Banterings said...

PT,

US Code of Ethics for Nurses provision 1.1 reads: "Respect for human dignity - A fundamental principle that underlies all nursing practice is respect for the inherent worth, dignity, and human rights of every individual." At least some of the alleged behavior would appear to violate this fundamental part of the code of ethics.

In addition, many states' code of conduct for nurses states that nurses shall not emotionally abuse a patient. Unnecessarily invading a patient's privacy would appear to be a form of emotional abuse. (Example: the Alaska Nursing Statutes and Regulations Article 7. Disciplinary Guidelines, Section 770: Unprofessional conduct)

Other licensed health professionals operate under comparable legal and ethical standards.

Another excellent paper, How Should I Touch You?,four themes emerged from the interviews:

--Communicate with me
-- Give me choices
-- Ask me about gender
-- Touch me professionally, not too fast and not too slow.

Participants said they want to contribute to decisions about whether intimate touch is necessary, and when it is they want information from and rapport with their nurses.

Choice recurred as a theme among participants. They discussed clinical situations in which they’d felt powerless and devalued by not being given the chance to express their preferences concerning intimate touch. Comments included...

"They ignored my concerns and said, ‘Oh, you’re okay." Participants said they wanted to be involved in deciding whether intimate touch was necessary and whether there were alternatives. Several participants said something like, "If at all possible, ask me if I can do it myself. If I can, let me do it." One participant put it concisely: "Let me make the decision!" They were emphatic that if intimate touch was needed, they’d want control over the procedure.


Nursing is another profession in medicine that has demonstrated its lack of common sense, respect for codes of conduct of the profession, respect for human dignity, intelligence, and academic learning.





-- Banterings

 
At Thursday, September 19, 2019 8:54:00 AM, Blogger Biker said...

Coming back to the recent discussion about the Tallwood Men's Clinic in Farmington, CT, I read the article, reviewed their website, and then contacted them. It was clear from the literature that their vision was one stop shopping for potentially related specialties that men might need, and providing the coordination to make it all work. That's a pretty good idea. The sports channel stuff in the waiting area is just window dressing.

Anyway I very politely contacted them asking if their men's focus extended to also having male nursing and support staff for men who would rather than than face a sea of women for their intimate care. I used cystoscopies as an example. I received a prompt response saying that while they have both male and female nurses (females being being the majority), presently all of the Medical Assts were female, but that the doctor would do the cystoscopy prep himself if I didn't want a female doing it. I find that response very positive as to their intent to serve male patients, though the limitation is a man would have to ask for accommodation in order to receive it. Still, their approach is far better than most urology practices. For anyone who lives in the I84 corridor in CT or the I91 corridor in MA or CT, Farmington is easily accessible if any reader here wants to give them a try.

As an aside, apparently they have MA's prepping men for cystoscopies. For the past 14 years I have only had RN's doing it. While in times past I had no choice but for females to do the prep, I would be very uncomfortable with an MA doing it.

 
At Thursday, September 19, 2019 9:33:00 AM, Blogger Maurice Bernstein, M.D. said...

And then, if course, is THIS. ..Maurice.

 
At Thursday, September 19, 2019 9:57:00 AM, Blogger Maurice Bernstein, M.D. said...

It "ain't" only women healthcare attenders who diminish patient dignity. But as you can read in my above posting link should there be prophylaxis (preventative) measures taken such as providing every woman of childbearing age and in some vegetative state being attended in a long-term nursing facility birth control pills? Should this be part of the transfer requirement of such a patient from an acute hospital admission to a chronic care unit?

What do you think about prophylactic birth control measures required of such women as part of entry to such a facility? ..Maurice.

 
At Thursday, September 19, 2019 9:58:00 AM, Anonymous Anonymous said...

Maurice


Yes, I am very well aware of the rape at Hacienda healthcare that you have listed. If you investigated deeper, Hacienda has a history of unprofessional events. Months prior to the respiratory therapist raping the female patient a number of female nurses made unprofessional derogatory comments about a male client’s penis. There is actually a video online about a supervisor there complaining about the comments as well as male clients who are able to bathe themselves yet, continually having female aids walking in on them in the shower.

My point is this, we have on this blog talked about the culture at healthcare facilities. When the negative culture is not acted upon, put in check, this is what you get! This is exactly what will happen to patients when you have a runaway system of people with no professional morals. I am very acutely aware of Hacienda healthcare as this happened in the city I live. The problems run deep at that facility and have so for a very long time.


For anyone interested in how disgusting the accumulation of unprofessional behavior that has played out for years at this facility can go to www.arizonacentral.com. There you can do a lengthy search. Not only did the nurses at this facility not know that this comatose patient was pregnant for 9 months, but the woman’s physician had no idea either. The matter with him was taken up by the Arizona state medical board.

Btw, all this drama, behavior coming to any medical facility near you if it isn’t already happening.


PT

 
At Thursday, September 19, 2019 10:05:00 AM, Anonymous Anonymous said...

Maurice


This female patient was a near drowning victim at a very young age and has been in this facility for over 15 years. Is your suggestion about birth control going to somehow prevent her or other female patients resembling her condition prevent them from being raped? What about male patients? Are all comatose male patients now eligible for a vasectomy? Wouldn’t it be something if nursing staff could just do their jobs and do real nursing care, like advocating for their patients.


PT

 
At Thursday, September 19, 2019 9:24:00 PM, Blogger Maurice Bernstein, M.D. said...

How about physicians who are psychiatrists? Would those writing here look at them, either male or female professionals, as someone you could trust to treat you humanely and with all the dignity of a needy patient? Would you be more comfortable since you don't physically have to undress but only to take off and expose your emotional behavior and history?

Has anyone here actually discussed with a psychiatrist past emotionally traumatic experiences within the medical system which you have felt has left you with residual emotional symptoms or even frank PTSD?

..Maurice.

 
At Friday, September 20, 2019 5:04:00 AM, Blogger Biker said...

Dr. Bernstein, I have never talked to a psych doctor or any other counselor, but that said I wouldn't care about their gender. I similarly don't care about the gender of any person in healthcare for non-intimate exposure matters. For intimate exposure matters I simply want the same degree of respect and consideration routinely given to female patients.

I am a realist and know same gender intimate care is just not always possible for men when many practices and units in healthcare settings often don't employ a single male. In those instances I blame those in charge of staffing for discriminating against men, but I don't blame the individual provider, nurse, or support staff. They are just doing the job they were hired to do. I only blame those individuals if they expose me more than was necessary, longer than was necessary, to more people than was necessary, or they behave in a non-clinical manner. Just as the women who work in healthcare have largely perfected their "this is purely clinical to me" gameface, I like most men have perfected my "this isn't embarrassing me" gameface.

 
At Friday, September 20, 2019 12:02:00 PM, Blogger NTT said...

Good Afternoon:

I'm in agreement with Biker. The only time healthcare gender really comes into play is when there will be any type of intimate exposure.

If healthcare wants to stop men from walking away from needed care, they are going to have to STOP ambushing male patients with unannounced scribes & chaperones.

Maybe a virtual scribe is the answer as far as scribes go. This doc talks about her scribe in a box on her desk.

https://www.kevinmd.com/blog/2019/09/virtual-scribes-are-game-changers-for-physicians.html

Regards,
NTT

 
At Friday, September 20, 2019 12:28:00 PM, Anonymous Anonymous said...

Dr. B,
Try finding a psychiatrist who will take medical PTSD seriously. I have tried in my area with no takers.

Ed T.

 
At Friday, September 20, 2019 4:34:00 PM, Anonymous Anonymous said...

Maurice


Why would we seek help from a psychiatrist, so we can be further labeled as outliers? There are big differences between seeking help with PTSD versus mental health disorders of an organic brain origin. Why should we seek help from those who are partly responsible for this whole mess in the first place. Let’s see, we schedule an appointment with a psychiatrist and upon arriving he has a female scribe in the room to dictate everything said. Next week, the psychiatrist is not available, would you like to see the psychiatric nurse quacktitioner. Your prescriptions are now available at your pharmacy, you are given Lorazepam .5 mg and Abilify 5mg. Be sure to notify your doctor if you have any suicidal thoughts. Thank you for contributing to the $4 Trillion dollar healthcare system. Have a wonderful day.


