Bioethics Discussion Blog: Preserving Patient Dignity (Formerly: Patient Modesty):Volume 108

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Saturday, January 18, 2020

Preserving Patient Dignity (Formerly: Patient Modesty):Volume 108




Related image
Continuing on with our current commentaries comparing physician vs 
veterinarians with regard to their relationship to the subjects (not objects)
of their attention,  I thought the above graphic tells us something for all
physicians to also consider: "the subject of your clinical attention may 
have an opinion about you or what you intend to perform which differs
from what you know or anticipate."  All physicians should not ignore
this possibility.

Graphic: From source noted below graphic through Google Images. AS OF FEBRUARY 11 2020, VOLUME 108 WILL BE CLOSED FOR COMMENTS. FURTHER COMMENTS CAN BE MADE OF VOLUME 109


165 Comments:

At Saturday, January 18, 2020 9:50:00 PM, Blogger 58flyer said...

Dr. Bernstein, This is an interesting comparison. Going back through my medical experiences, some were OK, one was horrifically bad, many were just fine, and some, super awesome. I have dealt with veterinarians since my earliest recollection. Cats, dogs, hamsters, and rabbits, now with a really unusual cat, I can truthfully say that I have yet to encounter a bad vet or the staff. While I agree with Biker that there is a totally different clientele, I do have to wonder, why do we humans encounter such problems. One species can get along with an entirely different species, yet the same species doesn't get their own species.

58flyer

 
At Sunday, January 19, 2020 4:34:00 AM, Blogger Biker said...

I like the cartoon header! Very apt.

 
At Monday, January 20, 2020 9:57:00 AM, Blogger Maurice Bernstein, M.D. said...

The following posting today by JF was erroneously deleted by me. I apologize. ..Maurice.



Dogs ( and cats ) give us real love and friendship. They are better people than real people are! They can't perform surgeries, but possibly otherwise benefit us more than some human doctors do.
JF

 
At Monday, January 20, 2020 10:36:00 AM, Anonymous Anonymous said...

Hello,

Since, I presume, many posters are in their 50's or older, the following may be useful. It's an article by Joseph Epstein in 18-19 Jan 20 Wall Street Journal.
" ' "Elderhood" is a book with an argument. The argument is that older people are misunderstood and thereby often mistreated by the medical profession. Most physicians, reliant on science and determined to cure even to the exclusion of their patients' well-being, fall back on surgery or drugs. Too often surgery and hospitalization, Dr. Aronson argues, are not the answer for older patients; and drugs that might be effective on younger adults can have deleterious effects on the elderly. Health professionals tend to concentrate on the body exclusively, when among the aged one's situation in life and past experiences can be crucial. Dr. Aronson [a gerontologist] who is herself in her 50's, writes throughout as an advocate for older people in a time when she claims "the second-class citizenship of older patients in medicine is entrenched and systemic." … geriatrics is badly scanted in standard medical training. Medical school, Dr. Aronson writes, "doesn't just erode doctors' empathy: it brainwashes the common sense right out of us." More alarming, she notes that, owing to ignorance in the profession about treating the elderly, "it's likely that medical care harms and kills old people in ways and numbers far beyond what gets reported." ' "

Reginald

 
At Monday, January 20, 2020 1:57:00 PM, Blogger Maurice Bernstein, M.D. said...

Reginald, important issue you just presented.

Recognizing and attending to elder abuse has been a regular formal teaching session subject for first year medical students at University of Southern California School of Medicine, my teaching school. Patient dignity is not preserved when elder abuse is allowed to happen in medical facilities such as hospitals and nursing homes or by nursing attending patients at home or by family members attending their elderly.

Ignoring the physical and mental consequences of elder abuse by others when a physician or administrator of a hospital or nursing home fails to consider and confirm abuse is itself an abuse. And as myself and my students learned about this clinical matter, patient abuse should always be in the physicians' differential diagnosis and attention. ..Maurice.

 
At Tuesday, January 21, 2020 8:05:00 AM, Anonymous JR Issues4Thought.com said...

I definitely feel elder abuse runs freely in the medical setting. The elderly are the majority of their patients and they are also returning patients. Hospitals classify patients over a certain age of being of advanced age in their treatment plans as evidenced in my husband's MRs. What this means exactly I am not sure. Info tells me that in dealing w/ conscious sedation that the amounts for elderly or critically ill patients should be at least half dose. They did not. Being of advanced age, use of sedatives and even hospitalization cause loss of mental capabilities. However, he knew he was not functioning as he should but they did not. I knew he was not but they did not but then it was due to the extremely high dose of meds due to both his intolerance of such meds and the meds being given to someone of advanced age and illness. So what does being of advanced age mean in hospital terms for the patient? It is not clear. However, the head of patient services told me that we should get use to being left exposed, not being involved in care decisions, etc. because as we age, we will have more medical encounters. So is this the idea that all hospitals have in dealing with the aged population? It is no wonder the suicide rate for seniors is increasing in addition to all the other things that happen to them. Supposedly they screen for elder abuse but do they actually screen or just check boxes? I mean they asked about sexual abuse while they were actually committing sexual abuse so I don't have much faith in them being really interested in facts.
Also, Dr. B., I disagree that is only abuse when an administrator of a hospital or nursing home or physician "fails to consider and confirm abuse is itself an abuse" because at that time it is a criminal act on their part. If I, as a school staff member, failed to report suspected child abuse, I could have been charged with a criminal act. Clearly, from all the posts here and elsewhere, the medical community as a whole does not consider the "mental consequences" of elder abuse as they would not be subjecting most all or any patients to being unnecessarily exposed, lack of consent & info., etc.
When hospice care is involved, there certainly is a lack of patient dignity involved because family members must provide intimate care unless a spouse does it all themselves which would most likely cause their health to fail. I remember being told by the hospice coordinator that we would be in charge of cleaning my father as bc of the meds, he would have bowel movements he would be unaware of having. Knowing my father, he would have been horrified but this is how hospice works as it saves Medicare money by putting these tasks on the family so they don't have to pay for care. My niece is a hospital social worker & was all I am going to do it even though she knew her grandfather would not have wanted her involved in his intimate care. Luckily, my son pushed her away & told her to get out of the room & he took care of it. My father would have been mortified at even him but certainly would not have tolerated my niece doing this. There is no dignity in using hospice as the kill vehicle.
It is my view that society has a whole has created the atmosphere in which elder abuse thrives. Hospital staff are mostly younger women who have no concept of respect for older people. Addiction rates of staff in medical facilities is also high so of course they don't care about the patients.
Dr. B. have you ever observed your students afterwards once they have been practicing their trade for a few years? Did what you teach actually stick or did they throw it away? I know what the textbooks say & even what hospital sites say but the fact is they don't in practice recognize let alone respect patient dignity especially for their elder patients.

 
At Tuesday, January 21, 2020 9:36:00 AM, Blogger Unknown said...

I heard once that if an elderly person signed their house/property to their adult child or grandchild, that that house/property has to be out of that aged person's name for 5 to 9 years before they go into a nursing home or the nursing home can sell the property and keep the money. I wish PT was around now. He would know if this was true or not.
Once in Ohio, our Assisted Living Home signed up with a Hospice service. They were negligent about coming over for our dying patient. Then the patient died and they offered to come over and comfort the staff. ( that was ridiculous )
Our boss was upset. I don't know if she was able to get out of her contract with them or not. JF

 
At Tuesday, January 21, 2020 12:14:00 PM, Anonymous Anonymous said...


Hello Dr. Bernstein,

Although elder abuse is a definite travesty, Dr. Aronson does not seem to be addressing that horrible issue. Her polemic appears to be that the medical profession seems to neglect the affective side of the patient. (“Health professionals tend to concentrate on the body exclusively….”) The greatest bane of the elderly is loneliness, not infirmity. Second to loneliness is what I’d term nullification – the loss of individual determination and identity. These are what “KILL” the elderly. When one has limited familial contact, is not free to make individual choices and is treated as an object (exemplified by the use of “dear” or “sweetheart”), life has lost its meaning. This is what physicians have failed to address with their concentration solely on the physical. Listening is a skill that you teach your students. Your emphasis is on listening in an attempt to solve the ailment riddle. For the elderly, listening needs to be redefined as compassionate presence. Listening becomes an engagement in their story. Compassionate presence can act as an antidote to loneliness and depression, sans Prozac. Nullification is the area where the problems of the elderly coalesce with our concerns for dignity. When physicians act paternalistically and nursing staff direct that a procedure "needs to be done", the collaborative approach to healing is lost and individual choices are nullified. When Mrs. Smith becomes the gall bladder in room 5C, that beautiful, exquisite individual becomes an objectified patient without human qualities. This is what we, as patients, abjure. We are not ciphers to be nullified by the medical profession. Elderly, or not, we ask medical personnel to treat our human infirmity with humane dignity.

Reginald






 
At Tuesday, January 21, 2020 1:26:00 PM, Anonymous JR Issues4Thought.com said...

JF,
I know Medicaid can put a lien on a house after the nursing home resident dies if the amount of the house is a over a certain limit. They won't do it under certain circumstances. I know several religious nursing homes require incoming residents to sign over everything such as property, pensions, social security, etc. They sometimes do it as a buy in to a house on the grounds but once you die, your heirs get nothing. Most nursing homes make you prove you have the financial means to be in there. They look at all your assets and earnings. They calculate how much everything will cost like keeping your property. The average nursing home costs I read a while back is around $100,000 a year so most will have to sell their property to be in there. I know if the property has been signed over so many years (exactly I know don't) you can avoid them taking it. I know of several people who have done it. I also have known of several people who have had a spouse with Medicaid paying the bill and once the person living in the house is deceased, the state takes the house. I also know of some facilities where you buy in and if you still have money to pay for your needs before you die, then your heirs can sell the apartment or condo. It varies. It is all just a big money game where the facility owners or administrators are the big money-makers bc the staff who actually does the care is not well paid.

We were told at the Hospital from Hell other location where my father was that Medicare prefers the use of hospice. They made is sound as if you were committing some criminal act if you thought someone would be at a hospital with supposedly skilled care. They said he could have went to a nursing for a limited amount of time but there "was a waiting list" and of course it was their goal to get him to die as soon as they could. I see Satan's little cars of death virtually everyday. Hospice is a big business bc they know everyone will die. The garden home in a senior community where my dad died was in no affiliated w/ hospice. Hospice only came after he died as they said it was not their responsibility to be there as he was dying. Of course, they freely sent all the drugs and wouldn't take them back to destroy so it is no wonder so many of them are used by addicts who have a relative in hospice care. I have heard very little in the way of positive comments from those I have spoken to about hospice. Maybe in the beginning it was better but now like everything else it is just a business of getting people to die and die thoroughly drugged.
Again, this is so ironic as they do superhuman efforts to prolong the lives of past presidents like Bush Sr. and Carter but the average person seems to get handed a death sentence. I have read several articles that the US spends too much money on elderly people's medical needs especially towards end-of-life. I wonder is it a formula they use to determine it will be your time or does the young doctor get to decide it for you like one did for my dad. Here's to hoping what comes around goes around for him too.

 
At Tuesday, January 21, 2020 2:33:00 PM, Blogger Maurice Bernstein, M.D. said...

Reginald, to your final statement " Elderly, or not, we ask medical personnel to treat our human infirmity with humane dignity", all I can add is "Amen".

Unfortunately, as teachers of medical students, our regular emphasis on each patient the student visits is a subject and not some object really gets lost into the student's later entry into residency where attending to the diagnosis, treatment and followup of the great patient load leads to a tendency to "objectify" the patient as to diagnosis in place of human personhood, being an individual human patient person. This becomes a fixed "professional handicap" when the now resident moves into final career practice. Depending on that practice demands, unfortunately such objectification may, by habit, continue and we end up with the basis for the many stories which have been described on this blog thread. ..Maurice.

 
At Tuesday, January 21, 2020 4:49:00 PM, Anonymous JR Issues4Thought.com said...

So how does this explain how female staff such as nurses and techs do not recognize the need to allow each and every patient regardless of being same or opposite sex the basic right to personal dignity? Nurses tend to spend more time with the patient and therefore should be able to see that patient as a person rather than an object to tell them to strip naked in Exam Room 1 as they watch and give no gown or sheet to cover. How can turn on a dime to transform from a caring manner to one of that of a captor ordering a captor to strip for torture? Is that a method they learn in school to gain confidence to put someone off balance to gain control and power? For older people, is this done because I as a child was taught to respect my elders so is part of the abusive behavior done to control the senior citizen. Is this the way they can detach themselves from the patient? As Banterings has said a number of times, having someone forced to be stripped and naked is done as a form of control. Are men perceived as threats so this is why they are treated a lot of times so much worse than female patients by female staff? Is this the place in life where women can and do assert their ability to have power and control over men?

 
At Wednesday, January 22, 2020 5:26:00 AM, Blogger Biker said...

On the elder abuse matter, now that I am in my 60's, for most routine healthcare visits for the past few years I am asked if I feel safe at home. They also ask questions about my living situation in an obvious effort to assess whether intervention of some sort is needed. Though I don't see myself as frail or elderly I have accepted it as part of the script and recognize it might prove helpful in some instances for those in a difficult situation.

There is another piece to this for those that, though they may still be living independently, have become less independent mentally. I see these people coming into Town Hall for me in my elected capacity to solve certain matters for them. Most will give me any info I ask for and so I am careful to never ask for any info that I don't absolutely need. I am extremely deferential to their dignity and unless I know them very well (this is a very small town), I am careful to address them as Mr. or Mrs. so and so. I am careful to only give them options or direction to a more appropriate spot if it is not specifically within my purview to solve. They are adults, not children.

At the same time I am careful to recognize when they need more help than simply being pointed in the right direction. Just telling such a person to for example call the Veteran's Affairs Office at the State capital isn't helpful if their body language tells me they are bewildered at the mere thought. In such a case I ask if they would like me to make the call, then I give the pertinent background as I understand it, and then put the person on the phone to take it from there. All of this applies to working with the elderly in healthcare settings too. Some people need more intervention than others but regardless their dignity must always be respected. I will add that I listen if they just want to talk, and I always find some common interest with which to engage them. It is very easy to do, and it does play into respecting their basic humanity.

 
At Wednesday, January 22, 2020 5:39:00 AM, Blogger Biker said...

On the matter of staff staying in the room while patients undress & dress, how common is this? I'm not talking decades ago, but rather in the more current timeframe. Most of my healthcare interactions have been in the past 15 years and nobody, male or female, has ever stayed in the room when I was directed to undress, nor when it was time to dress again. I am talking dozens of healthcare events over for which I had to undress/dress over this timeframe.

My comments here are pants & underwear related, not just taking off or putting on my shirt. That is done w/staff in the room most of the time.

 
At Wednesday, January 22, 2020 7:47:00 AM, Anonymous JR Issues4Thought.com said...

Biker,

I visit many different blogs for my research and I found it is not uncommon for this to happen for males. I know this has happened time and time again to my husband for prostate/rectal exams of which now he refuses to have. I have talked to many men here locally and this is how it is done for them. Any time any individual has to remove any clothing it should be done in private. For some women, it is a sexual act for a man to remove his shirt. You yourself have side in the past you have thought women have admired you being bare-chested. That is a sexual feeling and women do respond. Both men and women watch and admire upper torsos. If you watch tv, men removing their shirt is made to be a sexual stimulate. Women do admire bare-chested men. It is part of sexuality. Yes, for a female the shirt removal may have more meaning but even in same gender care settings, females aren't generally required to remove their shirt/bras w/ the MA or nurse present. They may open their shirt slightly but rarely is there full removal. It is wise for the use of the same rules of protocol for both sexes. It is sexism on part of the medical community to give gowns and sheets to cover areas of the female patients but not give the same consideration to the male patients. Most male patients are allowed no cover for exams of the genitals even though only side (front, back) is examined at a time. This is of course an area of concern if especially female staff is involved. Of course, female patients are usually draped appropriately whether the providers are all female. Once gowned, I guess they think they have de-neutralized the sexual aspect. Removal of any part of one's everyday clothing should be done in private. There is no reason they cannot leave the room for a few minutes and come back. That way everything can start in a "professional" manner and less intimate ties are established. I also think that calling me Ms. R or you Mr. Biker is more appropriate and establishes that invisible line of respect and professionalism. Usually the use of first names is granted by permission and used by those we have close contact social ties. I do not figure healthcare providers into my close, intimate circle so they should address me with respect as I will in turn with them too.

 
At Wednesday, January 22, 2020 8:02:00 AM, Anonymous JR Issues4Thought.com said...

Biker,

Although it is part of the script, I know people who are abused who are not elderly. This type of questioning should not be so discriminatory. Since for us hospital staff was abusing/assaulting during this questioning, my husband now answers these questions by referring back to the hospital abuse and saying no one in the medical community was interested at the time so stop the staff's abuse so he doesn't feel they actually need any info about his home life. I am sure his file has a lot of notes but this is a result of the abuse. What you are saying is very true about the respect shown in how you address. This is why I have such an issue w/ medical staff addressing patients by their first names. Most drs. are offended if their title is not used but they don't recognize patients also have the right of respect in using their dignified title unless otherwise noted. I think for many but especially for some elderly, medical visits are a stressful time. A lot of info comes at you and mostly they bark orders or demands. Unless you, they may not take to the patient as a person but rather as a subordinate. There are things done and said that even the average person may not understand. Many of the drugs the elderly are on help add to their confusion or loss of memory retention. My sister was being abused and the hospital knew it but did nothing. Of course, it was the hospital from hell. They resisted being involved even to the point of being timely in providing her medical info for court proceedings. So really they are required by law but you have to wonder what they really write in their files as I know for a fact what you report is not always written.
Kudos to you! If only all elected officials displayed a caring, compassionate attitude for their citizens they represent.

PS I am no longer shy about asking people about their medical encounters. I want that information as it is what helps me form my action plans. I don't use names but what they say helps me understand what is really going on. If someone doesn't want to talk about it, I completely understand because sometimes you just can't talk about what happened.

 
At Wednesday, January 22, 2020 8:29:00 AM, Anonymous Anonymous said...

Hello,

Great work Biker. As we've been requesting from health care, everyone benefits by going the extra mile to accommodate those with special needs. You'll never know the ramifications of your courtesy. "See how far that candle shines its light. So shines a good deed in a naughty world"-Shakespeare.
Keep up the good work.

Reginald


Reginald

 
At Wednesday, January 22, 2020 1:53:00 PM, Blogger Biker said...

JR, I hear what you are saying but the kinds of scenarios I am thinking about as concerns taking shirts off seem to be in the middle of office visits when the provider wants to check heart & lungs, after which the shirt goes back on. I had such a visit just a couple weeks ago. It would feel different if the MA rooming me said to take off my shirt while she watched and then just left me in the room like that w/o a gown waiting for the PA to come in. That I wouldn't like, but removing it for a clear purpose for a couple minutes in the middle of a visit doesn't strike me as disrespectful or undignified.

 
At Wednesday, January 22, 2020 4:25:00 PM, Anonymous JR Issues4Thought.com said...

Biker,
This also brings up another point and that is if the shirt removal for hearing the heart and lungs are really needed. My husband is not told to remove his shirt when the doctor listens to his hear and lungs. He is wearing a normal button down shirt. The doctor just listens through the shirt. This has been the habit of all he has visited recently including a NP even before his assault. It would be interesting to know if at the practice you visit if this is also the same protocol required of female patients or is this just reserved for male patients? Why? Because the answer would clarify if males are discriminated against or on the other hand, if women aren't treated equally. Whichever way. The bigger picture is shirt removal is not necessary if the material is not too bulky. It goes with having all patients totally naked, exposed during prep when it is not necessary. Furthermore, even if there is a sterile concern garments such as Covr could be used or even the gown can cover certain areas. In order to bring about change, we have to address why do they do such rituals when they are not necessary and may even be damaging a patient's mental health? This is the bigger point I am making--why do they demand unnecessary protocols be followed when allowing a patient keep their dignity and respect would go so much further in building a relationship of mutual trust and respect. We will have to disagree that the unnecessary shirt removal is a sign of disrespect that is part of the pavement of the major highway of disrespect. It is the eroding of our dignity with the little things that allows them to confidently take away our dignity in other areas. With the assault, these little things become magnified because we feel if they can successfully manipulate compliance in things like the shirt removal they will feel confident in doing more. For us, it is a matter of drawing the line of retaining personal and control of the medical encounter with the one who is paid for advice and should be delivering healthcare in their best customer service manner.

 
At Wednesday, January 22, 2020 11:05:00 PM, Blogger 58flyer said...

What concerns me is that there doesn't seem to be a national standard of care when it comes to the administration of healthcare. When I spoke to my current urologist he said that every clinic has their own way of doing things. In my past experiences, this is very much the case. Some clinics use the strip as you go approach where the patient, at least the male patient, is totally naked at the end which is the dreaded DRE. It's not the DRE that bothers me, it's the totally naked part. Then other clinics use the sequential undrape, then redrape throughout the exam. The patient is never naked. I had my first prostate exam at 19 years of age, and it was a strip as you go. The doctor did not explain to me what a prostate exam was all about, which I think that an explanation should have been a mandatory part of the exam. Many male patients would have left that experience saying "never again" and would have avoided healthcare going forward. This was for my first commercial flight physical and the FAA now allows for any pilot to "opt out" of any intimate exam. That is very fortunate for me.

Medical care should conform to a national standard. It should not be left to the discretion of various clinics, doctors offices, or hospitals as to what degree to respect or disregard the modesty needs of patients. That however seems to be the current norm.

