Bioethics Discussion Blog: Preserving Patient Dignity (Formerly Patient Modesty) Volume 109

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

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

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

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

Tuesday, February 11, 2020

Preserving Patient Dignity (Formerly Patient Modesty) Volume 109




JR wrote today in Volume 108 "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."  and but this why "speaking up" both to the profession and to fellow patients is so important and has been stressed on this blog thread. Every patient, provided
valid information or witnessing improper professional behavior has every right to express a "No!". 



Graphic: From https://giphy.com/ via Google Images

32 Comments:

At Tuesday, February 11, 2020 11:48:00 AM, Blogger Maurice Bernstein, M.D. said...

JF wrote the following on Volume 108 after it was closed for further comments. ..Maurice.


The root of these problems are in the ability/desire of empowered groups/people to silence other people's voices. And while modesty and dignity is extremely important so are other issues that get glossed over. How many times have Republicans won the Presidency? And yet abortions continue on and on. They always will, until God destroys this world. Why are we permitting lawmakers to make our laws? Are they doing such a super job of representing our needs that we just HAVE to keep them around?
Do our letters and emails and other communications have anything close to visible results? Are these people so poorly paid that we just can't resist keeping them around?
Anything can happen unless/until we get our fair share of voice about how things are done. And JR , I'm not bashing Republicans in this instance. I used to be one. ( because of the abortion issue ) But we've been absolutely unsuccessful in getting abortion outlawed. Çhildren Services is a sham much to often. Although I know of two cases where they accomplished a successful outcome. More often they don't even try. Police brutality. Wrongful arrests and wrongful convictions.
All these injustices run together because we the people are made to shut up! JF

 
At Tuesday, February 11, 2020 3:29:00 PM, Anonymous JR Issues4Thought.com said...

JF,
I am an equal opportunity basher so have at it. .



 
At Tuesday, February 11, 2020 9:42:00 PM, Blogger Maurice Bernstein, M.D. said...

Let's dissect the action of saying "NO" to your doctor or nurse. What action, words or behavior would you essentially say "NO" to your doctor's or nurse's words or other behavior. Does anyone here feel that you should say "NO" but you don't because it might be damaging to you either related to your underlying clinical condition or embarrassment or get into some legal or financial trouble?

If you say "NO" is that an expected sufficient response or must you follow the negative with some detailed explanation or do you feel in most cases this single word response is sufficient? Do you feel the need to "educate" your doctor or nurse or one word is enough and no further explanation is necessary? As the patient, what do you expect should be the response of the doctor or nurse?

If you were one of those medical professionals and a patient said "NO" to your advice or behavior how would you respond to that patient? Would you enter into an argument with the patient? Should the professional ever argue with the patient?

I apologize belaboring "NO" but I was impressed by my GIF graphic for this Volume and wondering if "NO!" is or should be the full and sufficient response by a patient. What do you think? ..Maurice.

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

On Monday I had my 3 month check with my urologist, then on Tuesday I had my appointment with my primary family practice physician. I had previously ordered some brochures from Medical Patient Modesty and I was armed with "Men and Modesty in Medical Settings" which I provided to both practices. On my last visit with the urologist, the medical assistant was unusually casual in performing my workup. She was new and it was the first time I had been attended to by a medical assistant in that practice. As I may have previously posted, she is the one who tried to open my pants for the bladder scan without asking me first. There were a couple of other things she did that were unprofessional and made me feel uncomfortable. Mainly, she was just too familiar and crossed some boundaries. I called her supervisor the next day and complained.

On this visit, I was called from the waiting room, and a female LPN who I had previously been attended to by asked me to do the usual go to the bathroom, provide a urine sample and then finish emptying into the flowmeter. Then I exited the bathroom and she asked me to sit and wait for a nurse whom I had previous experience with. That nurse brought me into the exam room and started the workup. I knew something was unusual about this. She told me that the medical assistant who attended me 3 months ago was unaware of my abuse history and that was the reason things went bad. She said the MA felt bad about what had happened but understood my anxiety. I said that my records should have been flagged with an alert and the nurse said that that was now the case but furthermore, she had been assigned to be my nurse for all my future visits since she was familiar with me and we had established a good relationship. This nurse was formerly an LPN but had graduated from an RN bridge program and was now an RN. I congratulated her on her accomplishment. My BP was 180 over 90 which highlighted my concern. But now going forward I am relieved she will be the nurse accompanying me in future visits since she is very aware of the abuse history and I am comfortable with her. In my previous procedures I had a male PA who did the intimate stuff during my urodynamics, cystoscopy, and TRUS with biopsy. The nurse was present for this but kept her back to me. So far, she has not seen my intimate parts.

