Preserving Patient Dignity (Formerly Patient Modesty) Volume 112
The ongoing anguish being presented by the participants on this web blog topic is whether being a patient who doesn't conform ("be yourself") with the behavior and requests or even demands of the medical system itself will provide harm to the patient. This patient concern may be the basis for many patients to hesitate to "speak up!".
It is my opinion that patients entering into the medical system should indeed "be themselves" and the challenge for the medical profession should always be beyond making a clinical diagnosis and performing a treatment to understand their patient as a individual, a unique individual to which the diagnosis and treatment and overall attention should be crafted for that patients personality and goals as well as the clinical diagnosis.
Unfortunately, in many relationships between the patient and members of the medical system it is the clinical diagnosis and treatment which overrides consideration of the patient as a unique individual who presents as "himself" or "herself". This defect in the system as expressed to the patient leads to forcing the patient into personal non-conformity toward themselves in order to get diagnosed and treated and does limit the option or, if attempted, the volume of "speaking up" to the system.
Remember, patient dignity involves the patient as a unique human and not just a named disease or when hospitalized a room number. So.. "BE YOURSELF". ..Maurice.
Graphic: Provided by a reader of this blog thread.
Starting September 12 2020, Volume 112 will be CLOSED FOR COMMENTS.
HOWEVER COMMENTS WILL CONTINUE ON Volume 113.
posted by Maurice Bernstein, M.D. @ 3:53:00 PM
180 comments
180 Comments:
Great graphic!
Banterings, in regards to your last post, you are right, but given 58flyer was "fired' from his prior urologist, he is likely best at this critical juncture in his pursuing treatment to not pursue every infraction. Yes the practice mishandled the situation initially but they did shift gears and try to make it right. I see it as focusing on winning the war rather than focusing on winning every battle.
Hello Dr. Bernstein,
Your descriptive leader for this volume seems to fit the position in which many of us are placed when seeking medical care. I'm sure that all posters wish that the descriptive could be disseminated to every physician in the country.
Reginald
Maurice,
Going back to when I started posting here and discussions that we had with opposing view points, mainly that certain procedures that are performed in a strictly scientific manner may be perceived as sexual assault by the patient. In this NIH referenced article, Development of the Healthcare Triggering Questionnaire in Adult Sexual Abuse Survivors, the authors develop a brief Healthcare Triggering Questionnaire (HTQ) with the goal to describe the prevalence of healthcare triggering memories, thoughts, feelings or sensations related to the patient's past sexual abuse.
What catches my attention is that to date (April 2017), no healthcare triggering assessment tool exists.
If the profession of medicine is so learned, compassionate, thorough, patient centered, and conscientious, why has this questionnaire never existed before?
This also validates that these exams, procedures, and situations are experienced with the same emotions, feelings, and perceptions of the patients' past sexual abuse. So why would a patient who has not experienced sexual abuse NOT experience these things as sexual abuse?
Your argument way back when was that this was not sexual to the practitioner, but this 2019 article A Pot Ignored Boils On: Sustained Calls for Explicit Consent of Intimate Medical Exams. refutes that argument that you once made.
Please note, I am not sure of your position on this issue now since your view on the existence and frequency of the things claimed by those who post here has changed.)
The article supports the patient's perception of such exams as sexual assault:
...Patients and members of the general public are often shocked to learn that physicians and medical students may perform intimate exams on them without explicit consent and believe such exams meet the criteria for battery, malpractice, or sexual assault. Whether these exams meet any such criteria is contested, but this tension underscores the dichotomy between societal and medical views of the intimate regions of the body. While the medical professional may aspire to a professional, scientific detachment, patients simply do not think of their intimate regions in a detached or neutral way and tend to have an inherent conviction that consent practices should mark this distinction.
...Ubel stated, “We don’t see a pelvic exam as having any sexual content at all, but that’s not how other people perceive it” (Goldstein 2003). “There’s no way a physician would ever equate a pelvic exam with rape—there is no rape content to it. But the fact that someone else perceives it that way makes it important” (Goldstein 2003). An unconsented intimate exam may feel like a sexual violation to patients.
What is even worse is that this 2019 paper refutes the reasons that providers, medical students, and teachers hold on to as justification to continue to perform unconsented intimate exams.
How can society look at physicians as anything but sexual predators?
-- Banterings
Banterins, I understand your documentation and the concern you and others have been expressing over the years. And, it has merit. But while medical students are instructed that taking a sexual history from the patient as part of a initial complete history and physical exam should they be instructed to review with the patient, male or female, their sexual concerns, in light of any past traumatic experiences, before genitalia or female breasts are exposed with the professional's intent of "laying on hands"? Really, what you reminded us all is that the medical profession should look at these exams as potentially psycho-traumatic even in patients without a traumatic past-history.
I would say that as physicians and nurses ask about allergies before beginning therapy with medications, past traumatic experiences with regard to genitalia et al should precede "laying on of hands". It would take just a moments delay but would create better understanding by the professional regarding the psychological impact of the upcoming "laying on". ..Maurice.
Hello Dr. Bernstein,
You have given a very creative solution to the dignity/ modesty/ trauma problem, which doesn't require the patient to "speak up" first. Again, is it possible to convince the entire medical community to ask trauma-informed questions BEFORE laying on hands?
Reginald
Banterings, first, I apologize for misspelling your name.
Speaking about apologies, I think a valid observation regarding the medical system is likely a tendency for professionals to avoid apologizing to patients or patient's family.
There is much written in the medical and law literature about apologies by medical professionals about errors in diagnosis or errors in treatment and there is an excellent review of this matter by the American Association of Family Practitioners.
However, there is often more to warrant an apology from a healthcare provider than a specific error in the technical diagnosis and treatment of a patient's illness. Let's see if we can have our readers here create a list, though over years of this blog thread many examples have been written here. But let's see a list of actions or inactions which deserve a professional apology. ..Maurice.
Here's a very interesting article I found after sexual assault of hospitalized patients:
https://www.plaintiffmagazine.com/recent-issues/item/sexual-assault-of-hospital-patients
It says what I have been saying is that sedated patients are some of their favorite victims especially post-op.
Hello Banterings,
Thank you for your article by Lori Bruce, "A Pot Ignored Boils On ...." Supposedly, general acceptance of a new drug by physicians takes approx. 6 mos. It will be interesting to see if the medical profession will address this issue within 6 mos. Additionally, do you have the URL for the actual Triggering Questionnaire you referenced in your 16 Jul post?
Thanks.
Reginald
Forbes has published "An Open Letter to Medical Students On the Road Ahead to Becoming a Professional Physician"
Read the letter and the advice to the medical students and write back here what is worthy advice but also what you find as misleading or simply missing. ..Maurice.
Maurice,
Should'a, would'a, could'a...
It doesn't happen.
Empirically, what are we to conclude other than the profession does NOT care about the patient and does what ever they want to with impunity. My proof to this is in the second article that AGAIN, someone has to refute the justifications by physicians, teachers, and medical students for obtaining EXPLICIT consent for intimate exams.
What this article supports is the fact that one has a MAGIC STETHOSCOPE, the patient may perceive the exam as a sexual assault AND their point of view is valid.
If these exams are so necessary, why do the students NOT practice on each other, their teachers, or other healthcare providers? Instead they have to drug and rape a patient. That is what it is. My litmus test is to take the situation out of the hospital or facility and put it in a motel room. When you do that, the actions are drugging and raping for the gratification (benefit) of the student.
-- Banterings
Dr. Bernstein, that Open Letter essay seems to ignore patients and what patients think and feel and want from their doctors.
I agree, the letter was oriented to the dynamics of the medical student (and beyond) learning process not with regard to the very subjects of their learning--the patients. I want to stress "subjects" (their current and future patients) and not "objects" which I think is, as I have repeated the distinction (subjects vs objects) here on this thread as well as many other threads on this blog. It is this transition in time that some doctors and nurses, often associated with heavy patient loads) look at patients as objects and therefore behave with the patient as such. No..none of you become "objects" or "some disease or disorder" when you interact with the medical system. Your personal uniqueness is what is part of your dignity which needs to be preserved. ..Maurice.
Dr B. I'm sick with the Covid. The symptoms are SO OBNOXIOUS! I don't think I'm going to need to go to the hospital though. The hospital is where many of our patients got it. JF
JF, I and I am sure our contributors here am sorry to read your sad information about yourself. I am sure we all are hopeful that your symptoms will ease and disappear and that hospitalization will not be necessary.
I am also concerned about your notation that "the hospital is where many of our patients got it." I have not seen this discussed in the literature but if so (hospitalized without COVID and then discharged to a followup care institution and then found to be infected) that is very upsetting and I wonder about the etiology of the infection in these patients. Were they already infected on admission to the hospital but not tested or negative on admission but infected by the staff or any visitors permitted.
My concern, however, after reading your posting is that your "obnoxious" symptoms clear, not require your participation in hospital-life as a patient. JF,best wishes. ..Maurice.
JF,
My thoughts are with you to have a safe and speedy recovery!
Dr B and JR. Thanks JF
Maybe it's the wrong time in our current COVID-19 pandemic.. but how about our visitors to improve the medical system in its approach to real patients becoming a "Secret Shopper". It might be a constructive approach for clinic or hospital systems to awaken to what is going on by the professionals in their system...and not only would you be doing a civic duty but getting paid for it! "Secret Shoppers" have been going on for a long time in commerce, how about making it a useful tool in medical care? ..Maurice.
The Secret Shopper thing is very interesting, though it has to be very limited in scope given how far can such a person possibly penetrate into the specialties and functions of a hospital?
I think a better way would be to randomly interview patients upon discharge or shortly thereafter. The Press Ganey surveys may in theory do the same but they are very limited in what questions they ask and depending upon how one answers doesn't generate another question that probes a bit deeper. I just filled out a Press Ganey survey last evening for a recent visit for some tests. Half the questions weren't pertinent to the visit. None of the questions pertained to staff gender or intimate exposure which for that visit didn't matter, but what if it did? If they don't ask they'll never know and so instead they just keep on doing things as if gender doesn't matter.
An example of the kind of follow-up I advocate was a few years ago after an ER visit to the local hospital. A couple days later I got a call inquiring about the visit. It gave me an opportunity to tell them that when the doctor entered the room he had a female scribe in tow and that he never introduced her by name or function or asked if it was OK for her to be there. I noted that had I been intimately exposed (I wasn't) I would have been very unhappy to have her just walk in that way. I also noted that a female clerk just walked into the room to ask an insurance question without knocking or asking for an OK to enter. I could tell my input took the woman on the phone by surprise. She apologized and said she will take my concerns up at their weekly staff meeting.
I will add that such interviews need to be done by a skilled interviewer who knows how to discern when it is time to peel away the layers to find out what the patient really thinks. Most patients wouldn't speak up in the manner I did.
JF, I hope there has been no progression of your illness and, in fact, beginning signs of regression.
Biker, I understand your concern about the limitation of scope available to a Secret Shopper within a medical system, however, you may not fully realize the weight a patient's description of symptoms and the home therapy and the course of the symptoms plays on the differential diagnosis of many disorders by the physician despite the physician unable, at the time, to correlate with any physical findings. What I am getting at is that "laying on of hands" and clinical testing may be carried out simply by the history presented by the patient.
It is possible that the Shopper can potentially "penetrate into the specialties and functions of a hospital" or clinic simply by presenting a intriguing history.
We teach students the critical importance of taking a history, many times diagnostically pertinent physical findings on physical examination may be a bit later in appearing. So.."penetration" of the system depends on how the Secret Shopper presents the history and responds with clinically appropriate answers to the physician's questions.
Oh..and the Secret Shopper can be teamed up with a "family relative" who is also a Secret Shopper and can can "enter" into the narrative being an observer and a commentator to the medical system physician or nurse et al, a role amply described by JR (though not a Secret Shopper) in monitoring and speaking up for her husband. ..Maurice.
Hello,
Dr. Suneel Dhand has written a nice article re treating the patient as an individual. Please see https://suneeldhand.com/2020/07/21/it-is-more-important-to-know-what-sort-of-person-has-a-disease-than-to-know-what-sort-of-disease-a-person-has/
Reginald
Patient dignity is not set by the physician's simple input of categorized clinical aspects of the patient's history and physical into a computer system. Dignity is set by the patient's use of words, the patient's own words, including as the physician covers not only the medical history but also, importantly, the patient's social history. One of the first categories we teach the medical students to obtain is the patient's social history (starting with occupation, marital history, education and much much more). Is that patient's narrative able to be incorporated into the common EHR "electronic health record"? Probably not. And yet, it is that history, recorded in some form, which informs others in the patient's medical team important elements which make up a patient's dignity.
In my opinion, careful recording of a patient's social history and how it is presented sets understanding of the patient's own view of his or her dignity.
Can this be detailed and included in EHR? I doubt it. ..Maurice.
Maurice,
Human dignity is endowed on us as being made in the Creator's image (sentient beings for the atheists). That is the whole problem. The profession of medicine doesn't recognize intrinsic human dignity, instead they dole out whatever extra they can afford to part with (but not giving away paternalistic power).
You are correct about the history. If the patient says skip the sexual history, that sets a certain tone. This goes for many aspects of the history. My whole life story is not relevant to whatever issue I am seeing a doc for (usually my ADHD).
Even if the patient doesn't raise red flags (such as gender concurrent care), this should still be offered or questioned if the patient is OK with opposite gender care.
That is the difference between dignity and modesty. We do not have to earn or fight for our dignity, it should be respected, even more so by the fact that we are injured or ill and did not choose to be this way.
-- Banterings
Banterings, I have a personal question to ask you regarding the relationship between physician paternalism and adult patient autonomy if the adult patient has a life history persisting with current symptoms associated with ADHD. Does the clinical issues in ADHD require physician paternalistic evaluation and therapy for the best current outcome than strictly follow a concept of the necessity for personal autonomy by the ADHD adult patient? Or is there some balance to be set between the two reactions..to truly attempt to maintain patient dignity? ..Maurice.
So, yesterday I had my visit with my Urologist for the MRI follow up. Some changes in the way they do things. No more BP checks, they ask your height and weight, and they didn't do the bladder scan. I suppose this is all to do with Covid.
The doctor was aware of the mix up with the female tech, and he apologized. I am kind of surprised that in such a large and busy practice that the information got to the doctor at all.
Anyway, the cancer is still there and very small. The doctor wants to rebiopsy me to get a baseline to go with the MRI. Once that's done we will decide on Watchful Waiting (WW)/Active Surveillance (AS), or treatment options. If we decide on the former we will attack the BPH issues from there.
The doctor said that during the TRUS/Biopsy, I will definitely have a male assistant. He said that no females are trained in the procedure so that should assure me of the male assistant. We shall see next Wednesday.
Banterings, I saw your post and I appreciate the suggestions. However I think that Biker expressed my situation quite well. I don't want to get labelled a bad patient.
58flyer
58flyer, I am pleased to read that you were treated in a way that accomplished what was necessary at this time but given a feeling of future confidence in your clinical management. All doctors should be aware that they are dealing with a human being as a patient and not just a disease. ..Maurice.
58flyer, I feel like your story is a success story. Of course that kind of success isn't possible unless the medical staff actually CARES about their patients and obviously by the way your former office dumped you....not all do. JF
JF, hopefully you are recovering from your symptoms. ..Maurice.
Thanks Dr B. I feel good about my progress. I promise you I don't want it again though. JF
58flyer,
I (reluctantly) agree. At least moving forward you will be treated with dignity.
Maurice, as to your question, I was diagnosed my a relative who is a physician as will.
After diagnosing my cousin and based on the behavior of other members of the family, ADHD was the diagnosis (history alone, mostly observable behavior), and Ritalin was prescribed. It quelled the symptoms but was not strong enough; medication adjusted. The family member treated me until retirement (about 10 years ago).
He was the senior partner of a very prestigious practice and a med school professor at an Ivy League institution. He is the best physician that I ever knew. He was old school: he would do in office sutures, could determine a cold/flu just by a phone call, was not afraid to "try" a treatment if it seemed logical.
No paternalism, no exam. My issue was solved and to this day I know that he has changed my life. If my ADHD was never diagnosed, I would not have been as successful as I am today.
-- Banterings
Banterings, I am pleased to read your encouraging self-story. As a member of your family, you obviously knew your doctor well including his practice and his academic work.
Do you think that a deficit of personal knowledge of the patient's physician is a major element in the upsets and worse which have been described over and over on this blog thread?
Of course, there has been longtime discussion in the literature regarding the impairment of beneficial management by family-member physicians.
Here is a link to a 2001 article on the subject of the role and effect of a physician diagnosing and treating a family member. I doubt there has been much change in the past 2 decades. ..Maurice.
Maurice,
My point is that there is no "NEED TO" here. Just last year, a close friend was pressured into a pelvic exam to get oral hormonal birth control even though one was NOT required.
It is common for physicians to dangle maintenance meds over patients heads unless they submit to invasive, intimate exams and procedures. My point is that these invasive, intimate exams are NEVER NEEDED, let alone having voyeur(s) in the exam room.
As for family members, if a physician is NOT able to care for a family member, then that person should NOT be allowed to care for ANY patient!
Do physicians NOT need to be impartial with ALL patients?
If a genital exam is indicated, AND physicians are trained to do them professionally, gender neutral, knowing when warranted, in a non-sexual manner, AND how to properly perform one, then if the physician cannot explain and gain the trust of a family member, then how can they do it with ANY patient?
I believe this applies to physicians treating themselves (if they choose) as well.
This is just a means to force a significant number of patients into a system where physicians can push "NEED TO..."
--I need to have a voyeur in the room to protect me...
--I need to fiddle with your junk...
--This med student needs to fiddle with your junk...
--etc.
This was a means to prove that physicians were pushing UNNECESSARY exams. This is why I teach and advocate black market meds, medical tourism, online patient directed tests, online prescribing, opting out of the system, and criminal/civil litigation against providers that do not practice customer service.
As for personal knowledge of the patient's physician, I believe that physicians should share their intimate details with patients to make themselves vulnerable (as patients do) in order to gain the patient's trust.
If they are not willing to do this, that is earn the patient's trust and convince the patient of the best course of treatment, then the patient should have the final say in their treatments.
The longer that the profession lies to itself OR denies the way things really are, the worst it is going to get for them. Just look at your own journey of enlightenment. You now acknowledge as reality what you denied on this blog.
When you believed that these things never happened (or happened as much as was claimed), you were able to support the profession's philosophy, physicians owned their own practices, medical knowledge was locked away in libraries in teaching institutions, and the answer, "because I am a doctor and I say so..." was an acceptable answer.
The internet has shined the light of truth on what really happens. The profession still tries to stick to the same paternalistic story line, and the rest of the world knows that "the king has no clothes."
I like what is happening to the profession.
-- Banterings
Banterings, you wrote "Just look at your own journey of enlightenment. You now acknowledge as reality what you denied on this blog."
For clarity, I never disputed the professional misbehavior amply described but at first I considered those writing about that here as statistical outliers and it was my assumption that the majority of patients were satisfied with their medical professionals. Now, well..yes..there is an "enlightenment" and concern about the behavior of the medical profession and the need for all patients to "speak up" when they observe misbehavior of the professionals. ..Maurice.
