What have you been reading, hearing or TV viewing that has provoked some feelings of comfort or concern about what is happening in the world of medicine, medical care, treatment or science? Ethics is all about doing the right thing. Are you aware of any issues in medicine or biologic science which are being done right, could be improved or in fact represent totally unethical behavior? Write about them here.. and I will too! ..Maurice (DoktorMo@aol.com)
REMINDER: I AM POSTING A NEW TOPIC ABOUT ONCE A WEEK OR PERHAPS TWICE A WEEK. HOWEVER, IF YOU DON'T FIND A NEW TOPIC POSTED, THERE ARE AS OF MARCH 2013 OVER 900 TOPIC THREADS TO WHICH YOU CAN READ AND WRITE COMMENTS. I WILL BE AWARE OF EACH COMMENTARY AND MAY COME BACK WITH A REPLY.
TO FIND A TOPIC OF INTEREST TO YOU ON THIS BLOG, SIMPLY TYPE IN THE NAME OR WORDS RELATED TO THE TOPIC IN THE FIELD IN THE LEFT HAND SIDE AT TOP OF THE PAGE AND THEN CLICK ON “SEARCH BLOG”. WITH WELL OVER 900 TOPICS, MOST ABOUT GENERAL OR SPECIFIC ETHICAL ISSUES BUT NOT NECESSARILY RELATED TO ANY SPECIFIC DATE OR EVENT, YOU SHOULD BE ABLE TO FIND WHAT YOU WANT. IF YOU DON’T PLEASE WRITE TO ME ON THE FEEDBACK THREAD OR BY E-MAIL DoktorMo@aol.com
IMPORTANT REQUEST TO ALL WHO COMMENT ON THIS BLOG: ALL COMMENTERS WHO WISH TO SIGN ON AS ANONYMOUS NEVERTHELESS PLEASE SIGN OFF AT THE END OF YOUR COMMENTS WITH A CONSISTENT PSEUDONYM NAME OR SOME INITIALS TO HELP MAINTAIN CONTINUITY AND NOT REQUIRE RESPONDERS TO LOOK UP THE DATE AND TIME OF THE POSTING TO DEFINE WHICH ANONYMOUS SAID WHAT. Thanks. ..Maurice
FEEDBACK,FEEDBACK,FEEDBACK! WRITE YOUR FEEDBACK ABOUT THIS BLOG, WHAT IS GOOD, POOR AND CONSTRUCTIVE SUGGESTIONS FOR IMPROVEMENT TO THIS FEEDBACK THREAD
I find that Volume 113 will accept NO further posting. Please continue here on Volume 114.. Please do not write further messages to 113, I cannot get them published. ..Maurice.
AS OF TODAY DECEMBER 10 2020, NO FURTHER COMMENTS WILL BE PUBLISHED
ON VOLUME 114 BUT WILL CONTINUE ON VOLUME 115.
posted by Maurice Bernstein, M.D. @ 11:07:00 AM
165 comments
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165 Comments:
JR, I fully agree, the patient's actual sexual orientation with regard to the sexual partner has no need for chart general display and only if there is a clinical illness which some partner is detailed, it should only be of clinical and diagnostic value to the attending physician and be included in a daily history revision, by necessity, to rationalize need for further specific clinical investigation regarding further clinical workup of a disease, treatment and prevention. Nothing "routine" and this history should be given voluntarily by the patient to the physician, ..Maurice.
My guess is questions on admissions forms such as JR points out would not stand up to any legal challenge. No hospital could possibly justify why they need such information in the absence of a relevant diagnosis. They might still be asking because that's the way they've always done it and nobody has challenged them. I would think that risk management staff would want such questions removed because it is one more piece of personal information that needs to be protected, and is something that could cost them dearly if it is inappropriately divulged. Asking for non-necessary personal info also sets them up for discrimination claims in a "you wouldn't have asked for that information if you didn't intend to use it" manner. The hospital loses the ability to say the info wasn't anything they used, because why would they have asked it otherwise. The old maxim "less is more" applies here. Less personal data is more legal protection. Until they smarten up, I suggest not answering irrelevant personal questions.