The problem is the doctor has been unable to convince management to hire another male PA or ARNP since the departure of the last guy. My PSA has jumped from 4.5 to 7.4 since my last visit so the doctor recommended a new biopsy right away. I provided the brochures to him and asked him to have the female staff read them and to send them to management. He said he would. I brought up the matter of the procedure shorts and they said they would order them for me. I took it upon myself to order some from Prime Pacific just in case. I will have the biopsy next Wednesday. I am worried the cancer is getting aggressive, but it could be just an inflammation that's causing the PSA to rise.

When I went to my PCP on Tuesday, I gave him copies of the brochures and asked him to distribute them around the practice and give a copy to management and he said he would. My PCP is concerned about some other issues which we will address in the coming weeks.

We will see what effect Misty's brochures will have going forward.

58flyer

 
At Tuesday, February 11, 2020 11:36:00 PM, Blogger 58flyer said...

Dr. Bernstein,

In response to your question of saying "No" to a doctor or nurse, I would say that should be enough of a notification for them to stop in their tracks to find out what the issue is. "No" is pretty much a universal denial to stop what someone is doing and to proceed anyway would constitute battery. My personal choice of words would be "Stop" as that gets attention also and it means the same thing.

I am past worrying what the medical person thinks of me and I am only concerned what is best for me as defined by me. I would expect that the words "Stop" or "No" would be shortly accompanied by an explanation of my concerns and I would be happy to provide an explanation. If I see something going wrong I feel I need to get it stopped right away and fix the problem and a short directive to stop is the best for all concerned. Then we can proceed with what my concerns are and if they will be able to meet them. Then I can make the decision to continue as is, continue with a change, or go elsewhere.

58flyer

 
At Wednesday, February 12, 2020 5:27:00 AM, Blogger Biker said...

"NO" is appropriate to stop an imminent harm but otherwise it is not enough of a descriptive to convey understanding or move an issue forward. For example if a nurse or MA without asking permission starts to lift a patient's gown, NO is going to be the most effective mechanism to stop them, but then it needs to be followed up with the "what are you doing" type questions and/or expressing your wishes on the course of action to be taken.

In the absence of an imminent harm, explaining your concerns or wishes (rather than simply "NO") will provide the staff with input that allows them to possibly offer alternatives that accomplishes the goal in a more satisfactory manner.

In the end the choice is ours to proceed or not, but simply refusing a procedure w/o further explanation possibly denies us healthcare we needed and that was possible with some protocol changes if we allowed the staff to offer those changes. Just saying no doesn't give them enough input to react to.

 
At Wednesday, February 12, 2020 8:51:00 AM, Anonymous Anonymous said...

JR, I hope I didn't come across as making this about Trump. I was TRYING to make it about the common citizens don't have enough say about creating laws and doing away with laws that aren't working. I like hearing from you, regardless of our different reactions of politics. JF

 
At Wednesday, February 12, 2020 10:15:00 AM, Blogger Maurice Bernstein, M.D. said...

Thanks to 58flyer and Biker for their responses to my NO! question but one of my questions I don't think was answered:
"Does anyone here feel that you should say "NO" but you don't because it might be damaging to you either related to your underlying clinical condition or embarrassment or get into some legal or financial trouble?" Do you feel that every patient has the potential to freely and safely to themselves simply state "NO" and be confident that there would be no personal repercussions? This is an important consideration to the "speak up" advice to patients. ..Maurice.

 
At Wednesday, February 12, 2020 10:24:00 AM, Anonymous JR Issues4Thought.com said...

