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Preserving Patient Dignity (Formerly Patient Modesty) Volume 110
This graphic reminds us and summarizes all of the concerns repeatedly described with detail on this blog thread. It comes from Google Images and I don't recall displaying it on a previous Volume of our topic. I am sure there are additional "misbehaviors" and worse which you could add. ..Maurice.
AS OF MAY 8 2020 NO FURTHER COMMENTS WILL BE PUBLISHED ON VOLUME 110. Continue your Comments
on Volume 111.
184 Comments:
Here is a possible "misbehavior" toward his patient by 58Flyer's urology clinic which was the last post on Volume 109 but I think should have followup discussion here on this new Volume. ..Maurice.
At Saturday, March 28, 2020 2:36:00 PM, Blogger 58flyer said...
After my urologist dropped me a few weeks ago I was able to locate a urology practice in my area which had male personnel at the assistant level. I verified this by calling around until I found them. So, I had my PCP do a referral to them. After some difficulty in getting the prior uro to fax copies of my medical records to them, one of the urologists in the referred practice declined to take my case. I was told this by the new patient coordinator and the doc gave no reason. This was last Wednesday. I asked the girl if there was another doctor in the practice and she verified there was. So I asked her to give the other doctor my referral. On Friday, she called to inform me that the other doctor declined me as well, again with no reason given.
No doubt my prior uro put something in my records that is scaring any new doctor from taking me as a new patient. I fear that will also be the case with any other new doctor. I am tempted to call the patient coordinator and ask to see what was sent to them. I did ask for and received a copy of my medical records from the prior uro. I didn't see anything suspicious in them, so that makes me think there is some kind of special notes that the prior uro wrote that I was NOT provided a copy of. I will have to run this by my PCP on Monday and see if he has any ideas. Maybe he can talk to the referred urologists as a physician concerned for his patient and maybe learn something.
I cannot ignore a cancer diagnosis as my life depends on getting the proper treatment, and BPH has to be dealt with too. That's a quality of life issue by itself. Maybe one approach is to just do a referral for rising PSA and not bother to mention the prior diagnosis. I don't like that idea but what else am I going to do? I can't believe that high BP is the deciding factor, there is just no way that something so treatable would cause a urologist to not take a patient.
58flyer
58flyer,
We requested all of my husband's medical records from the hospital from hell. What we found were so many lies, falsehoods, etc. they were unusable. So we only took out of them we choose, and sent them to the new cardiologist with the instructions they would not to request additional information from anyone connected with the hospital from hell. We had no trouble finding him a new cardiologist except we interviewed many before we decided on who was acceptable. We gave him only the info he needed that way you control what they will learn and give them no right to ask for any records. Of course, you will need to be out of the same hospital system to probably successfully do that. Do not use that patient coordinator as she knows whatever is in the file & is likely passing it on.
Prostate cancer is a cancer that generally allows you time to make decisions and decide on what the proper treatment is. My husband waited 5 months after the biopsy before having anything done. Even then, the cancer was downgraded from the biopsy. Don't feel rushed or panic. Find the right doctor. Do your research beforehand to find out what procedure you are interested in and find a doctor who does it. My husband did not have his done here in Indiana but went out of state to do it. It really wasn't much trouble to do that at all. You have my email if you want to talk. Depending on what you have done, the BPH might be a moot point. My husband took his PSA score to other doctors as a second opinion and to see what opinions they offered in treatment. They key is different hospitals. And no, it is not your BP as he would have just referred you back to your FP or to a cardiologist to get it under control before he proceeded. It was he didn't like having for a patient someone he had to treat with trauma informed care because of prior medical sexual assault. They don't like to acknowledge about that type of sexual assault. I wonder if he also treats female victims of sexual assault the same way or if is reserved only for males or for medical sexual assault victims? The medical community will not admit there is a problem as that would open the door to scrutiny and they do not want that to happen.
JR, The way your husband modesty was violated speaks HORRIBLY about the culture of that hospital. Whoever the main instigator(s) were how did she know that she could exposur him to so many different people and for HOURS! It evidently happened often enough to make her/ them that bold to expose him for hours like was done. Or maybe it was like with Twayna Sparks and when it was told to the higher up , nothing was done. Except for one whistle blower getting fired.
JF,
You're probably right. She did know. It was a Sat. night so night & weekend shifts are devoid of staff. She and the other nurse probably cover for each other. I did some research on the other nurse and found out she has had some money & legal issues so it probably wasn't hard to convince her to be part of it. The main one is a drinking, party girl sort that in her social media likes to make fun of people. The room was full of people for only a couple of hours then afterwards it was just her and the other nurse which is probably how they pass their time. The criminal nurse was assigned 1 on 1 to him whereas the other was a social worker nurse.
However, the main issue with the others is that society in general is very accepting of allowing patients to be exposed in medical settings whether there is a need or not. Most take it as business as usual. There a few who don't do it but the majority do or are accepting of seeing it. It is sad that they won't tell unless they have an axe to grind with the criminal medical worker but that is how they are. The Twana Sparks nurse only reported her after she personally had been harmed in some way by Sparks if I remember correctly.
As far as his modesty being violated, it wasn't modesty that was violated. He had accepted up to that point in his life female staff for intimate care without issue. If she hadn't done what she done along with the cath lab, there wouldn't be any issues. He hadn't ever requested males for his care or really ever thought about it like many as he didn't know there were options. Many don't like it but tolerate it.
58flyer, I am so sorry that your former urologist blacklisted you as it appears he has. You might consider starting from scratch with someone without having your records transferred. Let the new doctor discover the prostate cancer for himself.
Do you all think that "some" of the behaviors which has been described here over the years could be established as simply as an ethical dilemma?
“What is an ethical dilemma?” It is a Conflict between…
ONES PERSONAL and PROFESSIONAL VALUES:
A physician has a duty to his family (go to the football game) but he also has a duty to the patient (admit the patient to the hospital).
TWO VALUES/ETHICAL PRINCIPLES:
A patient has right to reject a treatment (autonomy) but a physician has a responsibility to protect the patient from a harmful decision (non-malificence)
TWO POSSIBLE ACTIONS, EACH WITH REASONS STRONGLY FAVORABLE AND UNFAVORABLE:
Treating the patient with a drug which though may have bad side-effects could possibly improve patient’s illness but by withholding the drug the patient has a possible chance of spontaneously improving and not be burdened by the bad side effects of a drug.
TWO UNSATISFACTORY ALTERNATIVES:
The patient with terminal cancer who has stopped breathing will die quickly if nothing is done but his family would not be able to arrive soon enough to be with him before the patient’s death. However intubating the patient and putting the patient on a respirator will allow time for the family to come to visit him but only prolong an uncomfortable period of dying.
ONES' VALUES/PRINCIPLES AND ONE'S PERCEIVED ROLE:
A physician has personal values that define abortion as immoral and yet as an obstetrician in a small community far from medical centers is now asked by a long-time patient to perform an abortion.
THE NEED TO ACT AND THE NEED TO REFLECT;
The psychiatrist suspects that his patient might commit a homicide and should notify authorities about his suspicion but he is uncertain that he should divulge to the authorities the patient’s private history without more proof of the patient’s intentions.
An important point about ethical dilemmas to carry away is that it is wise to try to avoid the situation, if possible, where they can occur but also one should be aware that not all ethical dilemmas if they do occur are settled to everyone’s satisfaction. Often in medical ethical dilemmas, it requires some consensus amongst the public and/or physicians, ethicists, lawyers and the courts to provide guidance.
..Maurice.
How is some of this an ethics dilemma? 58flyer's dr has blacklisted him and is preventing him from getting cancer treatment in a timely matter. He is also adding to 58flyer's stress which is not good for his BP or his cancer. All done because 58flyer suffered a PTSD episode and this dr. has known for years about 58flyer's needed accommodation but suddenly had issues. That is not an ethical issue but the workings of a monster. The is a clear example of the medical community not valuing the mental or physical welfare of the patient. What has happened to 58flyer is just wrong & is another prime example of what is wrong in how healthcare is delivered to patients.
In my husband's case, where is the ethical dilemma? The nurse choose to sexually abuse him? There wasn't a medical need that she had to wrestle his exposure or he would die. She did it out a dark, evil, criminal urge. For medical battery, his treatment choice was his decision and not theirs. It is was not an ethic dilemma but rather one of saving face as they called in a cath lab team & someone had to pay for it. The sedation they did was to enable them to force him into a procedure that they needed to have done. We will never believe what they did was for his good---or there was an ethical issue they were wrestling. You give them way too much credit.
I can see in some of the situations you mentioned but I don't know any of us who have experienced those. The things committed upon us were issues that should not have happened as they in no way can be considered for the well-being of the patient or do less harm. Doctors have an obligation to provide us with choices. It is our decision, if able, to choose the direction of treatment. As for the doctor that night who complained he would have rather been home, we too wished more than you know that he had stayed home too.
JR, you have made your point with regard to your husband and 58flyer. And I can't say your response is inappropriate-- however, one thing is missing when discussing the two sides of behavior (ethical vs unethical) and that is, just as in matters of law, to hear both sides of the behaviors from both parties. Unfortunately, that is missing on our blog thread. We don't have the opportunity to "hear" both sides of the discussed behaviors. And there may well be two sides but our blog thread continues to miss a presentation for our understanding, discussion and conclusions based on both.
It certainly would be wonderful but intellectually fair if the "other side" was invited to argue their ethical defense on our blog. That "other side" should be informed by those writing here to feel free to present their explanations of the accusations presented here. There would be a lot to learn by all (us and them) if that response was possible.
Does anyone think that such requests for presentations by those accused of all degrees of misbehavior is something fully impractical or wrong to consider?
How can we perform bioethics discussion with regard to human behaviors when only one side is making a presentation and nothing is written here by another side?
If what I wrote is foolishness please let me know. But I think with regard to the consideration of ethical issues, both and all sides should be encouraged to contribute.
..Maurice.
No, I don't think hearing the other side is uncalled for but we both know that won't happen as many times people committing wrongdoing will not divulge their motives. And besides that, their sense of self-preservation would be too strong to engage in a meaningful discussion. Generally, it is usually only the victim of wrongdoing that wonders why and wants answers. The wrong side is usually silent as they stride to protect their actions. I would be all for hearing but then how can you verify what they are telling is the truth as at least in our case, there have been so many lies. For sure, our judgment of those people was not good or else we wouldn't be where we are at.
Maurice,
In regards to your last question in the previous volume:
There is NO reform. First off, these providers don't feel that they did anything wrong. How do you rehabilitate someone who feels they are innocent?
How many practicing physicians have performed intimate exams on anesthetized patients WITHOUT consent as pert of their education? How many ever made a public apology? Why does this still go on????????
JR,
For the mistakes in the medical records, sue them for defamation and slander.
Biker,
You can request a copy of your medical records from the practice that denied you. Technically, they are YOUR records and you are ENTITLED to a copy.
-- Banterings
JR, I understand your argument "many times people committing wrongdoing will not divulge their motives." However, shouldn't those who are accused of "wrongdoing" and find that conclusion wrong want to tell, explain publicly why their acts were appropriate considering the situation?
As you are anonymous on this blog, they can also remain anonymous to our readers.
It is just a suggestion to all here who have presented their side of the story to inform their "alleged unethical, misbehavioral" healthcare providers an opportunity, anonymous to all but known to you, to present their explanation of the behavior which was attributed to them.
One may say that this suggestion is impractical and/or unfair to one or both parties. But, since this is a discussion blog it seems to me that this suggestion, though it may be just "wishful thinking", is only an attempt for a full and fair discussion. Don't we want a "full and fair discussion"? If "yes" then we should attempt to get input from "both sides". ..Maurice.
Maurice,
Here is a news story where the exam was done by guidelines and the patient left with severe PTSD: IT WAS HORRIBLE, GIRL TESTIFIES AT GENITAL EXAM TRIAL
Intimate exams continue to this day on anesthetized patients without consent to this day. Despite EVERYONE in the healthcare profession saying this should not be happening, are all against it, professional organizations oppose it, yet it is still going on. Proof that the profession has some psychological pathology.
-- Banterings
Dr. B.,
Would you like the names of the criminals who assaulted/abused my husband. I too would like to hear what excuses or denials they would give bc it is for sure they would not admit their guilt as they know it would be used against them. They is nothing they could see that would make the pain, the trauma, the damage, etc. lessen or go away. I really don't think you understand how deeply they harmed. What was done to my husband was intentional, criminal harm. It was an "oops", "You have nothing special so don't be modest", "I'm in a hurry", etc. It was criminal harm. There also was a lack of consent which constitutes criminal battery in any other part of life. So please, ask those people.
Now, I could see in some cases that some might but not the ones who actually should be tried in criminal court. I have talked to nurses on other platforms and have listened to their reason and they have listened to mine. I have changed a few minds about patient dignity and of course, some I have not as they are worthless creatures in my opinion. They may do their job clinically but they do deep and lasting mental harm which jeopardizes the physical recovery and future healthcare needs of the patient.
JR, no.. I don't want the true names of either the victims or those accused to be posted here unless names have already been publicized in the news media.
However, it would be interesting for those considered "victims" to challenge the "offenders" to explain their behavior on an ethics blog (this one!), It would be so interesting and worthy to read an explanation of the behaviors documented here by the alleged victims. Wouldn't those visitors coming and reading our blog thread want to read those "offenders" explanations?
Again, the title of this blog itself is about "discussion" and true and constructive discussion requires the participation of "all involved" which also
includes the alleged "offenders". Now, of course, I realize the reality of this request but as moderator of a discussion, I look to input from all sides to make "discussion" as constructive and valuable as possible. Is there anything wrong to express this "hope"? ..Maurice.
banterings, I remember that case in PA when it made the national media for a bit if I am recalling the same one. I hope the girls prevail. I can't imagine what the school was thinking to allow that to happen. I also wonder if the victims were boys, would it have even made it to trial vs the lawsuits just being dismissed. Of course even if the girls win, that doctor and those nurses will retain their licenses and they'll go on doing physicals on kids in other settings. The best one can hope for is that a 3 week trial will have given them pause to rethink their protocols going forward.
I wasn't going to post them here but email works. It would be interesting to see what they would say to you in regards to the issues.
I have told a fair amount of medical workers about this blog. I wonder if any of them care enough to check it out? I agree with what you are saying in a sense of the non-criminal offenders as I engage in conversations with them all the time.
To me, it is amazing that so many of them have a complete blindness as to the feelings of the patient. Most dismiss modesty as a reason to have same gender care. Their attitude is especially harsh towards male patients. It is a suck it up attitude. Even when reminded that men are entitled to same gender care they still don't care. When compared to having religious rights/beliefs some see it differently. They don't really accept modesty as a reason; however, they do accept the term dignity better. When I ask them if a male doctor told them to strip what would their reaction be it is often one of outrage but yet they do it to male patients.
There is a big need to get into these hospitals and continuing learning areas as patient activists to educate these people on basic humane patient skills. So many of them are lacking those skills. But no matter how much education is done, there are some of the criminal types such as those who assaulted my husband that education won[t fix. Lose of license, jail time, fines, being on a list (sex offender), etc would go a long way. Lack of consent is also an issue that needs to be addressed as well as the consent forms themselves as they do not protect the patient but rather the doctor as many have blanket clauses.
Hello,
Throughout their medical education nurses and physicians have been trained to view genitals as just another body part, like elbows. Although some medical individuals may view genitals with lust or distain, these individuals are considered “outliers” by the profession. These few “deviants” are not seen as impacting the profession, in particular, or health care, in general. Thus, any patient asking for genital privacy is considered a flat earther or someone from outer space. Physicians have no time for this nonsense. They need to concentrate their efforts more effectively: changing males to females or females to males and devising new ways to extract inconvenient in utero beings (something done by no other species on the planet). Is it any wonder that no medical individual would “waste” any time with a blog dedicated to dignity/ modesty? Why would they countenance a topic so inane? There are not two sides to this issue. There is only the pontificated and the anachronistic rabble.
Satirically, Reginald
Biker,
That was a 1999 case, probably the one that you were thinking of. There was a similar case at the same time in Oklahoma that involved nurses and HeadStart.
JR,
Perhaps Maurice can speak to providers being unaware of such things. When I stopped lurking (about) 2015, Maurice did not think that patient dignity violations and the effects to patients were valid problem, the extent that they occurred, etc. He finally conceded saying something along the lines of "Although I have never personally experienced it, I cannot deny their existence or the extent that it occurs."
As Maurice is entering the healthcare system as a patient, I suspect that he will gain firsthand experience of dignity violations. By his own admission, he has already had a nurse take a pic (which did end up in his chart) of his exposed backside with her personal cell phone, he doesn't remember an explanation and asking for consent from admitting nurse, and a definite violation of dignity by a student nurse.
-- Banterings
Banterings,
You're right as he ages he will experience more things. The hospital from hell when confronted about the sexual assaults, said ______ should get used to such things as he was getting older and older people would have more medical encounters where nudity would occur. Apparently, from this, I was able to gather the hospital supports the sexual abuse of its patients especially the older ones as why would it matter to an older person if their genitals are exposed as they are sexless, unattractive people who because of their age, should not expect compassionate, dignified care. Furthermore, outright sexual abuse is okay especially if one is drugged and ill. It is this attitude that this is typical medical care that is frightening.
Many nurses I have talked with do have that attitude of you don't have anything special or haven't seen before so why do they go to such lengths to unnecessary expose? That is the question. There must be something they get out of exposing patients without need? I think it all goes back to power and control. It is also in the language they use like "strip" which is given like an order. For some men, the MA will actually stay and start to unbutton their shirts which is really over the top. That does put a sexual context to it. But those same nurses asks for certain people to be involved in their procedures or to have all females. Why? Because genital exposure does matter but only they are important enough to be treated with dignity.