NOTICE: The above posting is from BIKER today
Changing the subject here for a minute, I was reminded again today of one of the reasons I choose to drive an hour & a half each way for all scheduled healthcare. I was raking some leaves out by the road and along came an OR nurse out for a walk. She's a very nice person and we had a good visit. Anytime I'm near the road anyone out walking will stop to chat. Invariably a couple cars will stop for the folks to say hello too. Its one of the nice aspects of small town living. The flip side of course is that should I suffer some trauma that causes me to need emergency surgery at the local hospital I could well have her as my OR nurse. Being a modest person and not being in the habit of exposing myself to the women in my hamlet, I'm not comfortable with that. I bring up this general topic given it runs counter to the unstated but assumed norm that healthcare providers and patients do not have personal relationships. Part of why patients are supposed to be comfortable with healthcare-based intimate exposure is because of the assumed anonymity. You see them as strictly providers and they see you as strictly patients. It's hard for that to be the case in small settings. There are too many community interconnections and
NOTICE: The above posting is from BIKER today.
Please be patient. This blog program by blogspot.com is new and is all screwed up. Just post your ideas on Volume 114 and don't go back to 113. Maybe I should have switched over to a 114 before we hit over 200 postings. ..Maurice.
Readers/Commenters:
Please be sure to post your comments here on Volume 114.
Volume 113 of Preserving Patient Dignity is no longer active.
-SMB
Maurice, StevenMD, et al,
Keeping with the topic from volume 113, let me pose the following question:
We all hear that we SHOULD get screened for different maladies, especially cancer. We hear how the rates for colonoscopy are below the targets set by the government; so why if providers WANT WHAT IS IN THE PATIENTS' BEST INTERESTS NOT MAKE BETTER A BETTER EXPERIENCE FOR THE PATIENT???
A breast exam can be done through a T-shirt, a colonoscopy done with a bra/T-shirt and boxer shorts worn backwards, a testicular exam can be done through underwear, etc.
So here are just possible answers of why they are not making a better experience.
-- Lack of critical thinking/intelligence to realize patients don't enjoy the experience or how to make the experience better.
-- They don't care about the patient's experience (empathy killed during medical education?).
-- Morbid human curiosity/excitement of seeing another person naked.
-- A naked patient is easier to control.
-- It makes their job easier.
-- It makes them money (reduces costs).
I would argue that before a provider recommends/performs a screening, they experience it themselves.
My best friend has been pushing me to get a colonoscopy. I agreed, RELUCTANTLY. (She said she will take me and even wear a "sexy nurse costume."
I have been looking for a provider (in the Northeast) that has a better colonoscopy experience OR works with abuse victims.
NOTHING!
I have contacted numerous providers and even played the ADA "I need accommodation" card (with some). Here are the responses I get:
*crickets* (no answer)
I won't do a colonoscopy unless I find a provider that creates a better experience, is compassionate, and sensitive to my needs.
I have heard all the BS that they are compassionate and sensitive, but when I ask for accommodations I get "this is how we have always done things."
-- Banterings
Good day Bantering,
I don't know how much accommodation you are asking for but I would think that a few basics should be easily granted. Personally, if I were considering the unpleasant prospect of a colonoscopy, I would ask about the use of colonoscopy shorts and about foregoing sedation. Beyond that, I might try my luck asking for an all male team but, if shorts were allowed, that wouldn't be a problem.
As for testicular exams, my opinion is that it's a gimmick. I don't really care how "good" a provider is (hell, even a specialist), if you know yourself and do TSEs on regular basis, there is no need for someone else to check them out.
Of course, the caveat to this is if you know or suspect there might be something wrong, then you should consult.
I hope you find someone who will be willing to accommodate you. Failing that, have you considered non-invasive screening like FoT or FObT?
Dany
This Covid is impacting just about EVERYTHING! Will it ever be OVER??? It's affected people's jobs. People working from home on computers. My job can't be done on computer but the huge loss of patients we had in July has caused us to have our hours cut. This here is just ideas to help each other through a rough spot. A REALLY rough spot . I saw on Facebook recently about people leaving coats on tree trunks for homeless people. It wouldn't need to be new. Maybe just from Goodwill or Salvation Army or been hanging in a closet for 20 years. Also if you can't give money to people standing beside the road asking for help we can give them bottled water or other drinks. It's just a thought but I've seen an increase lately. Possibly because of Covid related concerns.