I have said "No" to different situations like being trained on or having an observer. Most of the time as I have female doctors, they understand "No" means "No" w/ no explanation being necessary. The times I have gotten pushback are from female nurses. Obviously, they don't know or don't care that a patient $ only a patient only has the right to decide who, what, how, etc happens to their body. I don't feel I owe them an explanation but have retorted back if they think it should happen, then they should be first while I observe to see how it happens as seeing it happen could help change my mind. No takers. One was angry but as I reminded her my dr. was in the room next door as she had just had her baby. If a nurse was standing just looking during a pelvic exam, I would say move as that was just creepy & they'd move. W/ my reg. dr she knew my feelings & accommodated them. Even w/ a C-section, I was in & out of the hospital w/in 24 hours. For others I have talked to, some of the reasons they didn't say "No" were being afraid of making the med provider mad. In making them mad, their exam might be rougher (rectal), they could be dismissed as a patient, the medical provider might refuse to do whatever & the insurance would make them pay the entire bill, they didn't know they had the right to object, they were never asked but always rather told, & yes some were even to shy or embarrassed to stand up for themselves even knowing they had rights or something was being done they didn't like. However, the common thread is most feel upset after the encounter no matter what the reason they didn't say "No". Ones like me who do say "NO" have one thing in common is that we resent having to be put in the position of having to say "No" bc it does change the mood of the visit far too often. A medical encounter should not turn into a power struggle to maintain your personal dignity or beliefs. The issue of your health should be the primary focus & many have trouble remembering what is said so the additional stress of the adversarial situation of "No" add to this. In my presentation, I state common issues like chaperones, observers, etc should be advised upon the setting of the appt At the very least upon confirmation of appt or least acceptable upon checking in. No patient should be ambushed sitting on an exam table in various states of unaddressed as it automatically mentally puts the patient at a disadvantage. This is where many are put & they do not feel able to say "No" at that time and they know it.
I think "No" at that time is enough. However, I think after the exam education is in order. If it is an issue of dignity, perhaps a brochure from MedicalPatientModesty should be given to them. Let them know it is a real issue with more than you. The medical provider should not argue, try to persuade, etc. They should accept the patient's answer w/ a high level of professionalism. I think issues of conflict should only be discussed when the patient is fully clothed & is mentally the same footing as the provider. The mental pic of a gowned or disrobed patient gives the med. provider the idea they still have control over that patient person while also giving the patient person a disadvantage.

 
At Wednesday, February 12, 2020 10:33:00 AM, Anonymous JR Issues4Thought.com said...

If it is about a procedure, medication, or something along those lines, a med provider has the responsibility to give info so the pt can make the best decision. They should never argue but they can try to persuade. I would expect them to defend what they feel is best. If they present enough facts, then I could change my mind about a treatment or drug but I would take their advice & do more research. It has been my experience that nurses are the ones who tend to want to argue or turn paternalistic. MAs just flat out say it is the way they were told it had to be done. They have no thinking ability of their own.
My husband was one who didn't like to confront or upset them in fear of retaliation but learned to speak up. During this last time, I did not speak up & everything went wrong but in that hospital I sensed something different & unfortunately I was right.

JF,
I used to be a Democrat and now I vote my conscience and what I think works best. I have changed my mind a lot over the years as I have gotten more info than I had when I was younger. I just wanted to let you know that I was not offended as everyone even the ones with "wrong" opinions have the right to voice them. The silencing of the other side is one of the biggest crimes in today's society and it spills into areas such as the silencing of patients who have been harmed by the medical industry.

 
At Wednesday, February 12, 2020 11:59:00 AM, Blogger A. Banterings said...

Maurice,

I brought this subject up with my friend up north. He said that he had a recent, bad experience. This was his response in an email to me (as always, used with his permission):


I said NO and it was ignored. My doc brought up the issue of PSA testing by saying because of my age he is ordering a PSA test. I said NO, and my reason was because the whole PSA screening will distract focus from my healthcare.

Guess what? It did.

I also had an X-ray for a pinched nerve. At the 2 subsequent visits, he was pushing that PSA snake oil, talking about the "new, modern era PSA testing" (which is utter BS), aND he never mentioned ANY harms of testing.

I knew he was in the cult of religious cancer screening.

Automatically I would get defensive, and forget about asking what were the X-ray readings. It has been OVER a YEAR and I still don't know what was found.

My the beginning of my next appointment (first thing), I am going to start off with "I am very disappointed in you..." Then I am going to tell him what happened (he does not realize that he never gave me results). He is one of the better docs in our area; old school. Saying that he disappointed me is really going to hurt him (emotionally). When I tell how, that will cut him to the bone.