Dr. B. may acknowledge the existence of the problem but he truly doesn't understand what the problem is, how it affects the patient, the differences in infractions, or the need to help bring about change.
You're right he did experience issues especially with the cell phone picture because there is no way a personal cell phone should have been used. In any other aspect of life that is considered inappropriate so why is it allowed to happen to patients? Where is patient protection. And he did suffer nursing violations but didn't seem to be upset but it did validate what we have been saying they don't explain, ask, and sometimes it is entirely inappropriate actions.
It's hard to swallow the assumption regarding the concept that the medical profession--those who do the work of keeping patients alive and attempting to relieve their pain, suffering and prevent their death are as a class such cruel creatures. Certainly, the behavior of the medical professionals active or retired now in the Corona crisis should show that there is something humanistic and good within the profession.
Yes, we know there are the bad ones, well documented over the years in the news media but shouldn't this Corona virus catastrophe show that one should not generalize the established bad behavior of a few to the beneficent motives and actions and now personal health risks of the vast majority of those who perform their duties within the medical profession? ..Maurice.
The healthcare staff that were abusive, sexually and otherwise, to JR's husband are people who should not hold the licenses they hold but they are not representative of the vast majority of healthcare staff. The majority are out there putting themselves at risk right now with covid-19 and giving their all every day to keep patients alive. Where the majority are guilty is in looking the other way when they encounter the ones who purposely abuse. People are tribal by nature and the healthcare tribe is no different from any other occupation. They protect their own even when they see wrongdoing. There are exceptions of course, but few are brave enough to break ranks and report wrongdoing.
Most males don't encounter the kind of purposeful abuse that JR's husband and Mr. Kirschner experienced. Instead they experience the far more common meme that it doesn't matter who they are exposed to or for how long, and sometimes even whether they needed to be exposed at all. So long as the staff is comfortable with the male patient's exposure or if it is simply more convenient for the staff, then it is OK in healthcare culture. I doubt there is 1 in 1,000 who work in healthcare that stops to think about how the exposed male patient feels or whether he was exposed more than was necessary. They instead believe the societal norms that men have no modesty and/or men should not have any expectation of privacy. This is why they are shocked when a male patient speaks up.
With egregious cases like JR's husband, complaining as they did afterwards doesn't get taken seriously when the victim is a male. Even when the media gets hold of it such as with Twana Sparks, the Denver 5, and Mr. Kirschner's case, there still is no substantive punishment for the abusers. Those who choose to purposely abuse know the odds are in their favor that there won't be any repercussions even if they get caught. Is it any wonder then that the far more common casual overexposure and/or needless exposure of male patients isn't even on anyone's radar in healthcare?
Following Dr. Bernstein's last comment, I agree that most healthcare staff aren't cruel creatures. They instead are mostly clueless creatures when it comes to basic dignity for male patients.
Just because the medical profession may be doing their jobs of providing healthcare to sick patients during the Corona virus does not make them heroes. Just bc some retired ones are coming back, does not make them any less patient-unfriendly as to when they were practicing. Who taught the ones now how to be disrespectful of patient dignity? There are plenty of people working overtime and doing more than their fair share but we are only hearing about the medical "heroes" which is very disturbing to people like us who have been severely violated by some of those heroes.
As for generalized behavior, many in the medical field as I have been communicating with more and more of them do no respect patient dignity. They feel entitled to treat the bodily privacy of most patients like it does not matter and the patient should be accepting of that as they are in a medical situation. However, many of them require that dignity for themselves. Yes, there may be more good ones than bad but until there is a method by which you can safely tell before being victimized, having them all guilty and letting them prove innocence or guilt is the best way to avoid further damage.
You have to realize that once you have the experience of having them not really caring about your pain, suffering, living or dying, it does color your view of them just as once you have had a bad experience anywhere else in life that too colors your view. Only difference is medical care is very personal.
Dr B, Of course there are plenty of doctors and nurses who are decent and good. Many have a well balanced mindset of making it better for their patients as well as themselves ( and their loved ones ) It's perfectly good to work for a better life for yourselves and your family. ( and the patients.)
But the uglier nature we have been talking about is a real thing also. And people are HARMED by it. I think you know that we believe you fall into the decent and good group. This is an If the shoe fits, wear it, thing.
JR, I will agree that once trust is violated human nature is to not extend trust until it is earned. I have not been abused in the manner your husband was, but having had my own instances of inappropriate behavior, I am generally wary of female healthcare staff when exposure is a possibility. I practice avoidance when possible, and when not possible, until such point as they demonstrate I can trust them, I don't let my guard down.
1 in a 1000 Biker? That ratio is HORRIBLE! In my mind that would be 1 in 1000 who isn't TRYING to kill their patients! They just don't care if they do or not! I think you're probably wrong about the ratio.
Biker,
Both of your posts were spot on. Yes, those who assaulted my husband may be in the minority but it is problematic enough to worry after the odds of finding more of them. Also, in general, being subjected to exposure especially the usual medical unnecessary now causes a traumatic response whereas before it was at most not something he liked but tolerated without issue. But the issue is there are more out there and there is no way of identifying them. And there is still the common exposure men must face at virtually all medical encounters because exposure is usually done differently for men than for women. The attitude towards patient exposure must change and that must change even more dramatically for male patients.
The nurses I have talked to do not seem to have any issue with exposing male patients but they have a different idea when it comes to females being exposed especially by male care staff. They don't seem to think men have the same need for personal dignity/privacy as women. In this day and age, I am so surprised at the narrow-minded view and sometimes closed mind views of females. They don't seem to think men should have the right to same gender care. They do think L&D should have only female staff but say that is different. How?--usually not an answer. Many think doing a foley on male shouldn't be an issue for the male patient but think the reverse of male doing foley on female is. I attribute most of this is they do not want to see males taking their primarily female profession of nursing. They think they can bust down the doors on male dominated professions but the reverse shouldn't happen. They aren't as quite progressive as would like us to think they are.
But it mostly boils down to a lack of respect for the male patient. And during this time in society, it is almost impossible to educate people that men deserve respect too.
Maurice,
The providers may have the best of intentions, but the ends does NOT justify the means.
For providers, their goal is diagnosing and treating disease and injury. They want to do this in the fastest, easiest, and most efficient way possible. Here is a prime example:
a patient can go into surgery wearing pants/underwear. The staff can remove the pants for the surgery and afterwards put them back on the patient. This practice does not occur because it is NOT efficient.
Historically, doctors of the physical body have dismissed or ignored psychological iatrogenic trauma.
Iatrogenic wounds: a common but often overlooked problem
When Treatment Becomes Trauma
Iatrogenesis in Pediatrics
For some people psychological trauma hurts more than physical trauma.
Let us not forget that nudity was used as a means to control people (and humiliate them, adding to the control) in the Stanford Prison Experiment, Abu Ghraib, GITMO, and others.
Your statement; ...medical profession--those who do the work of keeping patients alive and attempting to relieve their pain, suffering and prevent their death are as a class such cruel creatures... is paramount to saying "Hitler loved animals, too." Saying this is using the ethics of The Prince by Niccolò Machiavelli.
-- Banterings
Banterings, I wrote: It's hard to swallow the assumption regarding the concept that the medical profession--those who do the work of keeping patients alive and attempting to relieve their pain, suffering and prevent their death are as a class such cruel creatures. Certainly, the behavior of the medical professionals active or retired now in the Corona crisis should show that there is something humanistic and good within the profession.
. This is about the medical profession, itself, the active doctors and nurses and not its occasional misbehavior or worse outliers. Hitler was Hitler. Most of the doctors and nurses are good doctors and nurses. ..Maurice.
P.S.- Let's specify the "bad" and support and encourage the "good" members of the medical profession. ..Maurice.
JF, when I say 1 in 1,000 I am just trying to make a point. I have no way of knowing what the true number is. If it were 1 in 100, that would still mean it is the rare day, if ever, the female healthcare worker exposing a male patient gave a thought to how he feels. Bring it down to 1 in 10 and it would still mean they're not thinking about what the patient feels 90% of the time.
I am not suggesting there is malice (for the majority) in their not giving it a thought. They've just been socialized and trained that modesty and privacy for male patients is a non-issue.
But even if it were 1 out of a 1000 then with about roughly a million patients a year being hospitalized, that is 900,000 and that is a staggering number but I think the number is much higher. Now if the number of them purposely setting out to harm a male patient is only 1% of that number that is 9,000 male patients which also is a staggering number especially if you are one of those harmed male patients.
At this point, I cannot separate the good from the bad because the medical community itself does not care enough for patient dignity and true patient compassion to separate out the bad. They know who is doing what but they allow it to continue so there is no compassion for them until they clean house or stand up for patient rights. It is not my responsibility to feel sympathy for them in doing their job when they cannot as a group make sure all are doing their job without purposely either through neglect or malicious are not performing their job to patient-friendly standards.
They are quick to cry "Poor Us--Pity US" but they do not acknowledge what harm is being each and everyday to female and especially male patients because of no compassion or basically following their own guidelines taught to them about patient dignity and autonomy. When they admit there is an issue and work to fix it, then I will work to fix their earned distrust of them. There is no test to tell which ones are the good ones until after the fact.
The fact is many patients will suffer patient indignities during this time as the staff will feel more justified as they feel overworked, tired, no one watching, etc. I do pity all those patients in isolation, dying alone w/o their families--scared. I feel for those families who have had their loved one isolated from them and they are left worried, stressed. And if that person dies, they never got to say good-bye and then they are told they cannot even see them after they are dead. The patients and the families are the real victims. Dr. B. I didn't even see that acknowledgement from you but rather only poor medical workers who are getting paid to do their jobs. That may sound harsh but I cringe every time I heard about only sympathy for the medical workers who did choose their line of work. The patients didn't choose to get the virus.
JR you wrote "The patients didn't choose to get the virus." And I can add neither the attending physicians and nurses. However, the difference between the two populations is that despite the established risk, it has been the doctors and nurses who are directly
and intentionally (to help their patients survive) taking the risk whereas for their patients their illness did not come out of any humanistic intention (except for those attending to a sick relative) but came out of unlucky chance. There is this difference between the two groups and this difference should be taken into consideration when attempting to understand the different dynamics leading to the illness or death of either population group. ..Maurice.
Maurice,
If you are NOT part of the SOLUTION, then YOU are part of the PROBLEM.
That being said, when you take into account all of those who turn a blind eye, do not speak up (for fear of retribution), those who have learned intimate exams on anesthetized patients without consent and do not own up to it, those who ever used the dirty tricks of saying "nothing we haven't seen before" or "we need to," the med students afraid to speak up, etc., then you see that the problem is systemic and the majority of providers are just as culpable as those who actually abuse.
The only thing necessary for the triumph of evil is for good men to do nothing..― Edmund Burke
As an abused patient, I don't care the selflessness of those on the front lines. Where were all of these saints and martyrs when I was abused? Why in the 45 years since my abuse, the system has not changed itself? Why has change had to come from outside the profession of medicine?
Why do intimate exams on anesthetized patients without consent occur if our hospitals are filled saints and martyrs on the front lines of COVID-19?
-- Banterings
Here is an amazing article:
One Bad Medical Experience Can Scar You For Life
But trauma also comes about from routine healthcare experiences—physical exams, childbirth, planned surgeries, and dental procedures to name a few. One bad experience sets the stage for anxiety and fear for the next, and so the downward spiral of triggers and more trauma goes.
Alison Barrett, a New Zealand-based OBGYN, says that in her 20 years of practice she regularly sees patients who have medically-induced trauma. In fact, she says, it's more common than not for people to hold some level of trauma around medical experiences.
Barrett says that births are not just linked to trauma because it can be painful and unpredictable, but also because "we still think the safety of the baby is more important than the parent's dignity and autonomy. We still think that experts should have more say in what goes on in birth than the birthing people, themselves. We say things like 'a healthy baby is all that matters.' It's not all that matters."
-- Banterings
Banterings, as I have written here many times to answer all your concerns "SPEAK UP". And that means "speak up" in communication environments where there is a significant chance of getting something done to resolve this issue. It seems, according to JR's postings, she is using different methods to try to accomplish change by speaking up throughout different environments. As I have noted here also many times, I have myself with assistance of others published a couple articles in the professional medical news as well as presenting the issue numerous times on medical ethics listservs to those professionals who communicate there.
But in the best advice it is up to "you all", as troubled and concerned patients, to carry the message from here to the medical and legal system and continue until constructive changes in the systems are created. What else can I say? ..Maurice.
Maurice,
I teach people how to fight back. I show them how to file lawsuits, how to file criminal charges, etc.
I speak the truth and I back what I say with academic and news references.
I am swaying the perception of providers in society.
I have seen my exact words become part of policies of healthcare organizations.
The profession of medicine has lacked common sense for a long time (intimate exams on anesthetized patients w/o consent).
What you have missed, that trauma-informed care should have been practiced for the last 150 years. The power of paternalism has corrupted. Trauma-informed care dictates that the provider ask FIRST, NOT that the patient speak up (first).
Look at the link in my previous post. The profession has refused to be accountable for its abuses against patients and society. That is why most physicians are relegated to being nothing more than retail employees.
So I ask you Maurice, (especially in light of the academic research and now the standard of care being trauma-informed, why is the question not "Why is the provider NOT asking the patient...?"
-- Banterings
It is part of their job description just as it for a cop, firefighter, bank teller, etc. Everyone knows with certain jobs there are inherent risks. Those medical workers are being compensated for their work. The workers at the grocery stores are the also doing their jobs keeping us alive by working at their jobs.
It is how they go about keeping patients alive is the difference between good and bad. They didn't physically kill my husband but by their abuse they did kill something within him that can't be repaired. Just because they are working doesn't mean they are good people or are being good to the patients. Just because they may physically do their job does not make them good or to be respected. Scammers do their jobs and put themselves at risk so does that qualify them as heroes? Everyone who is doing their job does that make them a hero? No it does not. If the medical provider doesn't want to treat the all the patients they don't have to. They can get another job but that is how they have chosen to make money. I am not questioning there are some good people in healthcare. I am questioning the ability to recognize good from bad before they can harm.
JR, you end with "I am questioning the ability to recognize good [PEOPLE] from bad [PEOPLE] before they can harm." That's a challenge primarily for their employer to make. It requires facts, evidence and this is where the patient and patient's family to provide to the employee's employer. This requires the patient and patient's family to
"speak up" and make their views of their experience known. Is there some "thermometer" available to make the distinction between the "good" and the "bad"? I don't know of one.
Banterings, yes, if communication is absent or failing in one or both directions, what could be considered "abuse" cannot be properly identified and prevented. ..Maurice.
By the way, if our readers here think that consideration by the medical community regarding what is acceptable by all male patients in terms of modesty, you might gain insight with regard to how the medical community has looked at the disabled in medical decision-making. Read this from the Hastings Center regarding disability discrimination .
As you see and I admit there is much to be improved within the medical system. ..Maurice.
The problem at a micro level is that most who work in healthcare either adhere to the "men have no modesty" mantra or they adhere to the thought that all is OK so long as they are polite and maintain a proper gameface when dealing with male patient exposure. In either event extra sets of eyes, exposing more than was necessary or for longer than was necessary, and staff gender are largely non-issues for them when it comes to male patients.
The problem at a macro level is that society as a whole, including the judiciary, agrees with those who work in healthcare on these matters. If society didn't agree there wouldn't be female reporters having full access to naked men in pro sports and college sports locker rooms, nor female guards supervising male prisoners showering or having strip searches, nor female staff doing the same for teenage boys in youth detention facilities, nor school boards, administrators, and coaches being OK with mandatory genital exams for middle & high school boys by female NPs with their female assts or female school nurses observing. Society deems any woman who works in healthcare, corrections, or is connected to school sports (journalists & school staff or contractors) to be a professional for whom the exposure of these boys and men is totally clinical, and society expects men to accept that.
The bottom line is healthcare operates within the standards that society sees as appropriate.
There are only two things that are going to change this:
- men start speaking up enmasse or
- a landmark lawsuit prevails that forces healthcare to change its ways
Legislation or regulation just are not going to happen. Few politicians are willing to stand up against the healthcare lobby, especially in an environment where anything pro-male is taken to be anti-female. Not only would legislation or regulation face the wrath of the healthcare industry but it would also incur the wrath of women's groups. Women's groups are not going to let the stranglehold women have in healthcare staffing be diminished just because some men don't want to drop drawers on demand for any female wearing scrubs.
The difficult part with getting men to speak up enmasse is that boys are socialized from a young age to "man up". The 5 or 10 year old girl that falls and cuts her knee is allowed to cry and is comforted. The 5 or 10 year old boy is told "boys don't cry" and is expected to be tough and silent. By time their 1st sports physical comes around in middle or high school they are already well versed in being tough and silent. To complain would risk being called a sissy or some such by the other boys who secretly are just as modest but wouldn't dare let it be known. By adulthood they have mastered the manning up process. For most men it is very hard to break out of that conditioning. It took me until just a few years ago to find my voice and start speaking up.
The landmark lawsuit coming around will be just luck of the drawer when and if it happens. How to get men to start speaking up enmasse is perhaps even tougher. The more articles and/or responses to articles such as some of us here do the more men will hear that it is OK to speak up and that the system needs to change. Additionally, the more that we do complain or otherwise speak up over specific instances the better. Other than that and speaking up for myself I am at a loss as to how to effect this change.
Dr. B.,
But in order for that to be done, it requires that first a patient must be harmed. What I and others as patients don't want to happen is to be harmed. Why should it fall on the patient and their family to have to be victims in order to screen bad from good? However, the system that exists today in healthcare does not recognize most patient's complaints or experiences to "speaking up" does absolutely no good. Yes, there is a thermometer available and that is what the patient is telling them but they refuse to acknowledge the reading as being real or do anything to relieve they dangerous symptoms.