Let's take flying for example. Me being a pilot I can speak of this. There is a national standard of how to fly airplanes. There is a standard phraseology when talking to controllers. The term "line up and wait" means the exact same thing at LAX as it does at Ocala, Florida. Meaning you taxi the airplane from the hold short and position the airplane on the runway and stop there until the controller says "cleared for takeoff." No matter where you are in the country, the phraseology, the manner of entering holds, flying approaches, receiving clearances, and so on are exactly the same. It can all be found in a manual called the AIM, or Airman's Information Manual, updated annually. Google it and you will see what I mean. In reality, it is the standard worldwide, with minor variations.

There could be created a Healthcare Information Manual, where all procedures follow a standardized set of instructions as to how to perform the delivery of healthcare services. Each procedure imaginable would have a specific set of instructions as to how to proceed. Attached to HIPAA, it would become the law of the land. Violations would be met with fines and suspensions and retraining. Protection of the patient's dignity would and should be a vital and mandatory part of the standards.

58flyer

 
At Wednesday, January 22, 2020 11:54:00 PM, Anonymous Anonymous said...

To answer this poster's question

"I heard once that if an elderly person signed their house/property to their adult child or grandchild, that that house/property has to be out of that aged person's name for 5 to 9 years before they go into a nursing home or the nursing home can sell the property and keep the money."

Most people do not understand that medicare does not pay for "custodial care" in a nursing home.

Medicare DOES cover care in skilled nursing facility if the patient received inpatient hospital care for at least 3 days and was admitted to the SNF within 30 days of hospital discharge. The patient must also require SKILLED care on a daily basis.

Medicare only covers 100 days of care in the SNF. It pays 100% for the first 20 days. After that you pay a coinsurance of about $180 per day. If you have a supplemental policy it may cover part or all of that copay.

Most people enter a nursing home because they require custodial care. The individual is responsible for paying ALL of those costs.

If a person requires custodial care and they are essentially destitute, then medicaid will cover the cost of their care. In most states the person can have no more that $2,000 in assets.

The individual would have to deplete nearly all their assets to cover the cost of their care before medicaid kicks in. This would include selling their home and using the proceeds of the sale to pay for their care.

To prevent people from transferring their assets to someone else and then claiming poverty to get medicaid to pay for their care, medicaid can look back 5 years. Any gifts or transfers made during that 5 years are subject to penalty.

cg

 
At Thursday, January 23, 2020 12:56:00 AM, Blogger Swannie said...

Hi, I am Swannie (59yrs) from South Africa and my recent experience should fit this topic.
While i considered myself as a sexually and mentally abused survivor, it changed 0n 12 Dec.2019 and now i feel like a victim again.
Underwent a stomach surgery to find out where abdominal fluid came from.Was told if hole in stomach, or intestines - a temporary colostomy bag would be fitted - THAT`S all i`ve been told.
When ordered to remove my underpants i asked why. Reason given - surgeon uses an electric implement and in case of a short circuit, rubber band of underpants would melt and fused in my skin.AFTER being drugged to the hilt, i was asked to sign the consent forms.
Before anesthesia, i bitterly complained being naked in presence of FIVE females in OR and my utterly humiliation.Was told they are professionals and i would not be naked for long.
Next i was aware of after operation, i was standing NAKED next to my bed, fitted with a catheter and a nurse laughing because a diaper was stuck to my back side. Door was open and i was in full view of nurses station.
I was NOT informed abt the catheter to which i would never ever have given consent, given my history of being sexually abused.
I was NOT covered covered at all after operation,only blanket over me.( Which nurses had removed to put diapers under me)
I feel so ashamed, humiliated, angry and all other adjectives you can think of.
It would be a lie to say i cry myself to sleep every night. While it`s true i do cry every night - i don`t sleep and if i do it`s only +- 2 h-3 hours.
Arrangements have been made by the hospital to receive psychiatric treatment, starting from 28 Jan 2020
Thank you for listening.

 
At Thursday, January 23, 2020 2:32:00 AM, Blogger Swannie said...

While i do not wish to elaborate on a public forum abt my history of being sexually and mentally abused, just know it was bad. I grew up in fear and with fear, every day of my life and the fear has never left me. At age 6 i was diagnosed and treated for stomach ulcers.
Medical profession let me down quite a few times too. At age 13 in grade 8, i was told - not asked - by a female school doctor to remove my pants, while her female assistant was present.I refused and then the usual ( according to most blogs) - "you have nothing i have not seen before" I still refused. Later that same day i received 6 lashings with a cane, because "i was disrespectful towards a grownup."
While married and (ex)wife did not conceive, we both went for tests. Gynecologist and Urologist had offices next door to each other.I was told to produce a "sample" by female staff and given a small container. When i handed in the container, she held it up in the air and asked in a loud voice when this sample was produced - in front of all the males and females in the waiting room. I really told her off.
A week later when my ex- wife fetched me at the station, she told me in the most inhumane way that i was to blame for us being childless.Said my doctor left the message with her to give to me.Next day when i phoned the doctor asking why he did not have the decency to tell me personally i was infertile, but instead left a message to my ex for me, he said i should not think i was a golden boy to receive special treatment as there were thousands of other men in my position and i should get over it.Well,the life i knew, came to a standstill the previous day. Since then i`ve been divorced for almost 21 years and was never interested to engage in any relationship.

And the last time the medical profession let me down during an operation ( as described in a previous post - if accepted by moderator) I was blatantly lied to as to why i had to be completely naked. Nothing was said abt me getting a catheter. It was not mentioned on the consent form as well. I was ambushed by a female doctor and her 4 assistants without any option to give my consent or deny the procedure.While i was a sexually abused survivor, i feel like a victim again.I wonder why males are treated with so much disregard, without any respect and being humiliated when being vulnerable?
When the time came to have the catheter removed ( after i unsuccessfully tried to remove it myself in the toilet) I refused point blank that a female would remove it.I said i`d rather snip off the pipe sticking out of my genitals and leave the rest for eternity inside me.Then along came an angel and i will kiss her feet if only i`d knew who she was.She promised to remove the catheter without touching me at all and in any way AND without seeing anything she was not supposed to see. She was as good as her word !! Now i am wearing a medical alert tag around my neck, stating"NO intimate/invasive medical procedure by any female. Never to be naked during any medical procedure." If anyone of these directives are not met by any female in the future - i will receive a life sentence for murder.
Although i have an appointment for psychology treatment starting 28 Jan 2020, i honestly don`t know how i will ever be able to overcome what was done to me AGAIN without my consent. Many times dark thoughts enter my mind.

 
At Thursday, January 23, 2020 7:39:00 AM, Blogger Maurice Bernstein, M.D. said...

Swannie, thanks for your contribution of experience from South Africa. It is of importance to this blog thread topics to understand medical professional behavior in countries outside of the United States of America. Is our experience in the U.S. "outliers" as compared to the medical system behavior in other countries around the world is something which has been rarely documented here. Again, thanks for joining us. ..Maurice.

 
At Thursday, January 23, 2020 12:34:00 PM, Blogger Biker said...

swannie, I am so sorry to hear what you have gone through. Just basic human decency would dictate that you keep a patient covered until they must be exposed and that you close doors or pull curtains if a patient needs to be exposed for any reason. That they have seen it all before does not matter. Were they themselves the patient they surely would not tolerate staff, male or female, treating them the way they treated you.

I wish I understood why some who work in healthcare, especially female staff, do not think male patients deserve to be treated as if the dignity of those men mattered.

 
At Thursday, January 23, 2020 4:49:00 PM, Blogger Biker said...

58Flyer, concerning your standards of care, I had previously shared the stark difference in the two bladder ultrasounds I had. For the 1st one at a small local hospital all I knew was I had an appt. for an ultrasound. Nothing was explained to me beforehand and I didn't know enough to ask questions at the time. I had no idea what to expect. A female sonographer had me remove pants & underwear (in private) & don a gown. Once on the table she proceeded to lift the gown up totally exposing me for a few moments before placing a towel on me.

Fast forward some years and I go for another bladder ultrasound at a large teaching hospital. This time the female sonographer just had me unbuckle my pants and scootch them down a bit. There was no exposure at all for the exact same procedure.

There is no excuse for totally exposing patients for a procedure that clearly does not require any exposure. That the same procedure could be done so differently at different hospitals is just plain wrong.

 
At Thursday, January 23, 2020 5:12:00 PM, Blogger Dany said...

Swannie,

Welcome to this very querky corner of the internet. You will find that your story isn't strange or unique at all among many of us.

I would rath not assume anything but did you ask why they used an indwelling catheter? And if so, what was the reason for it?

Have you considered writing a formal letter of complaint to the hospital? Failing that, is there a regulatory body you can contact to report what happened to you?

I like the idea of a medicalert type bracelet or necklace but I get the feeling this will be largely ignored. Someone will correct me if I am wrong but these things only work for allergies or medical conditions. As much as it frustrate me to say so, "patients preferences" are not going to be respected in any emergent situation (especially if you happen to be unconscious or with reduced mental capacity).

I hope you will stick around. There are quite a few smart cookies participating in this forum. I am sure you will be able to pick a tip or two.

Dany

 
At Thursday, January 23, 2020 6:00:00 PM, Anonymous JR Issues4Thought.com said...

58flyer,

I read your suggestion and it is brilliant. However, there needs to be a better enforcement mechanism in place that OCR that oversee HIPAA because they are worse than nothing.

Swannie,


Your story had similarities to my husband's story. You can read about at Issues4Thought.com My husband has refused to visit anyone medical provider connected to that hospital chain as they completely broke his trust. For that matter, they broke his trust in all medical providers. I, too, do not know why behavior like this happens. It is simply sickening. He too wears 2 medic alerts and he and I both carry multiple copies of what goes beyond a normal health directive stating what he will and will not allow. He states he would rather die than have any more female staff involved in his care during an emergency or in-patient hospitalization situation. He had it legally drawn up. It has been a very sobering experience to know this is what the use of the healthcare system has resulted in--an early death sentence for a man who never had these issues with them before nor did he have any prior abuse like you. Since they have in a roundabout way admitted wrongdoing, have you taken any legal action to bring the culprits to justice? The hospital from hell here said if he didn't like how they treated him, go elsewhere.

 
At Thursday, January 23, 2020 6:34:00 PM, Blogger Maurice Bernstein, M.D. said...

I want to elaborate a bit on the expression Swannie reminded us said to be expressed by a member of the medical profession: "you have nothing i have not seen before". That is a totally misleading and wrong expression to present to a patient. This is not what we teach medical students and this is not what should be a professional concept. It defeats the concept that the patient, the patient's mind, behavior, history, anatomy, pathology, diagnosis and treatment is a clinical "subject" and supports a concept that the patient is simply some "object". And this "object" approach to definition can lead to a host of errors in communication with the patient, the correct diagnosis and the correct treatment. Yes, there are similarities amongst patients in terms of their history of the illness, their anatomy, behaviors, individual pathology and response to treatment of their illnesses but accepting those possible similarities and applying them ("lumping them") to every patient with the explanation "you have nothing I haven't seen before" is erroneous and can damage the final result of the professional-patient relationship and clinical outcome. Professionals in medicine should consider that they "haven't seen everything". ..Maurice.

 
At Thursday, January 23, 2020 10:14:00 PM, Blogger 58flyer said...

Biker,
I am astonished as to the degree of exposure with your first bladder US. Of course you had no idea what to expect. All my bladders US's have been as described in your second example, except that in my most recent one that was performed by a medical assistant. She took it upon herself to unbuckle my pants without saying anything to me first. I stopped her and told her I would do that. I had a talk with her supervisor the next day about what I perceived was a boundary violation. None of the nursing staff there had just yanked my pants open without saying anything with my prior bladder scans, which at that point had been 3 in number. I think that medical assistants are the worst thing to happen to male patients over the last 40 years or so. A real close second is the idea that females can chaperone females.

58flyer

 
At Thursday, January 23, 2020 10:23:00 PM, Blogger 58flyer said...

JR,
You are correct. No law is effective without enforcement. Why make a law if there is no means to enforce it? With traffic statutes, there is the policeman ready to write the ticket. With criminal laws, there is the policeman ready to make the arrest. So, who is policing HIPAA?

58flyer

 
At Thursday, January 23, 2020 11:23:00 PM, Anonymous Anonymous said...

Regarding this question from Biker

"On the matter of staff staying in the room while patients undress & dress, how common is this?"

Part 1

I'm a woman. It's happened 3 times to me in the last 18 months.

18 months ago I was diagnosed with breast cancer. I had had a mammogram every year without fail. I had had a clinical breast exam during my annual physical every year without fail. My cancer was missed every year for 4-5 years. At diagnosis my very slow growing cancer was 3.5" in diameter. Mastectomy was my only option.

1. At my pre-op appointment anesthesia ordered a chest xray. The tech took me into the xray room and told me to take off my bra. I said where is the gown. She said you can just put your shirt back on. I said where is the changing room. She said, "you can just do it here." She stood there looking at me. I said, "No. I'm not." I changed in the staff restroom attached to the xray room. She rolled her eyes and huffed in disgust.

2. My surgeon wanted me fitted for a surgical bra prior to surgery and sent me to the prosthetic fitter at the mammography center. The fitter took me into an office and brought in another woman. She said this is Jane Doe. She's studying to be a breast prosthetic fitter, and she's going to be observing your fitting.

I said, "No. She is not. I'm a very private person. A cancer diagnosis is distressing enough. I do not need the additional distress of being watched."

The fitter started to argue with me. I looked at the student and said, "You get out" in my sternest mother/teacher voice. She went running.

The fitter continued to argue with me telling me the student needed 500 clinical hours in order to get her certification. She told me that she, the fitter, had also had a mastectomy and she had used her diagnosis to educate people about breast cancer. At this point I was crying and should have walked out. I just kept saying no.

Finally she handed me a gown and told me to strip from the waist up and put on the gown with the opening in the front. She stood there watching me. I stood there waiting for her to leave. Finally she said with annoyance if it bothered me I could turn my back to her. That's what I did. Again I should have walked out.

Then she left the room to get some bras to try. She watched me put on each bra.

I left the place crying. I'm sure she thought it was because of the cancer diagnosis. It wasn't. It was because of the fitter.

I HATE HER.

cg

 
At Thursday, January 23, 2020 11:25:00 PM, Anonymous Anonymous said...

Part 2
3. Six months after surgery I was at my PCP's for my annual. I told her I was having rib pain on the mastectomy side. My PCP wanted to get a chest xray. I told her that since I had not had reconstruction yet I didn't want to walk down the hall in her office wearing a gown w/o a prosthesis. She said that I could get dressed. The tech could take me to the xray room. The tech could step out while I put the gown back on. Then she could take the xray. She could step out and let me dress.

When the tech came to get me she was mad that I wasn't in a gown. She said, "You're supposed to be in a gown." I started to explain. She interrupted me and said, "I know how you feel, but you have to put on a gown before coming in here." I said, "Have you had a mastectomy?" She admitted that she hadn't. I said, "then you do NOT know how I feel!"

The tech and another woman stood behind their glass partition watching me change and whispering.

After the Xray I redressed in front of them.

I cried so hard during the xray that my shoulders were shaking. I'm amazed that the image was even readable.

I was so visibly upset when I left that a physicians whom I had never met stopped me in the hall and asked if I was ok. Could he do anything for me.

I've gone to that internist for 27 years and love her. She sold her practice to a big hospital owned medical group 3 years ago. They replaced all the highly qualified, kind people with cheap people. I planned to speak with my internist about my experience at my next appointment instead she told me that she was retiring. She had planned to work until she was 75 because she loved her job and her patients. She's been unhappy with the changes too and decided to retire 12 years early.

I didn't cry when they told me I had cancer. I didn't cry when they told me how big it was. I didn't cry when they told me I had to have a mastectomy. I didn't cry when they told me I had to have 36 radiation treatments.

The staff's total disregard for my modesty, my values, my dignity, my humanity destroyed my soul. They left me sobbing uncontrollably.

It doesn't matter if the patient is male or female. The same people who will mistreat a man will mistreat a woman.

It doesn't matter if the medical professional is male or female. Some people have something missing in them. Other people will respect another's values even when different from their own.

My female breast surgical oncologist was my champion for privacy. She complained to the head of the surgical department and made sure my values were respected. She even spoke to my plastic surgeon about his bedside manner.

My male radiation oncologist fought to get my values respected.

My female PCP has always been respectful of my needs.

My male dermatologist was incredibly kind and supportive.

My female physical therapist has been very respectful of my privacy needs.

I learned working in the business world that you won't get what you want if you don't clearly state what you want. Around age 40 I learned that people don't have to like me, and I don't have to like them. We do have to deal with each other courteously and respectfully.

I've applied these lessons in dealing with the medical establishment. They don't work. Many (not all) medical professionals will do one of the following:

- agree to respect your values and then do whatever they want
- argue with you and badger you until you give in
- tell you that your values are wrong

They seem to see courtesy as a weakness to exploit. You have to be almost hostile to get those people to respect your values. You have to use terms like "accommodation for my religious beliefs" and "medical battery."

I don't want to have to fight. I want a respectful,courteous relationship with my medical providers.

cg

 
At Friday, January 24, 2020 12:03:00 AM, Anonymous Anonymous said...

In response to 58flyer's statement

"I think that medical assistants are the worst thing to happen to male patients over the last 40 years or so. A real close second is the idea that females can chaperone females."

I think medical assistants are the worst thing to happen to ALL patients. They have very little if any formal education. They are not licensed. They make about $10 an hour. They don't know what is right or wrong. They don't have a lot to lose if they screw up. They can easily find another low paying job.

Medical professionals are not required to have a female chaperone for female patients. The first surgical oncologist I consulted was male. He walked into the exam room with an 18-20 year old male as his "scribe". His scribe didn't get both feet into the room before I ordered him out. I was wearing a tissue paper crop top. I felt very threatened being essentially naked from the waist up and having 2 males in the tiny exam room. I made sure he understood that.

He found a female nurse to chaperone.

I found a different surgeon.

I thought he showed bad judgement even bringing in that young man.

I left a comment on the practice's facebook page and on physician rating sites warning other female patients.

cg

 
At Friday, January 24, 2020 4:46:00 AM, Blogger Swannie said...

Hi Dany,
Thank you for the welcome.
I first emailed a complaint to the hospital manager, got a read receipt, but no reply. Then i wrote again,email for attention to the female doctor. Still got no reply. I emailed the Minister of Health, who in turn referred my complaint and concerns to The Community Outreach Programme.And lo and behold, who referred it back to the hospital with the instruction to find a solution. I was informed yesterday that all 5 females sent their written response to head office and i will receive it shortly.
No , so far i could not get an answer as to why i was fitted with a catheter.
When i talked to Ice-Tag Alert, they assured me any medical tag is a valid and binding instruction or information which may not be ignored at will. If in the event i am unconscious and catherisation is needed in order to save my life, then the onus will be on them to present facts as to why it was necessary.
I will not take it laying down however. There was NO reason at all NOT to inform me beforehand, even if it was only a remote possibility and there was NO reason at all not to cover me adequately after the surgery as to not compromise my dignity. I will wait for their written response and if i am not satisfied, i will take the matter further.

Sorry for any /all grammatical errors as English is my 2nd language.

 
At Friday, January 24, 2020 5:07:00 AM, Blogger Swannie said...

Hi JR,
Yes, i did read what happened to your husband as well and believe me, i feel exactly the same than him. NEVER EVER will ANY female touch me again without my consent ! In my email addressed to the female surgeon i wrote that i consider her the very last female who raped/molested me.It would be interesting to see her written answer as to why she felt the need to lie to me as to why i had to remove my underpants, when she knew it would be in the way of the catheter, instead of her lame excuse of an electric instrument which may short circuit and then melts the rubber band of my underpants to my skin.
Just before i went completely under anesthetic, her last words were i would not be naked for long as i would get cold and they would cover me with scraps of material. I cannot tell you how panicked i was, as being completely naked on the operating table was never on the cards at all.If i was not drugged (sedated ?) as heavily before i was anesthetized, i would have called "STOP !! i rescind my consent for this operation." It`s of no use to me that my body has healed, but i was left mentally unstable.

 
At Friday, January 24, 2020 5:31:00 AM, Blogger Swannie said...

Thank you Dr. Bernstein for your warm welcome in another post. I was SO glad when i found this Blog of you and still have a LOT of catching up to do on all the previous blogs.

Doctor Maurice, +- 2 months ago an Army Doctor in South Africa was found guilty in a court of law of molesting and sexually abused his patients, which immediately makes the statement of " you have nothing i have not seen before" null and void. Apparently all patients were instructed to strip, while being touched inappropriately even if their medical complaint did not warrant it at all.

My anesthetist told me she was a professional - but failed to disclose whether she was a professional strip teaser or pole dancer - as that statement did not eradicate my history as a sexually and mentally abused survivor. I am sure the Priests who abused boys could make the same claim as being professional.

If a person is a professional, don`t tell me, but show me through your actions that you still regard me as a human being. A certain DR, Linda is also a blogger and she absolutely gets it how male patients feel when intimate/invasive medical procedures are being carried out by females.

Thank you so much for this blog and my acceptance as a member. Knowing many other males feel the same than me, was a real eye opener.

 
At Friday, January 24, 2020 5:52:00 AM, Blogger Swannie said...

Thank you Biker for your kind words.