Of course, in the back of his mind is the fear of malpractice that will further haunt him. I am NOT even bringing up the implication of malpractice, that would override the emotions of hurt and failure with fear. Fear makes us strong, it invokes "fight or flight." I want sadness, self doubt, and self loathing to be the emotions that he experiences.

I will point out how his zeal for the cult of cancer screening distracted from my health care as I HAD WARNED HIM OF SUCH. Does a recommendation for screening that guidelines do not consistently agree upon trump a complaint of (current) numbness in my arm? Is waiting one more year?

A screening test is done to detect potential health disorders or diseases in people who do not have any symptoms of disease... Screening tests are not considered diagnostic... Source:

I will point out that by continually pushing the issue of PSA testing, this served only to make HIM feel better and has caused me (emotional) harm. I am then going to ask him to reflect upon this and his zeal for the cult of cancer screening so that other patients are not harmed.

Finally, I am going to tell him that the subject of PSA testing is permanently OFF the table. I do NOT want it brought up ever again (unless I bring it up).

I am really hoping that he has the common sense and intelligence not to bring up the topic of the other (or any) cancer screenings that he has been pushing (colonoscopy). That will only elicit my ire and I will permanently take the issue of ANY and ALL cancer screening OFF the table.



My friend up north's email made me think about another potential harm of screening, that is the distraction from the rest of the patient's healthcare due to the provider's zeal for screening when the patient refuses. If providers truly respected patients' decisions, they would just move on.

I am going to say it again: power corrupts and absolute power corrupts absolutely...

This is why power is being systematically taken away from providers.







-- Banterings





 
At Wednesday, February 12, 2020 4:00:00 PM, Blogger Biker said...

Dr. Bernstein, in response to your question:

"Does anyone here feel that you should say "NO" but you don't because it might be damaging to you either related to your underlying clinical condition or embarrassment or get into some legal or financial trouble?" Do you feel that every patient has the potential to freely and safely to themselves simply state "NO" and be confident that there would be no personal repercussions?"

For me I am very careful with my use of use "NO" because I don't want to be the patient that is deemed never satisfied and thus not taken seriously. As such I carefully pick my battles and look past less important stuff that may have been less than perfect.

I also try not to forget that my thinking is further evolved on these matters than theirs. This is where I sort of am at with the dermatology practice I go to. They know I want my privacy respected and I'm coded that way in the EMR system. Despite me being clear that all I want is to not have any female LPN's & scribes just standing there observing the genital part of my skin exam, they're needlessly carrying it further than that.

To explain what I just said, for my most recent exam, upon check-in I say its been a year since I was here do you have any male nurses or scribes yet. I expected the answer to be no but I was curious nonetheless. The answer was yes they do have a male scribe now but he's currently working with a different doctor & maybe they can get him swapped for my visit. I say no need to do that I can I talk to the nurse when I get roomed; but she runs off trying to re-juggle the scribes anyway. I appreciate her effort but it wasn't anything I asked her to do.

I get roomed and I tell the nurse I want my privacy respected in terms of not having female observers for the genital part of my exam. She tells me she understands completely and will take care of it. Later she comes back after I have changed into a gown and tells me no residents or students will be with the doctor, she'll stay away, and the scribe has been spoken to. In her quest to accommodate me she too carried it a step further than I asked.

The doctor & scribe enter and I don't know what the scribe was told but she faces away from me for the entire exam. It wouldn't have mattered because the doctor skipped the genital/rectal part of the exam, instead asking me if I had any concerns in those areas. Their protocol is the patient leaves their underwear on if they don't want that part of the exam. Mine had been removed but presumably trying to respect my privacy he skipped it on his own initiative. Even worse, my gown never came off my shoulders down onto my lap so as to examine my stomach/abdomen. Not much of an exam overall but the parts I can't see (back, back of neck & head) did get a good exam which to me was the most important part. He inserted a higher degree of modesty on me than I asked for. All in all they're trying too hard I think because they're still not fully understanding this male modesty stuff, and perhaps not enough male patients have spoken up so as to make my kind of request just part of a new normal. Because they're clearly trying I'm being patient in bringing them along.



 
At Wednesday, February 12, 2020 10:19:00 PM, Blogger 58flyer said...