There are professions that need to held to higher standards & medicine is probably at the top because everyone at some point in their life will have a medical encounter. There needs to be something in place so patients are not victimized. The medical community needs to be more proactive in working with patients like us who have suffered harm. The malpractice system is not the place for these type of things to be addressed. There needs to be a willingness on part of the medical administration to have a means to really address issues and to work to make sure those issues are resolved.
Like Banterings said, "For some people psychological trauma hurts more than physical trauma." This is a very true statement. Banterings also stated and is backed up with articles that the nudity is especially a way they use to control. Having all the unnecessary nudity allows the profession to attract people who use the excess nudity to their advantage to feed needs deep inside of them. Banterings also said, "
If you are NOT part of the SOLUTION, then YOU are part of the PROBLEM.
That being said, when you take into account all of those who turn a blind eye, do not speak up (for fear of retribution), those who have learned intimate exams on anesthetized patients without consent and do not own up to it, those who ever used the dirty tricks of saying "nothing we haven't seen before" or "we need to," the med students afraid to speak up, etc., then you see that the problem is systemic and the majority of providers are just as culpable as those who actually abuse." This is very true. Those who know what is going on need to be dealt with also and that encompasses many more than just the actual abuser.
That is why I want to work with hospitals in order to educate them. Surely out there at least of them is willing to listen and to change. It will make their hospital better for all--patients and staff. We can legislate changes but like it is now with informed consent, they ignore it and get away with the infractions.
Here is proof on physicians advocating for a double standard:
Dr. Zodda on intubating colleagues:
The most senior physician should intubate, and use video laryngoscopy
This is proof for patients to demand only senior physicians and refuse care from residents and students.
The profession should lead by example. Every facility should have a program that identifies licensed (active and retired) providers and automatically has student participation (at least 2 students and one being a different gender of the provider-patient) in EVERY aspect of their care whether it be for an annual exam or brain surgery.
Here is a link to a very good paper published in 1968 by the The Royal Medical Society: The Rectal Examination
To prevent this occurrence I believe it is essential that a doctor should submit himself to a digital P.R. at an early stage in his career. One distinguished colleague feels so strongly on this point that he not only expects his students to examine each other by digital examination, but requires them to undergo subsequent sigmoidoscopy. Only after such an experience can you confidently give instructions to your patient with a convincing explanation of what he can expect during your own "routine procedure."
I still maintain that it is incumbent upon the provider to ask (the patient) first. This has been validated by the most recent SOC; trauma informed care.
-- Banterings
Biker: "The bottom line is healthcare operates within the standards that society sees as appropriate."
JR: "The medical community needs to be more proactive in working with patients like us who have suffered harm."
Banterings: "I still maintain that it is incumbent upon the provider to ask (the patient) first."
I fully agree will all three comments. We, in the medical profession, should become more aware of the issues ("symptoms") presented on this blog thread over the years (as I have!) and make an effort to effect a "cure" by understanding the pathology leading to those symptoms and then devising prophylaxis or even better that permanent cure itself. ..Maurice.
Maurice,
With trauma-informed care now being the standard of care, people are going to learn about it real fast. In ANY malpractice case, the attorney will ask if the provider practiced trauma-informed care (which will most likely be NO). They are going to use this as evidence of a pattern of malpractice. If the provider did not follow the SOC at the beginning of the encounter.
-- Banterings
I would rephrase what Biker said to: "The bottom line is healthcare operates within the standards that society has blindly allowed." The society I have talked to doesn't think patients should be exposed unnecessarily, have chaperones especially of opposite sex, should have same gender care if requested for intimate care, etc. Of course, they are some who act like it is not an issue but who really knows about them.
I stand behind my remark that the medical community needs to work with patients like us to have experiences and solutions to offer. And of course, Banterings is correct in saying it is the responsibility of "the provider to ask (the patient) first." Too many patients are ambushed in care, are disadvantaged by being undressed, may be drugged and incapable of preventing what is happening, etc.
Banterings has been working for a while to bring about change. CS is also working to bring about change. I recently have joined the effort. But it takes more than just us. I once had a mentor that said: "Everyone has a complaint but few do anything to bring about change. If you have a complaint than have solutions to offer as many times it is easier to bring about change if you can do part of the work for them." That is what I and another lady I met from Indy are going to do. We want the consent process changed so we are going to give solutions. We intend not to have people harmed in the same way she was & my husband was.
I am doing a podcast that will be played around the world on Monday. My husband will try to sit in on at least part of it. I also am talking to a local tv media who is doing an investigative report on medical harm.
JR, of course society has blindly allowed it. It is not that school boards, administrators and those associated with sports programs purposely want to embarrass the boys with forced genital exams by female NP's with their female staff members or female school nurses watching. They instead don't think about it at all, in effect blindly allowing it to occur.
The company I worked for required pre-employment physicals. We used a firm that only did employer-based healthcare of that nature, worker's comp etc. I asked the Director of HR if those physicals included genital exams and if so are male applicants offered the option of male providers to do the exam. She had no idea whether genital exams were done or even if the firm we used had any male staff members. And yes she thought my asking such a question was odd. She didn't say it but her body language told me she didn't understand why any of that would matter for men. She too blindly allowed to happen whatever it was that was happening in those physicals.
As I said, it is a societal problem. Healthcare is just where we see most of what society deems acceptable play out. If society doesn't deem boys receiving sports physicals and boys in group home situations aren't entitled to the kind of bodily privacy & dignity we discuss here, certainly society doesn't see it as an issue for men.
When they do think about it, they don't care then either. Female reporters in college and pro sport male locker rooms was the result of court action deeming the rights of female reporters to do their job outweighed the rights of the men to privacy. Female guards supervising men showering or being strip searched was also the result of court action on the same basis. The employment rights of the women outweighed the privacy rights of the men. I recall reading a case where a man living in a court ordered halfway house that was subject to drug testing did not have the right to male staff for the mandated direct observation urination drug testing. He had sued over the fact he was forced to stand there fully exposed urinating while female staff watched. Again their employment rights outweighed his right to privacy.
So blindly or purposely, society does not believe men have any inherent right or expectation to intimate privacy. Healthcare is operating within societal norms. The question then is how do we get society to start seeing this issue differently?
Biker,
I totally understand what you said & were saying with the only difference being allowed rather than appropriate because I don't think much thought is given to make it appropriate. Yes, those situations you described would not happen to a female because females will not allow it to happen but thus far most men do not complain or make change happen. It wasn't a personal attack but rather a word choice on my part. You have some very wise posts even when we don't necessarily agree but I do take in what you say because I have been known to change my thoughts after digesting and researching.
People say I am too involved in a man's problem but my husband was also made to urinate in front of a mostly female crowd & has suffered great mental harm from that and the other things she did. He has suffered great mental harm. I am not willing to have this happen to my son or him again.
How I plan to make changes is through telling our story. To educate as many people as I can through personal talks, media, social media, and any other way I find. I have gotten some positive reception from a couple of legislators about some different issues. I plan to build on those gains. I throw things at a wall & I see what sticks. It is like with one of my favorite issues. The legislator said we have laws about it. We do but they don't work for the patient. He says it shouldn't be so hard to get something done to make it meatier & more bite. He said send me the ideas and he will find others for us to meet with and see what can be done. Okay. Now we have established a relationship. So after we work on this I will go again. Another one was surprised Indiana didn't have laws about another one of my favorite issues when I gave him an example of what could happen to his wife, daughter, mother, father, etc. I made it personal for him. So now he wants to know more. Sure, will do.
We all have the ability to do something. Knowing how it broke my husband is what motivates me because no deserves to be attacked while they are so defenseless.
JR, it may well be women like you, Misty, and others like you that bring about the change needed. Women have long been better at speaking up and organizing on social issues than men.
Yes, Biker, it is females who grow the child both inutero but also, particularly in the past, during the child's early life (husband working). I think it is this biologic-societal difference that might be the explanation for women to be responsible for the "speaking up and organizing on social issues than men." Does that mean that, in contrast, men can only "moan and groan"? Well, some here may dispute that question. However, from an academic point of view (as per my background) this difference is something that would be interesting to investigate. Bantering, I bet you can find some literature references which might explain the conclusion suggested by Biker. ..Maurice.
No, of course men just don't "moan & groan" but men have been taught to go about problem solving a different way. And too, men don't usually tackle issues like we are talking about bc it is thought to be unmanly & many would make fun of them or not believe. Many don't think it is possible to be sexually assaulted by a female nurse & many joke enjoy being exposed to a young female nurse. But many times this is just a coverup for embarrassment or humiliation. Women do learn that speaking up gets you noticed whereas being quiet doesn't. Men haven't learned that yet.
JR said:
....& many joke enjoy being exposed to a young female nurse. But many times this is just a coverup for embarrassment or humiliation.
Correct. By way of example, following my first bladder cancer surgery, I turned the fact that I was ambushed by 4 female medical students showing up in pre-op announcing (not asking) that they'd be observing my surgery into a joke with my male friends. I was mighty embarrassed by it, and so I turned to the standard male reaction; I joked about it to hide my embarrassment. I said that word must have spread that there was a country boy in town (the surgery was in Boston) and the ladies were so excited that they had to hold a lottery to see who got into the OR.
Speaking of men's problem solving; providers are very fortunate that the male patients that they abuse are young or infirmed. If this is was happening to able bodied men, NOT men or boys with disease, injury, or needing medical clearance, in the true nature of men, their response would be more violent.
Instead, most men just walk away from healthcare. The system by design, creates a provider shortage. Just like Biker's situation, men are faced with accepting abuse or death.
I have seen a great deal of trying to get men back into regular preventative healthcare. If you convince men to come back, they are NOT going to put up with it. They will either walk away (again), OR, if these campaigns are successful in convincing men that preventative care is necessary, somebody will get hurt.
I am fine with that.
-- Banterings
Biker,
Tell me what you think. A nurse said male patients sexually harassed nurses by making sexual comments about them. I wrote back saying maybe she needed to take into consideration they would doing it to cover up how humiliated or embarrassed they were when they were being exposed. I explained sexual harassment wasn't right but maybe if she changed how male patients were exposed, etc., maybe some of the sexual remarks/gestures from male patients would cease. I think some not all may use this tactic to cover up what is happening to them.
Banterings, You have a point. In my husband's case, he was very drugged & isolated so they were able to control him. He tries to deal with what happened to him by refusing to talk about as if you don't talk about it, it will somehow magically not have happened. He avoids healthcare and when he does has an encounter, it completely stresses him out.
I believe the US medical system overuses "un"conscious sedation so they can control and have power over especially men. Although many procedures elsewhere in the world are done without sedation, the US maintains they must use them. So are we Americans babies or is how healthcare delivered to us even worse than other countries?
JR, some men are pigs and will be purposely inappropriate with female healthcare staff, especially when intimate exposure is involved. Those men either have egos that are not justified by reality or they have no self perception in the manner they think every woman would want them.
However, the majority of men who say things with sexual innuendo in these circumstances are very much embarrassed and are using that tactic in an effort to convince the nurse (or other staff member) that he isn't embarrassed. Defensive bravado if you will. His embarrassment would be amplified if he knows that she knows he is embarrassed and the matter just hangs there unacknowledged. This is because he will have failed to properly man up in the manner most men have been socialized to do.
Men are not very complicated and one would think that female medical staff would be able to easily differentiate between a pig and an embarrassed male patient, and to then respond appropriately. The pig needs to be put in his place. The embarrassed male patient needs some empathy and acknowledgment of his feelings.
Biker, The pig and the embarrassed patient needs to not be naked/exposed. If he/she has to be, or not get the needed care then let the patients make that decision. Male staff person attending male patients. Female staff person attending female patients, unless patients request otherwise. How can the medical worker know who the pig is or who the victim is?
JF, what JR's post was about was nurses seeing all sexual chatter by men as harrassment. My point was that yes sometimes it is (the pigs) but that most of the time it is defensive bravado on the part of embarrassed men. The issue isn't whether the exposure was necessary or not or whether there are male staff members available to do whatever is being done. It is male patients making comments of a sexual nature when in such situations.
My guess is that you do not provide toileting and bathing care only to female patients and that the facility you work for does not make much attempt to provide male staffing for those matters for the male patients. That they don't do that is not your fault and when you are assigned male patients you are simply doing the job you were hired to do in as professional a manner as you can. Note that I'm not talking about the male patients with dementia but rather the ones who are aware it is a female that has been sent in to provide intimate care for him. My contention is that anyone who has worked in healthcare for any amount of time can tell the difference between a pig and an embarrassed patient making a comment with sexual innuendo. For some however it is easier to play the victim and take all such comments as harassment rather than seeing an embarrassed patient who could use some empathy and acknowledgement.
As part of the covid-19 preparations locally, the hospital has set up a 100 bed (cots actually) surge facility in a hockey arena owned by the local college, in effect doubling the normal hospital capacity. The cots are spaced out in the totally open main space of the facility. In a TV news story I just watched the hospital spokesperson says the set up does not provide much privacy but that that they will use portable screens that can surround patients when privacy is needed. I was pleased to see that they are at least thinking about patient privacy. Being a sports arena, there are two locker rooms to allow separation of genders for things like showers. I've never seen the locker rooms but given girls teams play there too, they surely are individual stalls rather than gang showers. The intent of this surge facility is for non-covid-19 patients. Anyway, I was glad to see that they're at least thinking about privacy in even an emergency scenario.
Biker,
All facilities have privacy protocol in place. All teaching institutions teach about the inherent right of patient privacy. In spite of these protocols and learning, the majority do not practice patient privacy. I have read time and time again the once you enter the hospital you lose all right to privacy. There is a book called Operating Room Confiedential by Paul Whang, MD where he also states, "But as they say, once you come into hospital, male or female, you've got to leave all modesty at the door." He also goes on to state that while male patients are under for urologic procedures they like to use the patient to embarrass new nurses. Using gas makes the penis larger and moves on its own. They like to infer the nurse is exciting the patient. "My, my, what have you done, Anna?...You've got a very special technique...Nice touch...Anna, you really know how to please patients." This is straight from his book so Dr. B. why don't you get in touch with this very immature, unprofessional doctor asking him why he thinks it is appropriate to use patients who are totally defenseless in such a sexual manner? Of course, there is no defense and this no more different than a frat boy who uses a drug like versed to sexually assault a girl. Where's the professionalism? Where's what you have doesn't matter? Where is any of them having any scrap of moral fiber to prevent this type of assault from happening? Is this an example that if the patient is unconscious than sexual assault doesn't matter? It matters elsewhere I life so why doesn't it matter here? Why would anyone consider trusting any of these predators to behave like a decent human being? Give me a reason? I highly doubt this type of behavior is an isolated episode as they think nothing of the patient they assault and wrong this is. He gave no thought to writing about it as for him, it is perfectly okay.
We have one male med tech on our shift. What I dislike about our assisted living home is no privacy curtains and many of the patients have roommates.
Last weekend our nephew had an emergency appendectomy in NoCal. He was sent home w/o an overnight stay. He was the only one in the Recovery Room. The nurses wanted him to leave because then only minimum staffing would be necessary. The nurses were discussing who would get to leave. Our nephew was not complaining about anything, just relating.
Last Monday our SoCal niece took her elderly neighbor to a large medical center emergency room due to a fall. Our niece reported that the medical center was "almost vacant". This hospital is our and her favorite and usually busy.
In late March, I canceled my mid-April pre-operation appointment for cataract surgery. The reception reluctantly accepted my cancellation - she wanted me to keep the appointment. Then in early April the receptionist called to cancel the surgery scheduled for May w/o requesting a reschedule date.
Recently my PCP's receptionist called to change my end-of-the-month appointment to a telemedicine call. Two+ weeks ago my wife had a telemedicine appointment with the same MD. She was satisfied since it was a routine appointment. I'm not sure that I will be as satisfied.
I assume most of this is due to COVID-19. Will the delivery of medicine be permanently changed after the pandemic?
BJTNT
BJTNT, the answer is YES. Read this article in the Smithsonian Magazine about the 1918 pandemic and its affect on medicine and its delivery. Now, of course, what effect it will have on the medical practice as amply described on this blog thread topic remains to be seen. ..Maurice.
A visitor from Boston MA wrote the following to my e-mail yesterday:
Dr Bernstein,
I am writing to you after finding your “Bioethics Discussion Blog”. I have seen numerous comments from patients on your blog describing the hell they have gone through in regards to getting adequate medical treatment from uncaring physicians.
I have been ill for the last eight years and no one is listening to me. I am struggling to breathe, I feel like I’m constantly suffocating, and my care team has given up on me because I’m not a straightforward case.
I’m looking for a good doctor, who can problem solve, has compassion, and isn’t willing to quit at the first sign of resistance.
My care has been a complete disaster since day one, and my financial, physical, and mental healthy have all paid a price. I am crippled.
Are you taking new patients? Are you willing to take my case? I’m willing to travel and live in LA if so. I’m desperately looking for quality help and cannot find it. I need someone fighting for me in my corner.
Please let me know if you would be willing to help me. I’m tired of being sick. I need to be working. I’m 31, male, Caucasian.
Thank you for your time,
I wrote him back to inform him that I was no longer in active medical practice.
I did offer to publish his concerns on this blog thread. With regard to suggesting a physician who might give him "problem solve"and emotional support, I mentioned that we have a regular visitor here, Biker, who may be familiar with the area and might be able to recommend a resource.
So Biker (and any others familiar with the Boston area physicians) if you can e-mail me (doktormo@aol.com) any suggestions, I will relay, without ever disclosing your e-mail address without your specific permission) your suggestions.
I am assuming, with the above request, that the requester is presenting a valid personal concern. ..Maurice.
Biker and others, this is the first request I have received of this context. It seemed to me to be appropriate to the discussions on this blog thread. However, this is the first time, I have been asked to become the physician of the writer. ..Maurice.