PT


 
At Friday, September 20, 2019 8:14:00 PM, Blogger Maurice Bernstein, M.D. said...

Now that we are talking about psych issues, I would like to promote another view regarding a "disorder" which has been repeatedly written over the years here (by my visitors and myself): PTSD (Post Traumatic Stress Disorder).

I found a great article which looks at what has been called here PTSD could really be expressed as "Moral Anguish", better expressing what has occurred to your body and dignity. Here is the description from the beginning of the article which, I think, fits better in expressing what has been written here.


What often causes moral anguish is trauma that is perpetrated by people or entities whom the victim has trusted – whether those trusted are family members, close friends, senior people in one’s workplace or faith-based community or educational, civic, social, or political organization; this causes moral anguish because of the conflict between that trust and the betrayal of it. For some people who have served in combat and have injured or killed people identified as the enemy, moral anguish often results from the tormenting conflict between having been ordered to attack and kill in the name of the good and the right, as opposed to an enemy that is presented as less than human…and then suddenly seeing that one has injured or killed a human being. Moral anguish often ripples widely, so that the victim understandably doubts their own judgment in many situations and doubts whether other people or entities are to be trusted…or is terrified to trust or is determined never again to trust. The immediate environment and often the wider world no longer feel safe.


Read the article and express here whether what many of our writers experienced was actually better expressed as "moral anguish". "These caregivers whom I expected to be attentive to me as a human patient subject and not just some momentary object failed me and I have to live with this memory". What do you think? ..Maurice.

 
At Sunday, September 22, 2019 12:21:00 PM, Anonymous Medical Patient Modesty said...

Hi everyone,

I wanted to let you know that I’ve put up a new article, How Nursing Homes Can Respect Residents’ Dignity and Prevent Sexual Abuse.

It’s heartbreaking that nursing homes assign male nurses and aides to women for intimate procedures. Many of those female residents have dementia or physical conditions that limit their mobility that make them defenseless and unable to speak up. It is also sad that many nursing homes do not put a heavy emphasis on male nurses and aides helping with male residents for intimate procedures. It’s sad that female inmates in women’s prisons are seemingly treated better than female residents in a nursing homes. Women’s prisons do not allow male security guards to strip women naked or watch them shower. I’ve heard that men’s prisons do not allow female security guards to come into contact with male inmates’ private parts. The nursing home and medical industry need to follow the same standards as the prison system.

I wanted to respond to what Dr. Bernstein said on Thursday, September 19th said in this sentence: It "ain't" only women healthcare attenders who diminish patient dignity. But as you can read in my above posting link should there be prophylaxis (preventative) measures taken such as providing every woman of childbearing age and in some vegetative state being attended in a long-term nursing facility birth control pills?

I disagree with this completely. No, this is not the solution to preventing a woman of childbearing age from getting pregnant,. The truth is all nursing homes need to follow the similar guidelines as women’s prisons by making a policy that prohibits male staff members from doing any intimate procedures on female residents including seeing them naked. There are some risks of birth control pills such as blood clots so birth control pills should be avoided as much as possible especially with women who have health problems.

Misty

 
At Sunday, September 22, 2019 7:17:00 PM, Anonymous Anonymous said...

Misty,
It's more common for female staff to attend to male patients than the other way around but it would be best if females attended to females and males, males.
I remember my first long time nursing home job we had this male CNA. When he first hired in a lot of us thought he was a girl. One lady never allowed male staff to take care of her. One night I went into her room and he was getting her ready for bed. I said " She's letting you take care of her?"
( the lady was deaf ) The guy said "She always lets me. She thinks I'm a girl."
Most of the sexual abuse that goes on in nursing homes though are the other patients doing it. I've already told of the instances I'm aware of when it was staff doing it.
I know of one instance of a female patient sexually abusing her female roommate. I also know of male patients sexually abusing male roommates.
The jail thing? One of my coworkers when I lived in Ohio, said she was showering in the county jail and she saw a male guard walk past. I asked my oldest stepdaughter about it. ( she's been in jail a few times ) and she confirmed it for me. JF

 
At Sunday, September 22, 2019 9:35:00 PM, Blogger Maurice Bernstein, M.D. said...

Here is an appropriate Brief on the issue of sexual abuse in nursing homes.. This presentation from Consumer Voice may be an additional reference to those presented by Misty in her website presentation. ..Maurice.

 
At Monday, September 23, 2019 5:54:00 AM, Blogger Biker said...

Like most here when I have a scheduled test/exam/procedure I try to educate myself a bit so that I at least know what questions to ask or what concerns to express or know it is time to speak up if during the exam/test/procedure I don't feel my privacy and dignity is being respected in the manner that it should. Fortunately most of our medical encounters are scheduled.

I suppose even in an emergency scenario we could speak up if our mind is clear enough, but when it isn't we are then totally reliant on the healthcare staff being true professionals in respecting our privacy and dignity. That assumes we know what is normal and required. This is why our speaking up can only be part of the answer.

Emergency scenarios have the added downside of our not being in a position of knowing what is normal and what to expect. I was reminded of this a few days ago when I went into anaphylactic shock after inadvertently hitting an underground wasp nest while mowing. I didn't even know the term anaphylactic shock let alone what was happening or what would happen when the ambulance got to the hospital. All of the staff were very professional and treated me with dignity but if they chose not to I wouldn't have really known, in part because I was somewhat out of it for the first few hours. For example one of the manifestations was a body rash at least on my legs (I was wearing shorts), chest & arms (they took off my shirt), back, and hands. Had one of them said they needed to remove the shorts and underwear for a full skin exam I wouldn't have had any way of knowing if that was a necessary part of the process or not, hence a reminder that in emergencies we are dependent upon the professionalism of the staff. I have no complaints whatsoever with the care I received. All were full professionals in my opinion, including the ambulance crew. It just gave me pause to think about how speaking up isn't necessarily possible in emergencies if one doesn't know what is normal and appropriate.

 
At Monday, September 23, 2019 6:48:00 AM, Anonymous Anonymous said...

Maurice



That is just one more worthless entity that is a no-nothing, do-nothing. When two female nurses laughed and belittled a male resident to his face about his genitals it was reported to the supervisor. The CEO of the facility threw a tantrum and said that if it’s reported to the state survey you will be fired. When a male resident who continually complained about female aids coming into his restroom while showering, he complained. The CEO threw a tantrum again . When the female resident became pregnant no one knew, not even the physician who examined her until the moment she delivered.

I’d be happy to show anyone the online video’s that support everything I’ve just said regarding Hacienda healthcare. This guideline is as worthless as core values in the twilight zone. That is where they all exist. Ever notice incidents that are brought up and discussed and yet somehow, from somewhere, these documents show up, that tells what to do and who to call and bla bla bla . Where were they all this time. In another dimension called the twilight zone. That’s where they all exist.


PT

 
At Monday, September 23, 2019 8:53:00 AM, Blogger Maurice Bernstein, M.D. said...

Biker, sorry to hear about your injury. I hope it doesn't take the anaphylactic shock in a patient for the medical staff to act professionally and humanely to a patient and anything less is open to behavioral misbehavior. ..Maurice.

 
At Monday, September 23, 2019 10:08:00 AM, Blogger Biker said...

Dr. Bernstein, my point is that because anaphylactic shock was nothing that ever crossed my mind as being even a remote possibility, I had absolutely no concept of what to expect at the hospital and no matter what they did I'd of had no way of knowing what was normal and appropriate. It is why speaking up is only part of the answer.

 
At Monday, September 23, 2019 2:37:00 PM, Blogger Maurice Bernstein, M.D. said...

Biker, of course "speaking up" requires the patient to first understand the personal emotional conflict or issue to express but also the basic environment or conditions where the issue may arise.
This would apply to your most recent experience.