I wish i could meet the person who declared a female body holy and that of men just a slab of meat. Females do not have to ask anybody to preserve their dignity. It is something which is automatically regarded as her right as a female.

Maybe i would have felt different if i did not have been abused and i certainly don`t think my genitals are made of gold, but to me it represents my manhood, or whatever is left of it after being told i was infertile.

And as it is part of my body which is always covered, i definitely feel i am the owner of it and therefore should be the only one to decide who may see or touch it.

 
At Friday, January 24, 2020 7:37:00 AM, Blogger Biker said...

Dr. Bernstein, on the "you don't have anything I haven't seen before" matter, you mention the training that you and others do with medical students. I think much of the problem is the lack of training below the physician level on these matters. Every level of healthcare worker is needed to make the system work but when you get down to the medical asst. level they may not have had anything more than some on-the-job technical training to do the tasks that practice requires.

In some States patients may encounter 16 year old CNA's whose training program might have been as little as 75 hours, including clinicals. How much instruction can they possibly have gotten concerning respecting patient dignity and privacy?

Why aren't they trained to respond in a respectful manner? A simple "I know this may be embarrassing for you but please know...." would go a long way to acknowledge the patient's concern and acknowledge that the patient is not an object. The rest of the sentence could be along the lines of saying they'll see if there is a male staff member available, but if they know one is not, to instead state how she will keep his exposure to a minimum and protect his privacy as best she can. Maybe she'll gain his trust, maybe not, but responding with "you don't have anything I haven't seen" guarantees that she will have needlessly embarrassed him.


 
At Friday, January 24, 2020 7:45:00 AM, Anonymous JR Issues4Thought.com said...

58flyer,

The Office of Civil Rights (OCR) is in charge of HIPAA and they are a joke. They do not care about individual infractions. We filed and they did nothing about his name and medical info being broadcasted 3 times on a speakerphone in a public hallway by a clergy. It didn't meet their standard. They generally only investigate infractions like hacks of info per EHR or such. Even those who can prove a medical person gossiped about their info to others such as on Facebook or to people in person have a very difficult time with HIPAA. They never contacted us after the initial paperwork was filed. After a year, they just closed it out. We also filed for violation of freedom of choice meaning a clergy was forced upon us and was privy to info that we felt violated our rights. Again, silence even though that is a OCR oversight. Overall, the government will rubber stamp whatever the medical community does unless it becomes so obvious even they can no longer deny it. However, those instances are few and far between. Patients really have no viable course of action in pursuing anything done to them. Even though we talked with the cardiologist's office about my husband, they chose to not make note of it so the MA was able to trigger an adverse reaction in him by her actions. She came back to say she had personally made a note but did she really or will it be deleted like those were about his rejection of versed? We do have the recording of this. Getting medical treatment should not be such an adversarial undertaking. It is difficult even just to get your information across and retain theirs but having to defend one's dignity each and every time is really too much. But I am going to take your idea of a national manual of standards of care and run with it. It is really a good idea. I hope I can do the idea justice.

 
At Friday, January 24, 2020 10:46:00 AM, Blogger Biker said...

cg, how horrible that you had to suffer such cold and unprofessional staff in conjunction with your breast cancer. I hope in retrospect they realize how cruel they were. A few years ago my wife had surgery for an anal fistula into her bladder, a rather undignified scenario at best. During her hospital stay she said the male nurses were gentler and more respectful than the female nurses. Good luck to you as you move forward.

 
At Friday, January 24, 2020 3:53:00 PM, Anonymous JR Issues4Thought.com said...

CG,

That was horrible what you had to go through. The disease was bad enough but the actions of those women were despicable. It goes to prove that sexual assault (unnecessary exposure) can happen even in same sex care and it does not make in any the less devastating. When you were so upset not a one of them inquired as they know preventable stress should be avoided. If the one needed training, why didn't she practice on them? It is bad enough to have constant medical treatment as happens during cancer therapy bc you feel like you lose part of your identity and just become an object or a breast or a prostate. They really made extra effort to make you a non-person. The male nurses I have encountered have in an overwhelming majority been more compassionate than the female nurses. You got probably the one doctor who used a male as his chaperone. It isn't a law they must have a female chaperone but there are so few males working in medical settings who are doctors. Most male patients get a female chaperone and say nothing but die of humiliation. Us women are more likely to speak up. My husband before this didn't really like my speaking up on his behalf but now he is grateful for he learned the hard way not every medical provider is compassionate and not perverted.

Swannie,

You summed it up when you said you are the owner of your body and have the right to decide who touches or sees it. That is what they don't understand. Consent is only implied that you are there to seek help. Consent had to be given for them to actually do anything. This is the area they seem not to understand. There are options to every procedure and treatment and only the patient has the right to make that decision. Every patient has the right to be explained, asked and then consent to any part of an exam. All procedures should be clearly and precisely explained. If some don't want it, then they can sign a form saying they waive that right. Automatic touch needs to be controlled. Just because I happen to go to a hair styling salon does not give them the right to start styling my hair without my input and permission. Why is this concept so difficult for the medical industry to understand.

Biker,
If a 16 year old's mind is not developed enough to drink, smoke, etc then why are they mature enough to deliver medical care is my question? There needs to be a certain maturity in dealing with such private and critical issues as healthcare services.

 
At Friday, January 24, 2020 4:58:00 PM, Blogger Maurice Bernstein, M.D. said...

The following is an example of a program at Los Angeles County Hospital-University of Southern California School of Medicine which demonstrates that there are folks in medical education who are considering the issues which is being described on this blog thread.
..Maurice.

 
At Friday, January 24, 2020 5:09:00 PM, Blogger Maurice Bernstein, M.D. said...


A collaboration between theater and medicine leads to an innovative empathy program for LAC+USC staff
Astrid Heger, MD, professor of clinical pediatrics at the Keck School of Medicine of USC, was looking for a way to teach empathy, kindness and caring that did not involve panels of talking heads or dreary online assignments. She was fed up with those. The answer, she discovered, was theater.

“When people get up out of their chairs and are acting together, nobody in the audience is on their phones,” said Heger, who is also the founder and executive director of the Violence Intervention Program at Los Angeles County + USC Medical Center. “They can see themselves in the situations being portrayed and you can have real learning. This way of learning should be driving us as a university.”

Four years ago, Heger had a dinner with Brent Blair, PhD, who directs USC’s Institute for Theatre & Social Change, that planted the seeds of a program called ACT Together that debuted at two adult primary care clinics at LAC+USC in 2017. The staff of those clinics work with some of the nation’s most vulnerable patients, and often suffer from caretaker fatigue. The clinics see patients whose physical illnesses frequently coexist with mental illnesses and addictions, and poverty often complicates their ability to follow medical recommendations.



Josh Banerjee, MD, who was then the medical director for the clinics, had a fellowship from the California Health Care Foundation that came with a charge to develop an innovative solution to a health care problem. Banerjee knew the problem he wanted to tackle: medical providers at the clinics feeling powerless, voiceless and burned out.

Blair, a professor of theater practice, has spent his professional life using theater to help marginalized and oppressed communities find solutions to difficult problems. Heger introduced Banerjee to Blair, and then provided funding for the project.

Blair hired actors — some from marginalized communities — to play the roles of patients. Doctors, nurses, medical technicians and hospital social workers were recruited to work with the actors to develop six scenes that illustrated some of the tough situations the clinicians frequently face.

 
At Friday, January 24, 2020 5:11:00 PM, Blogger Maurice Bernstein, M.D. said...


“We showed an ‘anti’ model of how things should not be done,” Blair said. “All the scenes were carefully designed and scripted for failure.”

One scene had a doctor recoiling in horror at the sight and smell of a patient’s badly infected leg wound. Another involved a woman who had suffered physical abuse being unable to show her scars to medical staffers because her abuser remained in the examining room. Another detailed how financial paperwork runarounds caused a patient to miss his appointment.

The scenes were presented differently by which the audience members, the clinic employees, were asked to step in and replace the actors and medical personnel originally doing the scenes. They were told to use their experience and wisdom to bring about better outcomes. The original actors and medical personnel performed the same scene repeatedly, giving the opportunity for several audience members to try different solutions.

“When doctors, nurses and medical staff get up and act instead of talk, they have body memory that lasts into their practice,” Blair said. The result is that employees feel seen and heard. “They feel better when they are on the medical floor the next day.”

Four times a year, Los Angeles County Department of Health Services (DHS) — which operates the clinics — measures employee engagement with surveys and Banerjee knew the clinics’ mid-range scores could and should be better. They had tried retreats, team building exercises and public recognition for staff members, all without much success.

The average for positive employee engagement for all DHS units was 3.69 out of a perfect score of 5. The score for the clinics Banerjee oversaw was 3.64. It’s difficult to raise scores by even one-tenth of a point, and Banerjee had an ambitious goal to raise the number to 3.75 during the six months the ACT Together program ran. Impressively, the clinics’ score went up to 3.81 during that time.

Survey questions specifically about ACT Together revealed approval ratings of 95 percent.

Banerjee has given credit to Heger’s support, and to Blair’s skill as a director.

Blair says that even when there is no intervention that neatly solves the problem in a scene, the audience has changed from being passive to feeling active, useful and engaged.

Since the program’s inception, Blair and Banerjee have done presentations on the project for the California Health Care Foundation and LAC+USC, and are planning to co-author a medical journal article about it. Banerjee is now the associate medical director for transitions of care at LAC+USC, and he and Blair are in discussions about expanding the program across the DHS.

— Allison Engel

 
At Friday, January 24, 2020 5:17:00 PM, Blogger Maurice Bernstein, M.D. said...

The above article was published in the current issue of the HSC News, internet publication of the University of Southern California School of Medicine. ..Maurice.

 
At Friday, January 24, 2020 5:24:00 PM, Blogger Biker said...

JR, my understanding is that hospitals require LNA's/CNA's to be 18 years old but that nursing homes and possibly rehab facilities will hire them at 16. Our senior citizens deserve better than some 16 year old being sent in to help them take a shower or to give them a bed bath or help with toileting. Bear in mind some might still be students doing their clinicals even.

 
At Friday, January 24, 2020 8:39:00 PM, Blogger Maurice Bernstein, M.D. said...


One scene had a doctor recoiling in horror at the sight and smell of a patient’s badly infected leg wound. Another involved a woman who had suffered physical abuse being unable to show her scars to medical staffers because her abuser remained in the examining room. Another detailed how financial paperwork runarounds caused a patient to miss his appointment.


OK.. now you guys and gals, step in as a professional and write how you would have handled these scenarios. ..Maurice.

 
At Friday, January 24, 2020 11:56:00 PM, Blogger 58flyer said...

As to the age matter, I think 21 should be the minimum age for a medical person to be able to perform any manner of intimate care, regardless of the sex of that person. In my State, you have to be 21 or over in order to be a police officer, and I think that is true in most States. Now that may be due to the fact that most if not all States set the minimum age at 21 to possess a handgun. I hired on at 21 and I have to be honest and say that I was not nearly mature enough to be a police officer. It took many mistakes for me to figure that out. How many medical mistakes are due to a lack of maturity on the part of the medical person?

CG,
Sorry to read of your horrible and cruel treatment as a cancer patient. What are these people thinking? Are they even thinking? I am starting my own cancer journey, and I am very apprehensive about what's to come. I have a second home in Pennsylvania, and when I went there last July, I visited my 95 year old neighbor and brought her some goodies from Florida, like jellies, marmalades, honey, and other good things from the mom and pop roadside stands along the way. To know this lady is to love her, she is so sweet and kind, how could anyone hurt this wonderful lady? She told me of her recent hospital stay and how the staff mistreated her. She spoke of how the female nurses were so insensitive, yet how the male nurses were so respectful and careful of her modesty. I have never told her of my own difficulties from a male patient perspective, yet here she was pouring out stories of her bad hospital stay. I was mad and upset, why would anyone want to hurt such a beautiful person? One of her granddaughters is a nurse, and agreed with her!

JR,
We need a codified national standard of care. Too bad we have to tell providers how to do their jobs. But we do. We cannot depend on the goodness of the many who do such a great job, but we have to force the not so good folks to step up or find another line of work. The only way is legislation, sorry it has come to that. Either provide professional care, or find another career.

Swannie,
Thanks for your contribution! We are all in this together!

58flyer

 
At Saturday, January 25, 2020 4:17:00 AM, Blogger Biker said...

1) While one would hope medical training would steel physicians for anything they might see or smell, if he or she let their guard down in this manner, I think the next step should be an immediate and honest apology to the patient that they didn't realize the extent of the injury/infection and that they will do whatever they can to help the patient recover. We're all human but honesty and sincere apologies can go a long way to recovering from something like this. The patient already knows the wound is disgusting so making believe otherwise may come off as disingenuous anyway.

2) JR will disagree with me but, I think standard protocol should include asking any family members or friends to step out of the room before an exam begins. If the patient says they want the other person to stay, then the other person should be allowed to stay; otherwise they leave. The patient is in charge, not their family member, unless of course the patient is a young child or otherwise incapable.

3) The staff aren't responsible for the broken insurance system but they need to be understanding of the dilemma some patients find themselves in and be accommodating for getting the patient rescheduled w/o penalty. The staff should as well point the person in the right direction to get the paperwork matter resolved. For the patient it may be the 1st time they are dealing with the matter. The staff has likely seen it before and know how to provide at least basic guidance to where help is available.

 
At Saturday, January 25, 2020 8:29:00 AM, Anonymous JR Issues4Thought.com said...

Biker,

Actually I don't disagree. No one should be in the room without the patient's consent PERIOD. The patient is giving consent to only the one doing the exam when they are advised of why and permission needed. Anyone else in the room needs consent of the patient too including family and other medical personnel which would include chaperones. This should be done before any undressing is done. I am in there with my husband as he has specifically said he requires me in there for his protection. I remember back when I was pregnant I wasn't asked if he could stay and I brought that to their attention over 25 years ago that I thought they should have asked and not assumed. The was both of ours but it was my body. I didn't have an issue with him being present but I did have an issue with them not getting my permission first. Once I was no longer involved in the bathing of my children I had no need to view their genitals so from that time onward if I needed or was asked by them to be present I would turn around. I completely believe in privacy and freedom of choice.

 
At Saturday, January 25, 2020 8:40:00 AM, Anonymous JR Issues4Thought.com said...

58flyer,

Actually my husband's prostate cancer journey was an easier journey than his heart attack. He was a healthy man going into the prostate procedure. He was able to choose his treatment, where and when. He knew what was going to happen and what he was going to choose to happen. No one made decisions for him even though he thought he had made the heart procedure choices they instead took away his autonomy and did what they wanted to do. He had his procedure done out of state on an outpatient basis which meant he was the hospital for about 24 hours. His surgery was at 7:30a and he was out by 8:00 the next day. He took the catheter out himself and has never looked back. No other treatment was done. That was 14 years ago. After the surgery, only the doctor checked the catheter. Nurses did not. They only strapped the bagged on his leg w/o any intimate contact. It wasn't that he refused or even had an issue with intimate contact then but that was just how it was done. I was told beforehand that they preferred someone to stay overnight unlike the hospital from hell who told me to leave when I didn't really have to leave. He had lap surgery but not DaVinci (SP?). We are glad as now there seems to be issues with the DaVinci. The radical prostat. was never a consideration for him as it is a really overkill in most situations. They let me be with him in PACU as they had curtains unlike a lot of them. I was there as they transferred him to a patient bed too. I was with him in pre-op as they understood he had severe reactions to sedatives. However, with most prostate surgeries there are issues that cannot be undone but those were explained so he was able to accept the consequences as he was advised and he made the choice. Someone else did not make the decision for him as in total medical strangers. You are in my thoughts!

 
At Saturday, January 25, 2020 8:50:00 AM, Anonymous JR Issues4Thought.com said...

58flyer brought up several good points in his post. I felt for the older lady he was talking about but sadly it is more likely it will be older patients that are on the receiving end of dignity assaults. It is the attitude of society in a whole that has eroded and made our older citizens irrelevant in status. In fact, I was told to expect such as we age we have more medical encounters. It is really difficult to understand bc the older population is really their bread, butter, and jam. W/o said population there would be no need for such a large medical industry. That is why one organization I am blasting is the AARP. I want them to finally become aware of what older people go through. No response yet but I have gotten some responses from my constant bombardment of email, posts, etc.

The other thing from the post is the Dignity procedures manual. It will take legislation and it will take someone with more medical knowledge than I have to write it as I don't have the education necessary to write a complete manual but only to give the idea that all patients require dignity in all medical procedures. That idea should be simple. I will list medical garments that provide for dignity. I will list how medical personnel can demonstrate they understand and will abide by giving all patients the dignity and respect they deserve as a human being. I can illustrate the basic concepts but I can't demonstrate actual procedures. So I am going to see if there is a medical person out there somewhere that cares about patient dignity. There may be one and maybe they are willing to help.

 
At Saturday, January 25, 2020 6:03:00 PM, Blogger Maurice Bernstein, M.D. said...

From Jan 7 2020 JAMA the following Abstract on "Practices to Foster Physician Presence and Connection With Patients in the Clinical Encounter". My question: Is the approach described realistic, practical and satisfying to you? ..Maurice.

Importance Time constraints, technology, and administrative demands of modern medicine often impede the human connection that is central to clinical care, contributing to physician and patient dissatisfaction.

Objective To identify evidence and narrative-based practices that promote clinician presence, a state of awareness, focus, and attention with the intent to understand patients.

Evidence Review Preliminary practices were derived through a systematic literature review (from January 1997 to August 2017, with a subsequent bridge search to September 2019) of effective interpersonal interventions; observations of primary care encounters in 3 diverse clinics (n = 27 encounters); and qualitative interviews with physicians (n = 10), patients (n = 27), and nonmedical professionals whose occupations involve intense interpersonal interactions (eg, firefighter, chaplain, social worker; n = 30). After evidence synthesis, promising practices were reviewed in a 3-round modified Delphi process by a panel of 14 researchers, clinicians, patients, caregivers, and health system leaders. Panelists rated each practice using 9-point Likert scales (−4 to +4) that reflected the potential effect on patient and clinician experience and feasibility of implementation; after the third round, panelists selected their “top 5” practices from among those with median ratings of at least +2 for all 3 criteria. Final recommendations incorporate elements from all highly rated practices and emphasize the practices with the greatest number of panelist votes.

Findings The systematic literature review (n = 73 studies) and qualitative research activities yielded 31 preliminary practices. Following evidence synthesis, 13 distinct practices were reviewed by the Delphi panel, 8 of which met criteria for inclusion and were combined into a final set of 5 recommendations: (1) prepare with intention (take a moment to prepare and focus before greeting a patient); (2) listen intently and completely (sit down, lean forward, avoid interruptions); (3) agree on what matters most (find out what the patient cares about and incorporate these priorities into the visit agenda); (4) connect with the patient’s story (consider life circumstances that influence the patient’s health; acknowledge positive efforts; celebrate successes); and (5) explore emotional cues (notice, name, and validate the patient’s emotions).

Conclusions and Relevance This mixed-methods study identified 5 practices that have the potential to enhance physician presence and meaningful connection with patients in the clinical encounter. Evaluation and validation of the outcomes associated with implementing the 5 practices is needed, along with system-level interventions to create a supportive environment for implementation.

 
At Saturday, January 25, 2020 6:10:00 PM, Blogger Maurice Bernstein, M.D. said...

What I am trying to display here on my blog thread is that there is activity going on in the medical profession system which reflects awareness of medical system-patient issues and attempts of value or attempts which might be considered potentially worthless in bringing the system and the patient (and family) together to the desired goals being discussed on this blog thread. .. Maurice.

 
At Sunday, January 26, 2020 8:51:00 AM, Anonymous JR Issues4Thought.com said...

There really is no need for another study. It should be a given, ingrained, or whatever term used that all patients are accorded certain rights. The things mentioned are things that should have already been a part of the procedure. However, what was missing was the specifics of how to address dignity/respect for each and every patient. Is the issue of chaperones covered? Is the issues of draping covered? These are things that matter. That is the blaring omission. Without a textbook or a sheet that spells it out for them, it is likely to be omitted, overlooked. You can listen but you can also not make notes of what you heard like in our case. There is no way for the patient to know until it is too late. You can take the time but still not follow the patient's wishes. Without patient input, it is like having foxes tell how to guard the hen house but it is really only a plan to better attack the hen house. Without patient input, they are only guessing and surmising and still will miss the mark.

 
At Sunday, January 26, 2020 10:45:00 AM, Blogger Maurice Bernstein, M.D. said...

JR et al, yes, patient input is essential but are all patients informed and aware about the details of the pressures and demands which the individual physician, nurse or tech is currently experiencing with respect to other patients within the same time frame or shortly thereafter? In a hospital, clinic or office, there are current but also upcoming patients to be attended. This potential "load" on the professional needs to be considered as a patient reacts.

In this regard, how do you or how to do you expect other patients to interpret the documented issue of professional "burn-out"?

There is a defect in the medical system these days which center about system financial income and inadequate numbers of professionals to meet the demands of public need.

Patient inputs to their caregivers are necessary and may be valuable to that individual patient but in my opinion (and I am sure many other professionals), it is the current defects ("diseases", disorders) within the medical system that need therapy and curing. ..Maurice.

 
At Sunday, January 26, 2020 10:48:00 AM, Blogger Biker said...