Dr. Bernstein, the only doctor I had in Boston was my urologist, and he retired a year ago. He was at one of the large teaching hospitals. Boston has a number of world class hospitals to choose from but the writer doesn't say what the nature of his medical issues are. As you know I moved my urologic care to a large teaching hospital in NH a few years ago and have since moved all of my care there, and I am quite happy with that decision. I've had a couple doctors there in different disciplines in recent months peeling away the layers trying to figure out an issue I've been having.
Though that hospital in NH is enormous by Northern New England standards (people refer to it as a city in the woods), it is small by major Boston hospital standards. Maybe that in combination with the more laid back and gentler culture of rural Northern New England (vs the urban frenzy of Boston) might mean he'd find someone that listens. It can't hurt to give it a try.
Dependent upon where he lives in the Metro Boston area, it is an easy enough ride up I93 to I89, especially if he lives on the north shore or close-in suburbs that give easy access to I95 to get him onto I93.
Sorry I can't be of more help.
Thanks Biker, I will write him what you posted here since he may NOT have been reading this particular Volume. ..Maurice.
Here is the response by the concerned man to the e-mail copy of Biker's posting.
NH sounds like a good idea. Perhaps up there I’d be able to spend more time with my care team if it is indeed more laid back.
I’ve been in Boston for several months and haven’t had much luck. I’ll make my way north and see where it takes me.
..Maurice.
I would like to express my view and feelings about looking at how the medical profession both active and retired are currently contributing their long days work and their risks to themselves and their families attending to COVID-19 identified or suspected patients as well as other patients but all in a potentially communicable environment. This tells me that the vast majority of doctors and nurses are not volunteering or part of their ongoing employment for reasons for their own sexual excitement or opportunities to express their own personal dominance upon the patients assigned to them. If either of these motivations were true, no volunteer or employee would be risking their life or the lives of their own families attending to patients with that apparently highly contagious disease.
The professional response to this disease does tell something valid about the medical profession and their humanistic and dignified behavior towards their patients. ..Maurice.
Dr. Bernstein, I agree that most who work in healthcare are not there for sexual thrills, and that yes many are incurring great personal and family risk doing what they do during this crisis.
As I have said recently, the intimate exposure problem we discuss here is, for men at least, a societal problem that for most of us primarily plays out within the healthcare system. Society does not see males as entitled to bodily privacy, especially if that privacy would infringe upon the career rights of women that choose careers that involve men (and boys) being intimately exposed.
Where fault can be found with the majority is in not self-policing their own so as to at least maintain some minimum standards. Women in healthcare know their chances of incurring a meaningful punishment are virtually nil if the offense is needlessly exposing or inappropriately exposing male patients. Most who work in healthcare would never dream of doing to a patient what the women at Olympia Urology did to Mr. Kirschner, yet healthcare system effectively condoned it anyway by virtue of no meaningful punishment.
Biker, yes those individual and relatively isolated published cases of professional misbehavior or much worse and all the personal examples of various professional misbehavior as written on this thread over the years still do not and should not cast a shadow of slimy behavior on the vast majority of medical professionals. I cannot, however, excuse the medical system itself and those physicians or administrators who supervise the system's functions and activities. They are clearly failing and changes in the system need to be made to eliminate more if not (and I wonder if that is possible) ALL of the misbehavior towards patients of either gender. So I am not rejecting the published "obvious" nor the personal experiences of those deciding to write here but I think that the vast proportion of medical professionals (including the students I have taught over the past 30 plus years) are out there to diagnose, treat and attempt to cure and not looking here and there for some sexual self-gratification in their interaction with their patient, male or female.
But, again, obviously the medical system is defective in this management issue and needs folks like you, JR, Misty and all the others writing and reading here to demand medical system awareness and changes to reduce, if not to totally eliminate, this totally unprofessional behavior in medical practice. ..Maurice.
Dr. B.,
Again you are defending the system by saying, " So I am not rejecting the published "obvious" nor the personal experiences of those deciding to write here but I think that the vast proportion of medical professionals (including the students I have taught over the past 30 plus years) are out there to diagnose, treat and attempt to cure and not looking here and there for some sexual self-gratification in their interaction with their patient, male or female." I don't think any of us has said all are doing it for sexual gratification.
However, there is an attitude of the majority of medical staff that patients do not have a right to expect bodily privacy so they must accept the manner in which they are exposed or the gender of care. There is an overwhelming majority of medical workers who do not feel that patient dignity is an issue that needs to be addressed or recognized. I would agree that probably the criminal element that my husband encountered or others have, are in the minority of those who exposed. But there is not way telling them from the other who expose. And by the way, unnecessary exposure that is done is wrong and harmful in any case. There is no excuse and that is what you are failing to understand.
For example, if a person drinks too much and drives that can cause an accident. They know the issue with drinking & driving but don't figure it will hurt. So they do it. There is an accident. Are they still guilty ever though they never intended to cause harm? There are rules governing patient dignity & exposure but many don't follow those rules/guidelines. Are they guilty of patient harm? I know you won't answer my questions as you rarely do but I think I have made my point. They know there is harm whether they intentionally wanted to do harm or not. Harm has been done because there is protocol. Causing mental distress by failing to give a patient the dignity they are entitle to is patient harm and does make them guilty. It all is harm. Some is just more of a criminal degree of harm than others.
Much of the divergence of opinion between healthcare staff and patients lies with what is considered inappropriate behavior and needless exposure. It is sort of like ships passing in the night.
No doubt virtually everyone who works in healthcare would agree that what was done to Mr. Kirschner was wrong even if it did go unpunished. Fortunately that sort of thing is not a common patient experience. However, what % of healthcare staff would agree that the far more common "you don't have anything I haven't seen" or "we have no modesty here" kind of statements directed at male patients by female staff is wrong? I posit that a significant portion of healthcare staff doesn't see such statements as problematic, even if they don't use such phrases themselves.
My guess is most in healthcare would agree that needlessly leaving a patient exposed in the manner JR's husband was is wrong. Again, that isn't a common experience for most patients. However what % would agree that routine matters such as when needing to access the abdomen, lifting the gown and then placing a towel or sheet over the genitals is wrong (vs covering the genital area with a sheet or towel first, and then lifting the gown from underneath). My guess is most don't see anything wrong with what they see as a brief exposure when in actuality no exposure at all was necessary.
Virtually everyone who works in healthcare will agree that inappropriate behavior and unnecessary exposure is wrong. They just have a different definition of what is inappropriate or unnecessary than do many patients.
I think that most female healthcare workers and even males as witnessed by the book I cited above think that exposing males is not an issue. It is not an issue to use their penises and testicles are part of jokes/entertainment as witnessed by Mr. Kirschner, the book, and what was done to my husband. I think most would not do that do women nearly as quickly as they would a man. For women, there is recourse but for men, there is none. There is discrimination in how intimate care is delivered to men and to women.
Yes, what Biker said is true. If they thought patient dignity did matter, there would be very little exposure as they are methods in the books they learn from on how not to expose a patient unnecessarily. They are the ones who later choose not to follow it. This is why I feel no pity for them. What they do to a patient's dignity whether intentional or unintentional is not acceptable. If they want respect, they need to learn to give respect. It is a very simple concept.
As some patients have done in the past: worn a badge or tattoo stating "Do Not Resuscitate" if that was their advance medical procedural directive. How about those patients who don't want their genitalia or breasts exposed at any time without the patient's specific permission wear a similar badge, not necessarily a tattoo, on entering a medical facility. It's there.. in black and white..easily seen by the provider and there would be no "ands ifs or buts". This approach would be much more visible and accessible then a statement written by the patient on the entry documents. Just a suggestion based on previous approaches to documentation of patient orders.
By the way, I hope all my blog readers and writers are surviving this current viral epidemic both in terms of disease and its social consequences. Based on my current reading, physicians are getting far less patients in their offices now then before the epidemic and are looking for financial help from the government. Here is an article from NPR on the subject.
..Maurice.
Dr. Bernstein, I find it unconscionable that any healthcare worker dealing with covid-19 patients, suspected covid-19 patients, or in otherwise high risk settings would have their pay cut. For the rest I wish it wasn't necessary, but the manner in which this has impacted the economy is hurting vast numbers of people across the board. That a dentist or a surgeon has fewer patients given current restrictions is no different than the untold numbers of other businesses suffering due to mandated shutdowns.
If I can get on my soapbox for a moment and go off-topic, as a former operations person who had to tend the minutia in order for things to work as they should I am appalled but not surprised at how poorly local, state and federal govt. has handled this whole mess. It is clear none of their pre-pandemic pandemic planning, to the extent they even had planning, ever delved into the interconnections and complexities of our economic and societal infrastructures. That we are surprised at some of the problems now surfacing speaks to the fact nobody carried any of the planning to any level of meaningful detail. Back in 2006 or thereabouts when I was tasked with creating a pandemic response plan for my employer, I figured the easy route would be to see what was in State plans. I looked all over the country and could not find any that made any sense or that even remotely dug into the details. And so now the healthcare industry, who should have had robust plans of their own, is finding out that they too are casualties in ways they apparently didn't anticipate. It didn't have to be this bad, and things aren't going to just go back to normal when we are all given the go ahead to open up again. Growth feeds on itself, and so does decline.
Hello Dr. Bernstein,
Your idea is Fantastic. Could you (or anyone) get the medical profession to honor such a request for no genital exposure, as printed on a bracelet attached to a patient's wrist?
Reginald
Reginald, there should be no issue regarding honoring such request documented on a wrist band which the patient is wearing. It becomes as legal a directive to the attending professionals as a POLST or MOLST order in your U.S. state does. Unless the patient is unconscious without a surrogate present and there is no chance for the physician and nurse to immediately discuss the need for exposure despite the what was written on the bracelet then I suppose the bracelet command would be disregarded. However, a DNR order on a POLST form would likely be reviewed with the patient with mental capacity as needed after admission and, of course, prior to that need. Anyone want to manufacture and sell those Reginald bracelets?? Great idea!s
Biker, I was not referring to the active participant physicians and others in their direct COVID treatment activities. I was writing about physicians within their private office practice with currently a large reduction in patients seeking an office visit, either for acute symptom or clinical followup. ..Maurice.
My husband now a medic alert saying no to certain hospitals and no to any female staff for intimate care or exposure plus his expanded directive. But they can say it was lost just like they lie about everything else. Sadly, they know they can lie. Make sure you always have a recording device turned on as they are expert liars.
Dr. Bernstein,
I wanted to respond to your statements about medical professionals helping with coronavirus patients:
I would like to express my view and feelings about looking at how the medical profession both active and retired are currently contributing their long days work and their risks to themselves and their families attending to COVID-19 identified or suspected patients as well as other patients but all in a potentially communicable environment. This tells me that the vast majority of doctors and nurses are not volunteering or part of their ongoing employment for reasons for their own sexual excitement or opportunities to express their own personal dominance upon the patients assigned to them. If either of these motivations were true, no volunteer or employee would be risking their life or the lives of their own families attending to patients with that apparently highly contagious disease.
The professional response to this disease does tell something valid about the medical profession and their humanistic and dignified behavior towards their patients. ..Maurice
I deeply appreciate how many both and retired medical professionals have contributed to helping with COVID-19 identified or suspected patients. I believe without those medical professionals more COVID-19 deaths would have resulted. My cousin is a radiologist and he contracted COVID-19 probably from a doctor’s lounge. Thankfully he has recovered and is doing well now! I thought it was wonderful that the police in my community honored medical professionals coming out of the hospital with roses to show appreciation to them. I love how Samaritan’s Purse, a wonderful organization has sent some medical professionals to volunteer their time to help with patients in New York.
The service medical professionals have provided in this pandemic reminds me a lot of soldiers who have served in wars. They have risked their lives so we can continue to have freedoms in America.
The truth is many of the COVID-19 patients do not need their genitals to be exposed unless they are so sick in ICU and need adult diapers / depends. The truth is most of the sexual abuse cases and modesty violations happen where the private parts are exposed. Many of those medical professionals are focused on reducing deaths and helping those patients to recover. I believe that is their motive for helping in this crisis. Now, it would be a different story if we heard of medical professionals doing genital and breast exams on those patients which is not necessary.
Some soldiers who have made sacrifices to this country and medical professionals who have sacrificed their time to serve COVID-19 patients are not immune from lustful thoughts no matter how good they are. I believe the reason many medical professionals may not be sensitive to patient modesty is because they were not really taught about this issue in medical or nursing schools. I am in the process of developing brochures about how medical professionals can be more sensitive to patient modesty.
I think it’s great that some businesses especially coffee shops have given away free drinks to medical professionals for their service this time. Businesses often give special discounts to those who have served in the military.
I think a bracelet/wrist band is a great idea for patients who do not want their private parts to be exposed. This could be like the “Fall Risk” wrist band hospital uses for some patients who are at risk of falling.
Misty
Dr. Bernstein, those physicians in their own practices or practices owned by the hospitals that they are seeing fewer patients now and suffering the economic hit are no different than untold numbers of other small businesses that have had their incomes cut, many cut entirely rather than only partially. I do not see physicians as entitled to maintaining their former income when their compatriots in other industries have no such guarantees. The circumstances they find themselves in is not their fault but neither is it for all the other industries that are struggling. The physicians at least will come back to normal with full waiting rooms. Many other businesses will not survive the shutdowns.
Biker,
You say:
Society does not see males as entitled to bodily privacy, especially if that privacy would infringe upon the career rights of women that choose careers that involve men (and boys) being intimately exposed.
I wonder how many men who sexually assault women do that as a response to being mistreated by women in a medical setting (perhaps as children)?
My friend up north has told me that he has done some very humiliating things (sexually) to medical providers. This was during consensual BDSM play. You can use your imagination. The providers enjoy these things being done to them.
My friend finds this helps him deal with the abuse that he suffered.Again, everything is consensual.
-- Banterings
banterings, I'm not in a position to answer your question as to the motivations of men who abuse women as that is not anything I have knowledge of, but I think the "women's career rights trumping the privacy rights of men and boys" is mostly a women's empowerment thing. The judges and bureaucrats that have made those rulings and judgments avoid the wrath of women's groups and they garner themselves politically correct bonifides in doing so that can advance their careers.
It is a one way street. Women who choose only female caregivers are celebrated as empowered and men who choose only male caregivers are castigated as sexist. In the current environment women who choose urology careers are viewed as breaking down barriers at the physician level and exercising their career rights at the nursing & tech level. Men who choose gynecology careers are looked upon with suspicion as to their motives.
As to medical providers coming out of retirement and volunteering, a very good friend of mine, a nurse, is going to the Javits Center, at my urging. I know the motivations that are driving her. She has severe ADHD like I do, and that is the driving factor of her in nursing. If my work was closed, I too would be in NYC.
What drives us to this is ADHD thrill seeking behavior. Don't get me wrong, she is a very compassionate person, but I knew that she would enjoy the adrenaline rush of working in a hot zone.
In the last 6 weeks, I have been outside of NYC 3 times. I was there unnecessarily (checking on friends), but I will say that the adrenaline rush was a driving force of me going. Many providers (like my friends and myself) are adrenaline junkies. Both professionally and recreationally, I like to be in areas of danger, were death can happen. I climb frozen waterfalls. I do it in a safe manner, but things can (and have) gone wrong.
I can also say with certainty that sexuality is definitely a component to the ADHD thrill seeking behavior. My friend up north and others also live alternative lifestyles. Are they sexual predators? Absolutely NOT! Everything they do is consensual. I know this for a fact.
Being that they have an outlet for this thrill seeking behavior, they are satiated. Others who may be unaware of alternative lifestyles or afraid of partaking in them, may turn to abuse of patients to meet that need.
-- Banterings
Following up on ADHD in physicians, here is a comforting example. ..Maurice.
In the current COVID-19 situation, medical schools have to limit teaching of 3rd and 4th year medical students to home learning.
Here is an example, as noted on a medical school education listserv of a video of a pregnancy delivery, as a student teaching tool, but on YouTube.
Is this the way, via YouTube that medical students should be taught obstetrics under normal circumstances or should students be present at the delivery table (of course, with the woman's permission)? ..Maurice.
No it is not how medical students should be taught. Remotely all they will see is what the person with the camera chose to film and the patient herself is relegated to being a body part. In person they see every aspect of the process with the patient and all of the staff that are present and can understand the dynamic of the patient that the procedure is being performed on. Remote/online learning is better than nothing but it is significantly limited.
With her permission is fine, so long as it's clear to that woman that nobody will be angry with her if she says no. JF
Today, my local paper ran an article from the Washington Post entitled "Many men avoid doctors, which can be risky". The article is written by a woman who is so empathetic that she knows exactly what it is like to grow up as a male in the U.S.;so she is well qualified to tell men what is wrong with us.
Not suprisingly, her conclusion is that we males feel that we "Should always act tough and never show any signs of weakness or dependence."
Although the article is fairly lengthy, there is not a single word about dignity or modesty or the large numbers of female providers we so often have to deal with we we seek medical care despite the fact that the photo accompanying the article shows a male patient with a female practitioner.
My question is, can the writer really be that clueless about the role male dignity and modesty play in the avoidance of medical care? Or does she deliberately avoid the issue rather than suggest that the female dominated health care system needs to make major changes if there really is genuine concern about men's health.
MG
One of my complaints of ALL medical guidelines and educational material (including videos) is that almost all do NOT mention consent or that the patient choosing NOT to have the procedure is an acceptable choice and it will be RESPECTED.
In all the guidelines and educational material it is a foregone conclusion that the patient will have the procedure (whether they consented or were coerced). Just as the video that focuses on the delivery turns the patient into a body part, having the the procedure as a foregone conclusion teaches paternalism.
Why do only the breast, cervical, and prostate cancer guidelines mention shared decision making?