Think of a woman being shot in the direction of the anterior chest though her clothing including a jacket and blood was heavily flowing down from beneath the jacket. Certainly emergency medical care would include at least removing the jacket and even underlying clothing to locate, evaluate and directly approach the wound for emergency treatment as indicated. "Speaking up" by the patient against "undressing" would be an inappropriate consideration, at the moment. Of course, if the wounding was self-inflicted in an attempt suicide, well, that would be an entirely different matter, wouldn't it. ..Maurice.

 
At Monday, September 23, 2019 4:48:00 PM, Anonymous Anonymous said...

Maurice


I think what Biker is trying to imply is that many, including himself would not know if behaviors were innappropriate or would how to speak up to these kinds of inappropriate behaviors in an emergency scenario. You would say that the efforts of life saving measures would supersede any and all issues of modesty concerns the patient might have. Yet I’ve seen for decades that emergency measures often amount to a gawk show when unnecessary personnel who have no real function with the patient.

The fact is and I’m sure you will never admit it that it goes unchecked everyday played out at every hospital countless times. Patient privacy is an expectation even in emergencies. Let’s use your female patient as an example. She has suffered a gsw to the chest, the bullet has nicked the right atrium. The hospital has been notified and the trauma team is standing by awaiting ems to bring the patient. Many staff will enter the trauma room because they want to see a “ good trauma”. These people have no real function but just want to watch,

Of course this patient’s chest will be cracked ( opened up) in order to stop the bleeding until they can get her to the OR, meanwhile you’ve got quite an audience. So what’s the solution? Who is responsible for unnecessary staff in the trauma room with no real function.Is it nursing or trauma services? Of course this is all recorded as is the case at every major level 1 in this country and has been for many years. Do they look to see who was standing around in the trauma room with no real function.

This parallels the hospital in Pennsylvania perfectly only there were soo many unwarranted staff in the operating room and cell phone pics were snapping right and left, it was said it looked like a cheerleading pyramid, observing the surgery on a foreign object removal in the patient’s penis. Gawk shows are very prevalent at every hospital in this country, every day,

PT

 
At Monday, September 23, 2019 5:24:00 PM, Anonymous Anonymous said...

Maurice

Is this how many people have to leave this world, the product of a GAWK show.


PT

 
At Monday, September 23, 2019 5:35:00 PM, Blogger Maurice Bernstein, M.D. said...

The gathering of "employees" in the ER around a critically ill patient---is this a "teaching moment" for them or is it a "sexual leeching moment". That is the question in a nutshell. And the answer is....

PT, you apparently were there, what did these folks apparently talk and walk away with? ..Maurice.

 
At Monday, September 23, 2019 8:33:00 PM, Anonymous Anonymous said...

Maurice


I’ll reference the incident at the hospital in Penn. to answer your question. One of the physicians who sent a cell phone pic to his spouse of the patient’s penis said “ we do share unusual stuff”.


PT

 
At Monday, September 23, 2019 8:51:00 PM, Blogger Maurice Bernstein, M.D. said...

PT, if you were aware of this incident, what was the consequences to the physician when his action was obviously
"made public" (in that you are aware)?

...

By the way, I think my SPEAK UP request for all is misdirected. If we are to maintain patient autonomy, perhaps we should really encourage patients to SPEAK DOWN as the ethical direction toward the healthcare provider. ..Maurice.

 
At Tuesday, September 24, 2019 10:51:00 AM, Blogger A. Banterings said...

NTT,

In regards to your link on virtual scribes, do you notice the hubris of the profession of medicine? NOTHING about the comfort of the patient not having another set of eyes on their body, NOT even in the comments section.


Ed T.,

I can appreciate the trauma that you live with. May I ask the origin of your PTSD?

The reason that I ask is that looking for a psychiatrist directly is usually a losing proposition. I recommend finding a support group OR nonprofit that specifically caters to people similar to yourself or similar cause of the trauma. For example, Wounded Warrior serves wounded veterans and would have resources for different needs including counseling. RAINN (Rape, Abuse & Incest National Network) is the nation's largest anti-sexual violence organization.

I have met people abused in a healthcare setting and they experienced it as sexual abuse. They received help and support from those groups. I do caution you that everyone tends to discount abuse by providers as you some how misunderstood what happened or it is OK for 5 unnecessary people to be in the room for an intimate procedure.

When you phase it as what if your partner forced you to have sex with them and they had 5 people in the bedroom against your wishes watching, it begins to put it in perspective.


Maurice,

Moral anguish is utter BS.

What often causes moral anguish is trauma that is perpetrated by people or entities whom the victim has trusted...

This attempts to turn the perpetrator into a victim. First the profession of medicine makes us crazy and outliers because we did not allow people to practice on us and voyeur to watch? Now the providers are victims because they victimized patients.


Biker,

Do you remember the Brian Persaud case about DRE for trauma patients? Despite this being a norm (Trauma surgeons use to say 2 reasons not to do the DRE; no fingers or no rectum...). Yet, when the science was looked at, it found that the harms to the patient including psychological and to the provider (violence, lawsuit) were much greater than the null information that it contributed.

Furthermore, notice in these articles they talk about "multiple people forcibly holding the patient down" to perform the DRE to check for spinal injuries.

-- Forcing Care on Patients
-- Rectal exam tried as 
assault
-- Reasons to Omit Digital Rectal Exam in Trauma Patients: No Fingers, No Rectum, No Useful Additional Information

So, we think that you have a spinal or internal injury, and 5 people are playing "dog pile on the rabbit" with the patient to FORCE the DRE, but that will not cause additional injuries?

Further proof that the profession is incapable of rational thinking.

If they don't know that such an invasive procedure is useless but still performed, and you expect these people would somehow magically protect the patient in the ED?

Their PROFESSIONALISM is just like the Hippocratic Oath; utter garbage marketing fluff.








-- Banterings




 
At Tuesday, September 24, 2019 11:38:00 AM, Blogger A. Banterings said...

Maurice,

"Speaking up" by the patient against "undressing" would NEVER be an inappropriate consideration!!!

If the woman in your example was a survivor of severe sexual abuse. Failure to take into account that in context to the ED treatment would constitute malpractice just as ignoring an allergy to penicillin. It is the duty of the ED team to gain trust and minimize discomfort of the procedure.

The problem that comes in is that the ED staff do NOT want to take the time to earn the patient's trust or explain anything. Even if they follow protocol, this patient will file a lawsuit for ANY reason because her requests were not respected or addressed.



-- Banterings



 
At Tuesday, September 24, 2019 2:47:00 PM, Blogger Biker said...

Banterings, yes I remember reading about the Persaud case previously. Ignoring the fact that the thinking on DRE's has changed since then, his case was a dramatic example of the patient not understanding what was then deemed the standard of care at that time.

Again, my point was that even me who tries to be an informed patient ready to ask questions or express concerns found myself thrust into a situation in which I had absolutely no idea what to expect or what was normal and appropriate. Given my condition in the 1st couple hours I was dependent upon the staff acting appropriately. They did and I have no complaints, but the point is the expectation more needs to be the staff acting appropriately than it does the patient being required to speak up and protect themselves.

 
At Tuesday, September 24, 2019 3:01:00 PM, Anonymous Anonymous said...

Just get an OK from the patients first. And if the patients aren't OK with it, don't do it. JF

 
At Tuesday, September 24, 2019 10:15:00 PM, Anonymous Anonymous said...

Maurice


As I recall, two physicians were suspended for 28 days but I’m not absolutely certain. The fine for a Hipaa violation ranges from $100.00 to $1.5 million with jail time. I’d like to see the government get very firm on fines and jail time. One of the male physicians sent his wife a pic of the patient’s penis. Would his wife have a different reaction if he sent her a cell pic of a female patients breasts or her genitalia.

I doubt at that point his wife would find it amusing. You see how gender plays into this, that male patients are fair game? Would she consider him a pervert if the pics were of a female. But it’s OK that it was a male because she can laugh. There should be many healthcare workers in this country that should breath a sigh of relief to know that I’m not the one to slap Hipaa fines on people. It would not be pretty.


PT

 
At Wednesday, September 25, 2019 8:05:00 AM, Blogger A. Banterings said...