If everybody spoke up there would be a whole different experience. And often things are done in a way so that speaking up isn't possible until after the fact. I feel like Bikers Office fired him BECAUSE he spoke up and his Office wanted to just do their own thing and weren't above stranding a patient without care in order to be allowed to do so. Patients are a dime a dozen and many working in healthcare are mostly working for the betterment of their own lives (too much ) and not enough for their patients. Let there be a healthy BLEND! JF
Story. Not Biker.58flyer. JF
JF, If that is you writing the 7pm posting, the statement is a bit ambiguous to me. By the way, to all my thread contributors, I would encourage those who have not signed into Blogger with a pseudonym or some other name such as contributors such as Biker, 58flyer and Banterings et al to do so. Otherwise, it is hard for me to moderate comments written which might be a bit ambiguous or seemingly inappropriate to the conversation in progress.
I will continue to moderate those who don't officially sign in to Blogger, but it would be helpful for me to do the evaluation. Thanks. ..Maurice.
Ok Dr B. What I said was AND often the moment for speaking up.doesnt happen until after the fact. What I should have said was BUT the moment to speak up doesn't happen until after the fact.
Also, people aren't doing anything wrong by going to college for years for the purpose of improving their own lives and the lives of their loved ones. But their work should be done in a way that the customers also have fair treatment.
I also have some problems with Congress and health insurance. Why can't we just pay the same approximate amount of money towards medical bills WITHOUT paying health insurance ( or have that option ) They often try to get out of their big bills anyway! Do we owe them a living?
Congress ( in theory anyway ) work for US but our wants/needs are POORLY reflected in the making/striking down laws. Congress make laws for US that excludes them. They get paid plenty whether they do quality work or not. JF
JF, you are right about our U.S. Congress and in contrast with "us". That is why it is so important that we all Americans "speak up" not just to the elements of the medical system itself but also to our representatives (President, House and Senate). Otherwise, we end up with inertia and no improvement and benefit.
Despite the current pandemic, I wonder how what JR had been doing beyond our blog thread to "spread the word" to lead to changes. ..Maurice.
OK..How about the role of TELEMEDICINE in solving a host of the communication, undesired inspection and "laying on of hands" issues by the professionals that have angered many who have been writing to this blog thread?
From what Banterings has written here, I interpret that he finds this method of interaction with medical professionals as ideal. Does anyone else here want to give us your opinion. Should the apparent increase in telemedicine application during this current COVID-19 pandemic be extended further for medical diagnosis and care beyond the duration of this illness? ..Maurice.
Dr B. My concern is that this Pandemic might ALWAYS be with us. For awhile there I feared my nausea was going to be lifelong. And I NEVER want another nose swab again.
SOME of what this Pandemic will expose is how differently things could have been done all along and how badly exploited many patients have been. My " granddaughter" attending me at home. By making sure I had something to eat. If that had been done in a hospital 159 THOUSAND dollars would have been supposedly owed. Maybe if who did what.was planned out by somebody with an HONEST and functional brain...
JF
While I can appreciate telemedicine playing a needed role in healthcare, I'm not a big fan of it myself. I did have several "office visits" via phone during the early part of the pandemic. It was convenient in that it saved me 1.5 hours of driving each way, but it just isn't the same as face to face. My 1st one attempted videoconferencing but the technology wasn't working right and we switched to just a phone call. Talking to a cardiologist on the phone precludes their taking my blood pressure or listening to my heart and lungs. It precluded him observing or touching the medicine-induced feet and ankle swelling I was reporting. I took my own blood pressure but who knows how well it is calibrated or whether I am doing it right. At best telemedicine is a partial answer.
Think about this: Do you feel that telemedicine provides the real opportunity for the patient to "be in control" in patient-doctor/nurse relationship? Does this technique of communication and inspection strengthen the patient's ethical property of autonomy? Isn't this autonomy represents what every patient writing here?
Many of the parameters of evaluation of the patient's illness could be carried out by communication and tools readily available at home or for chronic monitoring cheaply available with direct communication via internet to the doctor or nurse.
The difference between telemedicine and the patient's presence in an office visit might avoid transportation and office management issues and, in addition, discomfort about a sense of "inequality" in a doctor-patient office interview and finally uncontrolled bodily exposure.
One other issue to consider is regarding any difference in the financial price of a telemedicine vs office visit. Should there be a difference?
Interesting issue not previously detailed on this blog thread but thanks to Banterings and COVID, a topic for consideration. ..Maurice.
I think it's an excellent idea and one that will work.well for many patients. One size doesn't fit all but a lot of patients who would normally avoid care, will now be enabled to get more of the care they need. JF
It seems that telehealth would be ideal for certain visits when the technology is available. Many of us would be willing to pay for some equipment if we could avoid the "control with impunity" caregivers.
An unintended consequence of the resulting lost jobs due to telehealth would be that many medical assistants, techs, and receptionists would undoubtedly need psychological counseling if they obtained jobs in business where they would have to interact with customers, clients, consumers, and whatever, but not patients {objects to be processed}.
How difficult would counseling be for those control freaks with today's technology? There's no touch labor in psychology therapy sessions. Today, Skype and Zoom allow "face time" between the therapist and patient. What more is needed for counseling than today's technology?
BJTNT
Just wanted to post my experience with the TRUS with biopsy from yesterday. I am happy to say that it went very well with no distress.
I am still amazed that different facilities can do the same procedure in very different ways. I brought along a pair of disposable procedure shorts that I intended to wear. While sitting in the waiting area I imagined the scenarios I might encounter and how I might respond to them. I had my speech rehearsed if I were to encounter a female tech who might call me out but was to only escort me back, as well as what I would say if no male tech was to attend me. It all worked out very well. I was called out by a male tech and escorted back to a procedure room. I was encouraged by a sign on the door that read "Procedure in progress, do not enter without knocking." Once in the room, the tech asked me several questions relating to how I prepped for the procedure, such as the enema, stopping blood thinning meds, and so on. He was not wearing a name tag so I asked him what his position was and he answered "ultrasound technologist." OK, good to know. I showed him the procedure shorts and he said I wouldn't need them as I was keeping my pants on. He said they don't have a patient undress any more than necessary and instructed me to just lower my pants and underwear to midthigh and sit on the table and roll over to the fetal position. That I did. I asked him if I was to be covered and he said I would be. He inserted the lubricated TRUS wand and injected the lidocaine. He had me hold the cord of the wand against my leg and then covered me with a drape. He said he would leave to get the doctor. A short time later the doctor came in and began the procedure. 12 snaps later and we were done. The doctor said the MRI image was superimposed over the ultrasound image so he could precisely aim the biopsy needle to the lesion. I liked that idea, no blind poking needles around. Afterwards the tech wiped my behind of the gel and left me to get dressed. I will find out the results in a week by teleconference.
I did take a Valium that morning to keep the BP down. They didn't even do a BP check. I drove myself. Comparing this TRUS from my last there were many differences, and I don't know if this was from Covid precautions or not. On the first TRUS I had a nurse "workup" which included a BP check, bladder scan, and flowmeter. It was everything off below the waist and put on the procedure shorts and then attended to by a male NP. I was positioned by the NP and then a female nurse came in and faced away. The doctor came in and started with a DRE. Then the doctor inserted the wand and did the biopsy. The female nurse collected the samples. On this visit it was straight to the room, the tech did the wand insertion with lidocaine injection, the doctor came in, no DRE, did the biopsy, and I was done. Funny in some ways how they were so different.
I did receive an emailed patient survey. I was amazed at the number of questions. I gave them high marks in every area but I did post that I was disappointed that no one wore a name tag. One of the questions was "Did the staff introduce themselves to you by name?" I answered with a disagree. In the comment section I posted that in my first visits everyone had a name tag on but in this last visit no one had a name tag at all, including the checkout lady. Maybe this has to do with Covid. I indicated that I wanted a response to my survey so we will see if that's the case.
I hope everyone is staying safe.
58flyer
It still remains to be seen how deep will be the changes made by the Pandemic. One thing that I would like to see changed is more elderly living at home until they die. My grandmother did it. She had me, and my uncle and aunt to help her do it. And her home was saved because we were ready willing and able to do that for her. I DON'T kid myself that I could have done it without my uncle and aunt. That's where problems kick in for many families. The non contributors offer ADVICE and CRITICISM but not assistance. A friend of mine cared for her grandparents at home and got their home when they died. Of course with OUR lawmakers, many people doing this couldn't be tolerated. Laws would be quickly written so that THEY would be paid the brunt of the profits and not us.
( anyway that's my opinion ) JF
Maurice,
I do NOT like "tele" anything. I hate Zoom, Webex, etc. meetings. Same for doctor visits. I prefer face to face.
As to "us" vs. "the US," I think that one theory on the origin of the US dollar sign ($) appropriately defines the problem of the US Congress referred to.
The dollar sign (written with two downward slashes instead of one) came from the initials of the United States: A capital U superimposed over a capital S, minus the lower part of the U.
58flyer,
I am glad that the procedure went well for you.
COVID-19 is showing us what is truly required and what is optional. Apparently DREs and bladder scans are not necessary.
I wonder what would happen if you asked to place the TRUS wand yourself?
I also have a question for you, and this is just "morbid human curiosity:"
How bad is the experience of the injection of the lidocaine into the prostate?
I have read about the procedure but have never seen any who experienced talking about that specifically.
Finally, here is a new article that I just found: In a first, U.S. hospital apologizes to intersex surgical patients
This is no surprise since the Ann and Robert H. Lurie Children’s Hospital in Chicago (formerly Children's Memorial Hospital) has been accused of medically sanctioned violence and torture against intersex patients
I question if they chose to do this during the pandemic because nobody can show up to the CEO's office and ask for a comment.
I have asked this (similar) question (ad nauseum), and nobody has EVER responded. So again, I ask, what hat duty does the hospital, docs, nurses, and other providers owe to patients whose lives they screwed up?
I suspect that the hospital system feels that an apology is enough. The WHO has classified the accepted treatment of intersexed individuals as TORTURE.
How is this NOT crimes against humanity? We need another Nuremberg Physicians' Trial for the treatment of intersexed patients and intimate exams on anesthetized patients without consent among other crimes.
-- Banterings
58flyer,
From your story, I can see your dignity and your autonomy was not as respected as you first might think. You brought procedure shorts with you. Yes, you had a male tech that addressed modesty concerns of the opposite sex but he was dismissive of your personal dignity by 1) telling you the procedure shorts were not needed as they don't have patients undress more than necessary when clearly you were prepared to protect your personal dignity he was dismissive 2) I am assuming he was still in the room while you did the strip as you go routine --the question being would he stay in the room while a female drops her pants for an uro exam?3) he had you drop your pants in that awkward manner and had you climb onto the table and arranged yourself on the table while exposed 4) you weren't covered until he was done with the prepping meaning you could have been covered with your shorts 5) You really didn't keep your pants on unless you normally wear them around your mid thigh area 6) The tech wiped your behind I am assuming without asking and probably removing the drape but strangely left you to get dressed but was present when you got undressed.
Now maybe having a same sex tech addresses modesty concerns but clearly it is not addressing personal dignity issues. If they address personal dignity issues, there would be less concern over modesty because they would already know your gender care preference because they would ask and make arrangements. I imagine this tech would have a different protocol for female patients. I have never heard of a strip as you go and they watch exam for a woman even with a female staff member. From what I read, your tech was male and that was the only part of it that met with having your concerns met but this male tech still did not allow you much of personal dignity.
Banterings,
My husband had the biopsy so I asked him how it felt. He said the insertion of the transducer was painful which had the numbing gel on it. He said he felt every bang of the sample probe. He wasn't sure if he was given an injection of lidocaine once the probe was inserted. He said it was painful but tolerable. Of course, afterwards there was bleeding for days and extreme soreness. It makes you wonder if the sample taking doesn't help the spread of the cancer cells as they violate its boundaries. He said he wouldn't do again and he has not had a rectal exam since he had his prostate removed. He also has not done followup PSAs. He did no other complimentary treatments they try to get you to do such as chemo, radiation, hormones. His surgery is coming up on 15 years. His actual cancer pathology result was significantly less than the biopsy score. Why the difference (maybe a scare tactic)but we had it labbed twice to make sure the removed prostate score was correct. Of course with prostate removal, comes a whole host of side effects one which really caught our attention--the large increase in having heart disease. It is amazing how one "cure" causes other illnesses to strike. Is that on purpose?
Banterings,
The lidocaine isn't injected into the prostate, it's injected into the rectal wall adjacent to the prostate. That is the area most affected by the needle insertion. We know the anus is highly sensitive, but once past it not much so. I felt it, but it really was very tolerable. To me a lidocaine injection into the gums for a dental procedure is 100 times worse. It was really the easiest part. The actual insertion of the probe itself was the worst part. Even though it was well lubricated, it still hurt going in. Once in, it was OK. I could feel the tech moving it around to inject the lidocaine, but it was not at all painful. When the doctor came in and did the biopsy, I could hear the snaps but I felt nothing at all. He said he would announce when he did each snap, but even then I felt it was unnecessary. Overall, the worst was the initial insertion and the moving around of the probe. Very uncomfortable and somewhat painful. But the lidocaine injection and needle biopsies were the easiest.
To add here, for my first biopsy, the doctor, not having the benefit of the MRI images, performed a DRE. That put lubricating gel into the anus. Then when he did the TRUS, the lubricant helped very much ease the probe insertion. With the recent TRUS, there was no DRE and so there was no lubricant present. Sure, the probe was lubricated, but I think much of that was scrubbed off going in. I think that contributed to the higher pain level than the first biopsy. I would think that there should be a lubricating syringe, similar to when they do a cystoscope, used prior to the insertion of the ultrasound probe that would make the insertion easier and less painful to the patient. Perhaps that's an idea for a future suggestion.
There was some pain later in the day as the lidocaine wore off but I was able to take some Tylenol which helped a lot. The next day I felt no pain at all but there is still visible blood in the urine even now. I am in no pain at this point.
58flyer
JR,
You have a very valid point as to how the dignity aspects were handled. I guess I could have insisted he leave the room and allow me to put on the shorts, and I do think that he would done that. There really wasn't any climbing onto the table involved, I was already sitting on it. I felt it was OK to just slide my pants down to mid-thigh and roll to the side. Yes, he remained in the room, but he is a guy like me and it didn't really strike me as inappropriate. I am sure they have a well rehearsed protocol in place to do this stuff. No doubt some of that is due to time constraints and the need to keep on schedule. Of course I believe, as I am sure you do as well, that speed and efficiency should NEVER take precedence over patient dignity. Please keep in mind that I am in the position of having been "fired" by a previous urologist and I don't want that to happen again since it is very difficult to find a urology practice that has male assistive staff. I feel fortunate that they are close by and I don't have to drive to a distant city. Having a cancer diagnosis is stressful enough without having to be dismissed by my doctor.
You are correct that he wiped my behind without asking, but he then covered me before leaving the room. I am on the fence about the wiping part. We men know it takes more than a single tissue to clean up after a DRE, usually it takes several. There is a considerable amount of lubricant involved. My first flight physical was from a retired Navy Flight Surgeon who insisted on doing prostate exams, but he always wiped his patient afterwards. That was the subject of some amusing conversation among fellow aviators when we discussed our flight physical experiences. I have to say from personal experience that it is more comfortable to be wiped by someone who is proficient at it than to be handed the box of tissue and do it yourself while the doc just stands there. That's awkward in a huge way! Then imagine if the doctor is a female!
When all of this is over I might just include some of your ideas about how to properly respect a mans dignity when I answer the surveys I am sure will follow. Thanks for your input.
58flyer
OK, I want to add another element into the discussion of the preservation of patient dignity. Actually, this element ("Death Certificate Ethics") is being discussed by ethicists on an ethics listserv to which I subscribe.
The matter is: to what extent should input from the patient prior to death (of course) or from the family (after death) regarding the documentation of the cause or causes of the patient's death be considered or observed by the physician or coroner in the completion of the final death certificate document?
It could be that the patient or the patient's family does not feel that the patient's past history and now clearly unrelated to the cause of death should be included in the death certificate.
Is such inclusion in a legal document related to the patient's present death, in effect, possibly damaging to the dignity of that patient?
As you see, medical ethics is still "fluid". ..Maurice.
Dr. Bernstein, on the death certificate matter, my thinking is they should reflect the actual cause of death and contributing factors if relevant. In some cases the contributing factors might actually ease the interpretation.
My 33 year old nephew recently died unexpectedly. We all thought it was due to his Type 1 diabetes that he was having difficulty controlling in combination with the cancer he was being treated for having significantly weakened his system. The death certificate said he died of alcohol intoxication & drug overdose. His mother was devastated reading that, primarily due to it being an unexpected surprise but also because she knew there was more to the story. Clearly my nephew made a fatally poor choice that night but I think it would have been easier for his mother to have read his underlying weakened condition from the diabetes and cancer played a role in his lack of tolerance. Now when his young daughter grows up, or perhaps his grandkids someday see his death certificate, all they will see is he had a drug problem when there was more to the story.
58flyer, overall I think I'd of been happy with how your recent biopsy went had I been the patient. The main event went as desired (male staff). That was the critical aspect on which to focus.
On the wiping matter, I'm not sure what the right answer is either. At my last colonoscopy, when the doctor was done, the female nurse (or MA, I don't know what she was) wiped me without saying anything. I'd of preferred she had asked me 1st or at least said what she was going to do before she did it, but then I reminded myself I hadn't been sedated. She was likely operating on automatic given sedated patients need to be wiped by staff and she did it without reminding herself that she had a conscious patient on the table.
In the past for DRE's I was always handed tissue to wipe myself and I always found that to be a bit undignified when the doctor is still in the room. At the same time I wouldn't want the doctor wiping me either or heaven forbid having an assistant in the room for that task. Note that routine physicals with DRE's have always been just me and the doctor in the room. My former urologist however on a couple occasions did DRE's after my cystoscopies, and in those cases there was always a female nurse in the room too. The only positive is that I was given a towel to wipe myself with instead of tissues.
Biker, 58flyer, et al,
I have read about the DRE procedure written for the provider, and the recommendation is to have a box of tissues for the patient to wipe off the lube. At my house, we have the wet wipes in all the bathrooms.
When dealing with things like diarrhea, tissues are NOT good enough. Why do they not have stronger, better wipes??? (Answer is they really don't care. In medicine, it doesn't have to be good, ONLY good ENOUGH.)
I find it very interesting that NOBODY has ever offered any suggestion as to what duty is owed by providers that have committed wrongs against patients. I use the examples of students performing intimate exams on patients without consent and (paternalistically) normalizing surgeries on intersexed children.
Maurice, perhaps you can make this a separate topic. I would really like to hear people's thoughts.
Continuing on my previous post:
searched the internet for forward thinking providers who have "a better experience" for physical exams, colonoscopies, and other invasive, intimate exams.
NONE EXIST!
Why?
Again, the profession of medicine doesn't care.
These are "good enough."
Working conditions are NEVER going to get better for providers until the experience gets better for patients.
Just as all (subsequent) providers will bear blame for the disregard of a patient's dignity that results in a traumatic experience like the ones expressed here, so too will the working conditions continue to deteriorate when patient dignity is disregarded by ANY practice or practitioner.
Because of the experiences of 58flyer at the practice that fired him, working conditions will be bad for the providers of the "better" practice he is at now.
You might question how can the "better practice" change the "bad practice"?
My answer is addressing concerns at the macro level, and the best place to start is medical education. The fact that intimate exams on anesthetized patients without consent still occur in 2020 is totally unacceptable. This would begin to change the culture.
Culpability fall on the better practice by nature of "if you are not part of the solution (actively trying to change, improve, and police) then YOU are part of the problem (apathy despite your beliefs against the practice).