Should any procedure NOT be shared decision making?
The video should have the attending trying to get permission to film the delivery and the first patient refusing. Then they can show the patient being filmed agreeing and the following consent for who will be present and the roles they play.
Just like the rest of the medical education, the repetition will instill and reenforce the concept of correct method consent.
-- Banterings
Maurice,
Abuses of patient's dignity are greatly reduced first because so many procedures that can be postponed are. These include urologist visits (bring in the females...), even chemo is being postponed.
Second, as I previously stated:
You will see the abuses of dignity drop at this time because of the scrutiny that medical staff is under. The CDC, Johns Hopkins, and others are analyzing EMR in real time looking for any clue, especially transmission patterns. The risk to ANY medical staff of acquiring COVID-19 is much higher than the general public. When medical staff becomes infected, admin interviews EVERY patient that they were in contact with, thoroughly. The last thing that a medical predator wants is to test positive (even if not work related) and having their prior 4 weeks' patients interviewed and a pattern of abuse emerges.
COVID-19 has been shown to be acquired through fecal-oral route. So you unnecessarily exposing repeated patients and you test positive. Admin reviewing notes, reports, etc., hospitals at capacity, and a provider doing unnecessary genital exams? Procedures that are not critical are being cancelled; that is removing the opportunity to be "prepping" patients for surgery, thus removing opportunities for abuse.
Admin is no longer turning a blind eye when county and state health depts, CDC, and others are scrutinizing their records if not physically at their facilities.
-- Banterings
MG, none of us can know what how sincere the author of that article is but whether she actually believes what she wrote or it simply is what she wants the rest of us to believe, the end result is the same. It reinforces that the status quo is just fine if only we stupid men would listen to women telling us what we're supposed to think and feel. None of the articles in that genre even speak of staff gender or male modesty/dignity. Instead any woman who dons scrubs is a professional and every action and thought on her part is purely clinical. It is just men "acting tough and never showing and signs of weakness or dependence" that is the problem.
On another note, my previously cancelled annual cystoscopy got scheduled again for a couple months from now. After settling on a date/time, I reminded her that I prefer a male nurse for the prep, and she said yes I see that here in your record. So my account is flagged just as I thought was the case.
For followup of my every 3 weeks replacement of my Foley catheter, I can honestly say that the procedure is each time performed simply to complete the goal with infection safety and the least amount of routine painful distress. The entire procedure is performed each time by one female with no visiting employees and each time the experience is professional. I see no hint..no hint..that I am being treated any different than some other gentleman patient. If I see signs that I am being treated differently than other men, I promise to document facts here. ..Maurice.
Dr. Bernstein, it is good that you are totally comfortable with the manner your periodic catheter changes occurs. Were you not comfortable with female staff doing it and you asked for male staff, that is when you would find out whether the staff there are truly professionals. Would they mock you (you don't have anything I haven't seen) or bully you "we have no modesty here or we're all professionals here) or would they respond in a professional manner that starts with "yes I know this might be embarrassing for you....".
The staff being able to maintain a proper gameface and act in a purely clinical manner is easy when you the patient are complying with their protocols for their convenience or efficiency; in this case assigning female staff to do male catheters.
Biker, in my case, I am unwilling to "rock the boat" since in this case I have witnessed only what I consider professional behavior by the urology staff and, of course, I am a patient and needy of their assistance with my problem. I do understand that it would be of interest to my blog thread readers to read what would be the response of the staff if I did openly challenged the staff to present me with a change of provider gender.
However, in no way should my own clinical situation and reaction prevent others requiring repeated catheter changes to "speak up" and express one's serious need for care by the nurse of the other gender.
I am totally in favor of patient "speaking up" to their medical providers regarding their gender or other requests regarding the patient's care. ..Maurice.
Dr.Bernstein, I'm not suggesting that you rock the boat with the urology practice. What I am trying to say is that the staff maintaining a proper gameface and professional demeanor is not necessarily indicative of them being true professionals. Female staff that have mocked and bullied male patients that expressed modesty or dignity concerns do not begin the encounter in that manner. Rather they begin with the proper professional demeanor but then shift gears as soon as the patient becomes non-compliant by speaking up. Some will respond in a professional manner, and they are the true professionals. Those that respond by mocking and/or bullying the patient are not professionals even if they are good at pretending to be prior to the patient speaking up.
Dr B, How would you justify requesting male staff even if you wanted to? You've done intimate exams on female patients. So even if you would be embarrassed you would feel you would have to pretend you weren't.
JF, When I performed pelvic exams in the past when I was in active internal medicine practice, after explaining the rationale for the test and with a chaperone present, I would explain what portion of the exam I was to be currently examining and listened for any patient concerns. What I see and hear now with the nurse performing a Foley catheter change on my body is the same step-wise narrative including the warning at the point I would experience pain during a phase of its removal. I do not need to do any "pretending". ..Maurice.
Dr. Bernstein,
When you performed pelvic exams, I assume your chaperone was a female, correct?
During your Foley change, does the nurse have a chaperone?
58flyer
Dr B, I believe you that you're not embarrassed. Not everyone is. As far as that chaperone goes, a minority actually wants her there. ( patients) some don't care and for others she increases the problem. If she is positioned to where she can see everything she is absolutely part of the problem.
58flyer, for pelvic exams, I utilized only a female chaperone. During my Foley change, there never has been or was requested by me of any chaperone. The protocol in standardized, fixed and the procedure is fully completed in less than 15 minutes.
JF, the reason I am not embarrassed is that the Foley replacement procedure is carried out with only the nurse present and in a fully standardized manner so my only concern is that the Foley can be physically removed instead of what occurred last year when the balloon which prevents the catheter from slipping out could not be decompressed and I ended up in the hospital to have the balloon decompressed via a intra-abdominal wall needle via CAT scan into the bladder. To me these type incidents are far more important than chaperones. ..Maurice.
I am not sure on this blog topic we all have detailed the distinctions between "good" and "bad" actions in relation to "good" vs "bad" reasons.
Back in 2006, I put up a blog topic "Good People Doing Bad Things for Good Reasons" and had some worthy comments up to 2018. It might be also worthy to look and discuss here at some of the actions on either side of the doctor-patient or patient-doctor relationship with regard to the topic title. ..Maurice.
Concerning good people doing bad things for good reasons, my guess is that within healthcare the staff don't see anything they do as bad if it accomplishes something that they see as good. That is different than patients perhaps seeing some things as bad even if they allow that the end objective was something good.
An example is ambushing patients with students. Patients might agree helping educate the students is a good thing but still see the manner in which the doctor went about it as bad (ambushing vs asking before the students enter the room). The end result is the patient goes away feeling bad or angry about what happened and the doctor goes away feeling good about himself for doing a good thing for a good reason. Patient autonomy is not a factor in the thought process.
Another example is female nurses/CNA's/MA's mocking and/or bullying male patients who raise modesty objections. They see their mocking/bullying as something good in that it almost always elicits compliance which allows them to achieve good results (the task accomplished in the most expeditious manner). Patient comfort and dignity is not a factor in the thought process.
When it comes to how patients feel about the manner in which they receive healthcare, it is sort of a don't ask/don't tell system. Healthcare staff don't ask and patients don't tell. For most of what we discuss here it is as if the ethical dilemma posed by good people doing bad things for good reasons doesn't exist.
Dr. Bernstein,
In my question about the chaperone, I was trying to illustrate the difference between the care of men by women vs the care of women by men. As a physician you provided the patient a chaperone of her own sex for her comfort and your protection. But, when you had personal care delivered by a female, she did not have a chaperone of your sex for your comfort. Catheters and pelvic exams are both highly invasive and very personal. You provided for the female patient but the nurse did not provide for you. That is a sharp contrast between how men treat women and how women treat men.
I am bothered that some female providers see it as appropriate to have either have no chaperones for the male patients, or worse, have a chaperone of her own sex, as if she is really protecting herself. There is no science that I can find where a female provider has reason to suspect that she needs to protect herself from male patients, yet she will demand that another female be her chaperone with the male patient. A male provider will NEVER have a male as his chaperone. What a contrast!
I may have mentioned in the past my experience with a female nurse practitioner bringing in a medical assistant to be her chaperone, along with the drama accompanying that. Even with my past abuse history, I would have preferred the nurse practitioner have had no chaperone, male or female. I wasn't given the choice.
58flyer
58 Flyer, I think with this new pandemic and the recession or possible depression that follows, there will be men taking jobs as CNA's and techs/ medical assistants who wouldn't under normal circumstances. Also there will be women hooking up with men they wouldn't look at twice just to have food in their mouths and a roof over their heads ( and their kids ) Many people will tolerate treatment for themselves and their children what they wouldn't for survival purposes.
Ok. I got off topic, but more male care takers will prove that the same sex care won't fix our issue. Many MALE doctors ( and female ) have caused/ allowed other people around while patients are exposed. Male OR female staff can allow patients to be seen by people in the hallway or by family members.
Dr B, For whatever reason you seem to think studying for years is going to cure sexual deviancy. And even if a person didn't go to college for many years JUST to see and touch and display to other people exposed patients, it still doesn't mean they couldn't get pleasure from doing so. Also having personality doesn't make a person good. Charles Manson had personality. And Ted Bundy.
To follow what JF said about education not being a guarantee, this was in the news all over Vermont, and I gather has been spreading throughout New England and beyond. A 37 year old male ER doctor at the State's premier hospital was arrested for voyeurism. He is accused of installing a spycam in a staff bathroom. The hospital did the right thing and called the police who investigated and then arrested the guy. The hospital suspended him until the case is resolved. My guess is he'll be fired once the hospital goes through their procedures for such things. The real question for me is what will the VT Medical board do, if anything. I also wonder to what extent he was getting his jollies from patients in the ER. It is hard to imagine this guy threw away all those years of schooling and residency for some cheap thrills like this.
https://www.burlingtonfreepress.com/story/news/2020/04/18/uvm-medical-center-doctor-arrested-multiple-voyeurism-charges/5158650002/
... And that, 58flyer is the crux of the issue I - and many other men no doubt - have with the use of chaperones in clinical settings. It has very little to do with the protection of the patient and nothing at all for their comfort (if the aim is to ease anxiety). In fact, I will bet you dollars to daughtnuts that it makes things worse for many patients (mostly the male ones which, apparently, doesn't matter much).
A chaperone should never be imposed. It is inconceivable to me why that is considered "standard practice." And if it is to be a must, the provider should bear the burden of having qualified staff of both genders on hand at all times. Failing that, let's say a clinic can only secure a male nurse on specific days, then that clinic should group their male patients' visit for those days.
It's not rocket surgery, people. And if this raises the overhead expenses well... That's the cost of doing business. You'll loose that patient anyway (unless you're planning on embushing him).
Dany
Maurice,
In regards to your 3 week replacement of the Foley catheter, I am very surprised that you are NOT doing it yourself.
Was this option even offered yo you?
I know many people who self cath (both Foley and straight). I use to do it for my friend's mother since he felt strange doing it to his own mother. The training is very straight forward. I would also expect that as a physician, you would be able to do it yourself (still requiring you receive the proper training).
Granted, there are some medical reasons requiring it be done for you, but nothing you say hints at them. Having a suprapubic catheter or needing a coudé catheter are reasons (although many using coudé catheters self cath).
"Good People Doing Bad Things for Good Reasons" is Machiavellian. That rational would justify using force in a male patient's demands for male caregivers to protect themselves from PTSD.
Biker,
Concerning good people doing bad things for good reasons, that is the very definition of PATERNALISM; the provider deciding care based on the provider's values, NOT the patient's values.
Patients have spoken up, demanded customer service. That is why providers are like financial advisors (instead of stockbrokers) and retail employees instead if autonomous practice owners.
-- Banterings
Banterings, I want my Foley exchange (which must last for a 3 week period fixed in place) to be performed professionally. Unlike a standard twice a day bladder emptying by the patient inserting, waiting a minute or so as the bladder empties and then removing a catheter which the patient can perform on his or her own with attention to safety, my urologist decision for a Foley and attached leg bag requires the present management for the best function and my best safety. Each patient with that patient's pathology or history of surgery is different. ..Maurice.
In reference to the Vermont doctor as posted by Biker, it is interesting that he placed the voyeur-cam in the staff bathroom. I guess he wanted to assess the bathroom habits of his colleagues. Would we even had heard of this had he put the camera in the patient's bathroom? Possibly not.
This reminds me of the urologist in my hometown who secretly videotaped hundreds of patient exams (mine included) over many years and was only caught when he got divorced and his wife spilled the beans as part of the nasty fallout.
58flyer
58flyer,
If he simply claimed it was for urology medical research, e would have a note placed in his file at the board.
Reminds me of the pediatrician who photographed naked children and claimed it was medical research. Unfortunately, he only got a slap on the wrist.
Dr. Dix Popas:
...Nerve Sparing Ventral Clitoroplasty: Analysis of Clitoral Sensitivity and Viability by Jennifer Yang, Diane Felsen, and Dix P. Poppas. Writing in the typically dry, quantifying language of modern medicine, the authors report why they believe Poppas, a pediatric urologist at New York Presbyterian Hospital, Weill Medical College of Cornell University, has left a group of girls still able to have sexual sensation after he has removed parts of the girls’ clitorises. With parental consent, these girls’ clitorises have been cut down in size after the physician deemed these clitorises too big.
...Rather, we are writing to express our shock and concern over the follow-up examination techniques described in the 2007 article by Yang, Felsen, and Poppas. Indeed, when a colleague first alerted us to these follow-up exams – which involve Poppas stimulating the girls’ clitorises with vibrators while the girls, aged six and older, are conscious – we were so stunned that we did not believe it until we looked up his publications ourselves.
Here more specifically is, apparently, what is happening: At annual visits after the surgery, while a parent watches, Poppas touches the daughter’s surgically shortened clitoris with a cotton-tip applicator and/or with a “vibratory device,” and the girl is asked to report to Poppas how strongly she feels him touching her clitoris. Using the vibrator, he also touches her on her inner thigh, her labia minora, and the introitus of her vagina, asking her to report, on a scale of 0 (no sensation) to 5 (maximum), how strongly she feels the touch. Yang, Felsen, and Poppas also report a “capillary perfusion testing,” which means a physician or nurse pushes a finger nail on the girl’s clitoris to see if the blood goes away and comes back, a sign of healthy tissue. Poppas has indicated in this article and elsewhere that ideally he seeks to conduct annual exams with these girls. He intends to chart the development of their sexual sensation over time.
But this is OK because he has a magic white coat. BTW, this study was never approved by the IRB.
All I can say is "sick bastard..."
-- Banterings
Regarding that doctor that videod his colleagues using the toilet-I hope they were the kind of coworkers who just allowed him to humiliate patients and expose them unnecessarily and didn't turn him in. It would be poetic justice for them. The cops or whoever investigating seeing it. JUSTICE!
I hadn't thought about that JF, but I suppose it would be poetic justice if that ER doctor had been known by the staff to be a little too interested in intimately exposed patients to now know he was doing the same with them. There haven't been any updates since the initial story broke last weekend and I'm guessing neither the staff nor the hospital will be talking to the press while litigation is ongoing. In a small State like this it'll be big news when it does come to trial.
Banterings, I don't think that every medical provider who does intimate exams is guilty of a sexual fetish but I do think that they were created by people with fetishes. The chaperone policies and people wandering in and out of exam rooms when patients are exposed. I think fetishes created that also. And that freak doctor that you are talking about is a well paid legalized sexual offender. People generally can justify anything they want to do.
JF, remind me: are you actively working in a "nursing home" or equivalent institution? My following question is related to preserving patient's dignity as well as their life. Are the patients and staff there being attended to and treated appropriately in view of the current statistics showing the highest COVID-19 infection and death rates are occurring in such and similar institutions? Do you know whether the staff, patients, family members and institutional owners and managers are aware of the risk and the higher disease statistics than in the surrounding communities? What changes have you noted in the behavior of the staff towards the patients?
To me, one sign of preserving dignity is doing everything possible to preserve the patient's safety and their life. ..Maurice.
Dr B, As soon as we enter the building someone takes our temperature. Our masks are already on our faces. Then we put hand sanitizer on our hands. No visitors are allowed in the building. We also check our patients temperatures sometime during the shift and ours. One coworker was exposed to somebody who MAY have been exposed and she had to take two weeks off.
Something is happening within the ICUs and other areas of the hospitals dealing with the very sick and dying COVID patient which is destroying the matter of preserving patient dignity. What is happening almost shadows some of the experiences JR has had with her husband's professional management. That "happening" is the reluctance or prohibition of family members from attending and the bedside (speaking, touching, holding hands) of their very sick or dying loved one. It is, according to the news media descriptions, routine for all the attending medical staff to be appropriately dressed, masked and shielded to talk to, touch and even, hold the hand of the very sick or dying patient since family is not allowed to be present. For severe sickness or near death patients to be denied their family present who could be present in appropriate garb protection is a terrible example of ignoring the dignity of a sick or dying COVID patient. Does some "public health" order or fear of legal suit by a family member form the basis of preventing the family from attending and transmitting their perhaps final expression love to their sick member? Just a thought. ..Maurice.
Maurice,
I have a VERY close friend who is a nurse who works in a long term care facility and is waiting to be deployed to NYC and other friends in nursing; The one thing that I can say (in most instances) when it comes to dying, especially now during the pandemic, is that there will be at least one compassionate person with the person when they pass. Especially in the hospitals, they are using Facetime so that the families can connect with the patient via video.