Biker,

My point is not about the standard of care, but the actions of providers when the patient refuses. If you had a spinal injury and 5 people were on top of you trying to immobilize you and then ROLL you to your side, they are going to cause iatrogenic spinal cord injury.

The presiding goal of perioperative management is to prevent iatrogenic deterioration of existing injury and limit the development of secondary injury...

If these people in the ED who are suppose to be the best of the best do not realize or care about this bit of common sense, then what makes you think that they would treat anyone with dignity or compassion.

What it is NOT about about health or safety. it is a power struggle. You the lowly patient will be subdued by the almighty ED staff.

What prompted the science to be looked at was the Brian Persaud case and it found the DRE to be useless. Why did physicians NOT know this? Why were they taught to religiously use the DRE?

This is all just further damning evidence about the ineptness of the profession.

When they have demonstrated time and time again that they practice the CULT OF MEDICINE'S RITUALS (and not science), it is time that medicine ONLY make RECOMMENDATIONS and patients make DECISIONS.







-- Banterings

 
At Thursday, September 26, 2019 4:24:00 PM, Blogger Maurice Bernstein, M.D. said...

Banterings, I am in full agreement with you that the ENTIRE medical system in the diagnosis and treatment of a patient's symptoms and underlying illness is always based on the PATIENT'S (or surrogates, if needed) DECISIONS as educated by medical system's RECOMMENDATIONS. By the way, this includes all routine medical or nursing procedures. ..Maurice.

 
At Thursday, September 26, 2019 5:49:00 PM, Blogger BJTNT said...

Reference: Thursday, September 26, 2019 4:24:00 PM, Blogger Maurice Bernstein, M.D.

Is this an example of patient involvement in decisions affecting the patient's healthcare?

Last month I told the prepping assistant [How come the providers don't wear name tags anymore?] that benzos affect my long term memory. Are there any alternatives? Her total words to me during the entire prep was "You have a decision to make. Either do it our way or it won't be done".

You have to sort of admire someone who knows her power and is not timid about using it.
BJTNT

 
At Thursday, September 26, 2019 8:49:00 PM, Anonymous Anonymous said...

BJTNT - regarding benzos - at least she was honest.

In my case they just lied.

I met with the anesthesiologist before surgery. I asked if they had to use benzos to anesthetize me or did they use them to reduce anxiety. He said they just used it to reduce anxiety and to cause amnesia.

I explained that benzos cause anxiety in me and not knowing what happened was traumatizing. I'd rather know no matter how unpleasant the experience. I said don't give me a benzo.

The anesthesiologist said, "No problem. We just won't use Versed on you." They gave me 3mg of Versed.

After surgery I asked why they gave me a benzo after promising me they would not. They said, "I know you said you didn't want a benzo, but everyone wants something for anxiety, so we gave it to you anyway."

I wrote a letter to the CEO of the hospital and the dean of the graduate school of medicine stating that I was unhappy with the care I had received. The attending and his residents had lied to me. They had given me a drug that I had explicitly refused. They acknowledged to me that they had done so knowing that I had refused and proceeded anyway because all patients want that drug. I pointed out that that met the legal definition of battery.

The hospital investigated my complaint and then requested a meeting with me. The CMO, director of the service, and the director of the resident program met with me for two hours. They insisted that it really wasn't battery. It was just "ineffective communication."

They knew they had messed up. People at this level of management at a 1000 bed academic medical center do not spend 6 man hours with a patient if they did nothing wrong. They would have punted this to some lowly patient services rep. They just would not admit it.

All I wanted was an acknowledgement of their mistake and a plan to insure this didn't happen to another patient.

CG

 
At Friday, September 27, 2019 8:44:00 AM, Blogger A. Banterings said...

CG,

Wait a couple weeks then send a letter to all parties that you are experiencing anxiety, flashbacks , cannot sleep, obsessive thoughts of what MIGHT have happened, overwhelming crippling fear of doctors, nurses, hospitals, and you now have complete mistrust in the healthcare system.

These ADVERSE SIDE EFFECTS could have been avoided. You WARNED your providers that this could happen.

Ask what the facility and those involved are going to do to remedy this IATROGENIC TRAUMA that you suffered at their hands.

Then ask if you need to get a malpractice attorney involved.

You can also file a police report with your county detectives. If they just send a patrol officer or sheriff's deputy, you tell them that you need to speak to a detective. Ask for one specifically who is knowledgable about crimes of sexual assault. If the detective is unsure, you can go directly to the District Attorney's office.

I do not know what state that you are in, but most (if not all) states have laws about sexual assault. While these laws were enacted to protect drunk students (who are unable to say "NO") from being sexually assaulted at parties, they can be applied to a medical setting. You were drugged WITHOUT you knowledge, and your body was battered (sexually battered depending on what procedure you had).




-- Banterings



 
At Friday, September 27, 2019 8:56:00 AM, Blogger A. Banterings said...

CG,

I forgot to mention that you MAY have a claim under the facility not making a reasonable accommodation for your PTSD and anxiety under the Americans with Disabilities Act (ADA). Along with this federal legislation, many states ALSO have laws protecting those with disabilities.

In the future, phrase your request "...I am requesting a reasonable accommodation under the ADA of..."



-- Banterings


 
At Friday, September 27, 2019 6:13:00 PM, Anonymous JF said...

One good reason for secretly tape recording everything they say. She probably could be in trouble for saying what she did.

 
At Saturday, September 28, 2019 9:24:00 AM, Blogger Maurice Bernstein, M.D. said...

...And on the other hand..from Medscape: Patients Sexually Harassing Physicians Report 2018.

Of course, this review doesn't eliminate the argument and experience about physicians and their workers sexually harassing innocent patients but there are often two sides to a "sorry" story. ..Maurice.

 
At Saturday, September 28, 2019 10:45:00 PM, Anonymous Anonymous said...

JF,

What type of taping do you propose to be done without prior consent from the patient. Visual or audio? I for one feel that secretly videoing is a violation of a persons rights. I have problems as is with medical situations and it is getting worse with age. My husband and I have both tried to address things like this as well as neither of us want opposite gender support staff in the area if and when exposed. MSKS

 
At Sunday, September 29, 2019 1:45:00 AM, Anonymous Anonymous said...

MSKS, I don't know how you can think that it's a violation of privacy. Maybe in some circumstances it could be but in a circumstance where your privacy is at a high risk for being violated or you're expecially vulnerable.
JF

 
At Sunday, September 29, 2019 11:32:00 AM, Anonymous Anonymous said...

I was referring to the PATIENT doing the recording! I see things from the patients perceptive. JF

 
At Monday, September 30, 2019 9:31:00 AM, Blogger A. Banterings said...

MSKS,

English Common Law (which US law is based upon), and US law give individuals the right to defend themselves.

To kill another person to protect one's self or another without the presence of significant harm is murder (manslaughter if done unintentionally with a degree of neglect).

Most often this is done with a weapon such as a gun or a knife. For such reasons society has limited access to these weapons. You need a permit to carry a gun, knifes over a certain length are not permitted to be carries.

Other benign objects can also be used to commit battery, manslaughter, or murder. One of the most popular is a baseball bat. Because this is intended as a "toy" for children (mainly), society cannot limit its access without creating a greater social harm.

If one kills another without the presence of significant harm with a baseball bat, then the crime is murder (despite the fact that a "toy" was used as a weapon. Indeed society recognizes robbery with a toy gun to be the equivalent crime to one where the gun is real because the victim has no way to distinguish and operates as if their life is truly in danger.

If a burglar were to break into a person's house and threaten them with a knife, that person has the right to defend themself. If the person were to grab their child's baseball bat, and they kill the burglar protecting their own life, they have NOT committed a crime, even though they killed another person because they felt they were in danger and defended themself.

A person may use an item that they are legally allowed to possess in an illegal manner to protect themselves from the perceived presence of significant harm to themselves or others.

In this era of modern technology, new, nonlethal weapons have been developed to allow people to protect themselves. The most famous being the taser (stun gun). There are numerous other technological developments. The most prolific of these is the video camera. They are around both the outside and inside of properties and buildings, at intersections, IN MEDICAL FACILITIES, on police car dash boards and even on police officers' bodies.