-- Banterings
Apathy..Banterings, great behavioral truth when describing what is going on in medical practice both on the part of the professionals on scene and patients, family and others there too. And this apathy leads to much of the misbehavior in medicine which is amply described on this blog thread.
You all must read this great dissection of the problem and need for solution in medical practice by going to this article I found presented in the US National Library of Medicine titled "Actively Caring for the Safety of Patients
Overcoming Bystander Apathy".
By the way, it is clear from the article that the "bystanders" need not be solely referring to the medical practitioners but certainly also the patients themselves, their families and the public interacting with the practice of medicine.
Read the article and you will see that this is the very conclusion that we all have come to on this blog thread: "speak up!". ..Maurice.
Excellent article Dr. Bernstein. Though focused on patient safety, patient modesty/dignity/needless exposure could easily be substituted for safety. Something about human nature prevents most people from asserting right from wrong in group settings. In healthcare settings this is especially true if the patient is a male and the abuser is a female.
Biker, there is no reason to confine the definition "patient safety" simply to physical safety. A patient has much more than a physical body. It should be evident to everyone that that the patient's mind with its attached emotional responses is open to possible damage and needs attention by all. ..Maurice.
Hello Dr. Bernstein,
Thank you for the referenced article on safety. Have you seen any improvement in safety or dignity/ modesty in the 8 years since the article was written? (i.e. has anyone seemed to have cared?)
Reginald
Reginald, my only response to your question is based on what was written to this blog thread over the past 15 years. My personal professional and as a patient has been limited to the past 10 years of my retirement to participation on a hospital ethics committee, volunteering in a free clinic and, of course, in recent years being a patient myself as I have written about the latter here. During the 30 years teaching first and second year medical students all I can say is what I have already written here many times: the safety and dignity of patients they interact (history and physical) with is the goal of their current and hopefully future interaction. Beyond those two medical school years, my input on the professionalism topic in the students later years of behavior is from the news media and the input to my blog thread. ..Maurice.
Maurice,
The system is designed to keep the patient from speaking up. Just look at what happened to 58flyer. They fired a patient with a life threatening condition. Consent forms given right before being wheeled into surgery.
You need to stop blaming and shaming the victims!!!
I guess a person who is assaulted OR sexually assaulted is at fault because they did not speak up. I guess the anesthetized women who received pelvic exams from a line of students is at fault for not speaking up?
This line of thinking is exactly what is wrong with the healthcare system. Read: Arguments in favor of the status quo (which we define as failing to explicitly consent for intimate exams) are limited to those made by some physicians, institutions, and medical students.
People in the profession of medicine continue to justify the practice of performing intimate exams without explicit consent in 2020.
WTF is wrong with the profession of medicine???
Do you doubt what has been expressed by JR, Dr. Joel Sherman, Misty Roberts, and others???
I am offended as a victim of abuse by medical providers that you say the patient is responsible for speaking up. How does a 5 year old boy, naked in the ED speak up? Crying, screaming, kicking is only ignored and causes one to be physically held down.
How does the person who experienced that with a life long phobia of anything medical and a history of completely avoiding healthcare speak up when they are frozen with fear (fight, flight, freeze) when a nurse with his license less than 6 months is attempting to place an IV line because an IV nurse is not available: Something beyond his skills, and not concerned about your pain because he has objectified you?
To say that the patient needs to speak up reminds me of the movie Ghandi, where one judge asks British General Edward Dyer, "How does a child, shot with a 303 Lee-Enfield, apply for help?" (at time stamp 6:46)
Are physicians not taught in medical school to ask about allergies, medications, previous operations, existing conditions, and other things that may lead to unwanted side effects? Does the hospital also not ask about what meals the inpatient prefers?
Patient Centered Care, the correct way to treat patients today, requires respect for patients’ values, preferences and expressed needs.
How do providers know their needs, values, and preferences if they don't ask?
Does informed consent not involve letting a patient know EXACTLY what will happen and asking for permission?
-- Banterings
Banterings, there is no such thing as "fully informed consent" from the patient. In surgical procedures or complex medical management or even routine management there may occur extremely rare and fully clinically unexpected occurrences, reactions or complications about which the neither the physician nor patient can anticipate and prevent and subsequently rationalize. During surgery, for example, the totally unexpected can happen, something totally unexpected in the pre-op discussion with the patient. And this happening at the moment it occurs may need immediate unexpected surgical management to preserve function or even life and there is no time available to awaken the unconscious patient or discuss with family members.
And in internal medical practice, there may occur rarely medication reactions that is not as yet in the literature and there is no physician anticipation to communicate to the patient before treatment is begun.
Anticipating the universality of totally and fully informed consent, in the life where we live, requires all parties to be "fully informed" and that goal of "fully" is just an impossibility.
Yes, the patient could be asked beforehand by the physician "Something harmful or deadly can occur with this treatment we are discussing.If something unexpected by you and me and potentially harmful could occur with this treatment, what do you expect I should do or would you rather avoid beginning this treatment?" Is this is what a patient should expect to be told as part of "informed consent"? ..Maurice.
Yes, there is such a thing a fully Informed Consent. Consent is supposed to protect the patient but has been twisted as weapon used against patients. What is said verbally to the patient may not make it to the consent form. Often patients are coerced into signing the forms in a hurry or when sedation has been given. It is a racket. Too many don't want informed patients but rather sheeple. All possible scenarios need to gone over. I have heard stories from women who consented to have one ovary removed but wake up with both gone. They are devastated bc they told the dr they wanted children. That type of thing should not happen. Are there emergencies that happen during a course of a procedure--these but those risks should be covered too such as slicing an artery that would need to be repaired. By some things can wait until the patient is awake and can consent. Some providers also leave things out on purpose or get fraudulent consent. Informed Consent needs major reform.
As far as side effects of medicines, most doctors do not discuss possible side effects. At least none I have encountered. Even when patients speak up about side effects, they are told to suck it up or the MRs state "patient tolerating meds well" which is fraud/lies whichever you choose.
It is not the responsibility of the patient to "speak up" in order to get humane, dignified care. However, it is the responsibility of the medical profession to see that all patients get humane and dignified care. They need to start talking to us during their education and continuing education classes. During an appt or before the procedure is not the time as some will say "okay" and then either retaliate against the patient or ignore their request for humane, dignified care. 58flyer spoke up and got fired. My husband spoke up & was x2 medically assaulted and then sexually assaulted. CS also was medically assault and sexually abused. So speaking up to them during care can have devastating harm happen to the patient. Read some stories on Misty's site for others who have requested same gender care and read some of their horror stories. Medical care should be compassionate, ethical, humane, and should do no harm of any kind to the patient.
There is so much victim shaming going on. I see it on the time on Quora and Twitter. My husband that night did not seek medical help to become a victim. He had no clue the people he was dealing with intended on harming him because he said no teaching hospital, he did not want an invasive procedure, he did not take RXs as he doesn't believe in the long-term use of them, he didn't do follow up for prostate cancer over 15 yrs ago, etc. Is a patient not to have any say in their treatment plan? How was he to know they were silently planning a procedure when they gave no outward sign of the deception and harm to come? Why is medical harm an accepted type of "criminal" behavior? What has medical care been allowed to morph into healthScare of patients?
Informed consent is a true discussion of the condition, the treatment options and the risks/benefits associated with and the sedation. As far as the fluff stuff, everything should be opt in instead of opt out. Video, sales reps, students, etc. should not be listed as being there but rather a yes/no question. Details should be given on pre-op/post-op so patients know what will happen rather than just sleeping through the whole thing w/ memory erasing drugs. It's Their Body, Their Choice.
Just a question for those who are satisfied when their need for modesty is met by the use of the same sex nurse/tech who may or may recognize and act with regards to patient dignity. If the need for modesty recognition stems from not wanting to have the opposite sex involved in intimate care, have you ever given thought that your male nurse for a patient or a female nurse for a female patient is looking at you in a sexual way just as one of the opposite sex might? In today's world, you never the know the sexual preference of your caregiver to it is possible, in fact, very possible. Would the need for modesty still be met or perhaps should there be a need for patient dignity where everyone respects your bodily privacy? Just curious as clearly in 58flyer's case, the male tech did not recognize patient dignity but served the modesty issue of being a same sex paraprofessional caregiver.
For me and what I am fighting for is patient dignity meaning I don't have to wonder if I am going to be violated. I don't have to wonder if I will still be exposed even in a room full of female nurses because that is a violation of my right to privacy. And if one of those nurses are gay, then it is the same sexual meaning as if there was a male nurse present.
JR, I don't care about the sexual orientation of anyone that is tending me in a healthcare setting. Like most men who came of age a few decades or more ago, I had mandatory gang showers starting in 6th grade, mandatory swim classes in the buff my 1st year of college, and then as an adult a lifetime of locker room gang showers & changing rooms. After many thousands of times being naked in front of other men I am so used to it that it doesn't phase me despite being modest by nature. However, the number of women I have been naked in front of is extremely limited. I am not comfortable with being seen by any woman other than my wife.
There were likely just as many gay guys 50 years ago as there are now. They were just in the closet for the most part is all. That assures me that I have been naked in locker room settings with gay guys many times. Never once have I observed any guy being inappropriate in locker room settings nor have I ever heard another guy commenting on other guys attributes, good or bad, or sexualizing in any way their nakedness or mine. For many years the locker room I was in almost daily was where I worked, with a bunch of guys that exercised or did some form of sports during the lunch hour. Never once did I hear a comment about another guy outside of the locker room either. Guys just don't gossip about that kind of stuff about other guys. They are generally respectful of each other.
So, if I had to choose between a lesbian female nurse or a gay male nurse catheterizing me or helping me shower in a hospital setting I will go with the gay guy. Neither his or her orientation matters to me. Being modest, their gender does matter to me.
Biker,
But are you comfortable with a female doctor? If so, what is the difference between a female doctor and a female nurse besides the obvious education difference of a few years?
And actually men do gossip and look. Just take a look at the article I posted about the male doctor in Alaska after the surgery was complete lifting the drapes to take a pic of the male patient's genitals to send to his wife. Also, my gay male friends gossip about other men's attributes or lack thereof. Truthfully though, 50 years ago most gays were in the closet because society was not accepting but now it is a different story. 50 years ago women weren't so openly sexual as they are now.
I am not condemning your point of view but I just want to understand it better. It will help me in future endeavors. Modesty is a persona belief and personal beliefs of humans must be recognized and respected.
JR, I have yet to be in a situation involving intimate exposure to a female physician so I can't answer that question based on experience. I have had appts. with female doctors, PA's, and NP's for various things but never for anything that involved more than me taking my shirt off. My female primary care PA did ask if I wanted her to do a DRE at the end of a cursory annual checkup but I declined and there wasn't any push back from her.
That said, in my mind I do differentiate female physicians vs female nurses & other non-physician staff. I know that doesn't make any sense given education isn't synonymous with better character or even professionalism but it is not any different than most women more readily accepting male physicians than they do male nurses or other non-physician staff for intimate matters.
A piece of the differentiation is perhaps that a physician has a chance to earn our trust before doing an exam or procedure whereas non-physician staff usually don't have that opportunity. Not having that opportunity to get comfortable beforehand and having had a few experiences with female staff that were less than professional, I will now automatically opt for male staff or for example say I don't want the LPN in the room. Unfair to staff of good character and professionalism? Of course its unfair, but if the healthcare system doesn't insist upon proper protocols and levels of professionalism for all of its staff, then I have to do what I can to make myself comfortable.
So, while I don't see myself seeking out a female physician for intimate exams or procedures, I think I would accept a female physician for such things. Of all the physicians, PA's and NP's I have dealt with in recent years, a female neurologist is the one I wish was in charge of all my healthcare if such a thing were possible, including intimate matters. She's earned my trust.
Biker,
I understand what you are saying. It is about trust. The medical community lies at the root of causing systemic patient abuse. You can read story after story of female patients being sexually assaulted by male doctors. We are even staring to see stories of male doctors sexually assaulting males. We see stories of nurses mostly male nurses sexually assaulting female patients. We are starting to see stories of female nurses sexually assault male patients. But what we haven't seen is the medical community saying publicly what they are going to do to fix the problem. Isn't the medical system supposed to be in charge of research and cures for illnesses/epidemics? So why haven't they tackled this one?
Why instead is the answer for the patient to stand up, to speak out? What exactly does that do? They know there are issues. What are the warning signs for a patient to speak up? Do those warning signs only occur when it is opposite gender care or are there signs with even same gender care?
For a long time, you have had the request/feeling for same gender care based on events that happened long ago. But it is still a fight you must fight. My husband who grew during about the same time as you, did not walk away with the same feeling. He accepted opposite sex care as part of the mandatory requirements of receiving medical care. He never gave any thought to having inappropriate sexual conduct practiced on him. He knew my feelings of being wary of male medical care but it never entered his male mind the same could happen to him with female medical care until it did. And now it has changed everything. You seem to adjust to having to deal with it but in the almost 2 years since it has happened, his feelings of being sexually assaulted hasn't changed. And furthermore, with the COVID thing going on, the likelihood of having inappropriately sexual care has probably increased because there is no family there to make sure patient's dignity is respected. So if a patient's right to dignity is not respected, certainly modesty issues will not be respected.
I found an interesting article in the BMJ talking about chaperones needing to be of the same sex of the patient and even questioning if the chaperone was truly protecting the patient at all. It seems other countries have a more enlightened attitude than the US. So why might that be?
JR. I have been trying to make your point for a long time. I think for biker, he just hasn't encountered male staff leering at his body so it doesn't seem like it could even happen. I'm a person who prefers to not be unnecessarily displayed to ANY person ( at least if I'm conscious) whether thaf person is male, female, thrilled , repelled or nonchalant. Nonchalant isn't all what it's cracked up to be either. How many nonchalant DOCTORS permit other staff to freely stroll in and out of the room while a patient is exposed? How many people avoid care that they need because of it? JF
JR & JF, I have never avoided healthcare out of embarrassment or discomfort. Most guys have mastered the manning up game before they reach adulthood. That practice had 100% female non-physician staffing and that was simply something I had to accept up until I decided to switch to a more progressive practice.
JR, you are right that much of it comes down to trust. It isn't practical for the system to somehow allow time for patients to gain the trust of all the non-physician staff that do exams and procedures or that are simply present in the room. It would be far more preferable for healthcare systems to insist all staff follow proper protocols that minimize exposure in the manner we discuss here (extent, duration, and audience) but they don't. As evidenced by my having experienced total exposure for a kidney ultrasound by one female tech and no exposure for the exact same ultrasound by a different female tech essentially says each staff member is free to decide for themselves what constitutes professional protocols. It is hard to just give blind trust in a system without consistent standards of care. They all use words like respect, dignity, and professional but they never define such things at an operating level.
JR, JF, Biker, et al,
The ONLY thing that any of us NEED to do in life is die at least once. Doctors use the words "NEED TO" to coerce patients into things they do not want to do, as if they are being directed by some greater power and they have no choice but to do it to the patient.
Furthermore, the staff claim to be merely agents of the medical system, which is intent on providing good health care to patients. This medical system imposes procedures and standards which the staff are merely following in this particular instance. That is, what the staff do derives from external coercion—"We have to do it this way"— rather than from personal choices which they would be free to revise in order to accommodate the patient. (Source: Behavior in Private Places: Sustaining Definitions of Reality in Gynecological Examinations
This as a means to bully patients. This has been well documented in research literature. Simply tell the doc that you feel bullied by being the ONLY naked person in the room with many, clothed people. (Most healthcare facilities have anti-bullying policies.)
There are many people that have been abused by docs and providers under the guise of healthcare, may be survivors of sexual assault, abuse survivors, or victims of domestic violence. They may be comfortable with only one person in the room when they are so vulnerable and exposed. These people suffer from psychological problems like PTSD, anxiety, and others. (I suspect that this is the reason that you have asked this question.)
All you simply have to say is "I am a survivor and under the Americans with Disabilities Act, I request the reasonable accommodation that you (the doc) are the only person in the room for the exam."
You are under no obligation to disclose what your disability is (PTSD, anxiety, depression, phobias, etc.). Once you request a reasonable accommodation, it creates a legal obligation that the provider MUST accommodate or you have legal recourse against the provider and the facility.
-- Banterings
JF,
I have thought the same as you forever. I don't care who is exposing whom, it still needs to be done for medical necessity only with very limited exposure. For the most part there is never any need for any patient to be totally naked, naked for prolonged periods of time, and to have audience in attendance. This holds true whether the patient is conscious or unconscious. The attitude they're unconscious so therefore it doesn't matter is BS. I do not know the sexual leanings of the healthcare provider although they want to know mine so I have to assume they could be either so any exam can be sexual in nature to them. When a person is unconscious and molested does the molestation still not occur? So in this, special effort must be undertaken to make sure no defenseless patient is exposed/harm while unconscious.
I posit that when a patient is unconscious or otherwise unaware that it is even more important that they not be exposed more than was necessary (extent, duration, or audience) given they are totally reliant upon the professionalism of their caretakers and unable to advocate for themselves.
Biker,
That is the time when they are more likely to be violated by unnecessary exposure and all the actions that stem from that unnecessary exposure. When patients are unconscious/sedated the medical staff feels free to ignore patient dignity in favor of convenience, laughing and having a good time, talking to others, etc. During doctor visits you have the ability to have more control but during unconscious time you are a captive victim at the mercy many times of people who have no compassion but rather are so self-involved that care nothing for the human being they are tasked with to ensure the well-being and safety of not only physically but mentally. Some patients do have the ability to fight off the total efforts of sedations and have memory of the horrible scenario of being the person laying totally naked on a table in a brightly lite room in the cold with a room of strangers in masks and gowns acting like a party is going on and making comments or allowing people to wander in and out while they lay there exposed, vulnerable. Ask CS or my husband how this feels. The nurse on Quora said she and the others were able to hide their smiles, laughter behind their masks as they intentionally humiliated male patients. How many more are like that? How many of them get a thrill when they have a man in the lithotomy position and think that man finally gets to experience what women have for years? We all think these things when someone has something happen to them but we the public prefer to think medical people don't have these petty, human characteristics. That's why we can't bring about change is because most of the public refuses to acknowledge the medical community have human characteristics they carry with them on the job and while they encounter us, the patient.
JR, JF, Biker, et al,
Times are changing. Sedated patients are mostly unaware of of what happened to them and for the most part everyone else wants to believe the narrative that this doesn't happen.
The problem is "power corrupts, absolute power corrupts absolutely." For years the profession of medicine has used the threats of death and the promise of eternal life to reenforce their paternalistic power.
During this pandemic, they are seizing on this paternalism with threats of death trying to dictate how Americans live their lives. The slogan "Life free, or die" shows that the apex value in America is freedom, even above life and health.
Just look at the public response:
A big red target on their backs: Health officials face death threats over coronavirus policies
AMA statement on intimidation, threats toward public health officials
Public Health Officials Face Wave Of Threats, Pressure Amid Coronavirus Response
This is not I recommend you stop smoking, this is an imposition of rules that is a threat to freedom and a form of tyranny.
DO NOT SAY THIS CANNOT HAPPEN! Congress has many self acknowledged socialists and Marxists as members.
Surgeon General Jerome Adams opposes mask mandates.
"Americans value independence and self-determination, placing importance on the role of the individual in shaping his or her own identity and destiny through one’s choices, abilities, and efforts. " --Source: US Department of State
People have a right to defend themselves, their families, property, safety, and bodily integrity.
I have no problem with these people's identities being made public. If you are making a claim that affects the lives of other people, you need to be held accountable.
All this is happening here is people SPEAKING up...