Dany,
I am refusing the noninvasive option because it would be USELESS because I would not do the follow up colonoscopy if there is a positive. Add to that I would be filled with worry about having to get a colonoscopy (when I don't want to) and the worry of potentially having cancer.
As for accommodations, I would prefer boxers-on-backwards to colonoscopy pants because the opening is smaller. Colonoscopy pants expose your whole backside. Furthermore, I would wear a jock strap under the boxers to hold my genitals close to my body so they are nor dangling.
I would do unsedated like you.
I would request a Rx for anxiety meds for the time I make the appointment and one week after (to quell anxiety). I would also request a couple valium tablets for the day of, because we know that all that will be available is valium by IV.
I am also refusing an IV, because that allows the provider to sedate me against my will.
I will refuse the digital exam and will lube up my own anus if necessary.
I will also wear a T-shirt because there is NO REASON one needs to be totally naked for a colonoscopy.
An all male team would be nice, but not a deal breaker. I will however ask ALL staff present to face away from me (and not act a a voyeur getting their rocks off) when NOT actively engaged in my care. Note: Watching is NOT actively engaged in my care.
As an abuse survivor suffering PTSD, they MUST accommodate me. Technically, they can NOT ask what my disability (PTSD) is and they definitely can NOT ask for proof of my disability (PTSD).
-- Banterings
HOORAY, finally got Vol. 114 active. Thanks to all. ..Maurice.
Banterings,
Be careful asking for an anti-anxiety drug as they is what versed is supposed to be for and we all know why it is really used. Better specify which one is acceptable. With versed, once you have been given it you may not remember how they treated you or even if they kept your shorts on as versed will also make you uninhibited and very submissive.
Banterings, the 1st time I asked for no sedation for a colonoscopy the doctor at the local hospital said no. I said "no problem, they'll do it w/o sedation at(other hospital), I just wanted to see if I could get it done locally first". Their no immediately turned into a yes. I did agree to let them hook me up with an IV just in case I needed to be sedated during the procedure. Come the day of the procedure, the doctor whined so much about doing it w/o sedation that I shifted all future care to that other hospital anyway. I've had two there w/o sedation and w/o any drama on the part of the staff, though I have let them insert an IV "just in case". For me it was a fair trade-off as I was still in charge.
Not being sedated I haven't cared about staff gender being there is no way anyone is going to uncover me. I have no idea to what extent there is frontal intimate exposure with sedated patients as such things never get discussed in any literature. I'm talking about when they are positioning pre-procedure, repositioning post-procedure, and even the extent to which they keep patients covered during the procedure. Does anyone here know the answer?
I hope you find the right practice bantering.
JR,
I was talking about Xanax. As I said, I am refusing an IV.
-- Banterings
Hello Bantering,
Have you considered asking for Ativan (Lorazepam) instead of Xanax? It is also used for anxiety and is easily prescribed orally (pills). A couple 1mg ones shouldn't be that hard to get.
Dany
Banterings,
Versed doesn't have to be an IV. Remember CMS told me that a doctor has the right to give a patient any drug a patient has refused. They said it is the doctor's right. That was a verbal conversation I had w/ some supervisor abt them saying in a letter that if a patient refuses the "treatment" they are "unreasonable" which means you are mentally unstable. And we know what that means they will do.....
Biker,
When I observed a colonoscopy years ago, it was on an older man. They made absolutely no effort in covering him. The gown was pulled up and when positioning him and turning him, his genitals were fully displayed for all to see including me but I looked away. The older you are, the more the sedatives affect you. They didn't cover him until he was on the cart headed back to recover from the sedatives. I assume this would be standard for most as they really don't care about patient dignity. The staff doesn't want to be bothered in keeping the gown from being tangled or such so it more convenient for them to pull the gown out of the way. I don't imagine they leave it tied most of the time either.