-- Banterings
I have written my entire 9:15 commentary published on our blog thread, removing the statement speaking about JR's experience, to a heavily subscribed medical ethics listserv and already got a number of worthy supportive responses from the physicians, philosophers and physicians who subscribe. Here is the last posting I wrote:
And though we don't know the details from the news media, Senator Warren who just lost her brother to COVID stated as noted
in the current news item: "“I’m grateful to the nurses and frontline staff who took care of him, but it’s hard to know that there was no family to hold his hand or to say ‘I love you’ one more time ― and no funeral for those of us who loved him to hold each other close,” Warren wrote in a tweet. “I’ll miss you dearly my brother.”
My question would be "was there family available but were prevented from being present? Our President daily implies "no shortage" "no shortage" "no shortage" of PPE. Should we believe him? ... there is the family visitor's voice and narrative spoken which, if the patient is conscious and can hear could be recognized and even the family's exposed eyes and eyebrows as seen through a shield and mask might be recognizable to the sick patient.
There should be patient human dignity to be preserved or even attempted to be preserved despite COVID even if the prognosis for recovery is nil..
To show the importance of the issue I brought up to the ethics listserv (and of course here), an ethicist presented the following link about how the "fundamental religous/cultural practices in end-of-life care and funerals have posed a similar challenge to the containment of Ebola in parts of West Africa" https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4709130/
..Maurice.
..Maurice.
I am pleased to have carried out Bantering's suggestion to re-title this blog thread to "Preserving Patient Dignity" from "Patient Modesty" although the modesty issue continues to be an important component in the discussions within this blog thread. However, "preserving dignity" of patients allows us to talk about other aspects including COVID. Again, thanks. ..Maurice.
Hello Everyone .
Hope everyone is in good health . I thought I would share a email I received from a group I volunteer with . It might help people to understand what the healthcare providers go through in their fight with the Coronavirus .
I hope it gets you to thinking what they are going through .
https://www.samaritanspurse.org/our-ministry/ny-diary/?utm_source=FY20DiaryEmailA&utm_medium=email&utm_campaign=m_YCOV-20E5&utm_content=read-cta-button AL
Hello,
Please read a fellow physician's thoughts re family at the bedside of the dying.
https://suneeldhand.com/2020/04/23/if-any-healthcare-facilities-are-doing-this-its-unconscionable/
Reginald
Thanks Reginald for your pertinent link. I wrote a Comment to Dr. Dhand's view about which as you know from what I have written here, I fully agree. ..Maurice.
JF, but how about viral testing where you are employed. Are all the patients tested for the Corona virus and are all the employees tested for the virus too? If not, doesn't this tells us something about the non-preservation of institutional dignity or am I being to tough on the nursing institution? ..Maurice.
All I know is what I've told you already. We're told on the TV news how many COVID 19 deaths in the county and how many cases there are. JF
Moving on to preserving and not sacrificing patient dignity, do you think that what we physicians teach students and what we usually had written in the first line of a medical history was the patients age, gender, marital status racial and/or national origin and finally occupation? All in the first line of text.
That first line might also include some chronic major disease or disorder. "The patient is a 35 year old single oriental cook who has known chronic thalassemia.."
Maybe also add some social information as "homeless"..("...homeless 35 year old..."? Back in July 2009, I wrote a blog thread titled "Patient's Medical History: Should Description of Race and Ethnicity be Forbidden" and got some valuable reader responses.
I wonder if what and how doctors and nurses characterize and document their patients for the first line of the medical record or verbal communication need to be re-evaluated if such communication may be hurtful towards preservation of patient dignity and may be one factor causing the PTSD consequences amply written about on this blog thread. What is your opinion? ..Maurice.
Oops! In my example above "The patient is a 35 year old single oriental cook who has known chronic thalassemia..", I left out "single male"..Maurice.
Dr. Bernstein, I don't have any concerns with a basic demographic descriptive, and see it all the time in the notes I'm provided after my visits or procedures. It essentially defines the sides of the road in beginning to define the patient.
What I don't like is inferred characteristics that haven't actually been established. What comes to mind is the dermatology practice I go to inserting "No Residents" in big red letters at the top of my chart when I don't have a problem with Residents at all. What I had a problem with was a specific Resident who was incredibly unprofessional, not with his status as a Resident. They also added "Male Staff Only" which was only partially correct. Correct would have been "Male Staff Only for Full Skin Exams". I had to get that one corrected too before seeing a female Resident for a minor non-intimate exposure procedure. I had an appt. with her and then suddenly there was a frantic MA entering the room asking if I knew Dr. so and so was a female. When I explained I was only concerned with staff gender for full skin exams, she said she's that way too, and then all was well again.
Does anyone here have any concerns with as Biker writes "basic demographic descriptive"?
Would you all agree that regardless of how demographically and clinically descriptive that introductory first written line is presented, that is the way it should be written and should not impair patient dignity? Do you think that the patient, having capacity at the onset and since this may be a longtime existing document read by others, should be told by the physician what words of that introduction will be used and the patient given permission to edit? Some may interpret my question as "silly" but some may not. ..Maurice.
Oh! So much to talk about with this ongoing COVID-19 effect on patient office visits to their physicians--major drop in visits in most all specialties. Apparently, patients are using the telemedicine communication and examination from home with their physicians who are participating in that approach. But would you feel more comfortable with a telemedicine visit than one in person? ..Maurice.
I don't think descriptors such as marital status (married, single, divorced, widowed) and race belong in a medical record.
Only information needed for diagnosis and treatment should be included.
How does knowing the patient's marital status benefit the patient? How does it improve diagnosis? How does it direct treatment?
Cases have been reported where physicians have not offered the standard of care to patients because the patient was not married. The physician assumed that since the patient was not married, the patient lacked the social support to successfully complete the treatment course. The patient was offered a less effective and less demanding treatment.
Someone who is single can have a strong support network just as someone who is married can have no support.
Another argument for knowing marital status is it tells the provided who they can discuss the patient's medical information with.
This is bad reasoning. There are many reasons why someone might not want their spouse to have their medical information.
If a treatment is difficult, you describe what to expect and whether the patient has someone(s) who can help him/her. Then you let the patient decide.
If you want to know who you can discuss the patient's medical information with, you ask the patient.
Race is another lazy shortcut. There are some diseases that are more prevalent in some races than in others, but in the USA almost all of us have some genetic material from many different races. A provider shouldn't include/discard a disease from their differential just because of a patient's race.
I was being admitted to a hospital that asked race - hispanic white, non-hispanic white, black, Native American, Asian, pacific islander. They also had the option "prefer not to identify." I selected "prefer not to identify." I was quite surprised when I was discharged to see that someone had assigned me a race.
What if my father had been black and my mother white? Would forcing a patient to pick one be treating the patient with dignity? What if the patient had declined to identify and learned that a provider had decided for them which race they belonged to? Perhaps we should return to the days where if a person had even a drop of Negro blood in them, they were Negro.
Medical forms always ask my profession and my education level. They do not use this information to improve my care.
I don't think a single provider has even looked at it. I've had providers explain (incorrectly) how something works when my medical record shows I have a PhD in that field.
A friend was being treated at a top academic hospital. All the attendings, residents, and medical students addressed her by her first name and explained everything to her like they would a child. One day she offhandedly mentioned she worked at that university. They asked what she did. She held one of the distinguished research chairs. After that they addressed her as Dr. and explained everything in greater detail. Her degree and profession were in her medical record, but clearly no one had looked at it.
I've had medical forms ask if I own or rent!
I've had forms ask if I live alone or with someone and who! How are my living arrangements relevant?
This information is not collected to benefit the patient. It is collected to benefit researchers and health care providers. It's for reports to the government and various other agencies.
The medical community needs to revisit the information they collect and determine what is needed to diagnose and treat.
If they want to collect other information, they should mark it as optional and tell the patient how they will use that information. When patients realize that the medical community is invading the patient's privacy not for the patient's benefit but for the providers' and researchers' benefit, you lose trust.
-cg
Dr. Bernstein, I have had two routine follow-up cardiology visits via phone over the past month or so. The 1st included video via VidyoMobile & VirtualVisit via my cell phone until it stopped working. I'm not sure whether the problem was on my side or theirs but the doctor called me back on the house phone. The 2nd was just via the house phone. It was adequate given we were just going over whether a new prescription was working.
My wife has had a number of televisits with her primary care, with the hospitalist at the local hospital, and with a nephrologist as follow-ups going over test results, prescriptions, and what was needed for visiting nurse type care. She had recently been hospitalized for 22 days with sepsis and had incurred substantial kidney damage. In her case she wasn't ready to be sent home but they did purposely to better protect her from possibly acquiring covid-19 which they said she wouldn't survive if she did. The televisits seemed to stay on top of things and she is recovering nicely, but if she weren't, televisits certainly would have been inadequate for the doctors to properly assess her. Her visits were via the house phone with no attempt at video.
I should note that most people here have house phones given cell coverage can be spotty in rural VT. To the extent technological solutions of this nature are thought to be part of the future of medicine, a more robust investment in rural infrastructure needs to be part of it, at least in mountainous terrains such as exists here. Cell phone sort of work in my house due to a booster we installed but not in my yard but yes down at the far end of my property (1/4 mile from the house) where people often stop to make calls but not at all as I go over the mountain exiting the valley I live in. That's what I mean by spotty. We personally have good internet but many rural areas do not, so that as a solution also needs more robust investment. These are things that people in DC and in urban areas in general just don't understand when talking about the future delivery of medicine.
Dr B, What you just said is EXACTLY what I thought. JF
JF, please be more explicit as to what I "just said" since I have been doing alot of "saying" since I most recently started my posting with JF. ..Maurice.
Maurice,
Your description "The patient is a 35 year old single oriental cook who has known chronic thalassemia" is acceptable and relevant to the treating the patient. This particular patient is a great example for COVID-19:
Asian males (especially from South Asia) are more susceptible to thalassemia than other races. With COVID-19, it attacks hemoglobin in red blood cells, rendering It incapable of transporting oxygen, thus having thalassemia OR being susceptible to it.
(Reference: Research Reveals That COVID-19 Attacks Hemoglobin In Red Blood Cells, Rendering It Incapable Of Transporting Oxygen. )
The same way, black men are more susceptible o sickle cell anemia, thus COVID-19 affects theme more severely.
Biker,
Your demographics should be "white male, 50-ish, iatrogenic PTSD from abuse by female providers..."
-- Banterings
It's so easy to quote somebody wrong. Like saying somebody doesn't want females providing care when the male patient actually meant he didn't want to be intimately exposed to a female provider. So let it be confirmed with the patient.
JR, Nobody is talking too much now so I wanted to chime in about something we talked about earlier. You voiced a concern that the retired nurses coming back to work might have a negitive influence on staff regarding modesty violations. My thought is that staff often just follow their own character defects. It's true that when they see a coworker doing something wrong and getting away with it They'll be more likely to do it also but they already wanted to do it.
Where I work now at an assisted living home, one of my coworkers put one of my patients to bed before I ever started my shift. She was heavy enough to need a hoyer lift but we don't use them at our facility. He was trying to convince me to not bring her in her supper. I could have easily not brought her in her supper and nobody would have been the wiser. But letting a patient skip a meal isn't one of my many character defects.
Coworkers often bring out the worst in each other but it has to be in their nature in the first place or they couldn't bring it out.JF
JF, I think it was important to bring out your experience and fact that there is much more professional behaviors to degrade a patient's dignity than simply one dealing wrongly with the patient's "private parts". Thanks. ..Maurice.
Yes there is more to dignity than just gender/exposure issues and different patients are going to prioritize different aspect of dignity as to what is most important to them. Healthcare staff are similarly going to have differing opinions as to what constitutes respecting patient dignity.
The problem arises when patient and provider are operating from different definitions as to what is important, compounded when one side doesn't ask and the other doesn't tell. It is further complicated when for the patient gender enters into the dignity definition and for the provider there isn't anything they can do about that as is often the case. This is where provider training can be greatly improved. Simply acknowledging "yes I know this may be embarrassing for you but please know...." would go a very long way for many patients as opposed to having their concern dismissed or ignored. That only serves to amplify the embarrassment.
However, I suspect most training programs from Medical Assistant on up to Physician teach students to dismiss or ignore gender-based modesty concerns. Note that telling the patient "We're all professionals here" is equally as dismissive as is "you don't have anything I haven't seen".
I really appreciate how many healthcare workers have worked hard to help Coronavirus patients. I deeply appreciate Samaritan’s Purse sending a lot of medical professionals to volunteer their time to help patients in New York.
I find it very sad that many of those Coronavirus patients who pass away do not have the option of having a family member present with them. This is very wrong . Each COVID-19 patient should have the option of having one family member present with them. The family member could put on protective medical gown, mask, and gloves like medical professionals.
As the founder of Medical Patient Modesty, I am very disappointed in how hospitals have made policies prohibiting family members from being with their loved ones when they are hospitalized. It broke my heart to find out that two daughters (they were completely healthy and did not have coronavirus) were not allowed to visit their dad who had a massive heart attack and spent over a month in the hospital. It also bothered me so much to learn that a friend could not be with her husband who required hand surgery due to an accident at work. It bothered me that the Labor & Delivery department at that same hospital allowed husbands to be present with their wives for childbirth. Hospitals should abandon those ridiculous policies. The truth is family members are much less likely than healthcare workers to have Coronavirus. The healthcare workers are at the greatest risk for having coronavirus since they have person-to-person contact every workday, often exposing themselves to people who have the coronavirus. It makes me sad that hospitals are not really patient and family centered anymore in this pandemic. They could take the temperature of each family member before they visit their loved ones in the hospital.
As many of you know, I am a big supporter of patients having a personal advocate present for surgeries.
I got the below email from a man today and I agree with him. I feel like patients are at a higher risk of being violated and sexually abused with the ridiculous policy that many hospitals have today prohibiting anyone from being with their family members who are hospitalized. Also, those patients do not have anyone to advocate for them. The sad thing is many patients are left to recover from surgeries and illnesses without the support of their family members.
Hi I have been observing and hearing about changes in policy at most hospitals and clinics across the U.S. regarding the patients rights to have a spouse, friend, or family member present in the exam room with them during routine or intimate exams. This has been due to the covid-19. I don't know if this is a stipulation coming from the government or just the preference of each individual clinic. However I do feel like this is a major infringement of a patients right to take "one" person of their choice into the exam room with them for support or whatever personal reason they wish. I also think this is a right according to HIPPA. I feel these new policies of taking that option away may make more female patients vulnerable or put them at higher risk for sexual assault or misconduct by medical personnel because there would be no nonbiased witnesses to testify on the patients behalf or keep the moral/ethical atmosphere neutral thenceforth detouring and minimizing misconduct or inappropriate behavior. I think that these new rules because of this so called pandemic will allow would be sexual predators or deviants in the medical field to operate with impunity and cause the number of sexual misconducts to spike. I do not know the appropriate officials in which to take this matter or who needs to hear it but I definitely think it's an issue that needs to be addressed. If you have any information or opinion on this matter please share. Thank you for taking the time to read this!
Misty
And yet we all saw yesterday a photo of our U.S. Vice President in a room at a Mayo Hospital Clinic with others and a patient in the room.. all wearing masks except the Vice President. They didn't throw him out when he refused. ..Maurice.
Dr. Bernstein, just as VP Pence as an elite was allowed to waive Mayo's mask rules when it applied to him, I wouldn't be surprised if the elite in our society are still being given access to their hospitalized loved ones and/or are having family visitors when they are the patient. Rules for thee but not for me seems to be occurring with covid-19 matters throughout society. The wife of the Illinois Governor just skipped out of the stay-at-home order and flew to their estate in Florida. Mayor DeBlasio & wife in NYC could ignore the stay-at-home order and go to the park. NY Gov. Cuomo's brother Chris who was infected with covid-19 could leave his home and go with his entourage to visit a new home he is having built. And on and on.
And yet we see a US candidate for President who has a valid sexual assault case against him and many pics of him inappropriately touching women & children but still there is no real concern against this man from the very groups that always say victims of sexual assault should be believed. They should state except when it is the candidate of their choice, occurs to a patient especially a male patient, priests and children, etc.
As for Mike Pence, I have not seen him wear a mask. The fed. govern is loosening the regulations. I believe VP Pence knows enough to know what he is doing & maybe he has more info than you or I plus being tested regularly. Even the great medical guru Fauci doesn't seem to say much that makes sense & I imagine he knows a lot more than what he is saying. Mike Pence is an adult & can make his own decision as to wear a mask or not just as many people I see out & about. I am not seeing cops while arresting people for being out having on masks either. What are they breaking w/ protocol? But I understand w/ Pence it is a political dissatisfaction statement. He seemed to be the magical 6' away as the germ knows not to exceed 6' according to the great medical gurus who actually know not a whole about this. FYI, I don't see the great gurus such as Fauci wearing masks or even staying the 6" apart.
I agree w/ what Misty about the policies of hospitals not allowing patients to have someone w/ them except dads in the delivery room. What makes them to be more germ-free than other is only another example of the twisted medical logic. They in be known like to have patients isolated as that makes them more defenseless and compliant. A patient's mental well-being is not on their list of concerns. The fact that the medical community allows & coverups patient harms as if it doesn't matter speaks volumes about their moral & ethical compass as it is pointing due South. Now they have been given immunity from the harm they inflict, they are thriving. The Internet is full of videos of nurses dancing in vacant hospitals w/ one having them dance as they are carrying a mock dead COVID patient. How much more illustration of their uncompassionate & mocking behavior does the public need to see before finally realizing many of them aren't heroes and more to the point should not be in the business of being around innocent, defenseless patients?
I see people in scrubs in grocery stores. Why aren't they changing before wearing those into stores? No concern for others would be the answer. They have locker rooms in which they could change their clothes/shoes but maybe they don't want their co-workers to see them in a state of undress? But why would that matter to them? It means nothing so the patient is told. I have mentioned this to some I see out & about that it seems very careless of them not to change from the germy scrubs. If you want all of us mere mortals to know you are a super hero just wear a sign.