-- Banterings
What we need is more whistleblowers concerned about what they see and experience within the medical system. Better that the whistleblower are integral elements within the medical system itself but also patient family members or friends or the patients themselves. For them to observe and say nothing is not only unproductive for immediate attention but may contribute to ongoing unethical or illegal harm to the next patient or to a worthy system itself. I am all in favor of whistleblowers in the practice of medicine and will be the way to "SPEAK UP" to misbehaviors or worse within the medical system. ..Maurice.
I had my teleconference with my doctor on Wednesday about my TRUS/Biopsy results. I had expected the cancer to be spreading and getting worse, and then to discuss my treatment options. I knew my PSA was declining, but I thought that was a fluke. Imagine my surprise when the doctor said that there was no cancer at all! I was excited, but more so that the doctor was so excited! He said he has never seen this in the 17 years he has been practicing. He said he has never seen cancer just go away. I have had a lot of prayer support from my church. We have had other church members with cancer that was successfully treated and they got better. But none of them could say that their cancer disappeared. My doctor and I discussed my next concern which is the BPH issue. He wants to do an updated cystoscope. We discussed all treatment options which included medications but we are at the point of laser or cryo to deal with a very large medial lobe, as well as lateral lobes. When the scheduler called to make the appointment, I reminded her that I needed a male assistant to do the prep. She asked what I meant about male assistive staff, so I told her the person doing the prep needed to be a male. She asked, "no females?", and I said correct, no females. She said "OK, I will note that in the file." The appointment is next Tuesday.
58flyer
58flyer. Congratulations. I'm so happy for you. Me recovering from Covid was because of people praying for me also. That I'm aware of two people were fasting for me to. I have type 2 diabetes and I'm 60 so that puts me in the vulnerable group.
I completely understand the frustration of wanting our normal lives back. My 9 year old grandniece was crying this morning because she wants to go back to school. I was happy to go back to work Wednesday also. Routine can be carried too far but we need and want some. JF
58flyer, it is great to hear about your physician's observations and conclusion, particularly coming from a physician who has many years of experience in cancer evaluation and treatment.
I have a question that is directed to all who have read or written to this blog thread.
Do you think that the specific diagnosis or prognosis of a disease by the physician as given to you will affect how you subsequently evaluate the physician's or the clinic or hospital's behavior towards you? Or is your evaluation of the medical person's behavior towards you is in no way related to the diagnosis or prognosis already considered or given to you?
Another way of asking this question is whether knowing you have only a "common cold" vs "a prostate cancer' affect how you evaluate the professional's behavior in his or her medical practice towards you. ..Maurice.
Wonderful news 58flyer. The body is a mysterious thing.
The scheduler for your upcoming cystoscopy is the poster child for that which we discuss here. That she didn't comprehend a very clear request for male staff for something as up close and personal as prep for a cystoscopy speaks volumes. Her cluelessness is what men face every day in every hospital across the country.
Dr. Bernstein, the mood of the patient likely does affect their interpretation of how they have been treated. When in a good mood, people are more likely to let the small stuff slide. That said, a physician delivering bad news might make a patient sad but that is different than putting them in a bad mood. Bad news delivered with empathy will affect a patient differently than bad news delivered with indifference. The patient might be sad in either case, but only in a bad mood if the message was delivered without empathy.
Wow Biker! Your "a physician delivering bad news might make a patient sad but that is different than putting them in a bad mood. Bad news delivered with empathy will affect a patient differently than bad news delivered with indifference. The patient might be sad in either case, but only in a bad mood if the message was delivered without empathy." suggests to me that you should be teaching first and second year medical students! Thanks. ..Maurice.
58flyer,
That's great news but I have to wonder if you had cancer to start with as many times PSAs gives false positives and with you having BPH which also can contribute to high PSA readings. I think you should thank your lucky stars you are no longer being seen by the urology clinic as you could have had a procedure that would have left you permanently harmed on a false diagnosis forever. You are one very lucky man! Are the other mysteriously disappearing cancer men from the same urology clinic too?
Thanks Dr. Bernstein. Many years ago when I was fresh out of college and just starting my career, I had to help out in Customer Services one day in a role where I wouldn't have any support. I was nervous on account I had no idea how to do what I was supposed to do that day. The woman in charge there told me not to worry, that the work was easy; it was the people who were hard. I took that to heart and quick enough knew how right she was and how important good people skills were. Physicians getting the diagnosis right is their first and foremost priority, but the manner in which they convey it to the patient makes all the difference.
A heartfelt "Thank You" for all the kind comments.
JF, prayer is very powerful. Once my cancer journey began, my Bible study teacher always made a point to ask me how I felt every week. We also own a home in Pennsylvania and attend church with our next door neighbor when we are there. They have been praying for me also. I will pray for your continuing health.
Dr. Bernstein, Thanks. To answer your question I do believe how a patient is treated affects their outcome. When I had my hip replacement surgeries, before they do that you are given shots into the hip joint with something that helps relieve pain. I forget now what it is called. On my first hip injection the tech was a real PITA. She was one of the most unprofessional people I have ever encountered. The injection provided little relief. On my second hip injection I made it a point to discuss my concerns with the 2 ladies doing it. They stepped up and were most caring and respectful. That injection gave me several months relief. I am convinced that how the patient perceives how they are treated directly affects how successful the treatment is. Taking it a step further, my prior urologist informed me of my cancer diagnosis in a nonchalant casual sort of way. He just said "you have cancer" as if he was just telling me the time of day. That certainly put me in a bad mood. He could take 20 minutes to talk about the current state of horse racing in America, but he couldn't muster up some compassion to inform me of a life threatening disease.
Biker, I have no idea as to the qualifications of a scheduler, but I am quite sure the field is not rocket science. Frankly I am not surprised. But I will let you know how the event goes.
JR, Thanks. I am lucky to get away from this guy while the gettin' was good. I have no idea how other male patients of this clinic fared. That this doctor had no hospital affiliations and could only do in office procedures makes me wonder if he was effectively serving his patients. He was all about the Rezume procedure, which is totally ineffective when faced with the medial lobe enlargement, now that I know. I have the medial lobe problem. Again, a blessing in disguise. Also, the the Cancer diagnosis is not based on the PSA, but actual analysis of the tissue samples from the TRUS. That information comes from a cancer oncologist trained to examine the tissue samples from the biopsy. There is no such thing as a false positive when it comes to direct examination of the tissue. It is either cancerous or it is not. I have no doubt that I had cancer at some point, but now I don't. I am very happy about that.
58flyer
58flyer,
I didn't remember if you had had a previous biopsy so my response was based upon PSA result only.
Mitri Populos: Here is one for the books On a public social forum, "Facebook", a person using the ID of Ken Sharp-Knott, posted with the title of "Posted by a nurse who works with ventilators". The posting shows 5 people in ICU or restricted access area in a hospital laying face down bare ass nude with minimal covering. Consists of what appears to be 4 males and 1 female. One male is only covered with a folded hand towel over, to use the vulgar term,his ass crack. Now some one is going to tell me the patient signed a release form for this or was covered under "full disclosure". Are their families aware of this or agreed to an ultimate humiliation and disregard for their right to dignity by being publically degraded especially as the patient and families prepare for their deaths. This is on equal to the use of photos by the Nazis to record medical experiments, torture, crematories and death showers. Is some one going to tell me that the hospital where tis photo was taken is going to fire them-is the person responsible for this photo an "essential worker" and aware that these photos exist?
Although I am twisting the narrative of Mitri, I have another matter in mind, this time with regard to photos of doctors and nurses. It is about the availability of pictures of doctors and nurses outside of their medicine work environment--like posted on Twitter et al. Would it help to know "more" about those who are looking at and touching your body when those professionals leave their professional environment and "go out"? A female doctor or nurse in her bathing suit or picture the off-duty healthcare provider drinking a beer, wine or even whiskey. Or available on the internet narratives written by the professionals about their view of abortion, gun control, marijuana legalization or same-sex marriage. In other words, patients or potential patients having access to physician or nurses private off duty life.
Would or should a patient take a moment or two to challenge the professional about what they found out about their private lives? Would that information help patients sort out which professionals would make them uncomfortable or worse?
The point is: would it be useful for the patient to, in these ways, "undress" the professional. Any thoughts? ..Maurice.
I don't care about their personal lives except are they fit to be in patient care? There is a great need for regular testing to be done on medical staff of both mental capabilities/motives and urine/drug analysis. These tests need to be independent of the hospital. There needs to be greater attention to weeding out the ones with no conscience, who do harm, who are on drugs/alcohol, etc. There needs to be laws in place to prohibit personal cell phones in patient care areas. There needs to audio/video available at all times in patient areas to protect the patient with patient access to the video/audio and not just another hidden "file" in the medical system.
As for the pics of the unconscious patients and the story told by the nurse, it is total BS. She needs to go to jail for violating their privacy. The hospital needs to be held accountable for allowing this to happen. The nurse strongly inferred or even downright said those patients were there because they did not wear masks or stay 6' apart and this would happen to any of us common people if we dared to "disobey" the medical orders. She was victim shaming. She had no idea if the germ itself disobeyed the 6' rule by jumping 6'1" into the eyes of the masked patient. All these pics and post did was to re-confirm what I have been saying: They have no respect for patient dignity. They have no boundaries of what inappropriate action they will do as she took personal pics of unconscious patients and posted them to the Internet. She was victim shaming and clearly did not leave her personal feelings/judgments at the door as we are continuously told these "saints" do when they go to work.
If you notice, these patient victims all appear to be male which says a lot. Those patients are not allowed to have any family members there to protect them from violators like that nurse. Maybe some of you won't like what I say but I hope she rots in hell.
JR et al, would you all feel perfectly comfortable to be attended by a physician or nurse without knowing some things about their non-professional life, views and expressions? Would it be better for your emotional and physical health to be informed? Could that information be decisive with regard to accepting the care of that professional especially if the care was non-emergent? Do you feel that as a patient who is ill, "undressing" and dissecting the physical behavior and views of the individual's time out of his or her professional worklife might be of value to you? Do you think if this "undressing" or dissection was readily made available would be of value to all patients? Don't you think that the life the professional has outside of the office, clinic or hospital has a relationship to their inside the diagnostic and treatment environment behavior towards you?
What I am getting at here is if we are trying to make a change for improvement of the medical system to the behavioral treatment and even clinical treatment of all patients, the doctors and nursing staff should their "out of office" behavior and views be just as important to all patients as their graduation diploma which often might be hanging on the office wall? Why shouldn't the "out of office" life of all medical professionals be "undressed", documented for patient scrutiny and diagnosis? Certainly, patients are eventually undressed for scrutiny, diagnosis and, as amply described here and in the news for not strictly clinical "examination". ..Maurice.
Dr. Bernstein, I don't need to know or want to know the political opinions, hobbies, or any other personal stuff about my doctors so long as they are not criminals or mentally or physically impaired in a way that might impact my care. Keeping a professional wall between us is OK with me. In turn I don't offer up or otherwise share my opinions or anything else that I think is none of their business. I realize understanding my lifestyle and history could be pertinent and I try to answer as best I can. Quite honestly I don't think any of my doctors have gone too far with what they have asked me in that regard.
The patient-doctor relationship is not a level playing field. Even though I am paying for the service for the most part I need them more than they need me. Part of that playing field is that I may need to disrobe while they remain fully dressed. It is what it is. In turn I expect to be treated in a respectful and professional manner, including minimizing my exposure in extent, duration, and audience.
I just put up on a medical ethics listserv to which I subscribe the following with the title "Leveling the Playing Field" in Medical Practice:
From ethical and practical points of view, how much detail of the professional and moreover even the private lives and private views should patients need to know about their physician or the attending nurse to attempt to "level the playing field". Or, on the other hand, as with a passenger and his or her airline pilot, there is no need to level the field? However, if we are championing patient autonomy in general, wouldn't attempting to "level the field" be a worthy consideration?
Let's see if I get any responses to this interesting and important consideration as brought up by Biker. ..Maurice.
Here is a link to an article first published in August 2004 in the Journal of General Internal Medicine titled "Is Physician Self-disclosure Related to Patient Evaluation of Office Visits?" and the following is the Abstract of the full article reached by the above link.
Abstract
CONTEXT: Physician self‐disclosure has been viewed either positively or negatively, but little is known about how patients respond to physician self‐disclosure.
OBJECTIVE: To explore the possible relationship of physician self‐disclosure to patient satisfaction.
DESIGN: Routine office visits were audiotaped and coded for physician self‐disclosure using the Roter Interaction Analysis System (RIAS). Physician self‐disclosure was defined as a statement describing the physician's personal experience that has medical and/or emotional relevance for the patient. We stratified our analysis by physician specialty and compared patient satisfaction following visits in which physician self‐disclosure did or did not occur.
PARTICIPANTS: Patients (N = 1,265) who visited 59 primary care physicians and 65 surgeons.
MAIN OUTCOME MEASURE: Patient satisfaction following the visit.
RESULTS: Physician self‐disclosure occurred in 17% (102/589) of primary care visits and 14% (93/676) of surgical visits. Following visits in which a primary care physician self‐disclosed, fewer patients reported feelings of warmth/friendliness (37% vs 52%; P = .008) and reassurance/comfort (42% vs 55%; P = .027), and fewer reported being very satisfied with the visit (74% vs 83%; P = .031). Following visits in which a surgeon self‐disclosed, more patients reported feelings of warmth/friendliness (60% vs 45%; P = .009) and reassurance/comfort (59% vs 47%; P = .044), and more reported being very satisfied with the visit (88% vs 75%; P = .007). After adjustment for patient characteristics, length of the visit, and other physician communication behaviors, primary care patients remained less satisfied (adjusted odds ratio [AOR], 0.45; 95% confidence interval [CI], 0.24 to 0.81) and surgical patients more satisfied (AOR, 2.22; 95% CI, 1.12 to 4.50) after visits in which the physician self‐disclosed.
CONCLUSIONS: Physician self‐disclosure is significantly associated with higher patient satisfaction ratings for surgical visits and lower patient satisfaction ratings for primary care visits. Further study is needed to explore these intriguing findings and to define the circumstances under which physician self‐disclosure is either well or poorly received.
Apparently what the physician told the patient was “Statements which describe the physician's personal experience in areas which have medical and/or emotional relevance for the patient.”
Though it isn't described in the article specific examples of personal history "undressing" was disclosed by the doctor to the patient the article does give some beginning information about value of disclosure. ..Maurice.
Maurice,
As to the professionalism (bikini pics), they did it to themselves. How many times, along with you haven't got anything we haven't seen before, they say they are professionals to patients as justification of what has been discussed here?
So now society is holding them to their word, and it is society that has the expectation of what is considered professional.
Pose in a skimpy bikini? That is sexual. They tell patients they are not sexual (in the context of their work). Society wants no hint of sexuality because that destroys the narrative with the patient.
As to your comment with needing more whistleblowers: the obvious answer is that the profession has failed to self police. Reference: national investigation by The Atlanta Journal-Constitution
Denial is NOT a river in Egypt...
This is what is wrong with the profession, this head in the sand mentality. We can't police ourselves, so we need whistleblowers. And who would they report to? The same people who can't police the profession???
Again the profession's solution the the same as my reference in the movie Ghandi where one judge asks British General Edward Dyer, "How does a child, shot with a 303 Lee-Enfield, apply for help?" (at time stamp 6:46)
Watch that video. One must understand that General Edward Dyer's response is basically saying he doesn't care about the victims (patients).
What other reason than "we don't care" can there be for the continuation of Explicit Consent for Intimate Medical Exams in 2020???
Come writers and critics who prophesize with your pen
Keep your eyes wide, the chance won't come again
And don't speak too soon for the wheel's still in spin
And there's no tellin who that it's namin
For the loser now might be later to win
For the times they are a-changin
Come Senators, Congressmen, please heed the call
Don't stand in the doorway, don't block up the hall
For he that gets hurt will be he who has stalled
There's a battle outside and it is ragin
It'll soon shake your windows and rattle your walls
For the times they are a-changin
Come mothers and fathers throughout the land
And don't criticize what you can't understand
Your sons and your daughters are beyond your command
Your old road is rapidly agin'
Please get out of the new one if you can't lend your hand
For the times they are a-changin
The line it is drawn and the curse it is cast
The slow one now will later be fast
As the present now will later be past
The order is rapidly fadin
And the first one now will later be last
For the times they are a-changin --Bob Dylan
For the times they are a-changin...
New national guidelines take a hard-line stance on doctor sex abuse
-- Banterings
Many whistleblowers only blow the whistle when they personally have suffered a personal slight. They will stand by for years and watch the harm but never say anything until they are been personally offended. The same with chaperones. They are there for the patient. They are there to protect the medical provider who pays their salary. The BMJ has a very good article saying chaperones needs to be the sex of the patient to offer patient protection. It seems Europe has a better understand or at least the write about the subjects were in the US such writings are hushed up or stamped out.
In Earl Bradley's case, everyone knew what he did for years but yet they laughed it off and protected him. The nurse in Twana Sparks' case didn't whistleblow until she had a personal bone to pick, It is no one cares about the patient. When they see harm, they don't do the right thing which IMO makes them as guilty as the abuser/harmer. Medicine has no moral compass. If they do have one it is pointing due south.
After I have researched and analyzed the why of things happen in medicine, I was able to make predictions that I have seen come to fruition. I have certain terms and concepts that I use and push starting to appear in healthcare policy and guidelines.
I don't know if it is my writings here and other places (that policy makers stumble upon), Google's algorithm
(which counts the number of times a term and related terms are mentioned and linked to), or if there an enlightenment that just instantly happens (perhaps the the hundredth monkey effect).
One of my predictions has come to fruition. The witch hunts have begun. Patients are taking back control.
-- Banterings
The cystoscopy went well today. I was called out of the waiting room by a female and she had me follow her to the nurses station. There, she introduced me to a male tech and said he would be doing my procedure today. Great relief! Turns out he was a surgical tech who had been hired for when the practice opens their surgery center in a few months. He was from Puerto Rico and has been in the US for about 2 years but has been a surgical tech for the past 6 years. I was glad that he took the time to present a bio of himself. He was very friendly and outgoing. He was amused that the cysto room had been set up for a female with the stirrups in position. He chuckled as he moved them out of the way saying "we won't be needing these." I showed him the procedure shorts and he said I could wear them if I wanted but he was just going to have me lower my pants and under wear to just past my knees. He gave me the choice so I figured it was well enough to do it their way. He covered me immediately with a large drape. He also put a large paper drape between my legs to catch the mess. Cystos can be messy. He wiped the penis with a cold wet compress of sterilizing agent that was red in color and not the usual Betadine. Then the Lidocaine gel went in and a metal clamp put on the penis to keep the gel in. He covered me back up and we awaited the doctor.
We had some time to talk and I asked if he was allowed to work with female patients and he said generally not. He made the valid point that every male patient he works with is another one not attended to by a female. He totally agreed with my position on the gender issue and said that if the time comes for him to receive intimate care he too would ask for a male assistant. He said once he starts working in the surgery center there will be female patients since they will be unconscious and he has lots of experience doing intimate stuff to women in the operating room, including the placement of Foleys.
The doc came in and did the scope. He moved the screen where I could see it and explained all what was going down there. In a few minutes it was all done. I cleaned up and pulled up my pants and tucked in my shirt. The doc then escorted me to another room here we talked about and decided on the Green Light laser treatment for the BPH. He complimented me on being a good patient and must have said I did great at least 10 times. I guess some people don't do so well.
I felt my modesty was very well respected at every stage of the visit. I noticed that all the rooms had automatic closers so there's no leaving doors open like I have experienced in some practices.