Dr. Bernstein asked,

"Does anyone here feel that you should say "NO" but you don't because it might be damaging to you either related to your underlying clinical condition or embarrassment or get into some legal or financial trouble?" Do you feel that every patient has the potential to freely and safely to themselves simply state "NO" and be confident that there would be no personal repercussions? This is an important consideration to the "speak up" advice to patients. ..Maurice.

There was a time when I was hesitant to say no and failing to do so had bad consequences. I was worried that I might offend or be retaliated against. With one hip injection procedure I did voice modesty concerns and was retaliated against. In that instance I failed to discuss the past abuse history as my therapist advised me to do. Now it is my personal protocol to discuss clearly with my providers the past abuse. As in Biker's experience, they sometimes go too far. With my last hip replacement, I found out upon departure that my room had been placarded "NO Females." That's not what I asked for, but I did have an awesome hospital stay. With my recent urologist visit I saw that my doctor had noted in my records "patient is frightened to be alone in a room with a female." Again, that is not the case. Maybe they are overreacting.

As to your question of should a patient be freely and safely be able to say "No" and be confident that there would be no personal repercussions, I would say absolutely yes, they should be. And why not? It is the patient who is in control.

58flyer

 
At Thursday, February 13, 2020 6:10:00 AM, Anonymous JR Issues4Thought.com said...

I don't understand why the burden is on the patient to say no? Shouldn't the burden be on the provide to know when to bring up these issues and what issues to bring up? Shouldn't these questions be part of a new patient on-boarding and be part of the patient file? Would that not be a better solution if healthcare is truly patient friendly?

 
At Thursday, February 13, 2020 9:04:00 AM, Blogger Biker said...

58flyer, thank you for sharing your experiences. It is interesting that you too have experienced the overreaction which I suspect is from their just not fully comprehending the issue. The big question is why it is so hard for them to understand that some men object to being intimately exposed to the female nursing & other staff, especially when that exposure isn't necessary.

My most recent summary from my dermatology visit includes near the top in bolded red lettering: NO RESIDENT/PREFERS MALE PROVIDERS

I have never requested no Residents. My very 1st visit there was with a Resident. The Resident's behavior was very unprofessional as concerns my modesty and I complained. Somehow the problem has been interpreted as a problem with Residents rather than with the behavior of that one Resident. I have a brief follow-up appt. coming up, surprisingly with a female Resident, and I will try to get that NO RESIDENT language removed.

As for the PREFERS MALE PROVIDERS, yes I want male providers, but only to the extent intimate exposure is involved. I have no concerns whatsoever that I am scheduled to see a female Resident because that visit does not include intimate exposure.

It'll be interesting to see if this female resident sees the note before my appt. and I suddenly get switched to someone else.

 
At Thursday, February 13, 2020 11:18:00 PM, Blogger 58flyer said...

JR says,

"Shouldn't these questions be part of a new patient on-boarding and be part of the patient file? Would that not be a better solution if healthcare is truly patient friendly?"

I totally concur. Patient preferences should be a part of the initial consult and be a part of the patient records going forward. Anytime the patient is referred to a specialist, the preferences should be relayed to that specialist. That way there is no need for the patient to continually make their preferences known. If the patient requests gender concordant care, that should be passed along to the specialist and that specialist should honor the request or advise the PCP of their inability to meet the request so the patient can be referred to a specialist who can. However, I think legislation will be the only remedy.

58flyer

 
At Friday, February 14, 2020 11:26:00 AM, Blogger A. Banterings said...

JR & 58flyer,

Is that NOT part of the snake oil called electronic medical records that the public was sold?




-- Banterings


 
At Friday, February 14, 2020 2:26:00 PM, Blogger Maurice Bernstein, M.D. said...

My opinion which should be taught to all medical students: medical or surgical specialists have for a time in the patient's illness the patient's physician. Don't look at them as some "attachment" to the patient's primary physician. And in the developing relationship between the patient and specialist, that developing relationship demands (unless the patient has no capacity, at the time, to communicate or life or death emergency) communication between the two parties, if not simple review of medical/surgical history, certainly requests and attitudes of the patient toward the specialist. Yes, the primary physician may include some of the "patient behavior" to the specialist but I would look at that transmitted information as biased based on the primary physician's impressions.