Misty, I think the sexual deviates pretty much have impunity already. OUR protection is an extra person in the exam room, often positioned to where she can see EVERYTHING ( further violating modesty ) or an unlocked door so that staff can stroll in and out. Sometimes even a kid could open up the door before anyone can stop him. Or another patient could accidentally try to enter the wrong room. Any other person accused of sexual abuse gets all kinds of rules laid on them. But not medical workers. JF
Does anyone think that "patient dignity" is also a political matter beyond the relationship between a patient and a healthcare provider or worker? Do you see and can give examples of ignorance or impairment or on the other other hand support and enhancement in the preservation of patient dignity in political terms? We are living in a critical time when how patients and their families are treated is based on behaviors beyond purely originating from those who have been trained in medicine and medical care. Does anyone agree? ..Maurice.
Patient dignity is a political matter to the extent politicians and political correctness define who gets to decide what constitutes patient dignity. Ignoring the current pandemic, political correctness has deemed the rights of female staff members as superior to the interests of male patients who might prefer same gender care. Politicians and courts support this assignment of superior rights to women who in turn get to decide for men what constitutes dignity for male patients. It's dignified because we told you it's dignified. Your opinion doesn't matter.
During the current pandemic emergency certainly much of what we see in terms of restrictions is more politically based than science based. First, as harsh and sad as the no-visitors policies are, it does have a science-based component, especially in light of possibly not being able to afford using limited supplies of PPE for visitors.
Where it becomes more political than science-based is in things such as occurred in NY State where the State Dept of Health mandated that nursing homes take in sick patients with covid-19. Hospitals said they weren't sick enough to stay in the hospital and the State said the nursing homes had to take them. Was this because the hospital lobby was more powerful than the nursing home lobby or was it just incompetence? Where was the dignity in potentially dooming non-infected nursing home patients to a terrible death by knowingly introducing the virus into those settings?
It was political correctness that tried to stop Samaritan's Purse from setting up an overflow facility in Central Park, not because NYC didn't desperately need the capacity in the midst of a public health crisis but because the providers weren't "woke" enough. The alternative was possibly letting people die, something most of us would agree is far less dignified than being saved by someone that failed someone else's political litmus test. Fortunately they didn't get their way on that one and Samaritan's Purse provided a much needed service to the people of NYC.
In a more general sense of being given the basic human dignity as an adult to not be treated as an ignorant child, there has been the overall political response to the pandemic that has been seemingly devoid of much science behind decision-making. It is not the object or service being sold that generates the covid-19 risk but rather the setting and manner in which it is sold, yet seemingly nonsensical designations of essential vs non-essential are based on the product or service rather than the manner and setting of sale. Things like selling pot and liquor apparently isn't deemed a public health risk no matter the structure it is being sold in or the manner but don't dare try to take a driving tour, never leaving your vehicle, of a tulip farm such as was banned in NJ as a public health risk. In your car with no contact with anyone is risky but walking into a pot store and making your purchase is safe. These are not science-based designations but rather political (or perhaps just incompetence). There is far more dignity in science than in politics. Science might address HVAC system considerations, staffing & customer density and ability to maintain social distancing, PPE requirements for staff and customers, and so forth. Science doesn't care about what the actual product or service is, yet that isn't what our politicians did. Instead they jumped to pot is safe to buy but don't look at tulip fields in bloom. That doesn't respect the dignity of the public nor does it constitute science-based public health.
I strongly suspect that our people in power WANT our elderly to die. What we consider OUR social security benefits, they consider THEIRS. I saw a movie one time with a man burglarizing a house when no one was home. He brought a young boy with him. At one point he scolded the boy and asked him " Are you up to this kind of work, or not?" JF
A problem in reproducing BJTNT's very worthy commentary from 1:45pm today. Here is what was written. ..Maurice.
JR - Amen
Biker - Amen
Alexander Tyler, a Scottish history professor at the University of
Edinburgh, had this to say:
"A democracy is always temporary in nature; it simply cannot exist as a
permanent form of government. A democracy will continue to exist up until
the time that voters discover they can vote themselves generous gifts from
the public treasury. From that moment on, the majority always votes for
the candidates who promise the most benefits from the public treasury,
with the result that every democracy will finally collapse due to loose
fiscal policy, which is always followed by a dictatorship."
"The average age of the worlds greatest civilizations from the beginning
of history, has been about 200 years. During those 200 years, these
nations always progressed through the following sequence:
>
1. From bondage to spiritual faith;
2. From spiritual faith to great courage;
3. From courage to liberty;
4. From liberty to abundance;
5. From abundance to complacency;
6. From complacency to apathy;
7. From apathy to dependence;
8. From dependence back into bondage "
We have been a democracy [Republic] for well over 200 years. Are we in phase 7?
BJTNT
Been really busy as I am growing my social media presence. My husband and I did an interview that part 1 played last Monday and part 11 will play this Monday. I have gotten a new domain for another website called www.patientrightsinfo.com that will be a clearinghouse of all types of information patients need and plus give information on what changes need to be done to how healthcare is delivered. It will have articles, personal accounts, etc. It is something I want to be able to send anyone and everyone to for information.
There is a lack of recognition is many aspects of patient care regarding rights. The right to full & true informed consent (which is absolutely huge and extremely lacking), patient autonomy, & patient privacy of both the body & information to name just a few. This includes making changes in malpractice laws and also to change intentional harm into a criminal offense with criminal charges and punishment. It has to easier to weed out criminals and mentally ill healthcare providers so the purposeful harm they inflict will be stopped before 100s of patients are harmed or killed. Malpractice simply does not take care of this and an actual system that works to help harmed patients must be put into place as what we have now favors only healthcare.
Potential patients need information to really protect themselves against harm.
And now for the reaction and treatment of a condition currently present but also maybe pertinent for conditions in your past which led to your reading or participation on this very blog thread.
"WHO Guide: "Doing What Matters in Times of Stress. An Illustrated Guide" Look at the cartoon images but most importantly listen to the audio narration. Let us know what you think after you give the advice a try. ..Maurice.
Dr. Bernstein, certainly current pandemic circumstances are stressful for many many people given for some devastating economic impacts and for others the prospect (or reality) of life and death scenarios. For others simply having their normal routine constrained is more than they can handle. Though I'm not sure this is the kind of thing that the W.H.O. should be prioritizing, I like the manner in which they address it in an actionable way and explain it in easily understood terms.
Bringing it down to the subject matter we discuss here, certainly anyone for whom the manner of healthcare delivery is stressful needs mechanisms to cope with it. One mechanism not included in the W.H.O. publication is speaking up rather than passively accepting whatever is causing stress. The W.H.O. seems to overly focus on just being a nice person focusing on your values is the answer. Certainly I value being kind and respectful to everyone. However, that doesn't mean I should just quietly accept female healthcare staff not respecting my modesty. There is more to it than their just being polite and friendly.
Most nurses I've had over time were female--whether for cleansing and barium enemas, insertion and removal of catheters in the hospital and for a urodynamic exam. For the latter I was offered a covering for my genitals but didn't see any point since I knew electrodes would be placed around the anus and catheters in the bladder. I know females have been present for hernia surgery and colonoscopy exams. It doesn't bother me.
I don't understand why dermatologists [male or female] are shy about checking genital and anal regions. And don't understand why nothing below the waist is checked any more for a general physical exam. The last 2-3 physicals have only checked blood, urine, and above the waist. I want a full body checkup, whether by a male or female doctor. I may recognize changes if I can see them, but can't make a diagnosis. That's why I go in for an exam.
JimG
JimG, thanks for joining the conversation. I agree that physicals have become less thorough, having noticed it myself. It may be that the time pressure to churn through more patients in less time is the cause. If a patient doesn't indicate a concern the physicians may be just taking them at their word that all is OK so that they can get to the next patient all the sooner.
Many men such as yourself have no modesty concerns and that's a good place to be but the staff, especially female staff, should never operate from that assumption. She was right to offer you a covering for your genitals during the urodynamics testing given no patient, modest or not, should ever have more exposed than is necessary, for longer than is necessary, or to more people than is necessary.
As for dermatologists, some are more thorough than others. Where I go there is a sign in every room making it clear that they recommend complete exams. Apparently many patients choose to keep their underwear on. On that one I suspect more men would opt for the full exam if the doctors didn't bring a female LPN and female scribe into each exam. I let him do a complete exam but the LPN stays out of the room and the scribe turns around. Neither the LPN or scribe add any value to his doing a genital exam and thus have no need to just stand there watching him do it. For modest people like myself, it feels creepy to just be stared at.
Hello JimG,
Welcome to this blog. It's not every day we have visitors taking a leap and posting their opinions.
I can appreciate you not being too bothered by your experiences regarding your healthcare. Maybe you got used to it. And if you are fine with the way things are, that is great. You are getting what you want (or, at the very least, what you think you need).
But keep in mind not everyone shares your views, opinions or feelings about this. For many of us, me included, we object to the way health care is currently delivered. It isn't "right" and we are asking for changes. Or doing what we can to support that idea. Things can be done differently, if only the industry ans its many employees are willing to put patients first, an not their bottom line, traditions, or convenience (and then you have those who delight in embarrassing patients and expect it as their due).
I, and many other men, am a modest individual and I insist on limiting who has access to my body and when. I prefer male providers if exposure of my genitals is to be expected. I choose not to allow that when I do not believe it is necessary (and you would be surprised just how often it isn't).
I appreciate the opinion you share, just don't expect people here to agree with you.
Dany
Dany and JimG, I think a good solution would be offering options in the paperwork. With patients putting a check mark beside what they want. Not everybody is modest but many avoid care that they need because of modesty and blatant disregard of that modesty.
With this posting I don't intend to imply that what you are experiencing as a patient when being examined and treated by others is fully self-induced but on the other hand, the harsh feelings you are experiencing, perhaps initiated by others but are, in reality, being self-amplified. That is why I think that this view-point is important to hold and that the wonderful expression of the method of countering these feelings is expressed in this specific narration within the WHO document I previously referenced titled Making Room.
..Maurice.
Doctor Bernstein,
I can't help wondering if you are suggesting these coping techniques as a mean to make exposure more bearable (as in less embarrassing).
Dany
Dany,the "coping techniques" suggested in the WHO presentation are all indeed "coping techniques" for the "subject" of the experience and, yes, should be considered by the patient to make their clinical experience more "bearable" and perhaps less "embarrassing". I don't think there is any intent to have these techniques trump gross incompetence or criminality by the healthcare provider. But patients are going to react eventually to what has happened or is happening in a clinical situation and perhaps the suggestions made in the all the audio narratives of the WHO presentation may prevent or relieve the patient's uncomfortable or worse emotional reaction.
I thank JimG for joining our blog thread discussion. I welcome JimG to comment and invite other readers but who share varying degrees of views of what they expect and what they experience as patients in our medical system even if their views vary from the views more commonly expressed here.
I know and you all know that there are other views about the behavior and values of the medical system. And without exposing our discussion blog to those "other views" there will be no opportunity to formal constructive discussion.
..Maurice.
JimG,
The reason that they do not check below the waist is be cause it . offers NO BENEFIT! Furthermore, there are harms that outweigh the benefits.
This was the thinking with screening for reproductive cancers. Then when THE SCIENCE was looked at, it was found that screening (i.e. looking for problems that do not exist) causes MORE HARM than good.
Psychological harm is one of the harms now being taken into account.
Because physicians say we need these things like annual physicals (as long as it puts money in their pockets), they push for them. On my Twitter page, I have linked studies that say financial incentive (NOT science) is the driving force of screening and procedures.
One main procedure is prostate biopsies. Read the economics of prostate biopsies
Armed protesters enter Michigan statehouse to push lawmakers to END the lockdown, NOT extend it. These lockdowns are being pushed by doctors and nurses. They better tread lightly because society does not desire what the profession of medicine prescribes.
People will drink too much, drive with out seatbelts, eat fatty foods, and sex with too many partners despite what physicians say. Medicine is overstepping its bounds and is going to be put in its place.
-- Banterings
Dr. Bernstein, I posit that most men have sufficiently mastered the game of "manning up" that they do control demonstrating any reaction to being embarrassed. Some will subsequently choose to forgo certain healthcare, but most just soldier on making believe it doesn't bother them and continue to accept the embarrassment that comes with certain exams and procedures.
The more I think about it, it seems the W.H.O. is telling people to just accept whatever comes your way and be compliant. I reject the notion that I should accept that the efficiency of healthcare staff is more important than my dignity, and much of what we discuss here has its roots in it being more efficient for hospitals and medical practices to only hire female staff and to expose patients more than is necessary. I as well reject the notion that the female staff's comfort with my exposure is all that matters; that what I feel is irrelevant. Lastly, I reject the notion that my privacy and modesty is not as important as that of female patients.
The vast majority of healthcare encounters are calm and outwardly pleasant as the men play the manning up game and the female staff smile and make believe it is all purely clinical. The W.H.O. might see that as a desired way for such interactions to proceed; no anger or expressions of stress and everyone is calm, but is that really the way it should be?
And I have lived it manning up dozens of times and having had occasion where it was not purely clinical for the female staff.
Why all the sympathy for WHO? Is it bc they are under fire bc we now realize how political and inept they are bc Trump wants to defund them so it is always opposite day w/ Trump? Of course WHO says patients must be submissive & compliant & lays blame back on patients for not unnecessary exposure or even any exposure for that matter. WHO stands for protection of medical workers and their policies not for the patients. They do not advocate for patient rights or they would have such a barbaric philosophy. Biker's last post was right on target. I agree that all might not mind exposure and that is fine. Men like JimG has the right to his opinion & choice in how healthcare is delivered to him just Biker has that right to choose how healthcare is delivered to him. My husband used to fit in that category of not minding mixed care until he was sexually assaulted. Women will choose a male doctor without any thought of exposure but these same women do not like having a male mammographer or male nurse for intimate care. But that is their choice. But for the ones who do have preferences, those preferences should be granted w/ no questions asked or judgement. Patients do have rights. As Banterings said we are unhappy out here bc of the mess the medical community has made over COVID. It is clear their power & control has gone way above their head as it is clear they do not have any idea what they are doing. This includes WHO too. Healthcare is a service industry. It depends on customer of which patients are. They need to start being more responsive to their patients needs and not of their own needs. The time has passed for having a self-serving medical industry where committing harm and getting by with criminal acts are standard practice. Exposure done for no medical necessity is a criminal act as it involves someone in power & control doing something of a sexual nature to someone who is more defenseless whether it is an act of penetration. Definition of sexual assault has changed over the years. What has been like in the book I mentioned, to my husband, to Mr. Kirschner, etc. is a criminal act and we need to start prosecuting medical workers like we would any common criminal.
JR and Biker, I think you have the motivation and mission of the WHO dissertation wrong. As I have written previously, the WHO is not negating the "wrongness" in how the medical system is practicing its work for the public. It is simply presenting patterns of approaches to help prevent or reduce the stress of those who enter into stressful situations. What the WHO is saying is there are personal behaviors and reactions to accomplish that psychologically beneficent goal. Their presentation has nothing to do with the disgraceful behaviors detected and spoken about relative to some of the components. It is about emotional stress and how to help reduce its magnitude by personal behavioral suggestions. If you find the suggestions helpful..fine. If not, it is worthy to try to find other resources for personal stress treatment while working to change the medical system to eliminate the basis for the stress. Taking aspirin for a mild situational-based headache has nothing to do with stopping or preventing that symptomatic situation. Just some thoughts about the WHO attempt to offer approaches to prevent or ease some stresses. Nothing political. ..Maurice.
Maurice,
I have written on this blog and elsewhere how the standard of care should be trauma informed care. This is the latest research on the delivery of care without trauma. We should NOT have to man up or deal with it, the care we receive should NEVER be traumatic.
-- Banterings
Here are some doctors that I can get behind and support. They really put their money where their mouth is.
BERLIN — German doctors have posed naked online to protest a shortage of protective masks and gowns, which they say puts them at greater risk of catching the coronavirus.
Calling their protest Blanke Bedenken, or Naked Qualms, the health workers’ nude pictures appear on a website urging politicians to ensure doctors and clinics have enough protective gear.
“The nudity is a symbol of how vulnerable we are without protection,” said general practitioner Ruben Bernau in the Ärztezeitung. Source: National Post
One would expect that they know how patients feel, but that may NOT be the case. Just as JimG does not have problems being exposed to providers, these physicians may have no problem exposing their bodies to everyone.
If nothing else, they practice what they preach and I can at least respect that (as opposed to nothing I haven't seen before).
See their website; Blanke Bedenken, or Naked Qualms
-- Banterings
For me, I am reducing stress by working to change the system. That is my stress release to completely revamp the system that caused harmed without having even 1 ounce of remorse or regret. And yes, at this time WHO is a very political subject since the Pres of the US wants to defund it.
The system needs to work for patients and also for all who work within the system. We have to allow for those within the system who see things wrong to be able to whistleblow w/o fear and for all in the system to know they all have the responsibility to safeguard the patient in every manner possible meaning they need to recognize all aspects of patient dignity as it entails more than just bodily privacy.
JR, I fully agree that there are other ways for a stressed person or specifically a patient to help reduce stress. The WHO has presented one behavioral way but that way may not work for everyone.
I also fully agree that "we have to allow for those within the system who see things wrong to whistle-blow without fear.." Without getting too
political, this very point you bring up is a practice degraded in the recent past and
even in today's news when a productive medical scientist was fired from his position for "whistleblowing" from his governmental position regarding potentially dangerous medical advice given by our President.
JR, if you find "wrong" in our medical system, keep up your "whistleblowing". ..Maurice.
Dr. B.,
You may have jumped the gun on saying what you did about the "alleged" whistleblower bc nothing has been proven yet. Until it is, it is not fact. Besides there are just as many doctors/scientist supporting the use of HCQ including the one French doctor.