58flyer
58flyer,
Glad everything went well. What is going to happen when he goes to the surgical suite? Can you still have him?
Just my preference, I would prefer to clean myself and inject the lidocaine myself. There is NO reason the patient cannot do this themselves. I would even go as far as to cath myself.
-- Banterings
58flyer, I am sure we are all pleased your cysto procedure came out so well, certainly in terms of how you were treated as a patient.
I want now to present to the readers here what I wrote today to the ethics listserv regarding the "leveling the playing field" in medical practice" between patient and professionals which I posted here 2 days ago.
,
your example of a sleep disorder expressed by the physician to the ill patient is to a degree clinically
worthy since it demonstrates true empathy on the part of the physician (he or she has experienced something similar to the patient's symptoms and concerns) and if worded properly by the physician can lead the patient to
a needed workup. The "playing field" in this regard has truly been "leveled" and may lead to patient confidence in the physician.
It is my understanding reading the many, many comments by visitors over the past 15 years during which the topic thread in my blog of "patient modesty", now titled "preserving patient dignity" that they have been mostly wrongly spoken to and physically treated in their lifetime by both physicians and nurses often beginning in childhood and continuing often to the present. What I see has been missing is a lack of "speaking up" to the professional by the patient when they detect what they feel is improper communication or action by the professional. The professional "misbehavior" then continues and continues. In many ways, my blog thread commentators find with some professionals a stoic "clinical" attitude and then even physical misbehavior toward them. What is needed is better personal (not just clinical) communication in both directions between patient and professional and which, if my readers are not statistical outliers regarding their concerns and descriptions, may be then "personal disclosure in both directions" will represent the "leveling of the playing field" for the parties to better understand the requests and behaviors on both sides.
Finally, one may argue that with our current system, there is no "time" to encourage better communication because of the "needed" patient load placed by the medical system on both doctors and nursing staff. And that's why we have on the blog thread discussions about "changing the medical system". By the way, I think one thing which COVID-19 has shown society is that active medical professionals can emotionally suffer and even become physically ill and that, in a way, also :"levels the playing field" between the patient and the healthcare provider. .
Let me know if you all have some questions about what I wrote the ethics listserv. ..Maurice.
Glad it went well 58flyer. Sounds like you found the right practice.
Banterings, for my many cystos split between two hospitals, a nurse has always cleaned me and inserted the lidocaine. When done I have always cleaned myself, same as 58flyer did. The primary difference for me vs 58flyer is I have always removed my pants & underwear and put on a gown in an adjacent changing room. I am draped and the gown is lifted exposing the genital area only.
Banterings,
I suppose I could still get that particular guy if needed him in the future. The surgery center is in the same building and he would be just down the hall. They have other males working there too.
Biker,
I have had 3 cystoscopes in my life. All 3 were conducted differently. There appears to be no standardized way. The first one I removed everything below the waist and was given a small (about 3 ft by 3ft) paper to cover up with. The doc did the prep at my request. He did the scope through a small tear in the paper. Once done he left the room and I dressed using the paper to clean up with. It was very messy and the paper wasn't enough. My wife was there and she found some additional wipes to clean with. She also prevented a female medical assistant from coming into the room without knocking.
The second one was with the procedure shorts and a very large cloth covering. Again very messy requiring lots of paper towels to clean up with.
I've already described the latest one. The doctor did not use use very much saline so the mess was considerably less. Common to all three were the gel and the scope. Lots of saline on the first two and very little saline on the last.
58flyer
Maurice,
Why do you ignore my arguments about the onus on patients speaking up. I am sure that the provider checks in with 58flyer and Biker during their procedure to see how they are tolerating it. Is the onus on the patient to tell the provider about an antibiotic allergy or the provider to ask?
You continue to victim blame/shame by asserting that patients don't speak up. Are med students not taught bedside manner in doctoring courses?
You acknowledge the hidden curriculum. Troves of research on the hidden curriculum, patient compliance, and intimate exams on anesthetized patients has been presented, yet you still think we may be outliers.
I cannot that in your very institution, rife with providers guilty of sexual assault of students and patients, you could not find anyone who works as a provider to validate this.
You continue to ignore the shortcomings of the profession. You were well indoctrinated, enough so that you were trusted to indoctrinate new recruits. So well in fact, you fail to label abusive practices that you yourself experienced as inappropriate or unprofessional at the very least.
I cannot make conclusions based on intent, which is not measurable. I can only base it on observable actions. My conclusions are the "Shutter Island Effect" (live as a monster of die a good man), and/or the profession is apathetic (doesn't care or can't care due to learned sociopathy).
Let the profession ignore all of this.
Maybe we should deem provider suicides as outliers. There is no problem, most do not succumb to it.
Burnout? Providers need to try diet and exercise.
The witch hunts are beginning. Working conditions are not getting better. That is everyone else's fault. If you can't even see this, then why would anyone expect the profession to make changes.
Thankfully the profession is being taken over and run by people with business, management, and customer service skills: the MBAs.
Fauci could NOT even be honest and say that BLM rallies (with multiple unmasked participants in close quarters).
The public has lost all faith in the profession of medicine.
I am offended as a surviver of abuse in the healthcare system that you say the problem is patients need to speak up. How does a 5 year old speak up? Obviously, the patient speaking up is NOT the problem.
Where are YOUR ethics when you victim blame. That is what you are doing, and I say this as a victim.
-- Banterings
Banterings, what has been going on here on this blog thread for the past 15 years to others reading but also to me as a professional: you all have been "speaking up" and at least I have been listening and learning.
What I am asking for is for the "speaking up" to continue regarding the life malexperiences that most here have been suffering in the past and even continuing at times into the present. And this "speaking up" should be directed beyond me but also to the specific caregivers, the institution managers, the public and the government. It seems that JR is attempting to do this and I am fully in agreement with what she is doing. I recently "spoke up" as I wrote this very issue (which I reproduced here) to physicians,, lawyers, ethicists who are participants of the ethics listserv to which I subscribe. I agree "speaking up" is not the problem and it is not the victims I am blaming. But I think that informing the members of the medical profession about your medical history, drug and procedure reactions is one thing but informing them about ongoing patient expectation of professional behavior and present malbehavior issues are what I am writing about.
You, all have been speaking up to me during the past 15 years and I have listened and brought your experiences to my first and second year medical students and hopefully they are listening and speaking up to their "leaders" as they move into the third and fourth year "hidden curriculum" period.
I hope this explains my view of the subject. ..Maurice.
What I see is 2 different things being done: some want modesty addressed while others like Banterings, JF, and I want personal dignity respected. I don't care to have my personal dignity disrespected by even a member of my same sex but for modesty's sake it seems to be okay. I simply do not understand that because you are still allowing them to show disrespect to you as a person. Modesty is defined as more sexual in context and this where I don't understand because in today's world just because you have a male or female provider you cannot be sure of their sexual orientation so therefore you may still be viewed in a sexual manner. If you are allowing disrespect just in order to get medical care this is not saying anything good about how US healthcare is delivered. To allow disrespect just to be "cured" is really sad. Biker clearly illustrated the different ways the one exam has been done and how he finally is having it done to meet his needs. Having to get undressed if front of them is demeaning and that is how it is meant to be. Dismissing as not necessary a medical garment meant to give patient privacy is showing a lack of respect for the patient and I would never agree to it but I understand if a patient is not willing to stick up for themselves because this is the way the system is set up. Sometimes fighting for your rights like my husband did will end up with the patient being greatly harmed. That is why I am taking this fight into the public arena and out of the medical facility.
Yes, I am speaking up and out but I do not think patients should have to speak up and out as it is up to the provider to provider humane services. Patients should not have to opt out of things because that causes friction but rather should be able to opt in. Consent should not be assumed but rather explained and opted into. All exams/encounters should be done with Trauma Informed Care protocols. Chaperones should be of the patients choosing and patient advocates of the patients choosing should always be present whether that advocate is a family member or a paid advocate. Chaperones are there for the provider and not the patient because historically if there is any wrongdoing by the provider the chaperone ignores it or lies about it until they too have a beef with the provider.
What I personally wanted from you, Dr. B., is for you to introduce us to medical professionals whom we might be able to talk with in order to make a difference. We need to talk with those who make policy and set the tone. My witch hunt of medical providers only encompass those who harmed my husband. Others I am willing to talk with and encourage them to make a difference.
Maurice,
Why are "ongoing patient expectation of professional behavior and present malbehavior issues" any different from "medical history, drug and procedure reactions"???
Are PTSD, anxiety, depression, phobia, and other psychological, iatrogenic trauma NOT valid, unwanted side effects of medical procedures?
This is the typical thinking of the profession of medicine, psychological, iatrogenic side effects are NOT considered real side effects. (I have presented research previously that shows these are valid side effects with measurable harm such as avoidance of healthcare.)
How receptive do you think providers will be when the patient tells them what "professional behavior" is expected? Is that not your responsibility (as a medical educator) and the profession of medicine?
Look at what happened to 58flyer when he did that. That is SOP in healthcare: abandon the problem (doctors can no longer "bury" them).
The real problem is that providers are NOT informing patients of their rights (such as refusing any procedures, participating in their healthcare, etc.). Furthermore, providers do NOT inquire if patients have a history of abuse, what their expectations are, how they wish to be treated.
Here is the latest STANDARD OF CARE for all patients: trauma-informed care.
The first step is to recognize how common trauma is, and to understand that every patient may have experienced serious trauma. We don’t necessarily need to question people about their experiences; rather, we should just assume that they may have this history, and act accordingly...
For someone who has experienced trauma, the hospital or doctor’s office can be a scary place. Dr. Lincoln explains: “Patients often do not volunteer such information about prior experiences, because of guilt or shame. Medical professionals often ask about safety in a patient’s present relationships, but few ask about past experiences. A simple question such as, “Is there anything in your history that makes seeing a practitioner or having a physical examination difficult?” or, for those with a known history of sexual abuse, “Is there anything I can do to make your visit and exam easier?” can lead to more sensitive practices geared to developing a trusting relationship.
How often do providers solicit patients' feedback anyway?
If you are not victim blaming, the I suggest that you change the topic to lack of trauma-informed care, soliciting information from patients about past trauma and their needs and expectations.
If anything, the issue is the profession not telling the patient to speak up. (That is because when patients speak up, they are dismissed.)
I also suggest that you clarify that the problem lies with the profession in suppressing this, not informing patients, or soliciting the information.
You should also post that clarification on the ethics listserv. You don't want to be a target of the #MeToo movement...
-- Banterings
Banterings brought up some good points. After my husband was harmed, we interview future doctors. He told them about his experience and the lasting trauma/harm it has had on him. One doctor said, "Forget about it as it is in the past." Needless to say that callous, arrogant slug was not hired. They don't care about or acknowledge the harm patients have suffered at the hands of the medical community. It took 3 tries to Trauma Informed Care labeled in his MRs at the current MD even though they repeatedly said it would be. I know of too many examples of patients being harmed once they make their choices/rights known even though they are being very polite about it. It should not be the duty of the patient to make sure the "professional" knows how to do their job "professionally". That is what causes patient harm. They simply don't like it being told to them in the moment. You get fired like 58flyer or get harmed like my husband. My husband knew he had the right of refusal but they decided he would not have that right. They didn't give any clue they were upset so he thought the matter was resolved. This has happened to others too that I have been communicating with over social media. Just like with the consent forms, having spectators, sales reps, medical students should not be an opt out but opt in because the opting out creates bad feelings, is ignored, or even retaliation against the patient.
For males who have suffered sexual abuse especially medical sexual abuse, the medical community refuses to recognize it. They snicker and laugh and act like it couldn't have happened. Trauma Informed Care Protocol should be practiced on every patient so medical visits are less likely to further traumatized the victim. No more victim shaming. Although females are still victims of medical sexual abuse despite all the efforts to lessen it, male patients have probably had their care worsened over the years. Most males are denied bodily dignity as in the case of 58flyer. That tech would have never had a female pull down her pants in front of him. He wouldn't have so lightly dismissed the medical shorts as not necessary if a female patient had said she had them for the procedure. It is totally different for men in medical care.
JR, you and Banterings have amply presented your views which may well be the views of a good proportion of the patient population.
I cannot argue against or argue with the medical profession in general since virtually none of which has been described here has as yet happened to me, myself and formerly as a physician in active practice, none of what has been written on this blog thread was spoken to me by my patients. So.. now my input is from my contributors to the blog subject and what I have read in the news (yes, Banterings, also bad bad behavior involving USC physicians and Deans.)
Where are the physicians and nurses whose views are needed to supplement this blog thread? Why don't you, Banterings, Biker and the other contributors here proceed to publicize this blog thread on the media and get them to visit and to set forward their own views of the subject? Or am I asking for the impossible? ..Maurice.
But I have publicized this blog site to many and yet no takers or if so, they remain silent and don't contribute. The conversations I have had with the medical providers initially is denial until they can't deny it or they turn really nasty with personal attacks because they can't defend it otherwise. I have had several nurses agree that male patients are exposed unnecessarily because some of their peers like the reversal in power/control they have over especially sedated patients. Some argue this isn't done on their watch but they do acknowledge they know it is done.
I am not asking you to personally present our issues but help us gain entry to those so we could start. We need our foot in the door to help bring change quicker. Not only would change benefit the patient but also the medical providers themselves as they would be more humane and this would help them in their jobs and in the future when they or someone they love becomes a patient. Being a patient is unavoidable for most people so why not make the experience more humane? It is not an attack but an educational endeavor to make how healthcare is delivered compassionate and humane. Healthcare is supposed to heal not harm.
But, JR, I did reproduce here the text of my listserv posting to a medical ethics listserv read by many physicians, lawyers and ethicists reviewing the views which has been written here and ending with my name and a link to this bioethics blog which would display at the top of the page this very Volume. I request patients themselves, not just the moderator, to "spread the word" through the internet about our blog and thread site and the viewpoints presented. ..Maurice.
What I am seeking is an opportunity for some of us like Banterings, Biker, JF, Reginald, myself and others to take in a Zoom mtg with medical ethicists or professors to see how what we have to say might be incorporated into the teaching of and relearning activities of medical staff including doctors, nurses, MAs, techs, administrators, etc. Many of these people never learn from the patient point of view. I think it would be very helpful for them to know how patients feels and especially from those who have suffered harm. Not all want to harm but many do whether it be intentional as there is something wrong with them or because of the way they do things not really thinking how their actions affect the patient. The intentional harmers cannot be reformed but rather need criminal consequences so I am talking about those who are probably more in the majority of harming because they don't think about the consequences of their actions.
For example the tech who did 58flyer's procedure should have been more sensitive and not just routinely dismissed 58flyer's medical garment as unnecessary. For patients who feel they have a basic human right to person dignity as stated in the UN agreement the US has signed, it is important for personal dignity to be recognized even during same gender intimate care. While I think most patients know there is a degree of exposure required during certain procedures, how it is done it as important to the outcome as the actual medical skill involved. You can have a medically successful procedure but still have trouble physically recovering if mentally you were harmed because of the procedure.
As I said, I spread the word through my website (soon to have another one dealing in patient education/rights), Twitter which is growing daily heading to 2000, Facebook page and Facebook Patient Rights Info page. However, many do not think about personal dignity until they have been victimized. Most when it is worded to them realize the importance but have never fought for their dignity. So very sad and this points to why the importance of personal dignity is denied and abused by the medical community along with true Informed Consent and Trauma Informed Consent protocol.
There is also an epidemic of victim shaming because a patient becomes a victim. Too many don't understand many patients have no choice but to be victimized because even though they speak up, it sometimes causes harm or the answers are just lies and patients have no way of knowing this. Victim shaming needs to stop. It is up to the medical provider to provide the correct info and treatment because many patients simply do not have the knowledge they need.
I say "JR, keep up the good work". ..Maurice.
There is a big need for patient rights. I have talked with so many people harmed by medical encounters. So many have remained silent for years because they felt they had no where to go or no one would listen. I think once we open the floodgates we will see harm is not the exception and that harm comes in many different forms. It is not just about the harm done to my husband although it is always in the back of my mind and is driving my force, it is about stopping harm from happening period. Because of personal experiences, Informed Consent, patient autonomy and patient dignity are my main points of focus. These are the foundations of true patient-centered care.
Hello Dr. Bernstein,
I'm puzzled with the following: "I cannot argue against or argue with the medical profession in general since virtually none of which has been described here has as yet happened to me, myself and formerly as a physician in active practice, none of what has been written on this blog thread was spoken to me by my patients ...". Is this tantamount to saying that one can't comment about the dangers of spousal abuse because one hasn't experienced it oneself or, been informed of it by one's patients? (I use this example because it also is one which few individuals will address until actual physical harm occurs.) You are involved with an educational institution. Surely, you've received numerous directives from ADA (Americans w/ Disabilities) re reasonable accommodations. The crux of the dignity/ modesty issue is Could (or Should) dignity/ modesty regarding exposure, gender-concordant care, truly informed consent, etc. be reasonably accommodated? A correlate to this would be What accommodations are considered reasonable and how should these be implemented? There's no need for a physician, ethics committee or anyone else to have actually EXPERIENCED the situation. The lack of participation on this blog by ANY other medical personnel seems to indicate that dignity/ modesty does not rise to the level of medical concern. As patients we are told that we have the right to dignified care. Some of us have a high expectation for that care, possibly due to previous "negative" experiences. Until our situation is viewed as a disability to be accommodated, dignity/ modesty will never be viewed as a concern by the medical establishment. Since they have not experienced the issue, the issue doesn't exist as a problem for them. How sad!
Reginald
Maurice,
Continuing on Reginald's comment.
You said:
"I cannot argue against or argue with the medical profession in general since virtually none of which has been described here has as yet happened to me, myself and formerly as a physician in active practice, none of what has been written on this blog thread was spoken to me by my patients..."
In light of the bad behavior involving USC physicians and Deans, I can NOT believe that USC has not instituted some form of mandatory training for all licensed physicians (and other providers) that are educators, providers, or both.
Would that institution, as an academic leader NOT also incorporate that into their curriculum as well to have their students have the most advanced and THOROUGH (there's that word) training?
Is trauma informed care (the most advanced method of healthcare delivery) NOT taught and practiced at your institution and affiliated institutions?
After 15 years of hearing about the issue, have you not researched the issue at all? Did you simply believe what you were taught, that wearing a magic stethoscope makes patients enjoy the experiences? Especially as an ethicist...
If you don't believe it happens, then how can you teach your students NOT to be guilty of doing it?
I put forth the idea that you may not be able to recognize what is socially abusive or unacceptable behavior that is the medical profession' SOP.
When you have described your inpatient care, many of us threw up red flags on behavior that we found abusive. You could not even label it as unprofessional at the very least.
My friend up north's best friend has no problem being nude. She told me a story of being at the gyno's office and just undressing and refusing a gown. She also had no problem showing everyone who worked there the very intimate details of a medical condition that they would rarely see (if ever).
I had mentioned my past abuse and issues with intimate care and she could NOT understand my apprehension. When I described what I think happened to me, she did not even label it as abuse let alone inappropriate and unprofessional.
I have invited countless providers to this thread and get ridiculed and shamed. I am accused of being mentally ill.
My friend up north showed me a post that he made on another online social community with group discussion boards (totally UNRELATED to anything medical or to do with dignity), in a group called "Ask a Medical Professional."
He brought up the issue of intimate exams on anesthetized patients without consent. Most claimed to be unaware and condemn the practice. Some were aware, a few attempted to defend it. I can NOT believe that medical professionals are unaware of the practice when I am sure that the majority on that thread learned that way.