Dr. Bernstein, those are all good things in terms of connecting with the patient in a meaningful manner but it is unclear where respecting the patient's privacy and dignity come into play. Perhaps the 5th point if the patient isn't speaking up and they are good at reading body language. No matter how prepared for the visit they may be and attentive once in the room, if they ambush me it will turn into an overall negative. If a patient tenses up when the female chaperone walks into the room when its time for the genital exam, how many physicians will do as #5 days; notice, name, and validate the patient's emotions? Somewhere between few to none is my guess. To do so would mean they have to acknowledge the problem.

If the starting point of this kind of study is that medicine is gender neutral(at least for male patients; it seems healthcare takes some gender-based measures on behalf of female patients) and that patients automatically set aside privacy/modesty considerations in healthcare settings, then they are at risk of reaching incomplete or incorrect conclusions. Not for every patient but for many. Ignoring the elephant in the room does not mean the elephant isn't there.

I know in this particular post they are talking physician-patient interactions but nurse/tech/CNA literature abounds on respecting the patient's dignity but never acknowledges that for many patients staff gender is a major variable in respecting their dignity.

The medicine/healthcare is gender neutral meme is what needs to be studied.

 
At Sunday, January 26, 2020 11:09:00 AM, Anonymous JR Issues4Thought.com said...

But is really is the patient's responsibility to be concerned about the interworkings of the medical staff's professional life. We, school staff, were told whatever was going on outside of the school doors needed to be there. We should not let our issues become the issues of the students. It is not the patient's issues that staff may be overworked. That is something beyond the patient's control & should not be made a patient's issues as they are there for something else entirely perhaps life changing as a terminal diagnosis. Just because a staff member may be in a hurry to get to the next patient does not in any way give justification for unnecessarily exposing the present patient. I will not budge on that. It is personnel matter or administrative matter to have more available staff and is not acceptable to make the patient responsible or matter less. Patient input on how healthcare is delivered IS valuable to all patients. Research and such is important but it is not if patients have been so abused by the system they fail to seek treatment. Again, you cannot cure the diseases properly if you harm the patient in other ways. Besides, as one cardiologist said, there are no cures only bandaids and to think otherwise is misleading in itself because death for all is going to happen. And yes, there is shortage so apparently even bad, criminal staff are allowed to keep practicing because it is about profit. It is really ironic that with all the advances, that patients seem to be more chronically unhealthy. Is that because of the treatments and the resulting medications?

 
At Sunday, January 26, 2020 2:49:00 PM, Anonymous JF said...

Maybe more staff could be hired if there weren't so many middle men being paid for who knows what. Plus what Biker and JR said. Dr B. Do you say these things just for debates sake or are you still in denial? Some of the abuse might be because of rush but some things shouldn't be rushed. Also, my story and I'm sticking to it. Some exposure is sexually motivated.

 
At Sunday, January 26, 2020 3:53:00 PM, Blogger Maurice Bernstein, M.D. said...

JF, I am not in denial regarding all that is posted here nor the documentation of other clinical events in the news media. How can I be with no documentation to support such denial. The most I have theorized was, based on my own experience and knowledge, I have always doubted a profound magnitude of the professional misconduct. But I cannot deny, based on what is written here and in the press and literature that a medical system problem exists and further that something needs to be done to fix it--including suggestions presented by those of this blog thread.

I think any debate here is not that misbehavior or worse is absent vs present in the medical system. I am trying to encourage debate now on best approaches for control and cure of the medical system's pathology and its associated symptoms and disease. ..Maurice.

 
At Sunday, January 26, 2020 5:09:00 PM, Blogger Biker said...

Physicians and other staff are being treated like cogs in a wheel by their corporate masters and being pushed to process patients ever faster. Govt. mandates such as the EMR systems that seemingly serve insurance companies and hospital administrators more than they do the staff or patients add to the stress. The astronomical costs associated with becoming a physician in combination with downward compensation pressure might be the final straw for some. The burnout and dissatisfaction is understandable.

The flip side are patients with insurance that they can't afford to use given deductibles and co-pays on top of premiums that go up faster than their wages. To that is added rushed visits and the loss of primary care physicians overseeing the care of their patients such as we discussed recently, and which I grew up with.

The whole system is stressed no matter which side of the equation you are on. For my part I am always respectful of the staff I interact with and am a very compliant and even deferential patient with whatever instructions I am given. Yes I will speak up and ask to be scheduled with a male nurse when making my cystoscopy appt.for example and upon check-in I will politely remind the person at the desk that I had made such a request. I have not been ambushed since I found my voice a few years ago, but should that occur I will speak up calmly and clearly. In any such event that I was ambushed or my "male nurse" type requests were received in other than a professional manner, they will see what I'll call authoritative diplomacy which is being clear as to their mishandling of the event or interaction without my being visibly angry or impolite. It is a skill honed in my corporate suite days.

In return, no matter their stressors I expect physicians and non-physicians alike to be respectful of me, including of my privacy and dignity. Being in a hurry does not justify treating me as an object.

 
At Sunday, January 26, 2020 5:15:00 PM, Anonymous JF said...

I have zero doubt that there is burn out. That's ALL occupations where staff works too many hours and their outside of work life is being neglected. Unbalance is not a good thing. It's extremely common with low wage jobs because overtime is the only way to get a decent check.

 
At Sunday, January 26, 2020 5:45:00 PM, Blogger Biker said...

JF, I retired at 60 in large part because I was burnt out from decades of 50 - 60 hours weeks, being tethered to smart phones and laptops even on vacation, and just the overall stress of the job. I was very well treated and very well paid, but burnt out nonetheless. I totally understand those doctors that retire sooner than they might have previously planned on, or shift gears to a new career for that matter. Note that burnt out or not, I maintained my professional persona with staff, customers, vendors, and the community. It was my issue, not theirs.

 
At Sunday, January 26, 2020 6:02:00 PM, Blogger Maurice Bernstein, M.D. said...

JF, remaining fully anonymous in your name and place of work, do you see yourself subjected personally to a work-life which could lead to your own "burn out"?

I have never experienced "burn out" symptoms because the years of my active daily professional work as a physician of internal medicine was in a previous different era where patient load was light and "difficult required documentations" was not really present. And actually, "burn out" as such was not a publicized complication of medical practice.

And yet, today, "burn out" is a recognized symptom of a current modern clinical medicine practice pathology.

..Maurice.

 
At Monday, January 27, 2020 12:58:00 AM, Blogger Swannie said...

@ JR,
I`ve done some internet research and it`s amazing that in South Africa clear guidelines exist regarding any medical procedure to be performed, as per Code of ethics for nursing in South Africa, Rights and duties of Users and Health Care Provider`s Guide. NO medical procedure should be done WITHOUT the patient`s consent, EXCEPT in emergencies where patient cannot communicate.Will be interesting to read the replies from all the doctors/nursing staff tomorrow. Regarding my ICE-TAG ( Medical Alert), it is covered and accepted by law as binding and i quote: "
An advance directive is a statement made by a competent adult in anticipation
of a time in the future when he or she may lack the capacity to make healthcare
decisions. Such statements usually take the form of advance refusal of specific
treatments, but may also contain information about the patient’s values and beliefs." The HPCSA ( governing and registration body of medical profession) also states: “Where a patient lacks the capacity to decide, health care
practitioners must respect any valid advance refusal of treatment.” Therefore my TAG should protect me in future as it is duly registered.
But my problem is now. I have a real hard time just going through each day.My emotions are all over the place.

 
At Monday, January 27, 2020 7:32:00 AM, Anonymous JF said...

Burnout is not just for healthcare workers. I've been working at nursing homes or assisted living homes for 30 plus years and occasionally I have been burnt out. Sometimes a An Administrator or Director of Nursing have told us that we're not here to make friends. Meaning us
( not themselves ) Them saying that doesn't show a lot of insight. Our friendship with other staff and our patients is what brings joy into o
lives and if/when that is missing burnout is the inescapable outcome. Emotional needs are important.
I have Sometimes been burnout because of crushing work loads and too many hours. In healthcare we work every other weekend. Often more than that. We work lots of holidays and sometimes that really hurts.
I have noticed that it only takes one really strong obnoxious worker to ruin a place of employment. There can be a person here and there that I mildly dislike. And I can still like that job but a workplace bully is a whole different story. Just please don't get the idea that burnout is unique to medical or healthcare jobs. I've heard my truck driver brother speak of it and a school teacher sister. I don't hear a lot about it from too much other family though because everybody is usually at work.

 
At Monday, January 27, 2020 8:13:00 AM, Blogger JR Issues4Thought.com said...

Swannie

Most directives are not set up to deal with the issues we have covered such as no female staff and no genital exposure except....His covers things not normally addressed and states why. It also gives me pos if any sedative or pain killer is given to protect him from the them.
Our emergency care is similar but when they ignore the protocol nothing happens. Furthermore they know it. If you read my website you can see many similarities in what happened.

My husband is a guy who repressed what happened. He doesn't want help from them because it is the medical profession who betrayed and absolutely broke his trust. Unlike you he did not have prior assault in his past to compound things.

Yes day to day is difficult. He still suffers and probably always will. I suffer along with him and we deal with it differently. The rage is still there but doesn't erupt as much.

 
At Monday, January 27, 2020 8:44:00 AM, Blogger Maurice Bernstein, M.D. said...

Thanks JF for presenting and thus reminding us of the multiple experience factors that can lead to a professional burnout.

Also thanks to Swannie for informing us about the "advance directive" in the form of the "ICE-TAG" which has no uniform equivalent to openly and promptly display as a patient enters the hospital or clinic. There are rare equivalents in the news, however, of patients having "No CPR" tattooed on their skin. Also, such tags to be worn does not eliminate the wrong communication behavior of the patient's medical care providers.

Again, thanks to both JF and Swannie for their postings. ..Maurice.

 
At Tuesday, January 28, 2020 5:12:00 AM, Blogger Biker said...

swannie, I hope I am wrong but I think at best you will get a non-apology apology in the written response. Odds are they will deny having done anything wrong. Even then you will have won in that though they may have gotten away with it, there is now a record of the incident which will make it all the harder for them to defend themselves the next time a male patient complains. They'll never admit it but your efforts will make them think twice on how they interact with and treat male patients. Pursuing your complaint as you have is a brave thing to do in that it forces you to relive the trauma in pursuit of making the system become more male-friendly. Other men in South Africa will benefit from your efforts. Complaining as you have done is one of the most important things we can do.

 
At Tuesday, January 28, 2020 5:44:00 AM, Anonymous Anonymous said...

The story has gone on. At present it has now been as far as I can tell over ten months since I last posted. For those who are unfamiliar with my story I first posted October 30, 2018 under PA, then on November 6, 2018 then around January 23,2019 and then on March 6 and 7, 2019 and other times.

There have been some developments. I finally did file a complaint with the nursing board. I will cut to the chase and say they recently wrote a letter saying they decided not to prosecute.

Let's go back to the beginning. In April of last year I decided to see if a law firm with an emphasis on medical malpractice would take my case where if I threatened to sue I could receive an apology from these 2 nurse/techs as a settlement. The first law firm said no, the second said they only take contingent cases, the third I talk to an attorney. He talked about how he had been a lawyer for 40 years. He replied "We don't threaten to sue. We send a letter saying that a lawsuit has been filed. I've sent thousands of them." Thousands? Anyway he goes on to say that "No law firm in the state of Pennsylvania would take that case." That was pretty much the end of that.

So I look into and find you can have a settlement with the "nursing board". Actually there is no nursing board in PA. It is the Department of State which covers various licensed employees. So eventually I contact them and an investigator comes out and tries to establish that perhaps there was a misunderstanding. I answer his questions saying there was not. The complaint was 2 part, one against the prep nurses, the other against the director because of the protocol she states of lifting the gown above the pelvic bone instead of moving it aside. I tell the investigator if the gown cannot touch the sterile towel because the gown is not sterile how can the sterile towel touch the private area which is also not sterile? He seems to understand and says he will make an appointment with the Director.

The next contact from them is the letter where they say that they decided not to prosecute and the case file is sealed. The good news is that I will not have to testify and make the long trek to Harrisburg. They also say that the complaint was against the director and the doctor who performed the procedure. I email the prosecutor saying that the complaint was against the doctor's staff not him. I have yet to receive a reply. PA

 
At Tuesday, January 28, 2020 11:42:00 AM, Anonymous Anonymous said...

In response to some of the things that people have discussed on this site I will tell you what my experience has been. When I was at the local hospital for treatment for rapid heart rate of the five people attending me in the room where they fixed it all but one was male. I think the female was the RN although I'm not really sure. When I was transferred by ambulance to the other hospital both the driver and the guy in the "cab" were male which is typical. At the hospital where I stayed all of the dormitory nurses and nurses' aids were female with the exception of one young guy who was a nurse's aid. All of the cardiologists who performed the cardiac catherization were male which is typical. Generally all of the doctor specialists where I live in the greater Pittsburgh area are predominately male with the exception of the OB/GYNs who are generally female although there are still some male OB/GYNs.
Of the prep nurses for the CC procedure at the hospital where I was at there was one male team. The others I could not say. When I went to an urgent care center a little over a year ago they had two male and one female nurse. I have never known anyone who worked in a dentist office other than the dentist who was other than female. I have never know a "blood pressure check" nurse in a doctor's office who was other than female. In almost 40 years of owning a car I have dealt with a grand total of one female mechanic and believe it or not that was in the 80s. I have never known a cab driver outside of those I had seen on TV who was not male. But of the last 4 things nobody cares about that.

As far as what some other people have said about there being modesty guidelines for procedures I would agree and they should be imposed by the AMA (America Medical Association). If somebody does a procedure outside of those guidelines they should have to say why. In decades of seeing various doctors I have never dealt with a scribe. I had never heard of that before reading this site although I have dealt with physician's assistants which some doctors have and other's don't. Another guideline is that doctors should have to ask a patient permission for any non essential personnel when an intimate procedure takes place. As far as leaving patients in critical care undraped for hours on end I have actually heard of that before. A nurse on youtube talked about that. That should not go on. Well there you have it. PA

 
At Tuesday, January 28, 2020 12:53:00 PM, Anonymous JR Issues4Thought.com said...

PA,

Just south of Indianapolis, all of the cc staff except for the doctor, are female. I have talked to females who have had cc done at that hospital & they didn't have the exposure that was done to my husband. One woman had hers done as an emergency on the 4th of July. I have talked to other women who have had EKGs done and they have not been told to strip from the waist up. There is definitely a separate set of guidelines used for male patients. At this hospital, there are female cardiologists. The night nurses in the cardiac were female but he had two male nurses during his stay but it was too late he had already be violated.

In the case of my husband, not only did the EMT & RN from the helicopter accompany him into the cath lab but the pilot who does not have a medical license also went to become an audience member to violate his right to privacy. It doesn't matter if they are of the same sex or not, unneeded audiences members should not be encroaching upon a patient's very real right to bodily and medical information privacy.

You have to be careful in the wording bc a doctor will classify a scribe as being essential personnel. As for the AMA, that is like the fox guarding the henhouse. They wouldn't enforce sanctions on their own. It needs to be a citizen's watchdog group. The government is incapable too as evidenced by the state's licensing boards & CMS.

 
At Tuesday, January 28, 2020 2:47:00 PM, Blogger A. Banterings said...

PA,

GOOD FOR YOU! YOU HAVE MY LOVE AND SUPPORT IN CONTACTING A PROSECUTOR1

This is how change occurs, especially in our state (I am north of Philadelphia).

Here is the standard that I use, if this happened in a motel room, would this be a crime?







-- Banterings



 
At Tuesday, January 28, 2020 9:32:00 PM, Blogger Maurice Bernstein, M.D. said...

Speaking about lawyers, here is a little realistic humor from "Thesaurus of Humor", an old book I got and wrote about previously on this blog thread.

5240:
Lawyer: (Handing check for $100 to client who had been awarded $500) "There's the balance after deducting my fee. What are you thinking of? Aren't you satisfied?"

Client: "I was just wondering who got hit by the car, you or me?"


In the medical profession too.. it is important for healthcare providers to always keep in mind as they allocate their behaviors, results and benefit of their service, exactly to whom these elements were directed-- to themselves? No. To the patient! ..Maurice.

 
At Wednesday, January 29, 2020 5:13:00 AM, Anonymous JR Issues4Thought.com said...

Well of course their actions are directed towards the patient because they would not tolerate being treated like we are. They know how we are treated. That is why they go elsewhere for their treatment because many of them feel uncomfortable not being in control, being put on display, etc. One male doctor who had done a procedure upon his female hospital counterpart said in one post that he felt uncomfortable setting across from her at a hospital meeting after she recovered and returned from hip surgery. So it is not that they don't know or they don't recognize sexual feelings or whatever, it is they keep choosing to treat patients without the dignity of not exposing what doesn't need to be exposed. There are simple, sterile remedies that would eliminate unnecessary patient exposure during prep and surgery. There are simple protocols they can use using exams to help eliminate unnecessary exposure. So why don't they do it? Simple answer is they don't have enough humanity in them to put forth the effort to allow their patients to keep their basic human dignity. Somewhere in their upbringing they missed the basic concept that all people deserve the right to human dignity. For many who are associated with a religious hospital, somewhere that religious has traded in the belief of compassionate caring for pure greed as greed feeds the need for unnecessary exposure just as do power and control does for many non-physician staff.

 
At Wednesday, January 29, 2020 9:12:00 AM, Blogger Swannie said...

@ Biker,
Yeah, i received that letter yesterday, although it was completed last Thursday and then had to be send first to their Head Office. I believe it had to be "sanitized"as to not incriminate themselves. Yep, the letter was full of contradictions, denials and lies and was answered by 3 Heads of Departments. According to them i was only briefly exposed while my abdomen was prepped for surgery - did not mention the time taken for the catheterisation.The consent form i signed for the surgery was enough consent for any further medical intervention/procedure.Underpants may contain bacteria, may catch fire if soaked by alcohol and cause burns.May prohibit emergency intervention if or when needed and with too little time to respond while removing underpants.Catheter only inserted during emergency.My catheter was inserted to measure urine output and to prevent bladder from filling during surgery.According to them i was ALWAYS covered after surgery as well.Gowns are SOMETIMES only put on top of patient. Unfortunately due to the IV lines as well as the catheter i could not be dressed properly. Take note: i had NO IV lines, only the catheter ! In ward i could not be dressed either as wound had to be inspected regularly. When i awoke, there was already a long strip of sticky plaster glued onto my tummy and was never inspected till the next day i was referred back to my home town hospital ( Where i refused to be admitted and signed myself out)I had previously asked for a list of any and every person who was present from the start of my operation until the very end when i was wheeled out.I was promised i would get the list, but till now have not received it.It seems like there were more people in the OR as i have been let to believed, because the Quality Assurance Manager who said my complaint was "Thoroughly investigated" now wrote in the letter that he "assumed" my catheter was inserted by a male Intern. Before the start of the surgery , the female doctor told me they were females and only one male - (he is the head of the surgery department, and i recognized him the next day.
I sent that letter to the Minister of Health and wrote i found that letter an insult to my intelligence.
Today i lodged a complaint with the Human Rights Commission of South Africa. Unfortunately it is THE most racist chapter 9 Institution in our country. It is mandatory to state one`s race when a complaint is submitted.But this is not a topic for this Blog of DR. Maurice.
There is also another private law firm who may be interested in taking my case, however they are only interested in claiming monetary compensation which is not what i am after.No amount of money can repay me for all the tears i have shed so far and the up and downs of my emotions. I want these medical staff to be held accountable for their actions and to honor their oath as to not do any harm. While my surgery was successful, i have serious mental issues now - even more than i had before.
Fighting to get back the little dignity i have left, is all that keeps me going at the moment.
Being a member of this Blog also helps a lot !!! Knowing other males face the same problems i have, make me feel i am not alone in this world.

 
At Wednesday, January 29, 2020 9:26:00 AM, Blogger Swannie said...

@ JR,
We have various official publications in which Informed Consent features and it is also enshrined in our Bill of Rights. How to enforce those rights is another question altogether.
Okay i have learned to live with all the happenings in my past, although there were many times i got angry and cried, but most of the time i could handle it. Unfortunately my recent experience opened up all the old feelings.Being 59 years of age does not leave me with a lot of time to recover which i doubt would ever happen anyway. There are so many times i wonder why i was put on this earth, to only suffer through the hands of other people.

 
At Wednesday, January 29, 2020 9:37:00 AM, Blogger Swannie said...

Oh, i forgot to share my experience with the psychologist whom the management of the hospital organized for me.

After meeting him, he immediately asked me to refrain from making statements like (01)I feel sexually violated (2) i feel like i am a rape victim again.( Apparently he had access to my letters to the hospital manager)

Reason ? He knows the doctor in question personally and she always maintains the highest standard of ethics !

What can i say ? The meeting did not go well after that bit of wisdom.

 
At Wednesday, January 29, 2020 9:53:00 AM, Blogger Swannie said...

Dr. Maurice,
We also have "Medical Alert" tags which is doubly as expensive as the ICE-TAGS i am wearing. Most people prefer to wear an arm bracelet, but due to the nature of mine being real private, i preferred the neck chain. Was told not to exchange the chain for any other gold or silver chain, as the "bath tub"chain is universal and always associated with important issues ( like the dog tags i wore during my army days.) In case of accident the emergency personnel will always check for a bracelet or necklace first.

 
At Wednesday, January 29, 2020 1:02:00 PM, Anonymous JR Issues4Thought.com said...