We have coined a new term on my Twitter following which aptly describes the harm some have suffered like my husband when trying to assert their patient autonomy--Medical Retribution.
Biker and JR,
Invoking the Americans with Disabilities Act, they are compelled by (sometimes) state and federal law to accommodate me, including no IV insertion.
If they refuse, I will file complaints with state and federal governments. Then there are civil actions:
The ADA gives people with disabilities the right to file lawsuits in Federal court and obtain Federal court orders to stop ADA violations.
The key is that you need to request an accommodation BEFORE a procedure, which in an emergency situation (JR's husband) is hard to do. Even in an emergency situation (which is governed by STATE law), the ADA trumps that because it is FEDERAL law.
Dany,
I don't care what they give me, but I will take it leading up to the procedure and one week after. I will probably get my own valium and take that myself the day of the procedure.
Cut out the middle man.
-- Banterings
Thanks JR for sharing your colonoscopy observation experience, horrifying as their treatment of that gentleman was. I had assumed they were casual in protecting a man's privacy but it never occurred to me that they might be that abusive.
Many years ago when I had my 1st colonoscopy, the option of not being sedated had never occurred to me. In the midst of the procedure I briefly came to, though I was groggy. If I was exposed during the procedure I didn't notice it during that brief period of awareness.
Robert Veatch, a classic thinker and writer in medical bioethics from the beginning of the interest in the late 20th century and with whom I communicated recently died. His view was that patients should know more about the personal life and health of their selected physician.
As a followup to the issue set off, by me in Volume 113 by the AMA request regarding my personal medical status as part of a statistical presentation to the public, I would like to extend the discussion so go to and read the presentation and comments September 2005:
"Doctors Talking to Patients About Themselves: How Much and What?"
https://bioethicsdiscussion.blogspot.com/2005/09/doctors-talking-to-patients-about.html
Read and return to explain your view to us too in 2020. Is part of maintaining the dignity of the patient is to have confidence in their physician by knowing some things about the personal life of their doctor? ..Maurice.
I went to that link Dr. Bernstein and read the discussion. While I have had doctors that I could see myself being friends with, I don't want a personal relationship complicating the doctor-patient relationship. I also don't want to know too much about them personally for the same reason. I don't seek healthcare looking for new friends. I want anonymity and strictly professional relationships.
My wife on the other hand is the opposite. Her extreme extrovert nature makes her want to know all about everyone she meets, doctors & nurses included. Its how she relates to people.
Biker, ..and what is the outcome, the result, of your wife's, not rare, behavior in interacting with others? Do the doctors or nurses "submit" to her "wanting to know"?
If they reject her attempts, has there ever been any "consequences" for or towards her?
I really don't think your wife is some anomaly and I think it is part of the "nature" of many others. Obviously, you are not included. Thanks for your blog thread visit and comment. How about the other's on our blog thread? ..Maurice.
Dr. Bernstein, it seems to me that the doctors & nurses & others respond nicely to my wife's personal inquiries & sharing. I recall a couple years back the evening following a major surgery the surgeon coming to check on her. She quickly knew how old he was, that he was married, had two kids, their ages & gender, that he was born here of Indian parents, and that he considered himself fortunate to work in a world class hospital while living in a rural area vs having to live in the city to pursue his career. He came by early in the morning & in the evening to see her for the duration of her stay, I think because he enjoyed the interaction. During her prolonged hospital stay earlier this year the nurses & her were sharing photos of kids, talking about where their kids went to school, about the house one of them just bought with her new husband, whether the LNA's son should pursue becoming an LNA himself etc.
If anyone doesn't respond to her attempts at familiarity, she just keeps it all business. There are no repercussions. Most people respond though. Bear in mind this isn't just with healthcare workers and it has nothing to do with looking for better care or service. It's just her nature.
I on the other hand want my healthcare interactions to remain all business & I don't ask personal questions. They are free to share and I will respond in kind but I don't seek it.