As long as the profession remains blind to these problems, doesn't to know, or rather "die a hero than live as a monster," conditions for the profession are only going to get worse.How much do you think society will tolerate?
I also can NOT believe that it does not bother you if you truly cannot see how prevalent this is.
I cannot comprehend that after 15 years you still question its authenticity.
-- Banterings
Reginald,
Some excellent points! This is one of my posts on my Patient Rights Info site.
A man sees a woman at a wild party & wants to have sex w/ her. He figures why else would she be there? She flirts and such but says no to sex. He thinks she looks like she wants sex so he thinks some drugs are what she needs as the drug will make her cooperative, uninhibited and most likely erase the encounter from her memory. He is then able to have sex with her as she no longer is saying no and she is still conscious. He used protection and didn't physically restrain her so there are no bruises or cuts.. Is this wrong? Why when a patient says no, they can be drugged & the refused procedure be performed & govt. and most everyone else is okay w/ this?
We know in the real world there would be criminal charges but in the medical world there is not because no only means no when it is a medical provider telling a patient no. Otherwise, many in the medical world don't recognize a patient's right to no.
I also wanted to bring this study to the attention of this group. It was done in the UK as they seem to be more progressive and unafraid than we here in the US are of the medical community.
https://www.immdsreview.org.uk/downloads/IMMDSReview_Web.pdf
Although it pertains to mesh mostly, it can translate to other areas in the medical field. A study like this needs to be done in the US. By the way, stents are mesh and they are one of if the most over-used medical devices in the US. People in the UK are taking this study and running with it. It came to me via Twitter. I also have a former Chief-of-Staff contributing on my Twitter who seems to have many similar views that I have about healthscare and the state of it.
Banterings,
They are not blind but more like refuse to admit it because they know it is wrong. It is the old circle the wagons mentality of protecting all medical professionals no matter how criminal or wrong they may be. Take a look again at the Earl Bradley story as it is a classic example of wrongdoing happening under their very noses to the point where it was a common of "Is he up to his old tricks still?" and these old tricks was the sexual molestation of young babies. How funny, right? The night my husband was sexually molested, there were countless others present buy none of them did the right thing and stopped it. They too are pieces of scum. The system is aware but they will not do anything to stop it, prevent it, or change it. I have had many say I personally haven't seen that happen so therefore it does not happen.
As far as your friend, it is their choice how they display their body. I imagine it would be different if they were held captive and had things done to them against their will. You had no choice as neither did my husband. Therefore, it is different. Your body is the only true thing that is yours and when that has been taken away by force, it leaves a lasting mark. It is a violation so deep many cannot understand it. My husband describes it as a mental harm because once the physical abuse is over, the trauma becomes a mental scar in your soul.
It is not an issue of modesty but rather an issue of personal dignity of do they respect the patient as a person or do they think they are entitled to use that person as an object they are allowed to manipulate without explanation or permission? If it was merely an issue of modesty which boils down to sexual context, I would not want any sex to see me naked as I don't know their sexual preference although they ask mine which makes modesty even more of an issue especially if it is a gay woman nurse than she could be thinking sexually about me just the same as a male nurse. But then once you have been sexually abused, you need more than modesty--you need the right to maintain your dignity more than they need to act on their ego needs to have power and control over you.
The medical community needs to stop victim shaming/blaming and admit they have problems especially in today's society where anything seems to be okay like killing people on the streets, stealing, and otherwise. The medical community knows their harm victims have no recourse so of course they will continue to do harm until some of the ones within the medical community with ethics, morals, and maybe a soul say enough and work with us to bring about change. PS Archie, check my Twitter. There is a lot going on.
Banterings et al: I have, over the past 15 years of this blog thread, never expressed the concept that what was written here by my visitors was "made up" or "information to be ignored". Never. What I did state from the beginning was that the population of visitors who were writing here their specific complaints of their experiences with the profession represented a population of statistical outliers. This has nothing to do with the validity of those visitors content as presented.
Content was accepted by me as valid but whether this was an expression of what was going on with virtually all or most of the medical system-patient relationship was the point I challenged suggesting those writing their experience on my blog were statistical outliers. And this view of mine was based on years of direct professional experience and literature reading and my experience as chairman of hospital ethics committees of two hospitals. And finally, for whatever it was worth, based on my own experience as a patient
As time has gone on over the past 15 years, though I have had no personal reason and education in my occupation as physician and medical student instructor to switch my interpretation of the stories written here away from "statistical outliers" to overall "vast majority", I have continued this thread because even professional misbehavior or worse toward any patient represents an ethical and professional harm and should be publicized and acted upon for prevention. And, of course, I recognize that individuals in my profession is harming patients in many ways (based on what has been written here and in the news media) and I have tried to encourage my readers here to "speak up" to the system and government in an attempt to improve the relationship between the system and their patients. Statistical outliers or majority, there should be this improvement. ..Maurice.
And I agree we have to speak up and out but we have to be careful when we are doing this. I know of so many stories including my husband's story of patients who have been harmed speaking up in the moment. All was done in a polite way but asserting their patient autonomy and all have ended in patient harm. That is why I feel compelled to do what I am doing so patients don't have to speak up during the medical encounter and risk retaliation/harm.
I think we will find after at time of people speaking up and out, those of us here on this blog are not statistical outliers but are representative of a fair share of harmed patients. I have even met another spouse of a male patient who had an eerily same experience of us. It's crazy as I thought we were unique, outliers so to speak but not.
I came across this article:
https://www.unboundmedicine.com/medline/citation/21207825/Male_nurses_and_the_protection_of_female_patient_dignity_
Interesting the same effort has not been made to study female nurse/male patient scenario. It does hit you full in the face the medical society finds it fully acceptable for men to submit to opposite care while they do studies about issues of male nurses and female patient intimate care. Here is the 1st paragraph out of this report:
Abstract
Nurses need to be aware of their professional, legal and ethical responsibilities towards patients. Male nurses in particular face problems in their practice as a result of their gender and the stereotypes associated with male nurses. Such stereotypes can act as a barrier to their duty of care. This article examines the challenges associated with male nurses carrying out intimate, physical care. It discusses the ethical, legal and professional issues that male nurses should consider in relation to maintenance of patient dignity during nursing care provision, particularly in relation to female patients
Can anyone say bias or discrimination? Sure looks like it to me.
JR,
That is just window dressing. The profession of medicine sees all patients as warm cadavers. So these females are given the of female nurses, but as soon as they go into the surgical theater and are put under, they are medically raped by a line of students.
If the profession of medicine really believed that these exams were necessary, non-sexual, gender neutral, and one part of the body is like any other, then students would practicing these exams on each other and physicians would be volunteering to be exam subjects to further the profession.
Here is another example of doctors sacrificing the integrity of the profession.
Maurice,
Labelling these cases as outliers discredits what has happened to us as out of the ordinary when it is business as usual. To say we are outliers nullifies our assaults and our trauma.
The problem that I have with "patients need to speak up" is first of all, (as I have demonstrated) it is indicative the profession of healthcare be the one asking the questions (just as they would about allergies). Second, you chide the patient for not speaking up, yet you do not acknowledge that the profession is delinquent in their duties by not asking or following the standard of care of trauma informed care.
You give a pass to the profession and blame the patient.
Maybe I am not explaining my position in a comprehensible way. Can someone please rephrase this in a way that may make sense to Maurice???
-- Banterings
Banterings, "statistical outliers" is simply a statistical term representing the numbers in an analysis and has nothing to do with the value and worth of what is being championed by those who they represent. Each individual's self-description has merit for consideration regardless of the "outlier" term. As I have written a number of times previously, as the 15 years have progressed, I find less merit in my designation as "outliers" which I used back then based on my own personal knowledge and experience.
As for "speaking up", I feel this need is as much for the patient as for the healthcare provider or the medical system itself. For a patient to "speak up" to the health provider is just as important for the professional to "speak up" to the patient (notice, I didn't say "speak down"). What I have noticed in teaching first and second year medical students it that "speaking up" by patient and student is essential in the establishing both diagnosis and treatment. I recall being in the room with a student and teen-aged boy who was unable to speak up because of a neurologic condition and much, virtually all, of the history was obtained from the mother in the room but the point to be made is that taking a history indirectly is a handicap in truly understanding the true feelings of the patient both physical and emotional. And for the student to "speak up" to this patient was also incomplete since it was hard to know what the patient was able to hear and understand.
Banterings, you make sense in your argument but I want you all to know that I too am not an outlier with regard the concerns raised here about the medical system. After reading here and reading the news for the past 15 years how can I deny the concerns of those writing here. ..Maurice.
There wouldn't need the need to speak up about modesty violations if it was a policy that no patient be exposed unnecessarily or be displayed to ANY unnecessary person. I don't just mean staff either. Sometimes staff is fond/unconcerned about displaying patients to other family members also. Or unconcerned about people in the hallway also. With doors being unlocked even small children can run and open doors before anyone can stop them.
Hello,
An interesting statement has been made re informed consent. Please read below.
Physician Sexual Misconduct Report and Recommendations of the FSMB Workgroup on Physician Sexual Misconduct Adopted as policy by the Federation of State Medical Boards May 2020
“Where possible, the consent process should take place well in advance of any procedure so that the patient has an opportunity to consider the proposed procedure in the absence of competing considerations about cancellation or rescheduling. Requiring decisions at the point of care puts patients at a disadvantage because they may not have time to consider what is being proposed and what it means for themselves and their values. However, it is recognized that obtaining consent well in advance is not always possible for urgent, emergency, or same-day procedures. The consent process should also include information about the effects of anaesthesia, including the possibility of amnesia, because these can be particularly problematic with respect to sexual misconduct. Use of understandable (lay, or common) language during the consent process is essential.” (P6)
Does anyone here think that any of the above will be implemented before we are dead a thousand years?
Reginald
Maurice,
The provider does NOT speak up. They question, they educate, they inform. If the provider has properly done their job, the patient would NEVER have to speak up because the provider would know the patient's past history of trauma and abuse (in and out of the healthcare setting), their expectations, their needs, and their preferences in how their care is conducted.
Here is the standard of care: Best Clinical Practices for Male Adult Survivors of Childhood Sexual Abuse: “Do No Harm”
We have identified ten recommendations for best clinical practice in providing health care to male survivors of childhood sexual abuse (see Sidebar: Recommendations for Best Clinical Practices with Male Survivors of Childhood Sexual Abuse and Adverse Childhood Experiences). These recommendations cluster around issues of communication, control, and permission. The communications cluster focuses on asking about the man’s sexual abuse history and, if one is present, the interpersonal aspects of processing the information as part of physician-patient relationship building. Part of the control cluster focuses on integrating the process of anticipation of potentially triggering aspects of a medical examination, tests, and treatments. The permission cluster focuses on the interpersonal interchange that needs to take place before intrusive and intimate aspects of medical care begin. The gradual progression of a physical examination, which includes talking the patient through the process, is a way of pacing the examination at the speed the patient is most comfortable.
I think that you should focus the profession NOT following the standards of care of trauma informed care.
More so, the profession fails to inform the patient of his rights (including speaking up) and encouraging participation and feed back.
Again saying "speaking up" is faulting the patient. (As I stated, the provider does NOT speak up.) Saying that the profession is deficient in following the current SOC, practicing trauma informed care is more accurate.
Only after the provider informed, educated, and encouraged the patient to provide feedback is there any reason that the patient should speak up. Even then, the "best practices" put the onus on the provider to check in (sounding) with the patient.
-- Banterings
Banterings, thanks for the excellent link to the topic suggesting numbers of men arrive for medical or surgical care with a history of sexual abuse as a child (though not necessarily referring the abuse by a healthcare worker.)
With regard to "speaking up", "level" or "down", I may have mentioned this previously on this blog thread but, if so, I will do it again. We teach our first and second year medical students to introduce themselves and communicate with the patient who is lying in bed with the student sitting next to the bed but at the level of the patient or below the level of the patient and "speaking UPward" and but NOT sitting or standing while communicating taking a history while looking down at the patient.
"Speaking up" as I am using the expression here is for the patient "to express an opinion freely speaking up for truth and justice' and the patient's wants and desires to maintain the patient's life and dignity. ..Maurice.
From the article,
"The intent of this article is to act as a catalyst for improved patient care and more research focused on the identification and optimal responses to the needs of men with adverse childhood experiences in the health care setting."
Great reference Banterings,
I wonder if there had been any research in the area of sexual abuse of children/adolescents by healthcare staff?
I would argue that while many of the responses of the victim would be the same, there would particular concern when the abuser was a healthcare worker. That should be a field of study all by itself.
58flyer
I think this current article "Discourse on Beauty in Medicine" by a family physician who teaches art and medicine to medical school and residents (and which, by the way, has been a feature of medical student education in USC Keck School of Medicne) presents a clue as to what is going wrong in the medical profession ("emotional distancing is the core feature of the Hidden Curriculum of medicine". Here is an excerpt of the brief article:
In regards to meaning, one hears of finding meaning in medicine. Where was it lost? At the core of medical meaning is expressed human compassion. The empathetic urge to care for a fellow human being who suffers is the raison d’êrtre of the profession. Therein lies medicine’s beauty. Our passions permit our compassion. Medical meaning thus requires an emotional acumen to apprehend it. Yet modern medicine has become increasingly hyper-intellectualized and concomitantly clinical emotions have become progressively marginalized. Indeed emotional distancing is a core feature of the hidden curriculum of medicine. At times there are practical reasons for such emotional suppression given the overwhelming emotional content of medical practice. But if we in medicine go too far and lose our engagement with clinical emotion, then medical meaning is inescapably lost. Professional aesthetic discourse, as a deeply emotional exchange, facilitates an appreciation of and engagement with clinical emotion and medicine’s compassionate meaning.
Couldn't it be that this loss of concern for making medicine something of "beauty" leads to looking at patients as "objects" to attend and then is followed by the terrible patient experiences described on this thread and thus loss of patient dignity and whatever dignity can be applied to the medical profession. ..Maurice.
It's been an interesting week. I scheduled the Greenlight Laser treatment procedure with the scheduler for my urologist. Her name is Christi. While scheduling this with her, I ask if she knew who the clinical director was at the hospital where the procedure was to take place. Now, Christi is a scheduler, she has no medical training whatsoever. Of course she wants to know why I need this information. So I tell her about my need for same sex personnel for intimate procedures, and I want to talk to the clinical personnel at the hospital so as to arrange for as much of a male team as possible. For my hip replacement surgeries, my orthopedic surgeon's PA did the arrangements. Now it looks like I will have to do my own arrangements with the hospital. Christi is clueless, as I expected, she is not a medical professional. I finally had to call my way through the many layers of administration at the hospital with explanations at every step. I must have had to explain my sex abuse history at least 5 times, before I finally reached the nurse at surgical admissions. Her name is Roseanne. I explained my situation and past experiences to Roseanne. I sense she is genuinely concerned, she is after all a nurse. I realized Roseanne is really trying to help me when I get a call to extend the procedure to 2 weeks later. That gives her additional time to set up the team. Christi calls me with the news that the date is changed to 2 weeks later, like I didn't already know that. I know Roseanne is trying. She said she will get in touch as we get closer to the procedure date. Too bad my urologist doesn't have a PA to do my advocating, like my orthopedic doctor did.
In my conversation with Christi, she said that they have no male personnel at their practice for male procedures. I then reminded her that I had a male ultrasound tech for the TRUS/biopsy. She said that he was from an outsourced service, he was not an employee of the practice. I reminded her that I had a male surgical tech for my cystoscope, and she agreed but he was hired to help while awaiting until the surgery center was open. Christi said I was lucky to get them as they have no other male assistive personnel. That disturbed me, as I had made my selection of the practice from assurance that male assistive personnel were available.
Maybe I was just lucky, or maybe Christi doesn't know what she is talking about.
58flyer
58flyer, it shouldn't be as hard as it is, but regardless of their status, your new practice did have male staff for those two critical events. Hopefully Roseanne will be able to find a solution for you for this next one. I can appreciate schedulers need to ask questions before passing a patient on given they'd likely get in trouble with the practice manager if they didn't but they should be trained to be non-judgmental and to show empathy. That's not too much to ask no matter their level in the organization.
Hi folks, remember that MRI of mine? It has come back to haunt me.
One of the things I did last week was to call the Urology practice and request a copy of the MRI images on DVD to give to my primary on my next visit. They very nicely obliged and I picked up the DVD at the practice. When I got home I got curious and pulled up the images on my computer. I was MORTIFIED! In my online research on a prostate MRI, the pictures I found showed the images of the prostate, bladder, and surrounding structures. Even with the dreaded endorectal coil, images were the same. I was shocked at what I saw with the images for my MRI. It shows EVERYTHING! Penis, testicles, anus, bowel contents, pee hole, bladder, and in the middle of it all, my prostate. All in high quality, almost HD, black and white 3T imagery! So this was what the female MRI tech was seeing of me on her screen! Had I known this would have been what she saw of me, I would have certainly refused and cancelled the exam. Endorectal coil or not, I would have been out of there. I'd have blinded her with ass!
I went in after our little teary eyed discussion thinking this would be nothing. I kept my underwear on and I had a gown covering me quite well. I thought that she won't see anything. Wrong! Let down again. I know it's only an image, but it's MY image! It has me wondering if she really did reassign my MRI to herself for her entertainment.
Part of me wants to call the practice and speak to the clinical manager. But this all happens as the hospital is trying to accommodate my request for gender concordant care for the laser therapy. I don't want to endanger that. I don't want to get fired again. I will not see my urologist until the hospital visit so I can't discuss this with him to get his support.
I just received a copy of Dr. Pat Walsh's book on surviving prostate cancer. It's very good and highly informative. I've only read about 2% of it so far. The book refers to what I am going through as the "prostate years" of a mans life. For me, it's been a roller coaster ride.
58flyer
58 flyer. I'm sorry that happened to you. I feel stupid for believing in her. See Dr B? Speaking up has its limits because a certain number are seriously in this line of work for the wrong reasons.
58flyer, I wouldn't have had any idea what the tech was seeing was that explicit either.
Years ago my former urologist did a prostate biopsy without even telling me. I only found out afterwards when he got the results and told me in a very matter of fact way they were clean. He said he figured as long as he had me there he might as well do that too. I had gone in for biopsies of my bladder as a follow-up several months after my cancer surgery. Given that's done via the penis, obviously the whole affair is up close and personal, but the manner of prepping a patient for prostate biopsies was even less dignified than prepping me for the bladder biopsies. I was unconscious for the entirety of it.
58flyer, though I recognize from your posting your emotional anguish about what you saw in the reproduction of your genital-rectal area MRI study, it originally was performed by a technician who is skilled in the technique and needs to inspect and monitor what images she is obtaining and to make technical corrections or adjustments to meet the goals set by her physician supervisors for immediate application or of value for your urologist or general physician later on. This is totally different than the news story of a surgeon photographing a non-pertinent picture on his own camera of a unconscious patient's penis for non-clinical distribution to others. I would strongly doubt that your MRI was created for non-clinical value.
I do agree that it would be part of a urologist's duty, if you were given access to the images, to explain to the patient the purpose and value of the various anatomic images found on a MRI copy.
I know, folks on this blog thread were probably concerned that on two hospital admissions, nursing staff took photographs of my lower back including scrotum allegedly for bed sore legal protection and upon their request I approved. But there appeared to me a logical rationale. And, I have a feeling, 58flyer, your "photography" also had a rational basis in its detail. ..Maurice.