Swannie,

My husband was told by them to refrain from using the words "raped" or "violated" as it is degrading to women who have been sexually assaulted. Men don't matter as society's feel of men is sexist. I didn't think your session with their psychologist would go well as he was their employee being told to look at for their best interest. They circle the wagons to protect one another. My husband and I were told what happened but in the same sentence that since he was older, he should get used to such treatment as being older he would have more medical encounters. It never goes well after you are called a liar. The doctor apologize saying "if" they did something he was sorry. I responded "if" wasn't the issue for us but for him apparently an insincere, half-assed apology should make everything okay. I further said his half-assed apology seemed representative of how they deliver medical care and there lies the issue. The apology was just an insult.

We too have Informed Consent guidelines and Patient Bill of Rights. In fact, the hospital that violated my husband has a very glossy 10 or so page brochure about their compassion, patient rights, etc but it means nothing except to lure patients into a false sense of security to disarm them. No one here enforces patient rights or informed consent either and more to the point, the medical community know this and that is why that do what they do because they know in the end, they can get away with it.

For my husband, he does not trust the mental health help either. We are getting his story out there and are trying to make positive changes for all patients except them which I hope they will reap what they have sown. It has been a rough time and there still are rough patches but we can't let them win and destroy our lives. They did their best to destroy but we are still standing.

As I said my husband wears medic alerts on a chain w/ very explicit instructions so he has multiples. He also carries paper copies of his full directive and also has an app on his phone with the directive too. He refuses ER care without certain provisions being met as it was there the medical battery started. He refuses EMT care as they further carried out more medical battery. He refuses care at certain hospitals. He refuses certain drugs. He refuses any female staff. He refuses anything to be done without my consent or one of our children's consent if I am not available. He has a constant fear of repeat abuse as never in a million years did he think he would have been medically and sexually assaulted while receiving hospital care. It was never on his radar.

 
At Thursday, January 30, 2020 5:19:00 AM, Blogger Swannie said...

@ JR,

While i really need some professional help regarding my state of mind, it was at the back of my head to be very careful and with the trust issues i have at the moment, was not hard to do.

I think they have painted themselves in a corner as the meeting with the psychologist was arranged by the Quality Assurance Manager which should tell anybody that he acknowledged somewhere along the line something went seriously wrong with me during my hospital stay.And on my side i can prove that i had a meeting with a psychologist to receive treatment and my experience is more serious than just some unhappiness abt something.

What really worries me and i only found out on Tuesday, is the total breach of confidentiality. Every thing said between him and me, can be accessed by any person from the rank of Nursing Sister and upwards via the hospital`s own computer system ! In an off hand way he said he would not put his notes on the system as there was barely anything to write - remember i said the meeting did not go well ?

Shucks, it seems like genuinely nobody is to be trusted nowadays.

 
At Thursday, January 30, 2020 5:34:00 AM, Blogger Swannie said...

@ JF,

You are so correct that animals are better than people. Since i can remember from age 4. it was always an animal who comforted me when i needed comfort. Sometimes we shared the same experience when a certain person was very cruel to him. Then i sat in his dog house and held him tight while we both cried.

Even now when i do get some sleep, i sometimes wake up with my dog licking the tears from my face. I can honestly say that animals treated ( and still do) me better than human beings. They give me unconditional love and in return i give them the same.

 
At Thursday, January 30, 2020 7:16:00 AM, Anonymous JR Issues4Thought.com said...

I am really amazed about the response I am getting from talking with so many. It seems everyone has a story to tell. Most haven't told their story before for different reasons. Almost all agreed they never thought that male patients could be victims too. I have had several groups say they are interested in talking me to see how we can work together. A lot of the men have voiced they don't like how healthcare is delivered to them. I have left brochures from MedicalPatientModesty both the generic and specific male modesty brochure at several different places. I think I am going to make my talks more uniformed by doing a power point and putting it on a website so it can be viewed if someone tells someone else about what is going on. I am going to start circulating a petition like Misty said so lawmakers know there is traction to this subject and their voters are interested. I am trying to find out what it takes to properly "protest" at the Statehouse but am getting a lot of runaround. My state rep is the majority leader but I cannot get him or his office to respond. I may go locally to see if I can get a response.

 
At Thursday, January 30, 2020 12:43:00 PM, Blogger A. Banterings said...

Again, a profession that bills itself as so learned and compassionate is clueless and callous.

Again I ask, why something that is common sense is NOT being practiced and we need to do studies on it?

Over and over again, the profession of medicine has demonstrated that they ONLY care about themselves. Compassion is offered ONLY when it is NOT inconvenient.

Note in this article the profession makes themselves the victims along with patients

JAMA January 29, 2020;
Trauma-Informed Care May Ease Patient Fear, Clinician Burnout



To help them, Ravi has adopted a trauma-informed approach that works to restore patients' trust and give them a greater sense of control over their visit. This may include asking permission before touching and suggesting alternatives to certain procedures that make them uncomfortable. For example, she may offer patients who require a throat or vaginal swab the option of doing it themselves...

"It's essential to give people the opportunity to know all the steps that are going to happen and say, 'If that doesn't work for you, we can try this other way,'" said Ravi, an assistant professor at Mount Sinai Beth Israel...

For people with a history of trauma, clinical settings like a noisy, chaotic emergency department or a small, enclosed examination room may trigger trauma-related symptoms.

"When you're treating that patient [who] is a victim of a gunshot wound at the bedside, you might not just be treating their injuries from today," said Kyle R. Fischer, MD, MPH, a clinical assistant professor at the University of Maryland School of Medicine and lead author of a guide to trauma-informed care in the emergency department. "They also might be having a flare-up of their posttraumatic stress disorder [from previous trauma] at that exact moment."

Recognizing trauma symptoms and taking an empathetic approach can help clinicians navigate such complex patient interactions and deescalate a situation when a patient becomes agitated, Fischer said...

"The biggest change was that nurses came back and said, 'When I just acknowledge they are upset and I understand that upset, it takes about 40% of their agitation right off the top,'" Surico said. As a result, nurses reported being able to better care for patients experiencing a behavioral health crisis.

Because many trauma sources, such as a history of child abuse or sexual assault, may not be apparent to a clinician, some have chosen to implement trauma-informed care as a sort of universal precaution...

"Of course, you have to stay safe, but you have to think, 'What happened to this person that they are reacting in this way?'" said Rina Ramirez, MD, Zufall's chief medical officer...

They may want control over who's in the room during delivery, how exposed their bodies are, and to whom their history is disclosed. Asking all women about such preferences can ensure that those who choose not to disclose a previous assault still receive trauma-informed care, Sobel explained.




Medicine should have been practiced this way since day one! The fact that it is 2020 and we have to have these discussions shows that all practitioners are equally guilty if at the very least allowing their profession behave in such a manner.

The profession should NOT be upset when society uses the likes of Dr Josef Mengele as a representation of it's members. The profession continues to treat patients as warm cadavers.







-- Banterings






 
At Thursday, January 30, 2020 12:56:00 PM, Blogger 58flyer said...

JR said,

"I am really amazed about the response I am getting from talking with so many. It seems everyone has a story to tell. Most haven't told their story before for different reasons."

It is for this reason JR that I think you will have success when you finally are able to talk to your legislator. I am much more at ease talking with other men about my experiences and am amazed at how often it is that they their own story to tell. Chances are your legislator will have his own bad experience(s) to relate to. Of course I am assuming that your legislator is male but even if it's a her, she will no doubt have men in her life that she cares about.

I think your powerpoint idea is awesome, and there's Youtube also.

58flyer

 
At Thursday, January 30, 2020 4:40:00 PM, Blogger Biker said...

From the article Banterings posted

"The biggest change was that nurses came back and said, 'When I just acknowledge they are upset and I understand that upset, it takes about 40% of their agitation right off the top,'"

Applied to the modesty issue, this, paraphrased slightly, is exactly what the response from female staff should be when a male patient resists verbally or via body language to being intimately exposed to her. Just saying "I know this might be embarrassing for you but please know...." would go a long way towards affirming and respecting the patient than the more typical "you don't have anything I haven't seen".

 
At Friday, January 31, 2020 5:47:00 AM, Anonymous JR Issues4Thought.com said...

Banterings,

The glaring omission I saw in that article was there was not a single reference to men needing Trauma Informed Care. It is as if society does not recognize that men suffer from sexual trauma too. Of course, for those who have, it is not only untrue but dismissive, insultive. The battery of questions asked at a hospital about abuse is done in a joking manner when they are asking of it from a male patient. Case point when my husband was being exposed for hours and put on display, they thought were laughing as the social worker asked if he was sexually abused by his spouse bc it was funny to them as they were actually sexually abusing him. For the men who have said they have suffered sexual trauma in the past, it would be interesting to have access to all the files in their MRs to see what the medical provider has really said. I am sure there are some very inappropriate remarks. When I worked at DDS, long before EHRs, there were many handwritten notes that were downright mean and demeaning. I know there is the ability to have "post it" notes in EHRs that are meant only for medical provider's eyes. The Epic system is the big one around here.

58flyer,
My legislator is the head of the Indiana Senate so if I can access him that will be quite a feat but I am not holding my breath but I will keep trying. They seem to forget the little people once elected. I am going to get a petition going so they will know I am not the only one concerned so what I say might have more traction. The female rep that I did talk to had her own story. She hadn't really thought about how healthcare is delivered to male patients but now she is aware. It seemed to shock her but she did say to get medical reform in Indiana is almost impossible bc of the lobbying efforts of the medical community itself. So a shift has to be caused and that is by making the public enraged & call for change. I am probably going to set up a another website in addition to my Issues4Thought that is toned down. I will keep Issues4Thought but I want the other website to be a generic information site much like NTT was talking about. There is a real need to get patient friendly information out there. Education of the public is the key to changing how healthcare is delivered for not only males but also for females bc even though they have it better it still is not good. As I have said, just bc you have same gender care does not mean there cannot be sexual assault via unnecessary exposure. The mental trauma of assault is still mental trauma. There is so much I need to do!

 
At Friday, January 31, 2020 11:46:00 AM, Anonymous Anonymous said...

JR, Hopefully this doesn't post twice. I tried to post it before.
I'm thinking one thing that really needs done is court cases charging hospitals and other healthcare settings with false/faulty documentation. Multiple cases so that it can be seen that just because it is documented,it isn't nessesarily done. Provide witnesses from even inside sources.and their reasons for the faulty documentation.
Otherwise the actual humiliation is what is crippling our cause because humiliated people slither away with their tails between their legs. Then there are those selfish lawyers who won't take cases that aren't easy and quick.
My idea to get around that is for us to pick out a case from here on this blog. Your husband's case would be good but I think it would be too hard on him and it might just push him too hard and increase the harm to him. The members here would need to be willing to pitch in financially with the agreed upon case. Ask a skilled lawyer how much EXTRA money he or she wants to take the case. Make clear to that greedy
#@$&@ that he or she will be paid MORE if he/she wins the case. Maybe if and when we private citizens get more say about laws, we can require lawyers to take more difficult cases as a requirement for keeping their jobs or just getting top wages. JF

 
At Friday, January 31, 2020 1:41:00 PM, Blogger Biker said...

Just an interesting observation in light of the recent "shirts off" discussion. I had a cardiology appt. this morning at the large teaching hospital in NH that I go to. It being 9 degrees out when I left I was wearing a winter weight rugby style shirt (under a spring jacket; we're a hardy bunch up here), so heavier material than a shirt you would wear in the summer.

First an LNA wanted to take my blood pressure. Given the heavy shirt I had on I asked if she wanted me to take it off. Nope. She took it over the shirt. Next a tech came in to do an EKG. I asked her the same. Nope, just lift it up so she could do the patches & connections. Then a PA came in and when she wanted to listen to my heart & lungs I asked her too and she said no she could do it over the shirt. Lastly it was time for a Zio patch monitor to be attached to my chest by a different tech. She just wanted me to lift my shirt is all. Four female staff members and none wanted my shirt removed even when I offered.

 
At Friday, January 31, 2020 9:55:00 PM, Blogger Maurice Bernstein, M.D. said...

An article worth reading in The Health Culture which applies to our blog thread topics published in 2011 is "History of Patient Modesty" in two parts, read both. The first section is "how bodily exposure went from unacceptable to required. The second section is "Convincing Patients to Disrobe". Read both parts. And the invention of the stethoscope, of course, was one of the more recent attempts to solve the matter of patient modesty. Read and let us know how this two part article fits with what we have been discussing here all these years. ..Maurice.

 
At Saturday, February 01, 2020 11:58:00 AM, Anonymous Medical Patient Modesty said...

Dr. Bernstein,

The article you mentioned is very good. I was already familiar with that article. Many years ago before medical school was invented, male doctors were not allowed to examine private parts of women. Midwives and female nurses delivered babies and tended to intimate examinations of women.

JR, I appreciate how you've distributed the brochures about men and modesty in medical settings. It is a great way to get people to understand the importance of male patient modesty. So many people have fallen to the lie that male patients are not abused and that modesty for men does not really matter.

Misty

 
At Saturday, February 01, 2020 12:07:00 PM, Anonymous Medical Patient Modesty said...

This is another subject.

I am not sure how many of you watch the TLC show, Dr. Pimple Popper about a dermatologist, Dr. Sandra Lee who deals with special skin conditions. She surgically removes a lot of lipomas.

I thought the show on Thursday night was very interesting. One man had a large bump on his upper leg that he wanted Dr. Lee to examine and remove. Dr. Lee was very shocked when this man pulled down his underwear which was not necessary. You could tell that it made Dr. Lee uncomfortable. I know there are doctors who are uncomfortable with patients taking their underwear off for procedures. I think maybe this man was not that modest.

Dr. Levy who invented Covr Garments shared with me when I met him that some doctors found it uncomfortable for patients to be unnecessarily exposed for procedures. Dr. Levy grew weary of seeing hip surgery patients being exposed and this is what inspired him to invent those garments that allowed access to the hip, but no exposure of genitals.

Medical professionals who are uncomfortable with patients being exposed unnecessarily are the ones who would be more sensitive to your modesty.

Misty

 
At Saturday, February 01, 2020 1:19:00 PM, Blogger Biker said...

Interesting article Dr. Bernstein. If people were not by nature modest to a substantial degree, naturist lifestyles would be the norm rather than the exception. Such social mores vary by culture across the world, some more modest than the typical American and some less modest, but naturist lifestyles are not the norm in any society.

Those who work in healthcare share those social mores. If they didn't you wouldn't see them expressing their own staffing gender preferences when they are the patient and you wouldn't see them avoiding intimate care by their co-workers. It would be OK for medical and nursing students to learn via intimately examining their classmates or it would be acceptable for your students to intimately examine you Dr. Bernstein.

The article seems to acknowledge that there is generally an underlying discomfort with intimate exposure by patients, and that the healthcare industry knows it. My hypothesis is that healthcare doesn't put more effort into addressing patient modesty concerns because most patients either just silently grin and bear it or they avoid healthcare altogether. Even the latter isn't a problem when they have as many patients as they can handle anyway.

As I noted in a post a couple days ago, simply acknowledging the issue to the patient would be a huge improvement towards making the patient feel respected: "I know this may be embarrassing for you but please know......."

 
At Saturday, February 01, 2020 1:23:00 PM, Blogger Al said...

I view that article as another article written by another clueless provider . She mentions several times about patient embarrassment and how exposure is necessary . Not once does she mention the elephant in the room . Gender . She implies that you need to comply by getting naked and letting the professionals do their job . Lets not let gender get in the way when we can just browbeat everyone into complying . You want respect and a more comfortable patient base . Offer patients their choice of gender for intimate care . Until they get off their high horse and open their eyes , nothing will change . AL

 
At Saturday, February 01, 2020 2:18:00 PM, Anonymous JR Issues4Thought.com said...

Biker,

Maybe your providers in Maine have more common decency than the ones here in Indiana do. I don't know. Maybe there is a note in your file and the abide by that for you. But in any case, shirt removal is not a necessity. It is a power and control ploy. It is just here in Indiana, urologists have men drop their pants while standing in front of them and then turn and bend over. I don't know how other parts of the country do it but that is the most common way here. It is a very degrading & demeaning ritual but then they have an audience to impress w/ how they turn a man into their puppet. I wonder what they would do if someone said no they needed to give them a gown and leave the room while they change? How would that exam go? Would they be rougher than usual? Because of that fear is why most men comply.

Dr. B.,

I too read that article a long time ago as it was one of the few I could find that dealt w/ modesty issues. For the most part, US medicine tends to ignore unnecessary exposure. My personal opinion is most necessary exposure is done by the nursing/MA staff and I think it is bc they are asserting the position of control. A lot of the exposure I have read about on this board was done specifically by nurses, MAs, techs. Doctors are more guilty of bringing in the unwanted chaperone. I do imagine some patients both male & female are a little too free in self-exposure. Some may do it to put on a brave face by going overboard. Some are just weird. I learned in dealing w/ children to tell them exactly how, when, where, etc something was to be done before letting them do it. Maybe in the case of the pimple doctor, she needs to be more explicit or maybe this was just something added to liven up the show?

JF,

Great idea about the MRs. We have been using my husband's MRs to illustrate how they lie and falsify MRs. Hiring a lawyer would probably not be a good idea bc many would take advantage of us by charging way too much money if they see a gravy train. Too many lawyers & medical community members are cut from the same bad pattern. But yes, what is done to many patient's MRs need to be brought to light as many don't ever know about the lies in their MRs as they never ask for copies. It is also the info in the MRs that we as patients are not privy to that is also troublesome as many times this private info is only sent out as a mistake. It is their "private" notes about us.

 
At Saturday, February 01, 2020 2:25:00 PM, Anonymous JR Issues4Thought.com said...

Misty,

What I have found is that many people are interested. Many people have a story. Most men have comment they didn't know anyone else realized what they have to go through. They didn't know they have rights. But how do you find the medical professions sensitive to personal dignity? I am getting an intro to the patient advocate of the hospital from hell's direct competitor so I really want to make a point about Covr. I am going to take one of them w/ me when I talk w/ her. I also will taking w/ me the brochures bc they are really great especially the ones for men. I will be needing your help in putting together a petition to start circulating so eventually I can show it to legislators to show them people want change.

 
At Saturday, February 01, 2020 2:30:00 PM, Anonymous JR Issues4Thought.com said...

I am going to be putting up another website one much like the one NTT said was needed. Rather than being like my Issues4Thought (although I will still keep & post on it), I want the new one to address issues like procedures, consent forms, general patient info., conscious sedation, nursing homes, hospice, what are a patient's rights, what are if any actions a patient can take for protection if they have had issues, etc. I want it to have links to articles so people can do research as right now it is difficult to find info.

 
At Saturday, February 01, 2020 7:20:00 PM, Anonymous Medical Patient Modesty said...

JR,

You are doing a great job educating people. I believe that educating people especially men will help them to be more open and realize they have rights to modesty in medical settings. Our society teaches us that we should not question medical professionals.

I am glad that you are educating the patient advocate about Covr Medical garments. All hospitals should carry Covr Medical garments.

You can always email me with your ideas for petition. I believe the more people are educated the more likely we are to see some changes.

Misty

 
At Saturday, February 01, 2020 8:18:00 PM, Blogger Maurice Bernstein, M.D. said...

Biker, in answer to your question "would be acceptable for your students to intimately examine you Dr. Bernstein."
As I have written on this blog thread previously, the answer is "NO" if the definition of "intimate" is "examinations of genitals and rectums in all individuals and/or breasts, if female." Practice on examinations of these parts of the body are carried out on paid "standardized patients" for second year students. As I have previously noted here all students have the right to refuse even less "intimate" examination by their colleagues for specified reasons but it is, in my experience, extra-ordinarily rare for this to occur. They appear to enjoy their "laying on hands" experience by and to each other. No standardized patients are used for these frequent and common exercises except for student-standardized patient interaction at our school for one on one practice or graded testing individual student skills. ..Maurice.

 
At Sunday, February 02, 2020 6:28:00 AM, Blogger Biker said...

Dr. Bernstein, I'm not inferring that it would be appropriate for students to intimately examine each other or you but rather just use that as an example that those who work in healthcare share the same social mores as the rest of us when it comes to individual modesty.

The article you referred us to tells us that those who work in healthcare know this. In acknowledgement of that the author says patients need respect and compassion in the delivery of healthcare. The problem is she comes at it from the perspective that patients in turn are supposed to be comfortable being exposed to anybody and everybody in the healthcare system that we're exposed to. I doubt there is anyone in healthcare who doesn't say they treat all patients with respect and compassion, and surely all the observers say the same. The problem is the author (and many others) do not appear to understand what would constitute compassion and respect from the patient's perspective. That is what is so frustrating.

Patients do understand that a certain amount of exposure is necessary. To have a full skin exam by my dermatologist means he is going to examine all of me. If I wasn't agreeable to that the only option would be to forego full skin exams. My agreeing to such an exam (which I do) does not have to mean a female LPN and female scribe get to be there watching the whole thing. Their observation is not necessary to the exam and should not be something that I am expected to automatically agree to. "Respect and compassion" in that example would mean the dermatologist offers to bring in male staff instead, to do the exam without the LPN & scribe, or to organize the physical layout in a way that shields me from their view. "Respect and compassion" isn't just everybody in the room being polite. It is minimizing non-necessary exposure to that which the patient is comfortable with or agreeable to. Of course even then there is the question as to what constitutes necessary.

 
At Sunday, February 02, 2020 8:09:00 AM, Blogger Maurice Bernstein, M.D. said...

Biker, I now and previously fully have agreed with your comment. And any chaperone present demands the full understanding by the parties of a chaperone's role and full acceptance of the chaperone who has been selected.