The modern philosophy is that cameras protect.

In the case of secretly recording medical providers, a patient or person accompanying a patient may use an item that they are legally allowed to possess (a cell phone) in an illegal manner ("wire tap" laws) to protect themselves from the perceived presence of significant harm to themselves or others in a medical setting.

I have presented this position to several attorneys and they all found the position to be defensible.

There are enough Dr. Larry Nassar stories that would lead a patient to believe that despite the multimillion dollar marketing campaign about how compassionate care at any facility is, there is a great risk to the safety and well being of the patient (the greatest harm usually being being PTSD).

Here are two of the most recent and well publicized stories of this: Man Accidentally Records Doctors Mocking Him During Colonoscopy, Wins $500K Lawsuit and Patient records doctor's insults during surgery, wins $500,000 lawsuit.

I see no problem secretly recording medical encounters.





-- Banterings






 
At Monday, September 30, 2019 12:45:00 PM, Anonymous Anonymous said...

Banterings.
I think MSKS possibly thought I meant the medical staff was doing the recording. And visonal instead of just tape recording. THAT could be a real problem.
Actually I see value in a recording that isn't the healthcare doing and isn't aware of. Hack proof if that's possible. Designed for the purpose of catching inappropriate behavior and getting around to workers covering up for co-workers. JF

 
At Monday, September 30, 2019 12:54:00 PM, Anonymous Anonymous said...

Banterings
I LOVED that story and I loved that she/they got caught mocking that patient. I would have very much enjoyed seeing her face when she realized she'd been recorded. Saying derogatory things about other people is ABUSE regardless of whether they hear it or not because it influences how other people see and feel about the insulted person. JF

 
At Monday, September 30, 2019 4:28:00 PM, Blogger NTT said...

Good Evening Ladies & Gentlemen:

Signs of a little movement.

Advocates work toward Office of Men’s Health

https://www.urologytimes.com/health-policy-urology/advocates-work-toward-office-mens-health

Regards,
NTT

 
At Tuesday, October 01, 2019 3:59:00 AM, Blogger Biker said...

NTT, an Office of Men's Health would be a positive move forward, though to date the privacy and dignity of male patients has not been a priority or even an issue for the Men's Health Network.

 
At Thursday, October 03, 2019 3:13:00 PM, Anonymous Anonymous said...

To date, the privacy and dignity of male patients are not a priority or even an issue for The Men's Health Network.
That would be a great sign for somebody to hang up on the door of the clinic. JF

 
At Thursday, October 03, 2019 5:17:00 PM, Blogger Biker said...

More professionals at work:

https://www.cnn.com/2019/10/03/us/maine-hospital-wall-of-shame-medical-records-disabled-patients-trnd/index.html

From the article: "Employees at a Maine hospital created a "wall of shame" where they displayed confidential medical records of disabled patients in 2016, the state Human Rights Commission says.

The records detailed sexual activity, private body parts and bodily functions of patients at St. Mary's Regional Medical Center in Lewiston, according to the commission."

Another part of the article: "The shame wall was removed after four months, according to the report, although the hospital said it was removed in weeks."

Whether it took weeks or months to remove the wall of shame after it was reported is telling in either case. Why would it have taken more than 15 minutes to have it removed after being reported? It also appears only one person was fired for this egregious ethical lapse and HIPAA violation.

But no doubt the hospitals says all their staff are professionals.

 
At Thursday, October 03, 2019 7:02:00 PM, Blogger Maurice Bernstein, M.D. said...

And from the local newspaper today.
Another example of terrible "professional" behavior.

Listen, I have an answer to all of this.
My grandson is in the second year of college studying computer engineering.
Maybe, in the future, computer engineering will provide computerized physicians, nurses and staff who will be performing the tasks of humans in the medical profession. None of the sexual and other professional misbehavior will be programmed into the professional "objects" who will be attending to human patients. No more "walls of shame" or the other misbehaviors or worse. Or is this too big an ethical, legal or technical task for those in my grandson's specialty? Will preservation of patient dignity end up requiring such medical practice engineering? ..Maurice.

 
At Friday, October 04, 2019 8:02:00 AM, Blogger Biker said...

So at St. Mary's in Maine we have 3 employees w/o a need to know accessing Ms. McCann's medical records. One gets fired, one gets disciplined and nothing happens to the 3rd. Why no punishment for the 3rd person?

It takes months to get the "wall of shame" taken down. Why so long? Clearly it would have happened quickly if the mgt. of that hospital thought there was something wrong with demeaning and mocking patients with disabilities.

There is no mention of any discipline for anyone for creating the wall of shame nor is there mention of anyone being disciplined for knowing it was there and not reporting it. Why? Again, it would seem that the mgt. of that hospital didn't see anything wrong with it.

The words of the CEO ring hollow in light of his mgt team's actions.

If it is OK to demean and mock patients with disabilities, what are the odds general population male patients are treated with any semblance of dignity there? Not good is my guess. If nothing was done to one of the three that accessed Ms McCann's medical records, what are the odds anyone of interest to staff there is not at risk of having their medical records accessed w/o valid reason? Not good. if mgt only reluctantly ordered the wall of shame taken down after months of pressure, what other displays for staff enjoyment are there of patients elsewhere in that hospital?

Just how sick can a hospital's culture be not to be able to see just how wrong all this was?

 
At Friday, October 04, 2019 2:09:00 PM, Blogger BJTNT said...

Ref: Thursday, October 03, 2019 7:02:00 PM, Blogger Maurice Bernstein, M.D.

China is already underway with virtual healthcare. After an initial office visit, patients can interact with physicians via their PC. This is a good way to avoid the lack of respect and dignity extended by healthcare providers. See Bloomberg Businessweek, Where the Doctor Is Always In, Sept. 30, 2019, pp 12-14.
BJTNT

PS - Biker. Remember it's not about the patient [just an object to be processed]. It's about the providers.

 
At Saturday, October 05, 2019 9:26:00 PM, Blogger Maurice Bernstein, M.D. said...

And BJTNT with regard to the PROVIDERS, here is a link to a cartooned article for us doctors as we move along from medical school to the beyond..what we face and what we can do about it. ..Maurice.

 
At Sunday, October 06, 2019 8:01:00 PM, Blogger Maurice Bernstein, M.D. said...

There is another side to the preservation of dignity story from the Washington Post.

I’m a female doctor. I often face sexual harassment at the hospital. And I’m not the only one.


Anyone want to defend male patient apparent misbehavior? Do you think that episodes as described in the article lead eventually to the sad or worse behavior of the medical professionals? ..Maurice.

 
At Sunday, October 06, 2019 9:37:00 PM, Anonymous Anonymous said...

Dr B. I don't defend that male patient's behavior but he probably wouldn't act that way if he had a male doctor or nurse the way he should have , and NO, I don't think his behavior is the cause of the problem behavior from the medical world.
All the opposite gender intimate care shouldn't have been happening in the first place. Why are you so bent on blaming the patients? JF

 
At Monday, October 07, 2019 4:46:00 AM, Blogger Biker said...

Dr. Bernstein, I doubt any of the posters here would deny that there are creepy guys out there or that would defend their bad behavior. Even guys that try to use sexual humor in attempts to hide their embarrassment are wrong to do so. Better they learn to speak up and ask for male staff.

 
At Monday, October 07, 2019 5:10:00 AM, Blogger Biker said...

Here is a follow-up on the St. Mary's "Wall of Shame" scandal:

https://wgme.com/news/local/st-marys-hospital-still-wont-say-whether-it-notified-patients-of-wall-of-shame

It does not seem mgt there has taken this seriously at all. Apparently they haven't notified the patients whose records were breached or are even in process of doing so, or they would have said they had done so or were in process of doing so. If it had been determined that notification was not necessary, they'd of said that, but they haven't. It also appears they have done nothing with staff procedures or training, or again they'd have said they did. This in combination with the prolonged delay in taking the wall down, only having disciplined two employees, and the CEO's wimpy apology letter all point to St. Mary's not seeing what was done as wrong. They seem to have done the minimum they could get away with (two employees disciplined, taking down the display) out of necessity given the public furor. The article does note they've settled with the complaintant Ms McCann, my guess being so as to not incur the publicity of a trial.