Dr. B.,
You missed the whole point. 58flyer's "emotional anguish" goes well beyond a female looking at images of his genital area. It is because he had been a victim of sexual abuse explicitly a victim of medical sexual abuse. What was done to him probably puts him back to the time when he had no control over what was happening to his body. It is that loss of control and trust of the medical provider that causes what you term as "emotional anguish". He feels betrayed yet again by a system that failed to protect him. Evidently you have never met anyone who has been sexually assaulted. These feelings of betrayal and loss of control go well beyond just being termed as "emotional anguish" as they cut deep into your very soul of being.
This I know. My husband never gave much thought before especially when he was having prostate related treatments. He was in control and knew what would be happening. The females involved as far as he knows caused him no intentional harm. While it is true that looking back he now sees he was not given the personal dignity any patient should have at the time he just sucked it up and justified it as part of a man getting medical care. However, when he suffered intentional sexual harm, things have changed. He now no longer tolerates any type of personal dignity violations as they through him back into the sexual harm episode where control of what happened to his body was taken away from him by a criminal-acting nurse(s) and doctors.
If the same images would have to be done on my husband today for prostate cancer, he would refuse because he would know he would experience a loss of control that goes well beyond your dismissive "emotional anguish" description. We have the originals of those images and they will not be seen again by any medical provider. For victims of sexual assault, loss of control of over happens to their bodies is part of them now. For this loss to be taken away involuntarily is again like suffering the assault. If forewarned and explained the necessity perhaps the outcome would have been different. This is part of what Banterings has been saying about the need for patients to be given Trauma Informed Care protocol. Just because they can rationalize the need doesn't make it okay in the mind of a sexual abuse victim or anyone else for that matter. Having said this, I will say you are wrong in saying the urologist should have explained what he would see before handing him the images--all explanations of what would be seen should have come before 58flyer had the test done knowing that he is a victim of medical sexual assault. They again failed him and have further eroded his trust in them to further make every medical encounter a battle which he has to get survive. Is that how healthscare should be delivered?
As far as your pictures, if you are okay with some nurse taking pics of your genitals on what was probably her personal cell phone, why would I have a problem? While yours was initially for hospital record you have no idea if she than showed them to others who had no medical need to see them. I would have a problem if it was done to me or my husband but we don't know for sure the criminal nurse did not take pics of him. That is part of his nightly recurring nightmares.
Maurice,
Knowing what 58flyer's concerns were, the tech should have at least disclosed what she would be viewing. Now, her deception has caused more distrust of the profession of medicine. You, as a practitioner of the art are now guilty by association.
Every provider that 58flyer deals with in the future must pay the price for what this tech did.
For a someone who claims to know ethics, how can you NOT see the problem with the tech's failure to COMPLETELY address 58flyer's concerns and be open and honest with him?
For someone who was trained as a physician, you seem to lack logical thinking to see the problem with the tech's omission.
I suspect that your training as a physician has made you blind to this. The only other rational explanation is my "Shutter Island" theory.
With the volatility in society, and health professionals being demonized, how long until we have protests against the profession of medicine?
I have started adding #BLM (hashtag) to my tweets when I talk about things such as COVID-19. This is an attempt to get radical leftists to look at my tweets and let them develop a hatred of the profession of medicine as well. Perhaps they can start burning down hospitals.
I am just taking your advice and speaking up.
-- Banterings
"Speaking up" is the dynamic of this blog thread and, of course, the entire Bioethics Discussion Blog itself. And it is of great value to me as well as all the other visitors to this blog who are just reading and as yet not contributing their views. And as long as the "speaking up" is directed to the content, the content of discussion and NOT an ad hominem with regard to the personality of another writer then "speaking up" is what is expected here. And, in addition, what I am also encouraging is for patients to "speak" their needs and concerns to the members of the medical profession who are attending to them. What we teach our medical students is that every patient, even those with the same disease diagnosis is unique. That is why there is no such thing as describing "the gall bladder attack" (or 'cholecystitis patient') in room 201".
Attending to the care of a patient is much different than looking at patients as the next object coming down a "production line". If a visitor or patient ever sees that type of behavior expressed or acted out by a medical professional, the individual should "speak up" to that "professional" and to the system responsible for him or her. If that happened to me, as a patient but also a member of the profession and I didn't understand the clinical or legal rationale, I, too, would "speak up". By the way, in this reard, I have already communicated with my hospital rejecting the categorization of me as a VIP and I look for attention to this matter if I have to return as a patient. So.. do as I have done as a patient: "speak up". ..Maurice.
Dr B. There was nothing OK about about how that tech treated 58flyer. He made CLEAR to her that he didn't want to be displayed for her. She deceived him. There's plenty of patients who would be permanently run off by that kind of treatment. But that doesn't matter to medicine because they have plenty of patients. JF
Hello Dr. Bernstein,
Unfortunately, it has been my experience that (with the exception of my GP in his office) hospital, radiological and clinic personnel DO seem to treat patients as a production line.
Reginald
Reginald, you write "hospital, radiological and clinic personnel DO seem to treat patients as a production line" and I understand. These folks have not had the responsibility nor time to sit face to face with the patient as hopefully your general physician has had and develop an understanding and relationship. One cannot set these group of medical providers in the same relationship status as your general physician. However, you should take the opportunity, if possible, to "speak up" and educate them. Yet, I realize the apparent "potential hazard" at the moment to perform this "education" of those individuals who are about to or have already started "working" on the patient's body. But it is the patient who carries the ethical "autonomy" and has every ethical right to "teach", at the time, those professionals what needs to be taught about their current or anticipated behavior and actions which have just occurred or are to be anticipated. As an example, if you don't want sedation during a colonoscopy, first "speak up". You are a participant in a behavior or action and your medical ethical autonomy gives you the right to "speak up".
I hope this explains my view as an ethicist and physician. ..Maurice.
Maurice,
You miss the whole point, why doe a patient have to speak up and educate any medical professional????
This is my whole point. Professionals should already know how to do their job. They should already be practicing trauma informed care. They should already know how to protect dignity of the patient, if they do not know this, then they should not be practicing.
-- Banterings
Banterings, "they should","they should".. but unfortunately many just do not have enough time to sculpture their professional behavior and work to meet the behavior requirements of the individual patient they are currently attending. Of course, there are other "excuses" but I suspect this is the more common one. ..Maurice.
Here is a positive "student in the room" experience. I had an appt. yesterday with a tech for some extensive testing not of an intimate nature. An MA comes for me in the waiting room and as soon as we exit the waiting area she says that the tech has a student with her today, is that OK with me. I say yes, that's OK. She then brings me to the room with the tech and the student is already in there with her. The tech then introduces the student and asks me if it is OK that she observes. I say OK and we proceed.
I appreciated being asked before getting to the room and then the tech verifying again that it was OK. In the end I got some benefit on account she was explaining the readings to the student which is something that probably wouldn't have occurred if it was just her and me. I'd of had to wait until I met with the doctor.
If a hospital can do it right for non-intimate matters, they can certainly do it right for intimate exams and procedures.
So it is called "sculpture their professional behavior and work to meet the behavior requirements of the individual patient...." instead of being a vital requirement of healthscare to deliver it in a way that is ethical, respectful, and doesn't harm the patient? It would seem to me, coming from an educational background, that all interactions with patients should be done with respect of patient dignity and autonomy and not just tailored to those who demand it? Does that mean I delivered education to children in the wrong manner? Did I only have to be nice, respectful and teach the ones who demanded it or deserved it? WOW!!!1 I think you just hit the whole issue on the head! So it takes times to be respectful of patient dignity and autonomy and doctors/nurses simply don't have the time to treat us as human beings? Good to know. Kudos to you the medical provider who just made this so very, very clear.
Hello JR,
I don't think there's much that any of us can add to your analysis. Congratulations! I wish I had written it.
Dr. Bernstein,
As an example of assembly line hospital treatment, I submit the following example. The instructions on the colonoscopy paperwork stated that the patient should arrive 2 hours before the procedure. Ok. I arrived at 5 AM for a 7 AM procedure. Surprise! There was no one in the Enterology Dept. After an hour and a half of counting floor tiles, a receptionist arrives. I was presented with paperwork to complete, even though intake forms were already completed online. Halfway through completing the paperwork, I'm whisked to the colonoscopy area - paperwork still in hand. At 6:50 preparations are feverishly undertaken - assembly line here we come. No one addressed me by name. All worked robotically. Foolishly, I asked, "What's the rush?" I wish I had a picture of the expressions. My point is that I arrived as instructed. Why couldn't someone have been there to "process" me when I arrived? Isn't that simple courtesy? Does anyone in the hospital do work flow analysis? (That's a rhetorical Q.) If 1000 (exaggeration) procedures hadn't been scheduled for that day, the techs might have been more personable (maybe). Does the hospital's bottom line supersede patient dignity? (another rhetorical)? It doesn't take much to be a bit personable. A simple smile and a greeting by name works wonders. I think that even professionals can accomplish this. This doesn't take training. Isn't it basic humanity? But, isn't that what many of us have been extolling - Please treat us humanely!
Unfortunately, the thread seems to have become antagonistic - us against them. We need to have our concerns heard so that medical institutions become aware that their people skills are grossly deficient. What's the Rx?
Reginald
JR, how about the "patient population" (that means all of us) set a goal to find ways to get more individuals (male, female and other) into the medical profession so that there will be less and less patients assigned to each professional. This change would surely help allocate more time to each patient and permit "sculpturing" a behavior of "the best attention and response to the specific needs and desires of each and every patient". The way medicine is practiced now, it does look like that "production line" analogy.
I don't think that attempting to get more participants into the medical profession (physicians, nurse, techs, et al) will be harmful except to those administrators who more interested in their institution's $$$$ than the best in medical care and attention to each individual who becomes a patient in their institution.
JR et al, so the "speaking up" should be to a broader population and the goal is to get more and more students into the medical profession. This will provide the opportunity for each medical care worker to have the time to direct their attention to the patient in front of them and not any patient load ahead (the latter being the current dynamics of medical practice.)
What do you think? ..Maurice.
Reginald,
Thanks but I wish it didn't have to be said.
Dr. B.,
Yes, there needs to be more workers but more workers still won't solve the problem. I have been on social media for a while now. The overwhelming majority of medical providers are of the opinion they do nothing wrong so bc of this inaccurate observation by them, more workers wouldn't solve the problem bc they don't think there is a problem to with them in how they deliver health scare. Regardless of whether you admit it or even know, there is an overwhelming thought by the majority of medical providers that patient dignity (modesty) does not pertain to medical matters and that patient autonomy is the patient saying "yes" and no other options, no's, etc. are voiced or considered. Sadly, this is the state of medicine in the US.
I also think hospital administrators are a huge part of the overall issue as push for more $$$$. They want more procedures, more drugs, less workers, less time, but expect to be given gold star reviews and ratings for substandard care as physical success does not equate full success if the mental health of a patient has been harm and they won't return for any future needed medical help.
I have medical people following me and there are some, believe it or not, that agree with me. Healthscare as it is delivered now is bad for the patient and bad for the worker including the real doctors/nurses who care.
But without feedback from people like us on this blog and on my social media sites, hiring more workers will only result in more of the same treatment unless we are brought into the discussion. If they don't hear from us, things will never change. That is why I am speaking up and out like I do because I know from personal experience that speaking up even as politely as my husband did, can result in severe patient like it did for him. I cannot emphasize enough that it is not the responsibility of the patient to speak and teach each and every medical staff member how to respect a patient's rights but it is the responsibility of the health scare industry to make sure their service workers are trained in good customer service protocol which of course is aligned with the basic human rights all people are entitled to from birth to death. We did sign a treaty with the UN guaranteeing these rights. It is way past time to make the medical community honor them.
For those of you brave enough, join Banterings and I on social media. If you are interested, I will give out the info. We need numbers because numbers show there is an interest by the public for change.
Maurice,
I think providers are professionally taught and tested for competency in excuses. The US medical education is second to none; (the majority of)society continues to believe and accept them.
The best part is they think that we believe them. Most know the real truth.
That is OK, because I lie to providers, advocate for all patients to do it, even teach them how to, and support their decision with ethical reasons why.
-- Banterings
Dr. Bernstein says,
58flyer, though I recognize from your posting your emotional anguish about what you saw in the reproduction of your genital-rectal area MRI study, it originally was performed by a technician who is skilled in the technique and needs to inspect and monitor what images she is obtaining and to make technical corrections or adjustments to meet the goals set by her physician supervisors for immediate application or of value for your urologist or general physician later on. This is totally different than the news story of a surgeon photographing a non-pertinent picture on his own camera of a unconscious patient's penis for non-clinical distribution to others. I would strongly doubt that your MRI was created for non-clinical value.
Dr. Bernstein,
I have no doubt that my MRI was performed for proper purposes, It's just that I was told I would have a male MRI tech and I got a female tech instead. By itself that's not a problem until I found out the degree of detail that the images showed, which mortified me.
On Wednesday of last week I cautiously called the practice and asked to speak to a clinical manager. I was soon on the line with a female nurse manager. I explained to her the situation I had encountered. While trying to make my point in describing how I felt I was at a loss of words. She interjected "mortified". I said yes, as well as horrified. I told her I felt really bad about the whole experience. I started the conversation with an explanation of the abuse history. Her explanation was that the male tech was a CT tech and the female was the MRI tech. I asked her how a physician as well as a scheduler could get that mixed up and she had no answer. I asked her if it was possible that the male CT tech was also MRI certified and she didn't know but she would look into it. At my primary practice the male tech is certified in both MRI and CT. I know because I have had this guy for several imaging procedures over the last 4 or 5 years. This past February I had a CT of my hips which was done by the male tech. If I had known that the tech was female and the degree of exposure I would have opted to have my MRI performed at the office of my primary. Live and learn, I guess. My advice to all here, the MRI of the pelvis is very detailed as to the amount of quality in the images of the lower body. The genitals are very much displayed to the tech. You won't find that data in an online search.
My Green Light procedure has been rescheduled again. Now it is next Friday the 4th of Sept. I am thinking about asking my neighbor, a nurse who happens to be male, to come with me to be my advocate in the OR, if they will allow that. I will call him tomorrow to ask if he is available and what he thinks of it all.
58flyer
58flyer wrote concerning his recent MRI:
The genitals are very much displayed to the tech. You won't find that data in an online search.
Healthcare rarely informs patients ahead of time how procedures are actually done and those who try to educate themselves will usually only find either misleading or incomplete info. Based on 58flyer's experience I looked online at prostate MRI's and while one can find hundreds of photos, none even remotely approach what the reality is as described by 58flyer. Why?
As common as cardiac caths are, you cannot find any videos or photos of the prep process nor do written descriptions provide anything other than vague phrases. Why?
Versed sedation is ubiquitous throughout surgical prep and routine procedures (colonoscopies, cardiac caths etc), yet it is only ever described as "something to help you relax". Why aren't they ever told they will be effectively rendered unconscious given the amnesiac effects? Why aren't patients told it is used for staff convenience vs anything medically indicated?
Certainly we could come up with many examples making the same point. Why doesn't the healthcare system want patients to be informed ahead of time as to what their procedures will actually entail?
Biker,
And with the content of your post we are back to the main root of the issue: it is done for staff convenience. If you find descriptions which many have since disappeared for cardiac cath., you find they say they will provide for patient dignity. But what dignity means to them and the patient is are very different. Dignity for them means you will be exposed for their convenience and covered when they are ready to cover you. Dignity for them means they will give you versed that has in it the properties of making you uninhibited and erases your memory of being exposed and their conversations. But you will still be exposed. And yes, versed makes you actually sleep but arousable by voice commands or touch. You're right in saying it is described as "a little something to help you relax" but it is so much more. You even sign on your consent they have fully informed you about versed but is "a little something to help you relax" being fully informed? Most people don't know versed is not a pain killer. If you have pain, you will feel pain if you are given versed alone. You might not remember the pain afterwards but in the moment you will feel the pain. If not all the properties of versed works, like in my husband's situation, you will feel the humiliation and remember the humiliation of being treated like a gang rape victim. Coupled with fentanyl, this little cocktail used for their convenience can cause lifelong trauma.
Why don't they want us to be informed? There are many reasons but the first that come to mind through all my research are they really don't think we have the right to be actively involved in our healthcare decisions. They believe they tell us what should be done and we merely sign the paper saying we were informed which is basically what they did. They inform us of their decision and we give consent. They do not see informed consent to be what it was meant to be. Secondly, they believe if they give true informed consent, far too many patients wouldn't consent to what they want done or would want other considerations like those for dignity preservation. It always comes back to the main principles that motivate healthscare these days: Power, Control, and Greed. They are so intertwined you can't have one without the other.
Most men don't know during a robotic prostate surgery, you are in the lithotomy position and they also use the rectum to do part of the procedure. That is something you won't find in most literature. They use versed to once you are on the table and strip away the gown and the OR team puts you in the lithotomy position. You are aware of it as they will talk to you but you are completely naked for a matter of time while they position and then scrub you from the nipple line to the knees approximately along with the proper amount of drying time. During this time they will insert the foley cath too. Afterwards they pull off the drapes and you are once again exposed while they clean you up, attached the cath to you leg/thigh, and re-gown you. Most don't know this. Most would be completely shocked. During this clean time, janitorial staff may be in there cleaning up the room for the next patient but they are allowed to see you naked bc this is what dignity means to them.
My husband remembers after the PCI was finished, as he laid there naked on the table there were people in there cleaning the room. He remembers being entirely naked while the stitched him and while they shoved a pill down his throat. This is what being respectful to a patient's right to bodily privacy means to them. Scary? And no, they don't want you to know bc even if you aren't modest you may have issues they have no respect for you as a person.
58flyer,
Next time you have your appointment with your doc (NP, PA, etc.) and they ask how you are doing, start off with the PTSD symptoms, flashbacks, hypervigilance, etc. Even say that to the point that you don't know if you can continue treatment. They will include this in your medical record. When scheduling or discussing treatment, they need to avoid retraumatizing you.
You can also make a request under the Americans with Disabilities Act for these requests.
-- Banterings
It has been quiet on this Volume recently and I hope this hiatus in commentaries is not due to illness or even topic fatigue.
I want to invite everybody to click back to
"Patient Modesty Volume 43" dated July 2011 which started with a extensive detailed description of a female medical student writing an extensive posting regarding her feelings about the requirement to perform a pelvic exam. This is then followed by a huge number of men and women commentators including names familiar to me such as PT, Alan, Hexanchus, Jean, Erica and more and more variety of participants including Doug Capra and Doctor Joel Sherman, the latter two who have worked together on their "Patient Modesty and Privacy Concerns" blog.
If you have the time, I think it is worth to read that Volume 43 and see what has changed or remained the same in these last 9 years. Have we accomplished anything as we have moved on to Volume 112? We have much less in the numbers of comment contributors.
It is interesting to "look back" to set "where we should go in the future" with this on going discussion. ..Maurice..
Banterings,
Some good ideas here. I did get the current practice to post an alert on the EMR as to the past abuse history.
Dr. Bernstein,
Thanks for posting the "blast from the past". I do miss Doug Capra's and Dr. Sherman's contributions.