In the "free clinic", patients mostly speaking Spanish where I am currently volunteering, I always ask both male and female patients who I examine whether the gender of my interpreter is acceptable for being present during the examination. My regular interpreter is a male but I can access a female, if the patient desires.
And I always keep the door to my exam room closed even simply taking a blood pressure. The staff then knocks to allow entry. That is my current experience with this matter you presented. ..Maurice.

 
At Sunday, February 02, 2020 9:40:00 AM, Blogger Biker said...

What we need for the healthcare system is that they adopt the "Bernstein Model" for treating patients in a respectful and compassionate manner. Despite not being especially modest himself in healthcare settings, Dr. Bernstein understands than many others are, and then acts accordingly. The rest of the gang needs to follow his lead, though as discussed most of the problems patients encounter are not with the physician but rather with the nurses, techs and other support staff.

 
At Sunday, February 02, 2020 12:04:00 PM, Blogger Maurice Bernstein, M.D. said...

Thanks Biker for a supportive comment.
Now I am going to ask a question to my visitors which might stimulate a bit discussion, perhaps rejection.

Would any of you want to teach medical students by becoming a paid standardized patient? There is something wonderful in the feeling that you are participating in the education of a young medical student--just as my 30 plus years of participating as instructor for groups of 6 students each year. And, in my case, the payment is minimal since this is really a volunteer occupation.

Now, you should know that you will be clinical case educated by administration on the disorder and what to expect from the student in terms of history and physical exam before each session with a single male or female student. You will learn what is necessary to constructively evaluate the student with regard to their behavior and content. You, however, will remain an evaluator and not a "live" patient providing some brief feedback to the student at the end of each session and, as limited time allows. The feedback will be based on the criteria you learned from the school's education of you but also your personal experience with the student is important and the student recognizes and appreciates it. As I have watched the videos taken at the time of each of my students which are later reviewed with the students mostly in a group session, each standardized patient does provide a bit of their own personal unique reaction and feelings meshed into what they have been taught regarding evaluation by administration.

Would all this change how you feel about the medical profession?---being a formalized educator? Would you be more likely to "speak up" to your own physicians or nurses having been or currently being a medical school standardized patient? I don't know for sure.. but I suspect it would be of value. As an active real patient yourself, there is no reason you can't also be an educator for those who have already graduated from medical or nursing school.

By the way, it might be interesting to see how the professional responds when you tell him or her that you are also teaching medical students as a standardized patient.. would that turn you into a VIP? ..Maurice.

 
At Sunday, February 02, 2020 2:54:00 PM, Blogger Biker said...

Dr. Bernstein, strange as it might sound, and I surprise myself a bit saying it, I would consider being a standardized patient. However,the nearest medical school is about an 80 mile drive each way and so it is a theoretical stance at best. I realize not every scenario played out involves intimate exposure but even then I'd be willing to try it given the potential impact it could have on these future physicians and the thousands of patients they will care for. My caveat however is that the school has to allow my feedback to include commentary as appropriate on how the student handled my exposure.

As noted by me and others in the past, most of the privacy violations we discuss are not from the doctors but rather the nurses and other non-physician staff. Being a standardized patient at the local university's nursing school could add more value to the cause than doing it at a medical school. I don't think nursing schools use standardized patients though.

 
At Sunday, February 02, 2020 4:43:00 PM, Anonymous JR Issues4Thought.com said...

Dr. B.,

I don't think we have to become paid standardized patient to relay to them how a patient should be treated. All they have to do is to be willing to talk with some of us. We could even play patient without the exposure like they do when making some videos using medical personnel as they are never exposed. It is just the real patients that are exposed. There are body suits they wear. Biker is right, it is the nurses, MAs, techs, etc. that need even more education as they are usually the ones violating a patient's dignity. Doctors needs information on chaperones, scribes, and how to fairly treat both genders of patients. Also, pre-op is another area where unnecessary exposure is going to occur. Again, there needs to be more education. They need to look at some of us and realize we have been victims. They need to understand by personally seeing a victim, what it has done to that victim, and what was done to that victim. Without seeing the real harm many won't understand the harm. That is why MADD shows the results of drunk driving like the wrecked car, the accident scene, etc. They know seeing is more likely to make an impact. I would appreciate any help in getting an introduction to the IU School of Medicine, U of Indy nursing program. Ivy Tech, IUPUI nursing program, Marion University, or any other schools so they may see what harm looks like. Without real life examples many simply don't understand.

 
At Sunday, February 02, 2020 8:36:00 PM, Blogger Maurice Bernstein, M.D. said...

By the way, if you Google "standardized patient", you will find numerous articles on this subject, many from specific medical schools indicating the program regarding the standardized patient education and program in their school. I should tell you that for one disease session, you may be interacting with 8 or 10 single student sessions in one day, each 25 minutes in duration and each student behaves a bit differently from another.

I have videos in recent years of students participating with a standardized patient but I cannot publish them though they would provide insight in how first and second year students and their standardized patient handle the experience. If you are interested, maybe you could find published examples from other institutions on the internet.

Even if you don't intend to become a standardized patient, reading about the activity may give you insight about a generally accepted teaching tool in most all medical schools and how it could be related or unrelated to the issues discussed here. ..Maurice.

 
At Monday, February 03, 2020 8:07:00 AM, Anonymous JR Issues4Thought.com said...

I was reading through some of the material available for standardized patients and it seems you must not deviate from the script so stopping them from teaching you without permission would not be likely in a script. There are all kinds of protocols listed. I used

https://
www.usd.edu/~/media/files/medicine/parry-center/standardized-patient-manual.ashx?la=en

as one of the references. I could not find much in the way of IU except they seem to hire from employment agencies. Most say genital, rectal exams are not standard unless specified. You may be able to give feedback depending they say upon the time left but if they think you are not a good fit, they won't use you. So I am suspecting they are very subjective in what they want for a SP.

I am more interested in having groups of them rather than 1on1. I think there is a better potential for understanding not being seen as a patient but rather as a human who has suffered at the hands of what a medical "un"professional should not represent. Being a patient put one on unequal footing from the start so they are less likely to listen unless the coordinator agrees which is unlikely at least around here.

So again, I will say it would probably be more beneficial for them to hear from patient victims rather than 1 on 1. It could have a skit playing out what has happened to some patients for them to actually see. That might be helpful.

If anyone has anything they would like to contribute to the new website, please let me know. I know everyone who posts here has some really great ideas. Dr. B you are welcome to share too if you would like.

 
At Monday, February 03, 2020 8:47:00 AM, Blogger Biker said...

JR, I read that standardized patient description you posted. It was sufficiently thorough to convince me I wouldn't be interested in being one of their standardized patients. This is because they aren't particularly interested in what you as the patient thought about the encounter. How the evaluators see the interaction could be very different than how the patient saw it. Their seeming disinterest in wanting the patient perspective may be part of the problem with physician training. It is a good interaction if they say it was; what the patient thinks doesn't matter. This is no different than them saying your privacy and dignity was respected because we say it was.

From a purely technical perspective these sessions as described have great value of course, but for the kinds of things we discuss here I like the kind that Dr. Bernstein has described where small groups of students with a faculty member observing examine a standardized patient that provides direct feedback coaching and encouraging the students. That type I'd be willing to do.

 
At Monday, February 03, 2020 10:57:00 AM, Blogger Maurice Bernstein, M.D. said...

We have one student vs one standardized patient sessions in which the feedback to the student at the end of the 25 minutes does primarily involve COMMUNICATION matters between the two and is up to the students' and students' instructor after reviewing the video to later talk about the technical aspects of all that was carried out with regard to the physical exam and communication. This session, the student, is not formally graded. However, a subsequent different student-standardized patient session is held where the student is observed directly at the time but after completion by an observing instructor and details of the communication and examination are given to the student as well by the standardized patient when the exam is completed.

We also have had sessions with standardized patient "having a disease" where all 6 students attend together and each performs a separate portion of the interaction and physical exam with observation by instructor and patient and discussion after completion.

We also have sessions with 2 groups of 6 students together and each student takes turns following up on the prior student in just interviewing and responding to the standardized patient who demonstrates a behavioral or decisional issue with ongoing or later feedback by the instructor.

Finally, as I have repeatedly written here, second year students perform breast exams and pelvic exams on female standardized patients and perform genital exams on male standardized patients where these patients present ongoing instructions and feedback as the student carries out the procedure.

At our medical school, in the first two years, most of the interaction between student and patient including physical examination (except genital-rectal) is carried out on hospitalized patients with periodic monitoring by the instructor but always with specific permission of the hospital patient.

I hope this explains a bit more about how standardized patient involvement in teaching has been carried out in one medical school.
..Maurice.
'

 
At Monday, February 03, 2020 12:10:00 PM, Blogger A. Banterings said...

Maurice,

Do you not see the hypocrisy in NOT having students perform these exams on each other and the way that patients are coerced into allowing students and even having them preformed without consent while under anesthesia???

EVERY REASON that patients are given to allow student participation is justification to allow peer physical exams are reasons that EXPLICIT consent MUST be obtained from patients. This is just another hypocrisy of the profession that ERODES TRUST of the profession. Yet, over the the many years of pelvic exams on anesthetized women WITHOUT consent, providers and students used the following justifications:


- patients sign consent forms that vaguely allude to medical students’ involvement in their care, language that protects the hospitals from liability
- students need/want the educational benefits
- rationalized as necessary for medical training
- pelvic exams under anesthesia is a practice that is age-old and universally performed
- if asked, most patients would decline, depriving young doctors of getting real-life training
- a pervasive sense that the practice is necessary to train good physicians, and thus a social good that outweighs concern about consent
- examination of reproductive anatomy should not be any different from an exam of the lungs
- Do we want the sexual mores of society to place restrictions on the ability of physicians to care for the whole patient? More germane to this discussion, do we want medical students to graduate less prepared to assess the female reproductive system than the rest of the patient?
- teaching hospitals are known for their standards, with patients having the benefit of young doctors with up-to-the-minute education paired with senior physicians with decades of experience



Reference:
-- Medical Students Regularly Practice Pelvic Exams On Unconscious Patients. Should They?
-- Educational pelvic exams on anesthetized women: Why consent matters.
-- JAMA Forum: Teaching Pelvic Examination Under Anesthesia Without Patient Consent
-- The ethics of pelvic exams performed on anesthetized women without their knowledge


Even worse is medical students ATTITUDES about consent and intimate exams:

Even more disconcerting is reading through two recent lengthy threads of discussion devoted to the ethical dimensions of this topic onstudentdoctor.net, a popular discussion forum for medical students.The vast majority of the posts on the site defend the practice as necessary for medical training and dismiss concerns of those who see the practice as alarming, while a few voices venture to speak out against it before being struck down repeatedly. An example of the majority opinion can be seen in this post by ArmoryBlaine

It’s surprising [sic] how worked up some people get over the issue. You will be naked on a brightly lit table for all to see. A medical student will put a tube into your bladder. We’re about to flay your belly open and remove your uterus and ovaries. But to do a pelvic exam! What a violation!If you get into this habit of being deathly afraid of the patient’s feelings about an internal exam you will never learn how. I’m not saying that you should be a jerk about it, but you owe it to your future patients to get some idea of what stuff feels like.


Source: Educational pelvic exams on anesthetized women: Why consent matters








-- Banterings



 
At Monday, February 03, 2020 12:14:00 PM, Blogger A. Banterings said...

Biker,

the naturalist community is all people who consent to be naked in the presence of others who are also NAKED. in healthcare, the issue is FORCED NUDITY (exposure).

i am sure that more patients would mind less if they were NOT the ONLY one in a room full of people exposed.

(I bet providers would complain louder than patients and cite all of the psychological trauma it causes...)


-- Banterings



 
At Monday, February 03, 2020 3:13:00 PM, Blogger Maurice Bernstein, M.D. said...

Banterings, I fully agree that consent from fully informed patients should be given before any year medical student participates in patient examination, diagnosis or care whether in a clinic, hospital bed, radiology or laboratory procedure. Medical students should be introduced as "medical students" and NOT "student doctors" or anything similar.
The patient or if necessary the patient's surrogate should be informed regarding the role and behavior and extents of participation of the student and if such consent is not available, the student should not be present, participate or be part of any team.

My experience with first and second year medical students has been always to follow what I just wrote. And I would expect the same regarding students in the 3rd and 4th years participating fully on the wards.

Permission, written about in general terms, on some admission document is inadequate. Patients don't go to hospitals to be some teaching tool for some unknown student. Yes, 3rd and 4th year students should be allowed to be present and to participate within limits, set by teachers, but also finally fully approved by the patients who will be the subject of the participation.

Banterings, with regard to your second posting, I doubt patients who are shy to be validly uncovered for their clinical benefit would feel more comfortable ("mind less") to have their examiners were at the time likewise uncovered simply for equality in dress or undress. This behavior is unnecessary and unwise even if the patient was a "naturalist". The degree of dress or undress of the patient at any point in any clinical condition depends solely on the diagnostic value of requiring such state. How does a physician make a diagnosis of a topical rash vs an underlying herpes zoster without removing the clothing over the affected area of the chest or abdomen, inspecting and palpating? If a female patient is shy to have her chest exposed for a rash she knows to be present but she can't diagnose, how else can a diagnosis be attempted without the physician utilizing those techniques on the affected skin?

Patient modesty has certain limits for certain clinical conditions but also should be attended to for others if diagnosis and treatment is the patient's goal. ..Maurice.

 
At Monday, February 03, 2020 3:51:00 PM, Anonymous JR Issues4Thought.com said...

The exposure of the medical staff might be thought of as being ridiculous but it is criminal for them to unnecessarily expose any patient. Unnecessary exposure is done routinely in pre-op and afterwards. It can occur in PACU or even in a patient care room. If I have an issue that needs for an area to be exposed, than after the explanation, with my permission, and limiting of who is present, there wouldn't be an exposed if brief exposure was necessary. Limiting the exposure to only absolutely minimal exposure with only necessary personnel is something that should be mandatory rules. Exposure for convenience (as in the surgery area), exposure for power & control, exposure without consent, etc. should be outlawed and the offending medical staff should be terminated and licenses revoked. Unnecessary exposure is a form of sexual assault and we should not allow sexual predators access to patients as many are defenseless.

I can send you a copy of the consent form used on my husband. It basically states the doctor has the right to do anything they might deem necessary (which is one reason we know the form was not given for him to review as he always crosses out certain areas). This is how they can defend their pelvic exams as it is a blanket consent although morally & ethically it is wrong as many patients would not think if they are in there for knee surgery that they will be getting a pelvic exam. The form also goes on to state the dr. may have anyone they want to participate in care. This also covers the pelvic exam. It also states there may be students in attendance which is very broad in its definition. For sure, the consent form is for the medical professions protection and not for the patient's protection. It allows for situations most patients have no clue could happen so naturally they don't have any objections. It would be different if direct permission was asked by the medical profession prefers to hide behind smoke and mirrors. And they wonder why there is a trust issue?

There could be videos or still pic of the staff being used for different procedures. This might be an alternative. That way a patient could see the staff was willing to defend their "it doesn't matter, you don't have anything I haven't seen before attitude" as the patient could also say, I've seen yours so my we are on more equal standing. But then if patients were treated with dignity & respect, both in how their healthcare is delivered,by whom it is delivered by, and if they want any healthcare at all, I imagine some of this conflict would subside. It is the cavalier and paternalistic manner which is the biggest issue. Only the patient has the right to what happens to their body. Patients are not prisoners of the state but even then there are boundaries. Medicine seems to know no boundaries where a patient is concerned. Just because you enter the doors of a healthcare delivery system does not give them the right to do with you as please. They need to be educated on this.

 
At Tuesday, February 04, 2020 2:36:00 AM, Anonymous Anonymous said...

Maurice Bernstein, MD said, "I fully agree that consent from fully informed patients should be given before any year medical student participates in patient examination, diagnosis or care whether in a clinic, hospital bed, radiology or laboratory procedure. Medical students should be introduced as "medical students" and NOT "student doctors" or anything similar."

Dr. Bernstein, thank you for following this philosophy when instructing medical students.

Unfortunately this has not been my experience.

As a patient I want to be asked if I am willing to have students involved in my care BEFORE they are given my name, given access to my medical information, or brought into the exam or hospital room.

Unfortunately that has not been my experience. I have NEVER been asked. I can only think of 1 time in which I was informed that the individual was a student.

The standard is to bring someone into the room and announce "this is John Doe. He is going to be assisting me today."

Then I ask if they are a student, and only then do they tell me that they are.

At that point I feel blindsided, angry, and assaulted. I feel the physician/nurse was deliberately deceptive, and as a result I don't trust anything they tell me.

The only time that they told me the individual was a student I wasn't asked if I was willing to participate in the student's education. I was TOLD they would be examining me.

I'm so fed up with this that I make a point of asking the referring physician if who they are referring me to works with students. I check the practice's web site. I ask when I make the appointment. I continue to get blindsided.

The medical community seems to think they have a right to use our bodies to advance their goals without our consent.

This article from Kevinmd.com is an example of the problem.

https://www.kevinmd.com/blog/2020/01/this-patient-interaction-is-a-reminder-of-the-power-of-being-human.html

The author is a 1st year medical student at Rutgers Robert Wood Johnson Medical School.

He was shadowing a physician. The physician was running behind and asked the student to keep the final patient company until he caught up.

The student proceeded to examine the patient and take a detailed history. At that point the patient commented that it was unusual for a physician to spend that much time with a patient.

The author writes, "I confessed to him that I was a medical student."

He writes proudly of his actions.

I think he was deceitful.

I think he committed assault. The patient thought they were consenting to a physical exam by a physician. Consent must be knowing, voluntary, and freely given. This patient's consent wasn't "knowing."

- cg

 
At Tuesday, February 04, 2020 8:43:00 AM, Anonymous JR Issues4Thought.com said...

CG,

You are so right. I have accompanied my husband in the past during his prostate journey and have kicked out observers and students. They only say so and so will be helping me today so I would have to ask who they are and sometimes had to pry the info out of them. They act offended that the object of exam didn't want to participate in their education as if he was his duty to let them receive their educational requirements on him while he was undergoing a really life altering disease. This was before the consent forms where he can now mark out even if it is where his signature is as the electronic ones don't give that option except in the signature part. It does feel like assault and certainly once trust is broken it is difficult to get back. But often the medical community's version of consent is different than what it really should be. I seem to think the medical community thinks their own consent is all that is needed. That is why we record everything from the moment we enter the reception area to the moment we leave. We need a record of our own as their record may be full of lies and untrue statements. A consent form can be lost or altered. MRs can be altered or items flat out omitted.

I remember one urologist having a big smile on his face when he introduced a female with him as going to assist him. He must have had a banner day of ambushing male patients as he looked as though he thoroughly enjoyed the reaction but he wasn't smiling as she was walking out the door. We were harming her educational pursuit. He harmed his patient/doctor relationship as that was the last time my husband visited him. Having just started on his prostate cancer journey, he didn't need the additional of a "used car salesman" type of doctor. I know they need experience but it is not the responsibility of patients to give it to them. We pay for medical care by professionals and we always take care not to go to teaching hospitals although most of them now refer to themselves as teaching hospitals. No matter--it still is not our responsibility. There should be warning and also for those who want to let students participate, they should be a discount for their services as a lab specimen.

 
At Tuesday, February 04, 2020 11:26:00 AM, Blogger Biker said...

cg, I read that article and would have left a comment except they were closed. That student truly was pleased with himself and utterly unaware of how wrong he was to examine the patient under false pretenses. Had he done that to the wrong patient his medical school career might have taken a detour.

Within certain limits I am willing to allow students to observe or otherwise participate in my care but they need to obtain my consent first. It really is that simple. I suspect most patients would agree in most instances.

Back before I found my voice I was ambushed by 5 medical students, 4 female and 1 male who came into pre-op and simply told me they would be observing my bladder cancer surgery. The surgeon, nor anyone else, had mentioned to me that there would be student observers, thus the ambush nature of what occurred. None of them introduced themselves other than one of them saying they were medical students. None asked if it was OK with me. At the time I just assumed I had no say in the matter. I would add that I was a bit put off by their being in a cheerful mood. I was scared as to where it was all going, there not having been any cancer survivors in my family up to that date, and I'd of preferred that they at least have had a serious demeanor about them. It's not like it was a party or social event they were heading to.

 
At Tuesday, February 04, 2020 12:30:00 PM, Blogger A. Banterings said...

Maurice,

You, other med school teachers, professional associations, the whole profession agree that explicit consent be obtained from patients for student participation.

Why does THIS still happen???

WHY???

WHY???

WHY???





THERE IS NO VALID ANSWER.

If the WHOLE profession agrees to consent, and it is NOT happening, then it is a FAILURE of the PROFESSION.

If the profession can't get this straight (along with so many other issues ad nauseum, then why should anyone have any TRUST in the profession?

Obviously teaching methods 1st & 2nd year are faulty and ineffective because this still happens.


Self policing is a failure. We still have Dr. Larry Nassar, Dr. George Tyndall , and Dr. Dennis Kelly occurring.




Again tell me how compassionate the profession is. Tell me how the standards of medical education are working. Tell me how the practitioners abide by professional standards. Tell me of how there is common sense in the standards. Tell me why the profession deserves ANY TRUST?



-- Banterings

 
At Tuesday, February 04, 2020 1:18:00 PM, Anonymous Anonymous said...