From the article:

"Sullivan did not respond to questions about how many individual people’s records were depicted, or whom people should call if they wanted to know if their records or a loved one’s had been part of it.

She also did not respond to questions about whether the hospital has made any specific changes to the way it handles patient information or trains staff, or whether anyone has filed a complaint with the Office for Civil Rights within the U.S. Department of Health and Human Services. That’s the agency responsible for enforcing the Health Insurance Portability and Accountability Act, or HIPAA, which prohibits the names of patients and their medical records from being disclosed without permission. Maine law also protects the confidentiality of medical records."

Like every other hospital, their mission & values statement includes the following. No doubt everyone that works there is a professional too:

Values

Our Judeo-Christian tradition compels us to promote Gospel values in all of our endeavors. We commit to honor these core values:

Compassion

We show respect, caring and sensitivity towards all, honoring the dignity of each person, especially the poor, vulnerable and suffering.

Integrity

We promote justice and ethical behavior, and responsibly steward our human, financial and environmental resources.

 
At Monday, October 07, 2019 8:28:00 AM, Blogger NTT said...

Good Morning Everyone:

As far as the female doctor sexual harassment, If one can't stand the heat its time to get out of the kitchen.

This is the way healthcare set themselves up. They wanted to get rid of male caregivers so this is what they get in return. They need to put up & shut up just like they make male patients do.

She should have known from the start of her conversation she was going to have trouble with the patient so she had choices.

1. Knowing there would be intimate touching, she should have asked if he preferred male caregivers.

2. Knowing how touchy feely the patient was she could have asked a male step in, in her place.

Hospitals brought this on their employees so employees should shut up & put up with it or suggest a protocol to management to switch out females for males when intimate care is warranted.

They should have listened when men tried to tell them.

I don't feel sorry for any female employee that has to put up with harassment from male patients. Payback's a bitch.

Regards,
NTT

 
At Monday, October 07, 2019 9:38:00 AM, Anonymous Anonymous said...

Hello Dr. Bernstein,

Thank you for your Sunday, 6 Oct 19, article (I’m a female doctor. I often face sexual harassment at the hospital. And I’m not the only one.) and your comment. Again, I'm wondering re your questions, "Anyone want to defend male patient apparent misbehavior?
Do you think that episodes as described in the article lead eventually to the sad or worse behavior of the medical professionals? ..Maurice."

Based upon the young doctor's article and her statements below, your questions could be rewritten as, Does anyone want to defend ACTUAL PHYSICIAN MISBEHAVIOR? Do you think that PHYSICIAN episodes as described (below) lead to continued PHYSICIAN MISBEHAVIOR?

"Faculty and staff members are the perpetrators of almost half of the sexual violence female medical students endure. When such violence comes from above, the options for resolution become even more scarce.

One friend disclosed that she could remember more instances of inappropriate behavior from her supervising physicians than her patients."

My question is Where does the Guilt AND Shame for this PHYSICIAN MISBEHAVIOR REALLY BELONG?

Reginald

 
At Monday, October 07, 2019 9:20:00 PM, Blogger Maurice Bernstein, M.D. said...

To JF, NTT, Reginald et al: What all of this shows is that being a "professional patient" (we all get sick and sick again) or a "professional nurse, doctor, medical tech", we are all in the same interactive environment and there will be human creatures, at the time, either one or the other category, where the specific "professionalism" breaks down from respectful behavior to another and shows it's "ugly head". All "bad manners" or worse at the time for either category of "professional humans" is not to be dismissed but acted upon to return "dignity" to both classes of humans. ..Maurice.

 
At Tuesday, October 08, 2019 5:29:00 AM, Blogger Biker said...

Dr. Bernstein, I agree with what you are saying but there is a missing piece. Increasingly women in healthcare roles are speaking out against misbehavior by male healthcare staff and male patients against them, and rightly so when and as it happens.

What healthcare has yet to acknowledge in any meaningful way is inappropriate behavior on the part of female healthcare staff towards male patients. I think this is because it is almost always comparatively subtle and harder to prove as being intentional. I partly refer here to exposing male patients more than was necessary, longer than was necessary, and to more people than was necessary. The other piece is the passive aggressive mocking and bullying (you don't have anything I haven't seen, we're all professionals here etc) when men do speak up. There is also simply not making an effort to ask male patients if they have a staff gender preference while at the same time automatically assigning females to female patients in places like ultrasound. It is long past due for healthcare to acknowledge these things.

Healthcare surely knows that female staff frequently seek female caregivers for their own intimate care, and seek facilities other than the one they work at for their own care, but then insist that there is nothing sexual about healthcare despite overwhelming evidence that their own female staff sees it through a sexual lens when they are the patient. Why do they continue to ignore the elephant in the room?

 
At Tuesday, October 08, 2019 2:14:00 PM, Anonymous StayingFit said...

I'm not sure if you saw this, but here is some good news, with regard to women's consent to pelvic exams:


Article


While this law only applies in New York, it wouldn't surprise me if other states follow suit. It seems a shame that such a law had to be written, or that, recognizing the need, it took so long to be passed. However, it shows that progress may be slow, but, with enough prodding, it does occur.

 
At Wednesday, October 09, 2019 9:31:00 AM, Blogger A. Banterings said...

StayingFit,

Welcome to the blog.

The NY law is USELESS.

If you have a magic white coat and participate in a gang rape, " Violating the law will result in a charge of professional misconduct punishable by state licensing regulators."

The law fails to protect men AND both men and women from rectal exams.

One may make the argument that since explicit consent IS required, then under federal and state sexual assault laws, a crime has been committed.

How about 12 years in prison for all parties involved?



-- Banterings

 
At Wednesday, October 09, 2019 2:55:00 PM, Blogger Maurice Bernstein, M.D. said...

So now..help me in medical student education..
What should I educate the first or second year students regarding how to introduce the purely clinical need for a rectal exam, male genital or female pelvic exam?

What should the sequence be (after describing the procedure):
1. "I need to perform this exam which I know is necessary because......will you allow me to do so?"
or
2. "Will you allow me to perform this exam which I know is necessary because...

I hope you see the difference in the sequence of the requests. In 1. Explain the clinical rationale first. In 2. Explain ask first for permission and then explain the clinical rationale.

As a patient, which sequence approach is more appropriate and "sounds better" for the patient to answer so as to make the patient feel more appropriately treated? Think about it.

There is a difference in the patient's acceptance of one of the sequences. Or is there? Such differences ("ask then tell" or "tell then ask:) in how to communicate with a patient could be considered in many different clinical situations and is something which I think is of teachable consideration and value. ..Maurice.






 
At Wednesday, October 09, 2019 3:01:00 PM, Blogger Maurice Bernstein, M.D. said...

POST SCRIPT: Please don't tell me that some or none of the procedures described is clinically necessary and that there are much less "embarrassing" clinical approaches which can be performed for virtually all if appropriate clinical information is needed for diagnosis or therapy. ..Maurice.

 
At Wednesday, October 09, 2019 3:21:00 PM, Blogger A. Banterings said...

Maurice,

A PROVIDER NEVER SAYS THAT THEY "NEED TO..."

The only thing anybody NEEDS TO do is die at least once in their life.

See Joan Emmerson's "Behaviour in Private Places: Sustaining Definitions of Reality in Gynecological Examinations". Page 79 states:

Furthermore, the staff claim to be merely
agents of the medical system, which is intent on providing
good health care to patients. This medical system imposes
procedures and standards which the staff are merely following in this particular instance. That is, what the staff do derives from external coercion—"We have to do it this way"—
rather than from personal choices which they would be free
to revise in order to accommodate the patient.


The use of "need to."

Saying "need to" immediately takes away any professional credibility they or the profession may have [left].

Start by saying "I want to perform this exam on you...

DO NOT CREATE ANY JUSTIFICATION OF "NEED TO"
The only to diagnose a STI is do a genital exam and if I don't do it you can die...