My advice: Transitioning temporarily to the clinical management of a specialist still requires ongoing or previously experienced issues of the patient to, by the patient, directly communicate these issues to the specialist. The specialist skimming through computer notes about the patient, in this regard, may readily (in a few words) provide nothing or biased information. My advice: "speak up". And yes "NO!" should apply to your specialist as well as primary general physician.

And yes, I have said "No" to my own physicians, both general and specialist, and they have listened and responded to my personal satisfaction.
Don't explain this personal experience as VIP response. I would have reacted the same if my patient was not a physician. ..Maurice.
..Maurice.

 
At Friday, February 14, 2020 4:31:00 PM, Anonymous JR Issues4Thought.com said...

The EHRs just compound the issue. There are many notes contained in the EHRs that are similar to a sticky note that the patient will never see but other providers will. These are usually personal notes so there is a bias caused by the use of EHRs. There are things said about you that you will never guess in a million years. The EHRs are a very real invasion of privacy as you have no control over who sees your info and furthermore, you will never know as they won't be honest unless they are forced. Your personal info is treated as badly as your personal dignity is treated.

58flyer,

At the beginning of every school year, I would make it a point to find out what my students liked to be call, what subjects they struggled in, what subjects they wanted to learn, what their hopes & dreams were, etc. In order to better help them, I made/took the time. I did it bc I cared. The fact the medical community does not do this shows a very glaring lack of caring or compassion. Medical apps are sometimes stressful enough but to add in how badly healthcare is delivered compounds the stress. They don't seem to want to understand this by changing and indeed becoming patient friendly. It is smoke and mirrors. How they have handled yours and Biker's requests show they are not willing to take the time to really listen to what you are saying. I can't imagine what the sticky notes in your file says but I bet it is not good.

We told the dr's office in 2 previous visits my husband needed to a notation made he was a victim of medical sexual assault. For whatever reason, they didn't probably bc they didn't want to acknowledge it in writing. So they instead re-traumatized him by the MA assuming rights she did not have over him. The only assumed consent was he was there for a checkup. There was no consent given by him as to how it done nor did they explain or ask for permission. They assume too much and give too little in info and absolutely refuse to acknowledge patients have rights.

Dr.B.

They still know you are a dr. Unless you go somewhere else & do not use your MD title, you will never know for sure if the title influences how you are treated. Really, as a patient, there is no need for your title to be used when you are seeking healthcare treatment. But I doubt some 20 something MA calls you Maurice like she calls us ordinary fold John or Mary? So just by using your title, you have built in respect whereas we don't.

 
At Friday, February 14, 2020 9:43:00 PM, Blogger Maurice Bernstein, M.D. said...

To All: Please, please go to this link to Health.U.S.News.com and read the brief but tabulated article "How to Talk So Your Doctor Will Listen" but then near the bottom please click on or click here to read "12 Signs You Should Fire Your Doctor". Follow the links. This series of two subjects should provide ample ammunition for discussion here and some handy hints on moving on with your medical care when you have decided that a change is necessary.

Have you learned anything of help to you as a patient from this documentation? ..Maurice.

 
At Saturday, February 15, 2020 12:16:00 AM, Blogger Swannie said...

Dr. Maurice,
In response to your question about saying no to medical staff or a doctor:

I said No when told to remove my underpants, but then the doctor told me i may get burned in case of a short circuit with the electric instrument she would be using.

Therefore who would not comply with an order to avoid physical harm ? Yes it was an order and not a request! Only through my research i found out it was a classic example of coercion.

And by the reply of the hospital, the reason changed. The electric instrument would not cause a short circuit, but if a male`s underpants may get saturated by alcohol during prepping, the vapors may cause a fire due to combustion.

Still wondering how much alcohol is needed during prepping to saturate underpants.

Therefore to avoid being burned i had no other option than to say yes.

 
At Saturday, February 15, 2020 11:55:00 AM, Blogger Biker said...

It is just anecdotal but I have noticed that doctors seem to be better listeners when you are the 1st patient of the day. I feel less rushed and the doctors seem less stressed. When you are amongst the last patients of the day the doctor is carrying the stress of whatever that day has brought. Just anecdotal of course.