JR, This would be an example of the DOCTOR being at fault for the modesty/dignity violations and not just the supporting staff. A couple of days ago,it seemed like our group was putting 95 percent of the blame on the supporting staff and I wanted to chime in and say otherwise. There has been a lot of complaining through the years on this site about doctors allowing people to barge in. Sometimes even inviting them in in response to a knock on the door. What difference should it make to the doctor if that patient is harmed. It makes THE DOCTOR look dignified. And the patient should be in awe of being in the god/ person. If he or she isn't then they don't deserve medical care. JF

 
At Tuesday, February 04, 2020 1:21:00 PM, Anonymous Anonymous said...

Hello,
The excerpt below is from https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2758328?guestAccessKey=c2b159ed-88d8-44ad-8fd5-c4976c6f84b3&utm_source=silverchair&utm_medium=email&utm_campaign=article_alert-jamainternalmedicine&utm_content=etoc&utm_term=020320
Please read the entire article. It’s rather “interesting”.
“In a 2018 committee opinion, the American College of Obstetricians and Gynecologists stated that there is no evidence to support routine speculum and bimanual pelvic examinations in healthy, asymptomatic girls and women younger than 21 years and recommended that these examinations be performed only when medically indicated.”

Reginald


 
At Tuesday, February 04, 2020 2:59:00 PM, Blogger A. Banterings said...

Reginald

See the article: Many young women get unnecessary pelvic exams



-- Banterings




 
At Tuesday, February 04, 2020 3:50:00 PM, Anonymous JR Issues4Thought.com said...

JF,

You're correct that was all on the male doctor. The difference for us is that most of the violations occurred when we were able to do something about them before he was severely violated. Most of the instances before the hospital from hell were doctor violations which at the time were minor compared to what happened there. Yes, he had a female ultrasound tech for the prostate scan but at the time she acted appropriately although the tech should have been a male just like for mammograms the techs are female. Most infractions like at the urologist happened w/ the doctor present so the inappropriateness was on him. During his prostate surgery he was aware of how it was done & met the staff beforehand. There was not a lot of options & we didn't know about same gender care options at that time so it was what it was.
However why what happened w/ the nurses this last time was he was completely defenseless & they knew it & took advantage of it. They also did commit sexually inappropriate acts going far beyond any definition of needed exposure. For the prostate prep, they kept him covered until they needed to the area, prepped it, and draped it. That is not what happened this last time. There was no medical reason for the excessive exposure or really any exposure at all. They are garments made for this type of procedure. There are at the very least blue towels used to cover the genital area. The prep area does not include the genital area. Afterwards, it was the 5 hours exposure he suffered through in the patient room, drugged to the point of being paralyzed but alert enough to realize what was being done to him by them and knowing he was trapped for some reason & not able to get help. Having the feeling of being a tortured captive is a feeling that can hardly be described and he gets very silent & withdrawn when pressed to talk about how he felt then. Again, it happened because he was drugged, defenseless and they knew it. Thus is why all interactions with any female staff in the future is marked by this assault and is why we place more blame on female staff rather than on the male doctors of the past.

The harm from what happened is immeasurably greater from the female harm than being able to redirect potential harm. Yes, we realize doctors do harm too as well as male nursing staff harm female patients. But in his case, the male nursing staff after the female predator were more respectful of him but they may be he was not as drugged just foggy for the next week or so.

The other reason is when a patient is totally helpless when the abuse/assault occurs I speculate the consequences of the abuse/assault is magnified even more. You don't expect to be harm while seeking healthcare services & that is what they count on. As long as the medical community will not deal with those types of infractions, violations, and the predators themselves then people must learn to be wary of any interaction with them be they male or female--doctor, nurse, tech, etc. Thou shall not harm or inflict more harm should become their motto/oath to practice medicine.

You might be interested to know that I am making nursing home/senior care part of my speaking circuit. I have several organizations that are senior related interested in me speaking to them about issues such as dignity/respect that concern seniors.

 
At Tuesday, February 04, 2020 6:13:00 PM, Blogger NTT said...

Good evening:

We all know the system is broken. Congress things they can fix it with input from the medical community.

That is where they are wrong. You cannot fix this or any other system without public input preferably actual patients.

The system needs new protocols that are system wide not by facility.

The intake paperwork & the informed consent forms must be re-written so as not to hide things like if your at a teaching hospital you automatically consent to students & others working on your case.

Informed consent should be in sections dealing with each different aspect of what you might encounter like pelvic exams, films & photos.

If we want real change the American public will have to stand as one & raise their voice loud enough for all to hear.

The system is broken. Allowing it to do anymore self-policing, is out of the question. Look how long Dr. Larry Nassar, Dr. George Tyndall , and Dr. Dennis Kelly got away with it.

What's happening is women are speaking up & getting results against doctors. Whereas men are still staying quiet so the nurses, techs, & the rest of them are still getting away with abusing male patients.

Until we find a loud & clear voice & keep talking until they listen, nothing will ever change.

I went to Washington & spoke with my representatives. They were NO help. I told them don't expect my vote in November.

We need a men's movement. We know men are tired of how they are being treated. It's time for the guys to speak up.

It's the only way to force change.

Regards to all,
NTT

 
At Tuesday, February 04, 2020 9:46:00 PM, Blogger Maurice Bernstein, M.D. said...

Some may think that JR is over emphasizing her concern about her husband's treatment throughout his experience in his medical treatment. I don't think she is setting some excessive standard for a wife, husband or any family caregiver to behave in what appears to be gross misbehaviors by members of the medical profession or those associated with that work.

Wife, husband or other family caregivers and, of course, if possible, patients themselves should participate in bringing to awareness in the medical system of those mistakes or frank misbehaviors.

Here is an article with supports what JR is trying to accomplish:
"The Devastating Effects of Silence"
. Participants in providing effective and appropriate treatment, decision-making and even professional behavior also includes those not being paid by the healthcare system but those of the family and others out of the system and of course the patient, him or herself. ..Maurice.

 
At Wednesday, February 05, 2020 6:14:00 AM, Anonymous JR Issues4Thought.com said...

Dr. B,

Thanks for the insight. I am a person who meets conflict head-on. He prefers to avoid it so I am usually the appointed conflict spokesperson. Remember, my background is being a labor rep and dealing with kids with issues. Being silent is not in my DNA. Besides being a wife, I am a mother. I have a son who was diagnosed with Type I diabetes about 3 years ago in his early twenties which is really rare. I don't want my son to have to go through what happened to his father as I know as time goes on and this attitude of the medical establishment grows and flourishes, my son being a diabetic is most likely going to experience something like what happened at some point. I also have a daughter and I don't want her to be at risk for the pelvic exam rape either. I also witnessed the medical community forcing my dad to die without being able to keep sacred his personal dignity but he too was drugged. So yes, I am passionate about what I am trying to do. Yes, I use personal stories. I have tried to limit them on this blog but I needed to explain to JF the difference in what had been experienced before never was able to reach the point of being defined as an actual assault as I interfered. He asked me to accompany him to be the bad cop as he was tired of being objectified and he had a bigger battle to focus on. He didn't encounter all the female audience members or students for the years preceding his prostate issues. However, within the last 15 or so years, at least around here it has become more common.
But due to the torturous events of that night, I was silent but I will not be silent again. However, if my husband did not want me to accompany him or speak out, I would certainly abide by his decision as it is entirely his decision. But I would continue to work as loudly as I could to change how medical treatment is delivered.
I have learned a lot from the members of this board. I constantly direct others that I come across who have stories of their own, to view this blog and to know they are not alone. Sadly, knowing there are others is of great solace but also knowing there is effort to make changes help too.
Because just complaining and feeling sorry for us is not enough is also why I do what I do. I am putting together a new website to be a clearinghouse of sorts for patient information. It will not be is the style of Issues4Thought but rather a website of helpful info for patients and seniors albeit with a slanted point of view but not overly radical. I am also done w/ a power point to show at my talks with senior groups bc they are a ripe target for the medical community. I have extended the invitation before but again if anyone has any info to contribute to the new patient info website, please let me know. Once I have the website up with some content, I am going to use a professional search enhancer to bring people to the website.
PS I am just as crazy about animal rights & not killing animals to eat.

 
At Wednesday, February 05, 2020 8:59:00 AM, Blogger Maurice Bernstein, M.D. said...

I want to add a bit of nomenclature that we actually use in our hospital ethics committee which defines in an understandable term what was written in the article "The Devastating Effects of Silence" recommended for reading in my previous posting.

The term we use in clinical ethics is "stakeholder". The primary medical stakeholder is, of course, the patient him or herself but in virtually every case there are other stakeholders: physicians, nursing, administration but also engaged family members and legal surrogates for the patient. Stakeholder should have the opportunity and right to present their opinion regarding the current management and course of future management of the patient. That means, that even if the patient is in the ICU environment, patient, family and surrogates have the right to speak up and present their views of behavior of the system and more specifically the care, clinical decisions made, course and any mistreatment of the patient.
It is these views which as stakeholders are brought to the clinical ethics committee for discussion, education and mediation by the hospital clinical ethics committee. Many hospitals also have administrative ethics committees where primary administrative issues can be brought up by the stakeholders.

Patients and their families should be aware of their stakeholder role is just as important as those individuals employed by the hospital.

I hope JR and others, as I think I have already noted in past Volumes that as a stakeholder, patient and family, have the right and obligation to "speak up" with their ethical and perhaps legal weight. Hospital ethics committees is one body to utilize. ..Maurice.

 
At Wednesday, February 05, 2020 11:32:00 AM, Blogger A. Banterings said...

Maurice,

JR has every right to dwell on what happen to her husband and express her anger. She lives with the fallout from what these self-described compassionate providers did to him.

Look at the position that she has been put in; he would probably just avoid healthcare at this point. As a loving spouse, JR wants him to be around as long as possible. He faces the same issues that many cancer patients face, that is quality of life. Is the cure worse than the disease?

It should NOT be...

I know that my last comment was rhetorical, but the issues I bring up are no longer addressed and you no longer defend the profession as my views being those of an outlier.

Does it not bother that it has taken so long for YOUR eyes to be opened to what actually happens in the profession?


How many more physicians still hold the views that you once had?

I realize that this probably takes an emotional toll on you.

The American people are use to living with broken systems, be it government, cell phone carriers, airlines, ANT customer [NO] service, healthcare, etc.






-- Banterings




 
At Wednesday, February 05, 2020 3:06:00 PM, Blogger Maurice Bernstein, M.D. said...

Banterings, I am not inhibiting JR's view or its expression, as I have previously noted I am supporting it with the linked article and my acknowledgment that JR is a "stakeholder" and has every reason to hear her facts and arguments with regard to her husband's (patient's) treatment.

On this blog thread, regardless of proven statistics, I have always advised all patients or former patients or their surrogatess to "speak up" just as when I was Chairman or now as a nonchairperson member of a hospital ethics committee.

With regard to the "hidden curriculum" in the 3rd and 4th years of medical school education, though I have written about it quite a bit on this blog, as an instructor of first and second year students, I could only warn them of that issue as the students moved on into those later years. ..Maurice.

 
At Wednesday, February 05, 2020 11:33:00 PM, Anonymous Anonymous said...

JF,

You so correct that they are indignant when you refuse to have students involved. I have been told I have a responsibility to allow them to use me for their learning experience. I even had one physician yell at me.

I too avoid teaching hospitals, but I have discovered the only difference between teaching hospitals and others is that you know from the start there will be students at teaching hospitals. Other facilities don't advertise they have students. They prefer to ambush patients.

What I find most offensive is that according to my insurance it costs the patient 50%-100% MORE to be treated at teaching hospitals. We pay more to be treated by unlicensed providers. That's some racket.

Your husband is lucky to have you as the "bad cop." Keep fighting.

-cg

 
At Wednesday, February 05, 2020 11:49:00 PM, Anonymous Anonymous said...

Biker,

I considered complaining to his medical school. If he is so cocky as a 1st year student, what will be be like in his 2nd, 3rd, etc. years. As a 2nd year will he decide on his own to start an IV on a patient and do it? Someone needs

If I had been the patient, I would have complained to the Dean of his school and the CEO of that medical facility. I would also be complaining about the physician he was shadowing. The physician was responsible for him.

I also had the experience of students being too giddy when I was hospitalized. They were acting like they were at the zoo and seeing all these interesting animals. I wasn't facing anything as serious as bladder cancer, but it was still inappropriate.

There was a time when I would let students be involved. I won't anymore. The medical professions' attitude that they have a right to use me ended that. I don't care if all they want to do is check my pulse, a student is not touching me.

-cg

 
At Thursday, February 06, 2020 9:15:00 AM, Blogger Maurice Bernstein, M.D. said...

cg, as I have written here many times, the first and second year medical students to which I taught and monitored follow instructions that on their initial contact with a patient to which the student was randomly assigned is to as part of the introduction identify the student's name, year in school, what they have been assigned to carryout on a patient and after answering the patient's questions about the interaction, ask the patient for permission for the student's academic exercise. If the patient rejects..that's it..the student will thank the patient for considering and leave the room with good wishes for the patient. That is the routine and one that is followed by the students. Patients are always "in charge" throughout the history taking and fragmented physical exam for first year students or the developing more complete physical exam in the second year. Not so infrequent, a guest may enter the room or the patient doesn't feel comfortable to continue with history or physical and on hearing this, the student will thank the patient for prior permission and leave the room without argument.

First and second year medical students' relationship with their assigned patient is solely based on the patient's specific permissions and participation in a learning experience for the student..nothing more..no coercion by student or instructor. This behavior is unchanged whether the learning exercise is within the County Hospital or private hospital.

Final description: the patient is always in charge! ..Maurice.

 
At Thursday, February 06, 2020 10:14:00 AM, Anonymous Anonymous said...

You must have been talking to JR. JF

 
At Thursday, February 06, 2020 2:31:00 PM, Blogger Maurice Bernstein, M.D. said...

JF, my statement "the patient is always in charge!" refers to my teaching and experience with first and second year medical students, where the goal is to use the hospitalized patient as a teaching subject. The relationship between student and patient tends to get more complicated in the later two years when the student is, under request by the patient's physicians, to provide, within the limit of the student's skills at the time, actions and services to the patient, which are of student education value but also, at the time, mainly clinically based, unlike the purpose of student-patient interaction in the first two years which is directed primarily to the education of the student. (Though..I must say, occasionally the student discovers valuable history or physical information "not in the chart".)

However, the patient or surrogate, in most all major decision-making should "be in charge" for that decision. ..Maurice.

 
At Thursday, February 06, 2020 4:42:00 PM, Anonymous JR Issues4Thought.com said...

Dr. B.

I am not disputing what you say is protocol or what you teach but the difference is you. Out here in the real be it I am the patient or a patient's advocate, I have never seen a doctor ask for permission to have someone like a student with them. In fact, their presence is a statement such as so and so will be assisting me today. It is done like that bc if it were a ? than that would open the door to be able to object. Too many patients don't realize whether it is done as a statement or ?, they have the right to say no. But again, it is done to leave no room for choice or so they think. It hasn't worked when I am present but it does work most of the time. I have read the medical literature that teaches how to phrase sentences or use certain words to get certain reactions. In fact, as an educator & a former labor rep I have been guilty of doing so. My favorite kid statement would be: "If I am standing here, then you can be certain I know how you should answer this question." It gave them a choice but let them know to make the right choice. Words are weapons just as words can be used to manipulate. Even in a teaching hospital you can say no.
Informed consent is another one that gives the wrong impression. You meet the one to do your surgery but the consent form in all the rubbish usually has a clause saying your doctor can assign your surgery to whoever they choose. It may be a student or it may be another doctor. You never know unless you get your MRs and than it may or may not tell the true story. Just as the consent form gives a free pass for the pelvic exams on female patients by saying your doctor has the right to perform whatever procedures he thinks is necessary. You WRITE don't verbally tell cause it certainly isn't going to mean anything as there is no proof that you want no students, observers, pelvic/rectal exams and still have to hope while you were out nothing happened.
Ethical doctors would do the right thing but not all are ethical or we wouldn't be here on this blog. As I have said before, the students you taught may have learned the correct way but once they leave you, you don't know if what you taught really made a difference. We agree the patient should always be in charge but in real life it is not the way it works. Even for other doctors who become patients, I have read they also have issues like we have. You haven't but it could still happen so don't let your guard down.

 
At Thursday, February 06, 2020 4:58:00 PM, Blogger Biker said...

I take a different stance on the teaching hospital issue. Northern New England is largely rural without any large cities. There are very few large hospitals, and those few are the teaching hospitals. These hospitals have the latest and greatest in terms of facilities and equipment and given they are actively teaching medical students, Residents, and others, they are up on the latest techniques and research. They are where all the small local hospitals send the more complicated cases.

Except for ER matters where you go to the closest hospital, it is a no-brainer for me to do the drive to get to the large teaching hospital I use for everything else. For most things I am OK with the presence or participation of students. Just don't lie to me as to their real status and ask me if it is OK for them to be there. Most of the time my answer will be yes, not always but most of the time.

 
At Thursday, February 06, 2020 5:17:00 PM, Anonymous JR Issues4Thought.com said...

Dr. B.,

If your spouse was raped, would you have any reaction such as guilt, anger, extreme concern, etc.? Would you want justice? Would you want to help them? Would you want their attacker(s) brought to justice? I don't think my anger, guilt, etc. as a spouse of a rape victim is out of the ordinary. What is out of the ordinary is the victim was male and the assault committed by female hospital employees. But is it really out of the ordinary or is it more that male victims are silent about such attacks. He would have been but by the next morning I was no longer in shock & realized what I saw & he knew then & over time has remembered more. This is not a case of a spouse who is upset bc some medical worker saw their mate's genitals out of medical necessity. I am not sure it is understood that exposure done unnecessarily for prolonged periods of time in front of basically an audience is not medical necessity but rather one way a female can sexually assault a male patient who is defenseless as they were heavily sedated. It is different than a female nurse asking Mr. Smith if he needs help to use the bedpan & she assists in a professional manner. Just as it is different when a patient is prepped & only the areas needed are uncovered but it is sexual assault not to cover the genitals if no access is needed. In fact, they can use the Covr garment to maintain patient dignity so the better question is why don't they?

Other day, I used snatches of our story to give clearer meaning to a couple of earlier posts. Others repeatedly tell their issues of lack of patient dignity but bc I am a spouse it seems to be controversial. I was surprised by your post saying "others" might think I was overreacting in my concern, but I couldn't find those posts. The post in which I replied to CG was about his cancer journey 14 years ago as she was talking about hers. My husband is a man who avoids conflict, I meet it head-on except for one time. He internalizes stress, I let it out as you can tell. Most people find doctor's appts stressful, they are scared if health issues are present, or sometimes just not people who speak up for their rights. I advise everyone it is their right to have someone with them during medical encounters IF they want to have someone present. It is in their best interest to have someone present IF.....Some do, some don't--my husband wants me present & has for a number of years.

Not only am I a wife but I am a mother of a son who is a Type I diabetic so I don't want this to happen to him bc he is well on the road bc of this to heart disease, stroke, & kidney failure. I am also a mother of a daughter & I don't want her to be a victim of a pelvic exam rape. I am also a daughter whose father while he was dying had his dignity taken away from him bc of hospice and I don't want that to happen to my mother. So I have made this my fight even though I have written documentation saying I refuse medical care because I simply do not trust them nor do I have the ability to figure which ones are professional and which ones are sociopaths. For others, I am more than concerned with the state of how healthcare is delivered because paraphrasing Banterings we are used to living with broken systems and suffer the consequences. Thanks for listening & I am off my soapbox.

 
At Thursday, February 06, 2020 5:38:00 PM, Anonymous Anonymous said...

Dr B.
I didn't say anything. But you must have heard me thinking. I was thinking that the patients being in charge is in theory only. But I believe that you personally do right by your patients. JF

 
At Thursday, February 06, 2020 7:11:00 PM, Anonymous Anonymous said...

CG, I never heard before about hospital care with med students being 50 to 100 percent more expensive. Was it just that one hospital only? If a patient says no do they still have to pay the higher bill?
JF

 
At Thursday, February 06, 2020 10:47:00 PM, Blogger 58flyer said...

JR,

I posted a comment on your site in re to Gender Care Discrimination Against Male Patients. I hope it came through, though I don't see it on the site.

58flyer

 
At Friday, February 07, 2020 1:47:00 AM, Anonymous Anonymous said...

"CG, I never heard before about hospital care with med students being 50 to 100 percent more expensive. Was it just that one hospital only? If a patient says no do they still have to pay the higher bill?
JF"

JF, I don't know if this is universal. Several years ago there was an article in the local paper that several big insurance companies were dropping the teaching hospitals from being "in network," because treatment there cost 50%-100% more.

The insurance companies listed several reasons for it, but one of the main ones was that patients were being managed by residents. Residents perform a lot more tests than experienced physicians do, because they don't have the experience to know what is really needed.

Attendings let the residents run these unnecessary tests, because it's not going to hurt the patient to have that CT or CBC with Diff and CMP every 12 hours. The resident will learn that the CT or labs weren't necessary when they don't alter the treatment decisions.

The insurance companies said all the testing was expensive. They also uncover incidentalomas which necessitate additional testing costing more money.

There was a lot of concern at the state level because the teaching hospitals couldn't survive on medicare and medicaid patients only.

My insurance company was one of the companies that dropped them. It's been several years and my insurance just added them back in network.

-cg

 
At Friday, February 07, 2020 6:05:00 AM, Anonymous JR Issues4Thought.com said...