Never fear, I will continue on my quest to fix what is wrong in the medical system of how healthcare is delivered. The WHO also blew it when they did not fully report about the virus in China so I will take their advice w/ less than a grain of salt. I also do not respect the CDC or any other organized medical group as their main interest is to promote their agenda. If the these groups truly cared, they would be correcting what is labelled as the 3rd leading cause of death in the US--medical harm. But they do nothing but circle the wagons & protect the guilty sometimes the criminally guilty. But I am not a whistleblower, I am an activist. I am not on the inside.
banterings, I wouldn't say that those German doctors practice what they preach. What they did was a very original one-off protest but I presume the filming was done in closed sets with only an approved photographer present. Now if it turned out that their staffs and/or patients were allowed to watch I would come to a different conclusion.
Maurice and JR,
I have very close friends on the front lines in NYC. I will tell you that the best treatment is HCQ with Azithromycin. (HCQ alone is NOT as effective as the combination.)
Another promising treatment for men (already being used for 3 weeks in Long Island) is estrogen. Again, friends on the front lines are telling me this.
This past weekend, I was in north NJ (20 minutes from the George Washington Bridge). I have firsthand knowledge of what is really happening. Granted, the news reports what is going on in NYC more accurately than the news reports on other things. The national news is more convoluted and looks at multiple outbreaks. I am getting direct info on the NYC outbreak.
Biker,
You make a good point. I also wonder how many actually had pants or underwear on.
-- Banterings
Here is a pertinent published article pertinent to our blog thread ongoing topic and also pertinent to what is going on in our governments these very days. The research article published 2019 in PLOS is titled "The effect of admitting fault versus shifting blame on expectations for others to do the same"
Here is the publish Abstract of the article:
Abstract
A wealth of research has investigated how and why people cast blame. However, less is known about blame-shifting (i.e., blaming someone else for one’s own failures) and how exposure to a blame-shifting agent might lead to expectations that other agents will also shift blame. The present research tested whether exposure to a blame-shifting (versus responsibility-taking) agent would lead perceivers to expect a second, unrelated target to also shift blame. Contrary to our expectations, people expected greater blame-shifting after exposure to a responsible agent, particularly when perceivers were surprised by this reaction to failure. Discussion focuses on how people habitually expect some people to shift blame for their mishaps, and how expectancy violations when people act in unexpected ways predict the extent to which perceivers expect unrelated agents to also shift blame.
Don't get angry with if I quote, from the article, Titus Livius (59 BC-17 AD)
“Men are only clever at shifting blame from their own shoulders to those of others.”
Or is this saying absolutely of no meaning or significance regarding all that has been written on this blog thread all these years? Just something to think about.
..Maurice.
Dr. Bernstein, to the extent men have manned up rather than spoken up, we are guilty of shifting all the blame onto the healthcare establishment rather than owning up that we do share some of the blame for the way things are. By our silence we have enabled those who in turn took advantage of the situation to perpetuate the matriarchy of medicine.
Could it be that simple? Is the problem with "us"? Is it that we have a slanted view, perhaps biased by negative emotional experiences in our past? Somehow, this all seems... Well, a little too convenient.
Medicine and the provision of health care has made tremendous progress in the past 100 years. All to the betterment of humanity. At least one hopes. There's just one catch to this: it's still a (damn) business. More so in the United States perhaps. But I bet mercantile interests (I would use the word "predatory" myself) still exists elsewhere as well.
Maybe it's just me, but I can help to draw parallels and comparisons with the way health care is delivered in my own country (Canada). I cannot claim it is better as it would depend on what metrics is used to measure that but it sure is different. And I am not even that thrilled with the way it is done here. I don't know how so many people put up with it in the States.
Take only the concept of PPE (sport physicals). That is something that is simply not done here. Not ever. Why is it such a big deal? Also, why the marked differences in protocols for boys and girls? Silliness...
Speaking of physicals. Must it be done every year? Of course it doesn't. Even so-called "wellness" appointments are a waste of time (for the most part). Unless, of course, someone has a chronic condition. I don't see a clinician every year. It's not by choice, but rather a decision made by my employer. It is sufficient to do it every 5 years (if you're less than 40 years old), and only every two years after 40. What are we doing wrong?
Even when I did have to submit to a phisical examination, I make a point of not allowing my genitals to be examined. I am tupid? Do I take tremendous risks? Or do I keep dodging a proverbial bullet? Or is it just sheer dumb luck?
And yet... Here I am, still relatively healthy. Luck? I think not.
The list goes on... Hernia check(never had that), dermatology examination (nope, haven't done that either), DRE (yeah okay, one got snuck on me early on - but I learn from my mistakes), colonoscopy (it's the golden standard only in the States - I bet it costs more than an Fit or Fobt kit, that's for sure).
Did you know if you want to have a commercial driving license in some states, you might have to get a genital exam? Oh and if you ever want to apply to be a foster family... Yep, you guessed it. That too. What the what?!?
And that is only the tip of the iceberg... The health care industry has a lot of reckoning to do as far as I am concerned. But it is such a huge system, so much money goes around that it's nearly impossible to make changes. Because it doesn't want to change.
Blame shifting?... I can own up to my failures. I only wish the medical world would do the same.
Dany
I have forgotten whether this question has been answered on this thread subject: male patients have just "manned up rather than spoken up" and therefore "shifting the blame into the healthcare establishment rather than owning up that we do share some of the blame for the way things are." Biker, that is a great point for discussion.
Will those contributing to this blog thread subject admit to this male patient experience error?
By the way, since I appear to describe here tolerating how my repeated clinical catheter replacement is carried out by the nursing staff represent my "manning up" tolerance? I don't think so. ..Maurice.
Dr. Bernstein, for those who have no modesty in healthcare settings, it is not manning up. For those who would have been more comfortable or less embarrassed with male staff or who think they were exposed more than was necessary (duration, extent, or audience), then yes it is manning up if they remained silent.
Dany, I would agree that much of the delivery of healthcare in the US is revenue driven but I will disagree on the value of certain tests and routine exams. It was only an annual physical that discovered my then as yet symptomless bladder cancer at age 51 and it was only a routine colonoscopy that caught my brother's then as yet symptomless colon cancer at age 53. It was my brother who didn't get annual physicals or otherwise routinely seek care that died of cancer at age 47 who 2 years earlier I thought needed to see a doctor for something that looked funny on his lip (he was a smoker). And then there's my sister who never went to the doctor who died at age 59 or some kind of cardiovascular event and my brother who died at age 54 who was lax in caring for his Type 1 diabetes. Going through his papers I wasn't finding any recent doctor's visits, and for my sister who had saved every pay stub for the past 30 years, I found not a single document indicating she ever saw a doctor for anything. Dentists yes, doctors no. Only my youngest brother has not has any major health issues as yet and he, my other brother who had colon cancer, and myself are all diligent in getting routine care.
I can personally attest to the reality of profit-driven healthcare that is wasteful of society's resources and that the current system in the US allows and encourages it, but skipping annual physicals can be penny-wise and dollar foolish. I'd be dead if my primary care physician wasn't thorough in doing annual exams. Granted, hernia checks and DRE's never discovered a problem, but then again providing urine samples didn't either, until it did.
I will also agree that the sports physicals, especially for boys, may do more harm (via the manner in which they occur....female NP's w/ female assistants) than problems they catch. I suspect the manner of healthcare received as children and as teens is what caused many of us to feel as we do about the privacy/modesty/dignity matters discussed here.
So what magical pill do medical workers take that make them no longer have sexual thoughts/actions on patients? Does this hold true for MAs taking a 60 day course? So by what Dr. B. has been saying I conclude we should no longer have separation of men and women in restrooms, locker rooms, and clothing should be optional as there is a cure for having sexual thoughts about individuals. So everyone should be taking those magical pills as according to Dr. B. there is no issue with the other person just with one party--us and WHO has the cure for this although they weren't honest about COVID. This may work because if everyone is naked, everyone would be on an equal playing field. Scrubs could be made from transparent plastic material so they could still be viewed and wouldn't to be confined from showing their assets with the world. Masks should also be transparent so expressions would no longer have to be hidden from view cause like the one nurse said they laughed at exposing male patients behind their masks so this would make it better for the nurses to share their laughter at the patient with the patient. Seems like a fair solution and since now the nurse would be naked, the patient could also laugh at the nurse as her pendulous breasts swing freely over him. I used pendulous as I have read this subjective description more than once in a patient file during my time at DDS. No hiding or feeling superior because all things out in the open. No distinction or catering too sexes makes the playing field more level.
I am sorry to read from your posting that your have had so many experiences in your family that has moderated you regarding prophylactic medical attention but, nevertheless, you still are attentive to issues with the medical system in its various practices which need overhaul and repair or elimination. We can't always make judgments "in toto" in many life situations but also including the medical system and medical care. Yes, I agree with many issues within the medical system written here that need investigation and "speaking up" but obviously there are times like the current virus epidemic where professional support can be a supportive tool for physical recovery. Biker, I present "sorry" and "well thoughts" as comments to your life experience. ..Maurice.
Here's something taken out of my own backyard (so to speak).
A couple weeks ago, our local news network aired a small video on their news show about COVID-19. It was a joint initiative from one of the teaching hospitals in the area and the news station. They wanted to show what happened to infected patients who were heading out to the ICU to be placed on ventilators.
So the hospital had one of their team do a mock admission (a dry run, using only a mannequin as the patient). And they went through the whole thing (well, almost) from the pre-admission hustle where they reviewed information about their new "patient", to making sure safety rules were followed and then checking each other PPEs. Then in came the gurney with Johnny lying on it. Then they rolled the patient to the area where the negative pressure rooms were, transfer the patient, do initial assessments, prepared for induction (sedative, paralytic) then intubate, hook up to the ventilator. And voilà... Bah da bing, bah da boom, Bob's your uncle.
The segment was very short (maybe 7-8 minutes long) and for the most part there was a lot of voice over with a specialist explaining what was going on and why (and with poor Johnny in the background). It was meant as a mean to reassure the population and I guess to see "how it's done."
("See? Nothing scary there. We know what we're doing, we're professionals. Don't worry, you're in good hands.")
But wait a minute. What about body waste management? Surely if we're going to induced someone into a coma that could last upward of a couple of weeks, something gotta be done about that.
Yet that little video didn't mention anything about that. Not a pip. Zip, nadda. And while they spent a great deal of time making sure we knew about all the safety measures they were taking (which are important, don't get me wrong), I think as a patient I would be more concerned about what was going to be done to me.
There could be a few reasons why it wasn't mentioned. Some of them might even be rational but to me, this still speaks of a lack of transparency. And that is misleading.
Dany
Hello,
I DO NOT feel complicit with the lack of consideration that health care affords people, especially men. For years, and even now, health care has been autocratic – it’s our way or the highway. Prior to a recent hip replacement, the orthopedist indicated that the replacement could be done with a local anesthetic and without a catheter. He is young and had recently moved to CA from HI. Unfortunately, he didn’t know the hospital parameters. The head of anesthesiology over-ruled him. When I told the head about the prior arrangements, he mentioned that he wasn’t going to let “the inmates run the asylum”. Things would be done his way! These individuals still exist in health care, much to the consternation of the fine people in medicine. Amid all the advancements, there are still those who won’t venture outside their comfort zones; or, who will not share the power they’ve so desperately amassed.
The medical autocratic attitude was, no doubt, engendered by the esoteric nature of medical knowledge. Dr. Google has changed all that. Some forward-thinking physicians have welcomed the better-informed patient. Others have seen patient-involvement as an infringement of their status. Attitudinal change occurs slowly. Hopefully, small changes will create system-wide ones.
I’ll continue to endeavor to do my part to affect change; however, I WILL NOT agree that I had ANY part in allowing the system to become what it presently is.
Reginald
Dany,
Here in the states there is NO LEGAL mandate to "first do no harm." There is however, a legal mandate for corporations to do what is best to their shareholders' interests. That mandate can include maximizing shareholders' return. So do useless physicals every year, PSA testing that leads to many unnecessary, yet lucrative biopsies.
It has only after the data is examined scientifically, more of a ritual than an evidence-based practice. In recent years, many seemingly sensible procedures have little basis in science and fewer clear benefits than once thought. In recent years, procedures such as screening mammograms and PSA tests for prostate cancer, and even annual physicals, have turned out to be of questionable benefit.
I too have never had a complete physical exam, prostate exam, colonoscopy, testicular exam, etc., and I am alive and well.
Maurice,
As Biker stated:
"I suspect the manner of healthcare received as children and as teens is what caused many of us to feel as we do about the privacy/modesty/dignity matters discussed here."
I imagine that his siblings had these experiences growing up and opted out of healthcare. Even though they passed from preventable illnesses, they had many years free of the psychological trauma of preventative/ongoing care that Biker deals with constantly.
This is very similar to the death with dignity debate; QUANTITY or QUALITY? Medicine has always chosen quantity of years over quality.
Biker,
Have you ever spoken to your siblings about the abuse of patients and their dignity?
Do any of them have those issues?
-- Banterings
banterings, no I never spoke with my 3 deceased siblings or my two remaining brothers about these issues, nor do I know what their experiences might have been. It's one of those things I'll never know.
There was an article on Kevinmd.com that demonstrates what many in this discussion are saying.
https://www.kevinmd.com/blog/2020/05/patients-who-slip-through-the-cracks.html
In the article a medical student writes about her experience in the hospital. She writes about her Muslim patient:
"As Mrs. B was escorted into the OR, the scrub tech explained she must remove her hijab. She glanced over at me before reluctantly agreeing. She evidently felt uncomfortable, but understood removing it was necessary for her safety. With the final suture tied, just before the nurse opened the door, I gathered the courage to ask, “What about her hijab? Shouldn’t we cover her hair?” The nurse replied, “She’s still asleep, and recovery isn’t far from here.” I immediately felt a sense of guilt. How would she feel if she awoke without her hijab, knowing she had been exposed to a room full of people?"
She ends her article with, "Turning a blind eye to the microaggressions and cultural insensitivities plaguing the healthcare system is not how we progress. As physicians, we have a responsibility to care for our patients; as human beings, we have a responsibility to deliver that care with empathy and without prejudice."
I hope that she holds onto her compassion as she goes through her training. I fear that by the time she finishes her residency she will be referring to patients as GOMERS and whales and laughing at them. That will be explained as "dark humor" and explained as necessary to deal with what they see in medicine.
Every hospital in which I've received care has a statement that they will respect their patient's values.
What they really mean is "We will respect a patient's values as long as
1. They are the same as ours
2. The patient is awake and will remember what happened
3. It doesn't inconvenience us
This patient's values easily could have been respected by providing her a scrub cap / bouffant prior to surgery.
They could have respected her religious beliefs by covering her hair immediately after surgery.
They chose to not respect her beliefs because her values were not the same as their own.
-cg
CG
That article and you hit the issue directly so to speak on the head. They simply do not care for a patient's mental well-being. They do not care when they expose patients unnecessarily as it is not them being exposed. They simply believe they have the right to expose patients. CS was alert in pre-op & post-op but they still left her naked even though she was crying out to be covered and to have no males present. They made her walk around naked. They seemed to enjoy their torturing of her. My husband was left naked in the cath lab before and after the procedure although there was no medical necessity. They seem to enjoy the power and control over patients as he recalled they seemed to have no compassion for him. And most of the time this is female staff doing this. So all the theories that females are more caring are completely shot full of holes.
Medicine is not built upon the foundation of having patient respect or even compassion for the patient. They believe they are supreme beings in charge of doing whatever they think which is not always what will benefit the patient. They have no room for patient respect, patient autonomy, patient rights, or really anything that primarily benefits the patient. What good is a "cure" if how the manner in which it is delivered harms the patient to the point of negatively affecting the patient's recovery or ability to re-seek healthcare again? But then you have articles like the WHO one that essentially places the blame back on the patient for wanting to have patient rights by telling them to have coping tools in place for the damage forced on patients during medical encounters.
That is why I don't like the term modesty used as it infers it is the problem of the patient rather than all patients are entitled to patient dignity. It is not a patient flaw but rather a flaw of the system that does not allow patient dignity. We are a clothed society. It is implied that we have bodily choice/autonomy but when we are in the medical world although we are told we have bodily autonomy we in fact do not but yet we really do. It is not manning up that will solve the issue bc as what happened to CS who is female proves they are still issues in female care. They thought by having her drugged she wouldn't be capable of fighting their defiance of her all female intimate care directive. And this is back to the same issue, they use drugs to control patients so they may do as they please defying a patient's autonomy and basic human rights. So the question is what other major issues do they defy in delivering healthcare to a patient when they care so little about a patient they are willing to defy something so easily done as giving the patient dignity? Anyone undergoing any procedure should be worried that if something is a bother maybe they will just do a shortcut instead.
Just think about it. People who have said they will not accept opposite sex for any intimate care but later found out there was opposite sex care given to them when they were drugged, does this not constitute sexual assault or some type of criminal charge? If we are in charge of who touches our body and it is defied, do we not have recourse?
Well said cg:
What they really mean is "We will respect a patient's values as long as
1. They are the same as ours
2. The patient is awake and will remember what happened
3. It doesn't inconvenience us
cg, I like your summary:
"What they really mean is "We will respect a patient's values as long as
1. They are the same as ours
2. The patient is awake and will remember what happened
3. It doesn't inconvenience us"
My local hospital has plastered all over the place banners that say:
We Listen, We Respect, We Care...Always
I'm guessing the LNA that told my friend "you don't have anything I haven't seen" when he hesitated letting her shower him last year was too busy seeing all the male patients to have seen the banners.
AS OF MAY 8 2020, NO FURTHER COMMENTS WILL BE PUBLISHED ON VOLUME 110. HOWEVER, COMMENTS CAN CONTINUE ON VOLUME 111. ..Maurice.
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