If my appt. is delayed I don't let it stress me. When the doctor or the staff start apologizing I say no need for that, it is good you took the extra time for patients that needed it, someday I'll be that patient and will be glad if the extra time is taken with me. This serves to de-stress them a bit as it is not the reaction they expect.

I don't have much experience firing doctors in the context of what the article is talking about. I changed urologists because I was tired of driving 4 hours each way to Boston. I left a couple local doctors so as to consolidate all my care in a single non-local more full service hospital. I fired several along the way for causing needless extra appts so as to run up the bill. An example of that was a cardiologist that said I needed to come in for a follow-up after a test (which I already had the results of). I get to the appt. and a nurse comes in and asks if I had any questions. I said no, it was the doctor who wanted to talk to me. She didn't have any further questions and that was the end of that office visit. Never saw the doctor and it was billed as an office visit. Never went back there again.

 
At Saturday, February 15, 2020 11:17:00 PM, Blogger 58flyer said...

Is that NOT part of the snake oil called electronic medical records that the public was sold?
-- Banterings

Banterings,
Perhaps, if used as it should be, and the patient has access to ALL information, including physicians notes, then all is well. We know all is not well, big change is needed.

58flyer

 
At Saturday, February 15, 2020 11:28:00 PM, Blogger 58flyer said...

As to the topic of EHRs, legislation should be passed that stipulates that the patient, as the one who is in control of his healthcare, should have access to all information contained therein. That would "sticky notes." So far my urologist has supplied me with a paper copy of the records he will submit to my PCP. On my next visit next week I will just have to ask if there are "sticky notes" from the urologist that I can't see. I think my PCP is quite honest with me. I will bring along my urology file to show him to compare what he was sent. I'm rather curious about this. I have no reason to believe my urologist would not be totally honest with me but I would like to know for sure.

58flyer

 
At Saturday, February 15, 2020 11:49:00 PM, Blogger 58flyer said...

If I kept a file of "Thoughts that go bump in my head" this would be one of them.

I have observed that a lot of healthcare providers deliver their practice according to what their liability insurance carrier demands. I'm not an insurance specialist and I don't know anyone who is. I am sure that the insurance companies have standards and research that they look to to determine their liability exposure. And I believe they are constantly looking for ways to reduce their liability obligations. So much of the way doctors practice is determined by their liability underwriters. So, basically, a lot of what happens to us in the hospital or clinic is based upon the demands of the insurance carriers, not sound medical research. The notion that female providers must have a "chaperone" for male intimate exams is probably based on an medical liability insurance requirement.

The insurance companies could be our friend. If they could be made to understand that a female chaperoning a female with a male patient is just as liability packed as a male chaperoning a male with a female patient, they just might just mandate a change. There is plenty of data on female medical impropriety with male patients to alert the insurance carriers as to the possibility of liability claims. They might just rewrite their policies.

Thoughts?

58flyer

 
At Sunday, February 16, 2020 2:24:00 PM, Blogger Maurice Bernstein, M.D. said...

So much of what is written on this "Preserving Patient Dignity.." blog thread deals with a matter of "bad doctoring". So, with this in mind, I looked back to my 2008 blog tread title "Doctors' Bad Doctoring and the Their Penalty". The thread contains my review, at the time, of the quarterly Medical Board of California's actions taken against physicians which brought up a bunch of reader comments on the subject which, reading the thread now, brought up some issues pertinent to what is being described on our current thread topic.
Take a look and if you have a comment to make you can write it there or bring it up to our current subject thread.

I've had so many topics related to the ethics within the medical system published here over the years since 2004 that it is worth integrating them into the current threads as considered pertinent. ..Maurice.

 
At Sunday, February 16, 2020 4:38:00 PM, Anonymous JF said...

I don't know if anybody agrees with me or not, but I don't get why its regarded as so awful wrong for a doctor or nurse to become involved with a patient or at least a person who used to be a patient. Plenty of people meet through their jobs ( or one of their jobs ) As far as chaperons go, just male attend to male patients and females attend to female patients ( if its something that requires nudity ) but a lot of intimate care/exams shouldn't be happening. Swabbing for example. Patients usually could do that themselves and should be given that option.

 
At Monday, February 17, 2020 6:08:00 AM, Anonymous JR Issues4Thought.com said...