Next, you must say that refusal of the procedure is an acceptable option.

Then go on to explain the procedure, ask if there are any recommended modifications by the patient to make the patient more comfortable. Also let the patient know that the procedure may be requested of them again (by the attending).

This is just the beginning...



-- Banterings

 
At Wednesday, October 09, 2019 3:56:00 PM, Anonymous Anonymous said...

Dr B , Ask first. Then tell. There are enough patients who aren't especially upset by intimate care, with or without witnesses. Plenty. You're one of them. JF

 
At Wednesday, October 09, 2019 4:12:00 PM, Blogger Maurice Bernstein, M.D. said...

By the way, I would like to toss in another subject (but thanks to Banterings for his prompt addition to the "need to.." and sequence issue.)

I just finished a "Perspective" article in the current New England Journal of Medicine written by an identified gay male who is finishing up a pediatric psychiatric residency and "his" experiences with colleagues and superiors and patients though medical school and now through residency.

Reading, reminded me to wonder whether we have discussed here how interaction between the males writing here and if they were medically or surgically attended to by a member of the LGBTQ community. Would the behavior between the two be anticipated to be different than if attended by a professional nurse or physician maintaining their intact genetically intact sexuality? ..Maurice.

 
At Wednesday, October 09, 2019 4:21:00 PM, Blogger Biker said...

I agree that I prefer to hear "I want to....." followed by telling me why. If I have a question of some sort I'll ask and in most instances I will consent.

 
At Wednesday, October 09, 2019 5:22:00 PM, Blogger Biker said...

Dr. Bernstein, on your last question, I have no concerns being attended to by gay male healthcare staff. We had discussed this some time ago. First, having spent my life in Massachusetts and Vermont where gays and lesbians have lived openly for a long time, such things don't phase me at all.

More importantly, a lifetime of locker room usage since 6th grade equates to many thousands of times dressing and showering with other males. Surely there were gays amongst them. Never did I observe inappropriate behavior nor discussion, good or bad, about anyone's attributes. My experience has been men have been respectful of other men. This is why I am totally comfortable with male healthcare workers and am not concerned with their sexual orientation.

Regretfully I have experienced female healthcare workers being inappropriate in this regard. That makes me wary out of the gate. There is also the reality that female healthcare workers do see healthcare through a sexual lens as evidenced by their general refusal of male staff for certain procedures when they are themselves the patient. To me that makes it clear as day no matter how good they are at maintaining their gameface.



 
At Wednesday, October 09, 2019 6:32:00 PM, Blogger Dany said...

Much like Banterings and Biker, I would urge health professionals to avoid using "I need to..." when suggesting a specific examination process. It is misleading in that it often suggests a sense of obligation to comply from the patients.

(Of course, if the provider's intention is to manip- err nudge a patient into compliance well...)

Some acceptable alternatives are, as Biker suggested, "I want to..." or "I would like to...". Hey, I'd be happy with "I think you could benefit from (...), do I have your permission to do that?"

On my routine PHA a couple years ago, the doctor asked "would you agree to do a rectal exam?" I thought it was very thoughtful of him to present it that way. (Of course) I said no, and I didn't have to justify my decision. There was no argument from him or any attempt at convincing me. He just moved on. That's the way it should be.

Dany

 
At Thursday, October 10, 2019 3:39:00 AM, Blogger NTT said...

Good Morning Everyone:

They're bringing cell phones in the OR now.

https://www.aorn.org/about-aorn/aorn-newsroom/periop-today-newsletter/2019/2019-articles/phones-in-the-or?utm_source=Email&utm_medium=Newsletter&utm_content=10_09_19&utm_campaign=Periop_Today

They just don't get it.

Regards,
NTT

 
At Thursday, October 10, 2019 8:59:00 AM, Blogger A. Banterings said...

When providers tell me "need to" the first thing that happens is I immediately tell them they are wrong and explain that the only thing any of need to do is die once in our lives. Then I question their credentials.

As to Biker's experience of the locker room; everyone in the locker room at one point is naked. It is a shared group experience. Big difference when there is only one naked person and all the clothed people are bullying the one to be naked. The same happens with nudists and in other coed situations where everyone is naked.

I guarantee that if EVERYONE in the exam room was naked, patients would be more willing to allow student participation. I also guarantee that patients would NOT be asked to undress unless absolutely necessary. The way it is now, it is just too convenient to always have the patient undress.




-- Banterings



 
At Thursday, October 10, 2019 10:56:00 AM, Blogger A. Banterings said...

Here is an article that mentions the hidden curriculum as part of the medical education. It also states:

Unless the hidden curriculum, which has been written about extensively in the literature, supports the standard and informal teachings, future doctors won’t have the humanistic qualities that enhance the patient experience. It’s up to every hospital to ensure that physicians and residents, who mentor students, reflect the most empathetic and humanistic qualities.




-- Banterings




 
At Thursday, October 10, 2019 1:59:00 PM, Blogger Biker said...

Concerning the article NTT posted about cell phone sin the OR, here are the rules for that facility:

- Cell phone use has to be timed to not interfere with patient care.
- Cell phones cannot be used in front of patients or patient families.
- Cell phone use can only be allowed for emergencies to respond to or send an urgent message.
- By openly using a personal cell phone in the workplace setting, personal phones are now discoverable and can be implicated if a patient safety event occurs tied to the phone use.

Note that though they say phones can only be used for emergencies, it would be better if they specifically prohibited photographing unconscious patients just to be absolutely clear. Personally I think the temptation to photograph selected patients will prove to be more than some OR staff can resist.

 
At Thursday, October 10, 2019 3:01:00 PM, Blogger Maurice Bernstein, M.D. said...

Biker, interestingly and obviously cell phone utilization regulations are not a uniform part of all hospitals as exampled here twice or so by what happened in my July hospital admission: while in the act of being wheeled into my assigned room and as yet not settled in the final bed, out popped a cell phone and I was quickly asked by a nurse for permission to have a photo taken of my naked lower posterior body as I previously mentioned here for any skin pathology. I suspect while the cell phone itself was personal to the nurse, its use was for hospital intent and value and the image was later sent to me as part of the hospital visit documentation.

By the way, I think I have forgotten to ask my visitors here about their own personal experiences with the photo taking activity of cell phones by staff when they were clinic or hospital patients. ..Maurice.

 
At Friday, October 11, 2019 4:11:00 PM, Blogger Biker said...

Dr. Bernstein, my only experience with cameras taking external photos when awake has been limited to the dermatologist. With a cell phone he takes photos of my fingers and toes so as to see visit to visit if there is any change in linear melanonychia (dark stripes) in my nails.

Were I to be an inpatient and they asked to take a photo of my backside such as you experienced, my answer would be no. In fact, I think my answer to them wanting to do a full skin exam would be send a male to do it or it doesn't happen.

 
At Saturday, October 12, 2019 9:51:00 PM, Blogger Maurice Bernstein, M.D. said...

Here is an example from ProPublica of a medical institution defying a patient's dignity and the dignity of the patient's family just to statistically put the status of the patient such that the institution could continue to receive Medicare payments for heart transplants. Fits with what PT and Banterings have been writing. ..Maurice.

 
At Sunday, October 13, 2019 4:51:00 AM, Blogger Biker said...

Yes the ProPublica article supports what's been being said. Newark Beth Israel chose keeping the $ flowing in to themselves rather than the inherent dignity of this patient. Though hospital organizations always try to deem the unethical and sometimes illegal conduct that makes it into the media as a singular event not representative of the norm, the statistical chances of each singular event surfacing in this manner is extremely unlikely. It is more likely a case of if you screw up enough times, one of them is going to eventually get noticed. It is sort of like the drug dealer that has gotten away with hundreds of illegal sales finally getting arrested because he sold to an undercover cop. That singular deal was not an aberration from the norm for the drug dealer but rather the one time he got caught.

 
At Sunday, October 13, 2019 6:37:00 PM, Blogger Maurice Bernstein, M.D. said...

A worthy article from 2012 "Doctoring with dignity" sets the standards for how hospitals could express examples of their own dignity. The article fits with what has been expressed on this blog thread. ..Maurice.