58flyer,
I approved your comment & it is posted. I didn't know that type of exam had a name but thanks for the info. Most every man I have talked to has agreed that don't like the way that exam is done but have never said anything. Some said they didn't know they could but some said they thought the exam might be done "rougher" if they had "complained." Most do not have their spouse present but did have a female present whom they called a nurse but weren't sure if in fact they were a MA. The overwhelming majority didn't like having her present and really didn't know why as she just stands & stares w/ the only thing she does is hand them the tissue. She is not gloved so germs from wherever she has been are on her hands to the tissue to ....I posted that article on another site and I have gotten a lot of response from men who have issues with how that exam is done.

Banterings,

I have taken up your advice & have started tweetering. Any other suggestions to getting the word out there?
JF,
I know that the big med school here is more expensive but I don't know the percentages. And yes, you have to pay it as that is usually in the acceptance of receiving the services. Of course the amount you must pay has been decided by either your insur. co or the government or both.

After more than a month, I finally received a response back from my state senator requesting a meeting. It was sent by an intern which tells you how low on the priority list a response was. It basically said he's working on bettering patient care and for me to keep contacting but no meeting but. The others haven't bothered to respond yet or will not. I did get a phone number from the email which I am about to call to see if I can get any further.

 
At Friday, February 07, 2020 10:47:00 AM, Blogger Swannie said...

@ JR,
I commend you for being such a fighter on behalf of your husband and trying to right a wrong.

I also took a stand and will never back down for what has been done to me in hospital deliberately without my consent. The feed back i got from the hospital that i was never exposed, could not be dressed due to IV-lines ( NO iv-lines !!) and that i did not have any problems being attended to by female nurses before the surgery ( Why would i ? They only put in an IV-line which was removed BEFORE the surgery and hooked me up to monitors) and the consent form i signed was a blanket consent for any other procedure which may deemed necessary by the surgeon which i should have known ) NEWS FLASH ! NOT according to our Human Rights as per our Constitution and various other official documentation.

I was informed by the Human Rights Commission today that a lawyer is working through my complaint and presentation and will be in contact with me soon. ( I referenced the law and all other official documentation including even the page numbers regarding Informed Consent, which states clearly NO MEDICAL PROCEDURE shall be done without Informed Consent, EXCEPT in emergency where a life is at stake, or where the patient is unconscious.

My mood swings and anger rule my life at the moment.

 
At Friday, February 07, 2020 1:42:00 PM, Anonymous JR Issues4Thought.com said...

I finally talked to someone in my state senator's office. I told them I was tired of the run-around and would be picketing the Statehouse. I said the email was dismissive & if no one bothered to listen, how could how healthcare is delivered really be fixed to make it patient friendly? The aide said he would call me back next week with some meeting dates. I told him clearly the concerns we common people have w/ the healthcare system apparently mean nothing as the medical lobbyists have the money & power. I told him why have access to healthcare if the treatment you receive is abusive & harmful. I told him I was talking to groups and would continue to do so as the public needs education & eventually enough will demand change. I told him I know how this works as I use to lobby for the AFT/FSE/ISEA so I wasn't going away as I have a personal stake in the outcome. It wasn't necessarily a pleasant conversation but I was a polite as I could be bc I knew w/o being firm, I would just be dismissed. Hopefully, he'll follow through & I don't have to keep banging the door of this gatekeeper. I will also keep banging at the doors of all the others too until someone opens the door.

 
At Friday, February 07, 2020 2:51:00 PM, Blogger A. Banterings said...

JR,

Issues for Thought have some very good topics and very good posts.



-- Banterings



 
At Friday, February 07, 2020 4:59:00 PM, Blogger Biker said...

Good for you JR! Hopefully a meeting will come about.

 
At Friday, February 07, 2020 8:09:00 PM, Blogger Maurice Bernstein, M.D. said...

JR, same here. ..Maurice.

 
At Friday, February 07, 2020 11:16:00 PM, Blogger 58flyer said...

JR,

Great job! Please do call the media to cover your story if you do end up picketing the Statehouse. Getting the story out would make them take action because they cannot ignore you then. You also mention that you have gotten a lot of response from another site. Could you tell me what that site is as I want to read those responses, or if you don't want to post it here you have my email address from my comment on your site so feel free to send it to my email address. Thank You.

Swannie,

Nice to hear a lawyer is going to consider your case! It is a sad fact that legal action is the only recourse to effecting change, but do what you have to do.

58flyer

 
At Saturday, February 08, 2020 5:36:00 AM, Anonymous JR Issues4Thought.com said...

Swannie,

Thanks for the kind words! This is personal for me. I want to make a difference not only for my family but for others as no one deserves to suffer the issues we have shared on this blog. We are only a small sampling of what really goes on. Many more just remain silent & suffering.

We got that same song & dance from the hospital from hell. They said in writing if we don't like how they deliver healthcare go somewhere else. They said they have the right to do things however they want. We went through the nursing board but nothing came of it. We went through the State Board of Health. Nothing came of it. We went through OCR. Nothing came of it. We went through CMS (Livanta). They said they only examine what is in the MRs as the truth inferring patients lie. So if a criminal doesn't write in the MRs they do something then it didn't happen. However, the flipside to that is there were procedures recorded in the MRs that didn't happen but CMS said that was a mistake. It was so blatant that our government is covering up for the medical industry it is not even funny. So what we have learned even though they say they investigate, the let it set for months and then send a letter saying, "Too bad for you." There absolutely is no oversight or anyway at the present to prevent these things from happening again and worse, the medical industry knows it.

Moods swings, anger, depression, fright, silence, etc. are part of the process. Eventually you have less. Sometimes those periods will return. But always it is in back of your mind especially when time for another medical encounter rolls around.

 
At Saturday, February 08, 2020 5:59:00 AM, Anonymous JR Issues4Thought.com said...

When I think about what really makes a medical encounter go wrong is the lack of consent. Most assume bc a patient is in the office or at the hospital, they have a blank implied consent to do whatever. That is not true. The only implied consent is a patient is there to begin the journey of having healthcare delivered but hasn't consented to why, by whom, or how. Many providers don't ask rather they state which makes many patients feel they do not have alternatives. They use words like order, must, shall not, etc. to imply authority and lack of choice. Clearly, there is not a partnership but their literature says there is. It is more like a boss/employee, parent/child relationship rather than a mutual respect relationship working together. Of course, the patient has the bigger stake in the outcome bc it is their life. Rarely is a patient asked why will work best for you? Dr. Smith has a medical student (giving specifics) shadowing him. Is it okay for this student to be present during your exam? This should be done during the initial appt. set-up & again at check-in. The same should be done w/ chaperones. Procedure consent forms are another area that needs to be made more patient friendly. They absolutely do nothing to protect patients or do they actually give detailed consent information. They are so broadly general that many things can happen to a patient & be covered by the consent form. Why is there even a consent as it only protects the medical provider?
In all other aspects of life, service providers ask before proceeding so why are medical providers exempt from this practice? We as the public are more likely to complain about our food being cold than our bodily privacy being violated & being exposed to the point our bodies are trembling. Are we scared of them and what might be the result if we complain at that moment bc we know they literally hold life & death (ours) in their hands? If this is the reason, how did this come about to be? Are all medical workers (doctors, nurses, MAs, etc.) taught the medical demeanor of stating rather than asking, using certain words to infer authority, control, to ignore textbook teaching about preserving patient's dignity? Is this done after becoming part of the medical working world. The lack of consent starts at the office exam level and goes straight in a larger dose at the procedure consent form level. This is how it appears to me. This is why women still get pelvic exams while under bc the consent form allows for this even though they know ethically it is wrong. But a blanket consent was signed for something you had no idea would happen as you were in for knee surgery.

 
At Saturday, February 08, 2020 10:27:00 AM, Blogger Swannie said...

58Flyer,

The lawyer will be from the Human Rights Commission and i am not really holding my breath, but i have to go through all the hoops. After more than a week i had to inquire from the COO of the Commission why i did not even receive a read receipt on my complaint.I think the fact it`s mandatory to write one`s race (Caucasian) for "statistical purposes" may have something to do with their disinterest. And now i will be marked as someone who goes straight to the boss.

No matter what, i WILL hold all those conspiring female medical staff to account and i will not rest until something is done about it. I was stripped of my dignity for the benefit of the medical profession and not for me as a patient.

 
At Saturday, February 08, 2020 5:20:00 PM, Blogger Maurice Bernstein, M.D. said...

It pleases me to read that folks are "speaking up" and to potential resources of investigation and change, beyond just speaking to the readers and contributors to this blog thread. This is the direction I have repeatedly called for.

You may ask why I am not "speaking up" in this manner. Although, I (and even my wife or family members) still have never experienced, as yet, all the behavioral mistreatments and suffering of emotional trauma as described here (or in the news media) and I have not witnessed this or having been told by my patients about this in the past, I can't ignore the experiences written here. However, I have not ignored what was written here and have written a published article about this in the American Medical Association newspaper and multiple times to two national medical ethics listservs, the latter with subsequent discussion.

So, my concluding advice is "speak up" and "go to it!" ..Maurice.

 
At Sunday, February 09, 2020 7:30:00 AM, Anonymous JR Issues4Thought.com said...

Dr. B.,

Can you give us a link to those articles you referred to in your post? I am collecting research material to use & those may be helpful and I am sure the others here would like to see them too.

Just been reading articles on pelvic exams on women & rectal exams on men while under. The defense is would you want a doctor who has never done an exam perform on you? or They have to learn somewhere. They say it is not sexual for them but what they don't realize is it is very personal for the patient. Everyone has the right to know & consent for anyone to touch their body. Just bc they are "under" does not give them free reign to violate such a basic "law". It is no wonder their mass anxiety for patients thinking about being "under". These types of violations compound just the normal scary aspect. It would probably be safe to say that all patients in big medical centers are subjected to these exams & many of them will never realize it until they read an article like this & the thoughts of did it happen to them will creep into their mind. Their MRs will probably not disclose the info so they will never know who, how many, etc. So the mental health harm has been done & the seeds of physician distrust have been planted and are thriving. Of course, they could hire a standardized patient. They could get proper consent & even offer the patient an incentive. But no they do sneak attacks which signals there is reason for mistrust. If they cannot be honest and upfront with a patient then what does that signal? How can you supposedly tell them everything when they in turn purposely deceive you? That in turn leads to wondering what else they have deceived you about? Also, it is doubtful there is a record in the MRs saying exactly who was involved in the exam & exactly what they did & they found for future reference in case what they found but may have dismissed did matter. The performing of these intimate exams shrouded in secrecy is not unlike hostile countries carrying out forced experiments on unwilling captives. There is an uncanny similarity. For ones who have been given proper, real informed consent it is okay. I know Biker has no issue with med. students if done as he stated & I have no issue if a patient has been properly informed & have agreed w/o coercion or been deceived. I do have an issue when it is defended by saying it is the right of the medical community to do so & it is the responsibility of the patient to be a lab specimen. No to both. But I will not be that patient under any circumstances bc I don't they will want to be my lab specimen for the learning curve of my career choice of now.

 
At Sunday, February 09, 2020 1:19:00 PM, Blogger Swannie said...

JR,
Go to www.encyclopedia.com and download patients rights. At the bottom of the page are other topics too. It was updated on 23 December 2019
It will definitely help you with your campaign regarding dignity of males The second column is of great importance as it deals with consent.

If for some reason you can`t find the web page to download, i will copy the exact long web page address for you.

 
At Monday, February 10, 2020 6:43:00 AM, Anonymous JR Issues4Thought.com said...

Swannie,

I went there but got a notice saying the website was having issues. I will continue to try. Any info like that will be helpful and much appreciated. If you have the info downloaded already let me know.

I have became acquainted w/ another consent form victim from here in Indiana & we are going to work together on some of these issues. A lot of the issues stem from lack of proper consent whether it is an office visit, test, or actual procedure. Information is not given beforehand in a clear, complete manner. The "may, might, possibility, could, etc" needs to be narrowed down. Why is something needed to be? Who is going to do it? Who is going to be present & what are their positions and names? What exactly does the procedure entail & what are the deviations & what are acceptable deviations to the patient? What drugs are being used and why? What are alternatives? Consent are too broad and general to actually protect the patient. You should have all the details. Those forms do not give the details as generally you aren't given the details verbally either. It will take time as Indiana is so completely backwards and the medical lobbying groups have a stronghold. I am also going to still hammer my US Senators and Rep as this needs to be done on a national level to bring consistency. Banterings enlightened me about the Patient Bill of Rights but it needs to be expanded and made meatier. There needs to be real oversight.

 
At Monday, February 10, 2020 7:50:00 AM, Blogger BJTNT said...

JR,
You said "There needs to be real oversight."
Agree. I encourage your efforts.
BJTNT

 
At Monday, February 10, 2020 11:17:00 AM, Blogger Swannie said...

JR issues4Thought.com,

Here is the complete website:
https://www.encyclopedia.com/social-sciences-and-law/law/law/patients-rights

I wish i could use the info on this website, but unfortunately it`s only applicable to the USA. However i have enough articles containing all the relevant laws in South Africa to be able to prove coercion, battery and unethical behavior.

I do have a problem obtaining records of all medical staff present during my surgery. I can get ward records at a fee, but it won`t help me at all. In the hospital`s official reply to my complaint, the Quality Assurance Manager wrote: "I assume DR. XXXX ( male) Intern, did the catheterisation" As he was not present when the female doctor told me there are 5 females and one male in the operating room and the females will take care of me ( The male was the head of surgery dept., but not involved at all) ...it makes me wonder who else was then also present without my knowledge.The female surgeon signed off on my discharge paper as to what surgery was done without mentioning any other doctor`s participation.Maybe the Quality Assurance Manager is only lying, but it will be something for the lawyer to sort out.

I also observed most laws or rules/directives about dignity and patient`s dignity, feature almost exclusively to female`s genitalia and breasts. However a Professor in law at a university, assured me today that all laws have changed to gender equality.What is applicable to females are also applicable to males as absolutely no discrimination will be acceptable.

 
At Monday, February 10, 2020 11:27:00 AM, Blogger Swannie said...

JR issues4thought.com

Here is the complete website.
https://www.encyclopedia.com/social-sciences-and-law/law/law/patients-rights

I wish i could use it, but unfortunately it is only applicable to the USA.

I wrote much more in my previous reply, but it happens quite frequently when i try to post my comment, that captcha thingy does not work ( cannot connect to the re-captcha service) and when i reload the page, my whole comment is deleted.

 
At Monday, February 10, 2020 12:55:00 PM, Blogger Maurice Bernstein, M.D. said...

Here is the link to the blog thread containing the article I wrote to the American Medical Association News in 2008 for which I was given permission by AMA to copy into that thread "Medical Blogs: What are They Good For? My Answer on AMA News"

As I noted as introduction to the thread, at the time there was a great potential reading audience to read my published article though, as you will see, I received only 2 comments in response and I am sure not physicians.
Nevertheless..my writing was published.. so JR.."good luck" ..Maurice.

 
At Monday, February 10, 2020 3:42:00 PM, Anonymous JR Issues4Thought.com said...

Here is a post I received in response to an article I wrote about Unequal Gender Care for Men. I thought it was very telling.

"Very thorough I must say. You are very correct in that guys are not afforded anywhere near the privacy accorded the girls. When interning at a mostly male hernia facility we came in and rolled up their gowns to at least chest high to shave them. No curtains or drapes here pulled in spite of the fact that non med personnel were present getting final signatures and even some volunteers and family wandered in as they were totally exposed. I was only 19 at the time and we all wore masks so the poor guys could not see our smiles at their predicament. Yeah I thought it was funny at the time, but now realize how uncaring that must have made them feel."

I tried to screen shot it but couldn't so had to re-type but it is as it appeared w/ words spelled incorrectly. I think what this lady said is very enlightening?

 
At Monday, February 10, 2020 4:56:00 PM, Blogger Biker said...

JR, that post you transcribed is horrifying, though I suspect it was a long time ago vs something more current. I wonder if it was a regular hospital for the general public or perhaps a military one.

Those of us now 60+ years old can speak to males not being entitled to any expectation of intimate privacy in our younger years in any healthcare, military, or educational setting unless it was deemed offensive to females that might have been present. I can easily see what that woman described having occurred back then.

An example from when, in the 1960's, I was a hospitalized 11 year old early bloomer (and thus aware of my body): A woman (no idea what she was) comes into my room and without even speaking to me yanks my gown off leaving me lying naked on the bed and then proceeds to bath me. The door wasn't shut and I was fully visible to anyone walking past. No curtain was pulled and I was fully visible to anyone coming in to tend to or visit my roommate (another boy my age). It was humiliating. I never said a word to my parents because I knew I'd be chastised if I did. Authority was not to be questioned, and this woman by virtue of working there (and being an adult) was authority. More importantly I already knew the unwritten rules that boys were not entitled to privacy. I had already learned that in mandatory gang showers after gym class at school and from a school physical a few months earlier. That school physical entailed us 6th grade boys lining up in the main corridor of our Middle School in just our underpants waiting our turn to enter the nurse's office for our physicals by the school nurse w/her female asst at her side. As each of us had our turn (in full view of the boy next in line behind us) we had to drop our underwear (why I have no idea). To make it worse, it was next to an open doorway to the main office where we were visible to women working there, and anyone that happened to walk in. Our male gym teacher supervised us boys in line. No complaining was allowed.

So, what that poster described is very believable if it was from back in that era.

 
At Monday, February 10, 2020 5:40:00 PM, Anonymous JR Issues4Thought.com said...

Biker,

Her pic shows about a 30 something year old and her bio says she got her RN in 2013 so I am thinking it was about 10 years ago or so. Actually, I think what she described is likely still happening in todays world for male patients. Things have not improved for most men in how care is delivered. For women, there have been advances but only while they remained conscious. Once sedated, they are as likely to be sexually molested. But for most men, it seems to go with being a male who receives healthcare. Even her attitude now that she is an RN doesn't sound as if she truly recognizes the mental harm she and her "girls" did to those men. I gave her a lecture but so I don't know if she will respond to me again but I am going to ask her if she has changed how she deals with male patient dignity. I tried to be nice in explaining how some males might have felt.

 
At Tuesday, February 11, 2020 4:30:00 AM, Blogger Biker said...

JR, if that post was describing something from 10 - 15 years ago then I am truly horrified. While I can understand any individual trainee such as the poster being too immature to grasp just how wrong the processes were, how could the people in charge have not seen it? It sounds like an organization still operating in a time warp from decades early.

 
At Tuesday, February 11, 2020 7:16:00 AM, Anonymous Anonymous said...

Hello JR,

Would you please post the URL of the nurses statement and your retort as well as the bio you mentioned. Thank you.

Reginald

 
At Tuesday, February 11, 2020 7:38:00 AM, Anonymous JR Issues4Thought.com said...

Biker,

Sadly, I think this kind of cavalier behavior is still very much happening. That is why many of us are on this blog. We have people telling us it still happens in today's medical world. I have talked to men who have experienced some smirky faced MA doing something that humiliated them but said nothing until I opened the door to conversation. Many man don't like how they are treated but don't know it should be done differently. Some are ashamed of what happened and thus remained silent. I have some say they just hoped it would be over with quickly & they would never have to see those females again. Certainly the medical community uses the perception of having more power and control than they really possess to intimate and elicit certain behavior patterns from their patients. I am trying to find that article written by a RN that talked about doing this same thing to her male patients but she would purposely have other females present just to humiliate them as she enjoyed the humiliation she was causing. So much for the do no harm oath or protect your patient oath. Yes, there are differences in how healthcare is delivered to males but also society needs to recognize that all medical providers are human and are subject to being mean, petty, inflicting harm, etc. as your average person. They do not check their total personality at the door and become this "professional" that never lets their personal biases or mental illnesses creep into their job. This is the myth that needs to be busted.
That is why I am so convinced that great changes need to be made. In today's world where laws may or may not have to be followed, where it is okay for feelings to be acted upon in unacceptable ways, retaliation for some perceived grievances are okayed, etc. it is indeed a scary place to be a patient especially if you are male or don't align with their personal standards.
How it is happening out here is not how the textbooks are teaching it. Maybe some of the educators are inserting their personal opinions. But I have read quite a few textbooks trying to glean why personal dignity is not important. There are few very articles from the US. Most articles talking about personal dignity come from other countries. So that begs why doctors from these countries do not make sure their US patient's dignity is respected? That is a really good question.

 
At Tuesday, February 11, 2020 9:21:00 AM, Anonymous JR Issues4Thought.com said...

Reginald,

It is on Quora under my article "Unequal Gender Care for Male Patients". It was one of the comments to my article. I had a couple others but this one really stuck out. If you look at her pic and read her bio you will find she is now a RN. I am looking for other places to put this article. It is also on my website but the response came from Quora. They will keep re-circulating it over and over so it is bound to pick up more responses. I have been Quora in order to get issues out there because patient dignity and how healthcare is delivered seems to be a subject not much talked about especially since we are likely to have medical encounters at some point during our life. From what this poster said, I don't really think she understands the mental harm she and the others did to each and every patient that was in essence sexually assaulted as she made it clear what their intent was and how it was done.

 
At Tuesday, February 11, 2020 10:37:00 AM, Blogger Maurice Bernstein, M.D. said...

AS OF FEBRUARY 11 2020, VOLUME 108 WILL BE CLOSED FOR COMMENTS. FURTHER COMMENTS CAN BE WRITTEN TO VOLUME 109. ..Maurice.

 

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