Swannie,

Their stories didn't match bc the real reason is bc they want to do prep fast & for their convenience. If you had anything on, they would have to slow down & be careful as it they got it wet, you could get burned. There are garments made to cover genitals but even those they don't like using bc again they have to be careful and not just slap it on. Their need for convenience overrides their obligation to private their defenseless patient just about every time.

58flyer,

Since part of our issue is the falsification of EHRs, I have done a lot of research. What I have found is part of the "sell" is EHRs use cut & paste, or click a phrase. Adding items in your own words is discouraged bc if there is a malpractice suite, using your own words is more likely to show the wrong committed. Their standard, pre-chosen phrases limits this as there are prompts that show which phrases should be used for every type of procedure or care. This limits saying something that could be helpful in showing what went wrong. Oftentimes, they do EHRs way after a procedure so things become foggy too. As for one dr. sharing private info from another dr., I wouldn't count on it. There is a solid personhood of protection. Those sticky notes aren't meant for you to see. I talked w/ the insurance company about the sexual assault & they just seemed immune. They didn't care. In the medical world, this type of behavior seems to be acceptable as part of the risk of receiving medical care.

JF,

The reason I am so opposed to involvement is medical staff says seeing you naked is not something sexual to them, they're not check you out. If you throw in dating a patient, then the sexual aspect is very real & at any time, your medical provider could be for real 7 not just in theory, checking you out for that potential date. For patients to be in a more safer atmosphere to be naked, there must not be the accepted potential of physical involvement. This is how I see it.

Banterings,

Again, we're in total agreement.

 
At Monday, February 17, 2020 4:45:00 PM, Anonymous Anonymous said...

JR, Doctors and nurses don't always see their patients naked. And it should happen a lot less than it now happens. When it just can't be avoided then the male staff should attend to male patients and female staff should attend to female patients unless the patient requestes otherwise. As far as intimate exams/care being sexual to providers, sometimes it is. Everybody knows that. JF

 
At Monday, February 17, 2020 5:59:00 PM, Blogger Maurice Bernstein, M.D. said...

What I read and re-read here is about the stress of being a patient.. not just related to being physically sick but how one is being treated by others in the medical profession as their patient.

Now I just read today, and reminded or, in my case, informed that STRESSED is actually DESSERTS spelled backwords.

Yes, I know that PTSD has been attached to many of those who have written to this blog thread. Yet..
has anyone found a tasty (not sour) ending to any of your stressful experiences as a patient? Is there something "good" or "acceptable" to recover after being stressed? Maybe the dessert is "education"..to know what to expect and thus to be "on guard". What is your opinion about looking at STRESSED backwards? ..Maurice.

 
At Monday, February 17, 2020 6:25:00 PM, Anonymous JR Issues4Thought.com said...

As a dr., you know that DESSERTS lead to weight gain that could lead to diabetes, heart disease, increases the chance of certain cancers, etc. so there is not much of a bright area in DESSERTS vs. STRESSED.

Yes, both my husband and I have PTSD. The "sour"ness of what happened, a rape, and battery will never fade or disappear. The feeling of deep violation is one thing that cannot be forgotten. I really don't know how you can recover from rape and captivity especially knowing the guilty parties are still there ready to do it again (not only the actual ones involved but also any medical encounter could end the same.)

However, I now have made patient rights a part of my life going forward. I want to educate others so they don't become a victim like my husband. I want to give them the info they need to retain their dignity and control. No one should be sexually assaulted especially during a medical encounter. No one should be forced to have a medical procedure. No one should be forced to anything they do not agree to during a medical encounter. Nursing homes must become safer places for older citizens. I have met a lot of nice people. I hope that our story will help some avoid being victimized. Doing research & speaking to others help me as maybe I can prevent them from the same awful fate. It is also depressing because change will be very hard to bring about but I won't stop.

 
At Monday, February 17, 2020 7:36:00 PM, Blogger Maurice Bernstein, M.D. said...

JR you conclude with "I hope that our story will help some avoid being victimized. Doing research & speaking to others help me as maybe I can prevent them from the same awful fate. It is also depressing because change will be very hard to bring about but I won't stop."

And as I look at what you wrote, your response and observing its effect to the benefit of others who have been or might be stressed within the medical system will end up being among your delicious but healthy desserts. ..Maurice.

 

Post a Comment

<< Home