 
At Monday, October 14, 2019 4:28:00 AM, Blogger Biker said...

Though it does not touch upon staff gender it was a good article overall. With the exception of staff gender the authors & contributors to the article seem to get it. One phrase in particular worth repeating is:

“Ask permission for crossing the ordinary boundaries that we have in terms of our physical modesty as well as our personal space”

My experience is that asking permission before touching me or exposing me has more become the norm than the exception in recent years. It is a protocol change vs not all that many years ago.

Not everyone has gotten the "be respectful" message yet though. Here I point to my friend's recent hospitalization where when he hesitated over a female LNA helping him shower he literally got the proverbial "you don't have anything I haven't seen" message to embarrass him into compliance, which it did. I will note that the article did not speak to that kind of bullying & disrespectful staff behavior.

 
At Monday, October 14, 2019 8:39:00 AM, Anonymous Anonymous said...

Hello Dr. Bernstein,

Thank you for the insightful article "Doctoring with dignity". Do you think that there has been much "improvement" in patient dignity in the seven years since the article was written?

Reginald

 
At Monday, October 14, 2019 10:59:00 AM, Blogger Maurice Bernstein, M.D. said...

Reginald, I can't answer your specific question regarding "improvement" but if not then "why not?".

I have a feeling, unlike my years of experience in day after day responsibilities in individual patient medical care ending 19 years ago this very month, these days, unlike those days, expose both physicians and nurses to "the patient has come to us to be diagnosed and cured" and to accomplish that task under pressure of attending to the "next patient", there develops certain time or individual patient interest limitations in fully meeting the criteria of "doctoring with dignity".

When I was recently hospitalized, I did observe a certain "rush in and after the task "rush out", staff behavior. Allowing time with the patient is one sign of "doctoring with dignity". That may be currently missing. ..Maurice.

 
At Monday, October 14, 2019 4:05:00 PM, Anonymous Anonymous said...

I have seen a steady decline in "doctoring with dignity."

Things that are contributing to it are:
- physician practices are no longer owned by individual physicians.
- hospitals are owned by larger and larger organizations
- when patients are admitted to the hospital they are no longer followed by THEIR doctor. They are assigned someone and that changes every shift.

When your doctor owned the practice and there was a process that affected an individual patient, the doctor had the power to modify the process for that patient. Now the doctor has to follow the policies of the corporation.

When the hospital was a small, locally owned, community hospital, it was more responsive to the concerns of the individual patient. Employees were empowered to address individual patient concerns.

When you chose your doctor, you could choose a doctor who respected your values. S/he was concerned about his/her business and reputation in the community. They were more responsive to the patient's concerns.

When your own doctor followed you in the hospital, they knew the patient and their values.

Now patients are just objects to be processed through a factory.

Getting a huge hospital system to respect your values requires being a very knowledgeable patient who isn't afraid to make waves and who knows to use phrases such as "accommadation for my religious beliefs."

CG

When my

 
At Monday, October 14, 2019 5:57:00 PM, Blogger Maurice Bernstein, M.D. said...

CG, I think one important statement you wrote was "When your own doctor followed you in the hospital, they knew the patient and their values." That's the precise part of the doctor-patient "connection" that is missing in hospitals utilizing hospitalists. What is missing is that "connection" with the patient's primary office physician during the interval between hospitalizations. All that detail is not or only incompletely or inadequately communicated to the hospital or hospitalist. And that is what has changed in the years since I retired from active practice. Though this is only one factor to consider as inhibiting "doctoring with dignity", it is an important one. Thanks for bringing up this factor. ..Maurice.

 
At Tuesday, October 15, 2019 1:44:00 AM, Blogger mitripopulos said...

CG- You got it right. This is not just one part, it is the biggest part of what is missing in hospital care and even in all relationships with doctors in corporate own medical care/doctors. In 1979 I was admitted for cardiac arrest and quickly ended in ICU with an on duty doctor at 10PM. My internist was in at 8AM and took over without the revolving door of doctors and worked with the head of cardiology. I was out in 4 days as he knew what I wanted and recovering at home with my wife and 3 dogs was better than the institution.

 
At Tuesday, October 15, 2019 12:56:00 PM, Blogger A. Banterings said...

Maurice,

As to "the patient has come to us to be diagnosed and cured," this is true, but the patient also wants it done in a manner that is dignified and NOT abusive.

The 2 are NOT mutually exclusive. Why is it then that physicians can only cure in an abusive manner?

I have repeatedly demonstrated on this thread (backed by academic research) how undignified treatment leads to PTSD, avoidance of medical care, ands iatrogenic traumas that are indeed preventable side effects.

The real question is why do physicians who re supposedly so intelligent (as they remind us mere mortals) do NOT realize that there are preventable serious side effects or why they just do not care?

This is why the public does NOT care about physician burnout or suicide: It is in their heads, they are imagining it. Besides, this is how it has always been, physicians working long hours. Besides, things have improved, at least residents are limited in their duty hours today.

Besides, the ones that kill themselves are crazy.

They knew this was the job when they came to it to treat and cure their lack of money, prestige, and not having a career.

"Be careful of the toes that you step on today, they may be attached to the ass that you are kissing tomorrow."

Again, proof that physicians either are not as intelligent as people think they are, have no empathy thus are (borderline) sociopathic, just don't care (power corrupts...), or some combination, is pelvic exams on anesthetized women without explicit consent.

That is the best documented and one of the most egregious examples, and the profession of medicine keeps it around.

If so many medical associations have statements that the practice is unethical, then why does the medical education produce unethical physicians?

If you are not a part of the solution, then you are a part of the problem







-- Banterings



 
At Tuesday, October 15, 2019 3:49:00 PM, Anonymous Anonymous said...

Banterings,
You keep bringing up pelvic exams on unconscious women without consent. There's one thing even worse than that and my best fried experienced it.
She was pregnant for her first child and she was in stirrups for her prenatal care when in walked her doctor with his med students.
She hadn't been asked or informed or prepared in any way. The doctor examined her then said "NEXT"
She found her voice at that point and said "NO".
As far as physician burnout and suicide, I don't automatically think it's them in love with themselves arrogant &@$$ holes desiring staff meandering in and out, a person closely watching... kind of physicain. I'm more inclined to think it the decent and good doctors. Possibly pressured into unethical actions. A well paid slave who is no longer connected to his/her spouse or children. I don't personally know doctors outside of their jobs and could be wrong. These are just my thoughts. JF

 
At Wednesday, October 16, 2019 9:01:00 AM, Blogger A. Banterings said...

JF,

Abuses of patients giving birth are starting to be more and more documented. The World Health Organization has sounded the alarm of the excessive high rate of C sections in western, industrialized countries and the UN's Special Rapport on torture has documented other birth practices that amount to cruel and inhuman treatment.

I like the PE example because it has been well documented, condemned by professional societies, yet it still occurs. This is absolute proof that providers exhibit sociopathic tendencies by enabling the practice (by doing nothing) or are students learning in that manner, teachers teaching in that manner, others that cover the practice up, etc.

The worst practice is the one that happens is the one that happens to you. (Think Ronald Regan's recession/depression speech.)

A day of reckoning is coming.



-- Banterings



 
At Wednesday, October 16, 2019 9:07:00 AM, Blogger Maurice Bernstein, M.D. said...

My StatCounter has failed to detect any recent visitors from Arizona and we haven't heard from PT since last month. I hope PT is "OK". ..Maurice.

 
At Wednesday, October 16, 2019 2:16:00 PM, Anonymous Anonymous said...

Dr B, I noticed that. We haven't heard from JR in awhile either.
JF

 
At Wednesday, October 16, 2019 2:40:00 PM, Blogger Maurice Bernstein, M.D. said...

JF, JR may have been upset with a feeling that her ventilation on this blog thread wasn't accepted by "us".
From the beginning, I have always accepted "ventilation" as possibly therapeutic for the writer and have never deleted such writing. It is a form of "speaking up" to those who read this blog thread and possibly getting some degrees of support and perhaps comfort. If she desires, she can write me: doktormo@aol.com
..Maurice.

 

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