Not to take anything away from the Volume 43 postings, as I do consider it worthy of present discussion, I want to present my current status at this time. Tomorrow I will go in for my GreenLight laser treatment. It has been an interesting past few days. The normal pre-op visit was done over the phone. The nurse at first didn't impress me much as she sounded like a barkeep with her 3 pack a day cigarette voice. I wasn't sure at first who I was talking to until later in the conversation when she revealed her status as a nurse for the past 35 years. She assured me that I had an all male team assigned. She sounded as if she was curious but wasn't inclined to ask why. Having been in law enforcement for 41 years I have had all the in-service courses in interview and interrogations techniques. I have a knack for bringing people to talk about themselves. She revealed her own past sex abuse experience with a family member. She said she fully understood my situation. For the record, she no longer smokes. At this point in time, I feel confident that my needs will be met. Yesterday, I did my labs visit and the obligatory covid test. Yes, that probe through the nostril was uncomfortable. So, tomorrow morning bright and early, I will go in for the treatment. I am feeling quite sure I will survive it. I will let you all know as soon as I get on the computer tomorrow. The only glitch is that Home Health hasn't made contact with me. I have been rescheduled 3 times so maybe they got lost in the shuffle. They are important as they will be doing the catheter removal and assessment if I will need to be cathed again. Of course, that will require male personnel, which I am assured they have. I will need confirmation of that as I will not allow a female nurse to do that kind of care.
58flyer
I have noted in the past that there is only one urologist in my county, a male, with an all-female staff including one NP. The urologist has been looking to retire and his replacement is a young woman with stellar credentials who recently completed her residency at one of New England's premier hospitals. As a urologist she is definitely an upgrade for this county. I also found that she did a study/wrote a paper about women as urologists that amongst its conclusions stated than men need to be disabused of their provider gender preference views. What are the odds she'll ever hire any male staff? Zero to none is my guess. Hopefully she'll at least demand all of her staff be respectful of male patient exposure. I'll never know as I will stay with my current urology practice in NH.
I am glad that women increasingly have the option of female urologists, but I am saddened if those female urologists can't understand and be sensitive to the fact that some men prefer male staff for intimate urology matters.
Maurice,
So this attitude was pervasive at her medical school, AND is pervasive at ALL other medical schools EXCEPT the Keck School of Medicine, hence why YOU have been unaware that patients were treated in such manner that we describe here.
You were unaware and never saw such things (as T-shirts) of second year students teasing and lampooning first year students:
...cracking jokes, and from receiving e-mails from students selling T-shirts that compared the exams to sexual activities, making light of the way we must complete the exam once on an actor as part of our Essentials in Clinical Medicine (ECM) course in our second year [Moderator: Link is in error and cannot be completed]. You can see from the link how insensitive and immature my classmates are to sell such T-shirts.
Furthermore, after hearing these stories all these years, you simply believed what you were taught:
Even worse, this Dean promotes a philosophy to his students that as long as nudity, touching, and penetration occur in the medical setting, then no sane person could possibly feel violated.
You also never thought to investigate such allegations that were made on this forum, repeatedly. It was just much easier to label them outliers than to seek out scientific data as to the validity of such claims.
Of course, seeking out patients that might have experienced such things would only be anecdotal, but perhaps you would have heard a firsthand account and know it to be real.
Did you ever really ask YOUR patients if THEY felt this way (NOT just waiting for them to "speak up"). Of course, silence does equal consent...
I find it hard to believe that you practiced your entire career in such a bubble. More and more, I am feel that you are in denial of what you have always known and there is some deep seated guilt associated with it.
Students seem to find it very difficult to consider female genital display and manipulation in the medical context as entirely separate from sexual acts and their accompanying fears. Buchwald's lists of fears makes explicit the perceived connection between a pelvic examination and a sexual act...
How does this woman believe she can tell all adults that an exam, mechanically the same as digital sex, is not sexual? Why does she think she can speak her mind for all adults about human sexuality in medicine by resorting to empty buzzwords like "professional" and "clinical" to do so? In fact, she cannot define what is and is not sexual (or sexually violating) for any other adult.
You never read Buchwald's paper or "Public Privates" by Terri Kapsalis.
-- Banterings
Banterings, on this matter, regardless of my own personal history both as an active internal medicine physician with no
personally experienced patient input and no spontaneous concerns expressed by my students, I have continued this topic of modesty and dignity] regarding my visitors views about the issue, to whatever degree it is occurring, month
after month and year after year since 2005 (that's 15 years).
If I really thought the subject was worthless, I would
have terminated the subject, years and years ago.
But, obviously, I don't think the subject presented here is
worthless and it certainly has been shown by the writers to these
Volumes that my assumption has been correct.
What is necessary is to promote ethical equality
of behavior and response between every gender both as patients
and those who attend to the diagnosis and treatment of patients.
And that this ethical behavior applied in every single interaction regardless
of gender or clinical issue. It is obvious from what has been
written on this blog thread suggests that this behavior has
been missing. And now should be the time for action... or else
the problems described here and in the
news media will harmfully smolder along. ..Maurice.
Dr. Bernstein, I did read Volume 43. It was quite the discussion. I certainly hope medical schools have gotten better in what and how they train students, but I wonder if they have as evidenced by the new female urologist that has come to my county thinking male patients need to "disabuse" (her words) themselves of provider gender preferences for intimate exams and procedures. She managed to get through an elite medical school, internship, & residency without gaining any sensitivity towards her male patients.
Beyond that things have certainly gotten better for female patients to the extent the % of female physicians has grown significantly in the ensuing years. Things have also gotten better to the extent men have taken note of the #metoo movement that more readily calls out men for inappropriate behavior. The smart ones know they won't get away with what they might have gotten away with years ago.
I doubt anything has gotten substantively better for male patients. In fact it might have gotten worse to the extent they are far less assured it'll be male physicians tending them in an ER or OR or that they get randomly assigned to otherwise. I am only referring to intimate matters here, not routine things that few would ever care about physician gender for.
Maurice,
I did not read the thread yet.
I am wondering what ever happened to the student?
I assume that the profession indoctrinated her, with empathy killed she was able to complete the required exams, went on to graduate, and no longer sees the exams as sexual, but rather as necessities.
-- Banterings
Banterings, read it and then go ahead and continue to read Volume 44 where the discussion initially brought up by that "stressed student" (SS) continues with extensive multi-commentator expressions. Banterings, to your question, as you will see, the answer is NO. She lost her scholarship and left and gave up the goal of becoming a physician. There really are extensive and multi-commentator discussions on those two Volumes.
It would be interesting to read on our current Volume what the folks here think about the discussion back in 2011. ..Maurice.
And yet, shouldn't the dignity and health of the healthcare providers be considered in this current healthcare pandemic tumult? ..Maurice.
Maurice,
Having been abused in the healthcare system, I look at all providers as potential predators. You are guilty until proven innocent. Even if you are one of the good ones, and you have started earning my trust; if I have a bad encounter, you are now just as guilty as the perpetrator.
If you are not p art of the solution, then YOA are part of the problem.
I am the customer, so you need to practice customer service. YOU do what I tell you to do. I really don't care if you are depressed, tired, or burnt out. I expect you to do your job with a smile and the way I tell you to. If you can't do your job, then QUIT. NO EXCUSES.
Now, if the entire profession REALLY put patients first, I would like you. I would think of you as a human being instead of a sociopath. The fact that the profession has practices that dehumanize patients shows that you, and the profession don't care.
You still perpetrate the lie of gender neutral, allow intimate exams on anesthetized patients without consent, expect patients to allow students to practice probing (and other procedures on them) while med students don't practice these on each other, there is no compulsory mandate and formal for providers to have students participating in ALL aspects of their healthcare (so as to allow experience but not at the expense of the patient... and so on...
Patients are objectified by the profession as warm cadavers; I am simply applying the same standards to the profession.
Two years ago, I was abused by an unqualified nurse with a cannula, it caused the psychological wounds of the trauma from when I was 5 years old to be reopened. The stress of the pandemic (face masks erasing our identities, isolation, etc.), stresses at work, and other stresses has caused me to no longer be able to suppress the PTSD (and it's symptoms) that I had been suppressing for the last two years.
If I am not sympathetic about your depression, your burnout, or the suicide of a colleague, that is how the profession of medicine conditioned me to be. I may be cold, uncaring, unempathetic, and uncompassionate, just as your medical education made you that way, it too has made me this way.
Do NOT point a finger and blame us the patients for your plight, do not accuse us of being mentally ill, do not say we are being unreasonable; when you point a FINGER at us the patients, look at the palm of your hand, there are THREE fingers pointing back at YOU.
-- Banterings
Banterings et al, shouldn't each medical care provider be held responsible for the wrongs to patients which they personally commit? Is it fair to generalize to all? Yes, there are commonly identified issues that deserve generalization--such as physicians allowing and requiring students to perform pelvic exams on anesthetized patients without the patient's direct informed consent. Those physicians who reject such teaching misbehavior and act on their rejection should not be given "3 fingers back" by "pointing out" this behavioral wrong in the medical system.
Bantering, I think you and others here have described professional misbehavior or even worse which does call for more constructive education, in hopes of prevention, about what I would personally say is not sufficiently described and emphasized in the current education of medical students.
What do you all think of a question which is not asked of their assigned patient by medical students and should be part of the full history taking: "Have you ever been mistreated by a physician or nurse in the past and how has this affected you afterward?"?? I think this should be as routine a question to be asked as the students are told to ask the patient about their sexual or alcohol or drug use history. ..Maurice.
Hello Dr. Bernstein,
I'd like to suggest the following question for physicians to ask their patients: "Do you have any concerns regarding bodily exposure?" Do you think physicians would find this question too difficult to ask? Would it give them information which would cause them to alter their well-established (and closely cherished) protocols? Would a patient then be treated as an individual, rather than as just another person with disease X?
Reginald
Reginald, if I can speak for all physicians to your suggested question to their patient "Do you have any concerns regarding bodily exposure?" I would generalize and would think that such as question would NOT be too difficult to ask. I don't recall that I have specifically asked such a question at outset but it could be considered appropriate if the physician has already described what bodily parts need to be examined and we do ask other general questions such as the patient how the patient is feeling at the time of the examination.
I must say that our teaching to medical students learning to perform a patient's physical examination is to start out with a general statement regarding what areas of the anatomy are going to be examined and when that part is about to be examined the student is to explain to the patient what is about to happen such as "Now I am going to press lightly on your belly, let me know if you have any discomfort" The students are not told to ask the patient whether specifically allow a patellar reflex to be carried out but simply inform the patient "I am going to tap your knee now".
I certainly think that it would be appropriate after the question about "concerns" is asked, for the physician to followup with appropriate questions and considerations if the patient does express such "concerns" and this physician response shows the patient that the patient is an individual and not simply a disease. Reginald, I hope this answers your question. ..Maurice.
Maurice,
If you are not part of the solution, then you are part of the problem. Physicians need to do more than just reject the practice, they need to make meaningful change. The profession has always had a poor record of self regulation
In the UK, medicine is no longer a self-regulating profession
As for asking, the patient needs to be explicitly told they can refuse ANY part (or person) of the procedure. Even though EVERYONE knows they have the right to remain silent, the police MUST still say it.
-- Banterings
Banterings, if the patient is explicitly told that they "can refuse ANY part (or person) of the procedure" and informed the possible clinical consequences, who, then, becomes legally responsible for an injurious clinical outcome for the patient as specifically related to the patient's refusal, which was obeyed? ..Maurice.
The patient
Dr B. The patients should be. There should be something signed to that affect. If and when that doesn't happen a certain unknown number of patients avoid care. It all go back to how our laws are created. Lawmakers have too much say about it and no accountability to us. And the general population has too little if anything to say about creating or striking down laws. Plus the lawmakers are overpaid. It would probably take a revolution and massive bloodshed to change that.
Maurice,
The patient.
Your question implies that there is a reason to deceive the patient by not explicitly letting them know what their rights are.
-- Banterings
Hello Dr. Bernstein,
Thank you for your response. The physicians under your tutelage are instructed to INFORM the patient regarding each step in the procedure. My proposal was to have the PATIENT INFORM the physician about the "boundary parameters" BEFORE the procedure. If the patient is asked the simple question, "Do you have any concerns regarding this procedure?", the patient is given the opportunity to disclose any fears, anxieties, etc. BEFORE the procedure. The patient could then say, "Well doctor, do you suppose we could ...." This would provide the two-fold benefit of allowing the patient to express concerns; and, it gives the physician guiding information possibly heretofore undisclosed. This seems to be a win-win for both parties. Expecting the patient to express concerns at any step during the procedure fails to appreciate the emotions and anxieties that the patient may be enduring at that particular moment.
Reginald
Are all patients, particularly if they are sick and symptomatic, willing to take the full responsibility for the consequences of their own final decision which was then specifically followed by the physician or medical system?
Another way of looking at the discussion is can there be limits to the ethical principle of patient autonomy which is accepted in order to to protect the intrinsic dignity of all patients?
Yes, there is. Here is the link to a brief article on the subject titled "Are there limits to a patient's autonomy in making health care decisions?" ..Maurice.
Dr B. I'm not sure we' re talking about the same issue right now. You may be talking about safety issues and we're talking about modesty/dignity violations. What's wrong with a patient being given a disposable pull up? If it needs to be removed quickly? Thwy rip at the sides. If patients can't put on their own? Then one same sex caregiver should put one on. If they can't put one on in a timely manner than I guess the patient would need to tolerate the embarrassment.if the urgency for the patients safety is in question.
Privacy protections should be an automatic anyway. Just assume that all patients are modest unless/until they inform staff otherwise. Males attend to males unless patients requires otherwise. NO unnecessary displays unless patients has agreed in advance to students.
JF, my impression was that Banterings and perhaps others here have extended the discussion beyond simply modesty,specifically genital or female breast exposure but, for example, JR has been concerned about administration of drugs that affect awareness and so forth. Are we only writing about some very narrow mal-behaviors? ..Maurice.
Dr B. In JR's husband's case being drugged against his wishes was a stepping stone towards medically and sexually abusing him.
If a physician presents the risks & benefits of a procedure or medication to a patient, the patient should bear all consequences for the choice they make. Regretfully in our litigious society, the physician is still at risk of claims they didn't adequately explain the risks.
The larger issue I think are where the patient's interests may clash with standard operating procedures. Here I refer to those aspects of healthcare for which there is only minimal medical risk, if that, and for which the informed consent discussion never even occurs. The use of Versed when it is not medically required is one example. Staff gender for intimate exams & procedures is another as is the presence of non-medically necessary audiences and needless exposure done in the interests of staff efficiency.
Here is an example of what I am talking about. Some hospitals as standard operating procedure require a daily head to toe skin assessment. There is a valid medical basis to it in terms of detecting bedsores or other problems that may be manifesting, yet how often is it posed as a recommended option for those reasons vs patients simply being told it is happening? I posit that the patient should be able to refuse such an exam and bear the risks of something not being detected early. At issue here is the manner in which the nurse poses it may preclude the patient knowing they can refuse. "I'm going to do a quick head to toe skin assessment" vs "I like to do a head to toe skin assessment so as to detect any skin breakdown or other issues before it becomes a larger problem, are you comfortable with that? I will only expose you sequentially as I look at each area."
Bravo Biker! That's a great idea! Your version of the skin check scenario take about 5 seconds longer than the "I'm going to ..." version. Your version also respects the individual's autonomy and dignity. Do you think it will happen in our lifetime?
Rewginald
As we are soon to move on to Volume 113 of this blog thread topic, I would like to repeat now what I wrote as the title subject of this Volume and fits with the current view of the writers here. ..Maurice.
The ongoing anguish being presented by the participants on this web blog topic is whether being a patient who doesn't conform ("be yourself") with the behavior and requests or even demands of the medical system itself will provide harm to the patient. This patient concern may be the basis for many patients to hesitate to "speak up!".
It is my opinion that patients entering into the medical system should indeed "be themselves" and the challenge for the medical profession should always be beyond making a clinical diagnosis and performing a treatment to understand their patient as a individual, a unique individual to which the diagnosis and treatment and overall attention should be crafted for that patients personality and goals as well as the clinical diagnosis.
Unfortunately, in many relationships between the patient and members of the medical system it is the clinical diagnosis and treatment which overrides consideration of the patient as a unique individual who presents as "himself" or "herself". This defect in the system as expressed to the patient leads to forcing the patient into personal non-conformity toward themselves in order to get diagnosed and treated and does limit the option or, if attempted, the volume of "speaking up" to the system.
Remember, patient dignity involves the patient as a unique human and not just a named disease or when hospitalized a room number. So.. "BE YOURSELF". ..Maurice.
Hello again Dr. Bernstein,
Thank you for your very succinct description of the problem. Your last paragraph was excellent!
"Unfortunately, in many relationships between the patient and members of the medical system it is the clinical diagnosis and treatment which overrides consideration of the patient as a unique individual who presents as "himself" or "herself". This defect in the system as expressed to the patient leads to forcing the patient into personal non-conformity toward themselves in order to get diagnosed and treated and does limit the option or, if attempted, the volume of "speaking up" to the system."
Do you think that this "defect" in the system (since it may cause the patient to compromise his/ her values) rises to the level of an ethical "consideration"?
Reginald
Maurice,
I have posted the research that supports these statements in previous volumes, so I am not republishing it.
Research has shown that patients are less likely to sue providers that are respectful, protect their dignity, or have a good bedside manner, even if the patient had a bad outcome. Providers that may be the best in their field or have the best outcomes are more likely to face a lawsuit, even for minor infractions, even if the patient had a good outcome.
Basically, if the patient and/or their dignity is not respected, they will file a lawsuit for any legitimate reason as a means of seeking justice.
So not giving the patient options opens the provider up for lawsuits that would not have happened.
Right now the profession has justified "we do what we want to do." It reminds of "the Caveat of Insurance: The big print giveth and the small print taketh away..." So the marketing fluff says "first do no harm," but the physician declares the patient incompetent or the situation an emergency and they can do what they want.
What you are suggesting is what the profession has always done. How did that work out for the profession? Burnout, suicide, loss of autonomy (how's it feel?), etc.
-- Banterings
Reginald et al, do you think we could summarize what has been written here all these years about an unfortunate reality in medicine is that "each patient is NOT considered as a unique human being but only a disease or a group of symptoms"? If that is really so, then we are teaching and practicing the profession of medicine wrongly.
And therefore, we need more physicians such as Memorial Sloan Kettering Cancer Center critical care physician Louis Voigt who presented his philosophy and actions regarding a "holistic approach to the practice of medicine, as well as to his patients and their loved ones." His discussion of his approach to medical care is presented in this MSK brief presentation titled "Each Patient is a Unique Human Being, Not a Disease or a Group of Symptoms"
I hope over the years I have practiced this philosophy of how medical care should be carried out. I think, in retrospect, this "holistic approach" should be emphasized more then we currently do as we teach our medical students about their performance in their upcoming profession.
Reginald, you ask Do you think that this "defect" in the system (since it may cause the patient to compromise his/ her values) rises to the level of an ethical "consideration"? I will answer "Yes, I do and that is why I have continued this subject on my ethics blog" with a number of previous thread topics discussing the medical education "hidden curriculum" and the ethical principles involved. ..Maurice.
Dr. Bernstein,
I concur with your sentiments. I would add that the vast majority of physicians (especially GP's) are caring doctors who treat their patients as individuals. Specialists, hospitals and clinics seem to be the greatest offenders. I would suggest that the inhumane treatment comes from specialists, many of whom are arrogant; and, from hospitals and clinics which are too overwhelmed. In the specialist, hospital, clinic setting, most of us would just like to scream, "Wait! I'm a person, not a project!"
Reginald
Starting September 12 2020, Volume 112 will be CLOSED FOR FURTHER COMMENTS.
HOWEVER COMMENTS WILL CONTINUE ON Volume 113. ,,Maurice.
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