Banterings,
Even though my husband's situation was non-planned, he did refuse the invasive procedures and had opted for the drug treatment method which was a gold standard and was used during the Spring outbreak of COVID. One doesn't have to invoke the ADA because when a patient says no, NO means NO otherwise it is assault and battery. It is rare if not never that a doctor is charged with criminal assault and battery. @medicalcorrupt has done extensive research into the criminal behaviors of the medical community and found even when there was a written confession by a doctor who murdered patients, he was not tried for murder. In any situation like my husband's or in invoking the ADA, you have to have proof it was done. They can simply ignore it/omit it like in my husband's case and do as they please. The insertion of the IV is the key of how they control. Once the IV is inserted they have the evil power/control needed to make sure they can override your bodily rights and do as they please. He never knew what they were inserting as they did it totally without permission or explanation. Most doctors do not like being told what they are allowed to do. Just look no further than what happened to my husband, @medicalcorrupt,@ireneguesta, or @DrTessaT. When patients come no matter how politely they assert their bodily autonomy rights (my husband was so polite) it can set off in them the need to show the patient who is boss. It can end with medical retribution being imposed upon the patient. I don't know PA laws but from what I have seen (mandated mask wearing in houses), they leave a lot to be desired but recording all encounters may be your best option although @medical corrupt recorded and so far, it hasn't helped because the medical boards in Indiana are so corrupt.
Because the medical community(in general) does not believe in patient autonomy is why issues like patient dignity is also ignored. Banterings has done extensive research on the training and thus mindset of the medical profession which to me explains why this is happening. In the mindset of many medical providers, a patient is an object placed there for their power and control--no more, no less. They expect total obedience from the patient thus the widespread use of sedatives for procedures because they don't want to have to change their method of delivering the service nor do they want to have to humanly interact with that patient during the procedure. They have more important things to talk about such as something negative abt the patient or their game of golf. The patient is merely a paycheck and a way to satisfy the overwhelming hunger of the hospital administration to bring in more and more revenue.
JR,
If you are talking to any attorneys at this point, perhaps pose the question is it easier to sue, and would more attorneys take an ADA case?
Invoking the ADA opens up more possibilities for justice from government agencies that are NOT "in bed with healthcare."
I have seen it work. How many people would believe that a transgender person can get hormones WITHOUT blood work?
-- Banterings
I don't really want to know much abt them but in the future it would be nice to know their political thinking bc of an extremist did inflict harm. Wasn't it political motivated? Don't really know but it is a possibility. What is certain is that medical people do not leave their human feelings as the door like we have been told. They aren't machines that do not let their hatred or personal views creep into the medical treatments they are supposed to be providing without bias or harm. But in the same token, they don't need to know a lot of personal info about the patient either. My husband did not give them the info--they filled it out. The info I personally gave was twisted into untruths which has forever labeled him as being a gay, married man. His MRs forever label him as having a baby. Because of their personal views/hatred, his was medically and sexually battered. I don't need info personal info from their mouths bc as I have experienced it, they lie. What I do need is a system in place to weed out psychos who want to abuse and harm with unnecessary patient exposure being part of the psycho profile. I need to assurance the while on their shift, they are not under the influence of drugs or alcohol. I also need to know an advocate of the patient's choice can be present during every second of any medical encounter to safeguard the patient from harm/abuse. The only thing I may need to know abt them is their sexual preference bc that may come into play in preventing sexual assault but having your advocate present would be a better way of preventing sexual assault. Any recordings which most hospitals do in most all parts of the hospital, should be made immediately available to the patient or their rep. in real time. With so much hatred and moral decay in society, we need to put real protections in place to protect those who are the most vulnerable such as a medical patient. They need to be protected from a predatory medical community.
Hi everyone,
It has been a while since I’ve posted here. I wanted to let everyone know that we have brochures for medical professionals about how they can be more sensitive to patient dignity and modesty and you can find more information at this link.
You can also find a video of me speaking to medical professionals especially nursing and medical school students on Youtube under this title, Medical Professionals Being More Sensitive to Patient Dignity and Modesty. I used sign language in that video because I am deaf. My talk is a little slower than usual because the interpreter had to voice me.
I have developed a password protected web site that includes a link to the video and the brochure in electronic format for nursing and medical school students. I got this idea from a nursing school instructor who was receptive to the idea of me speaking to nursing school students at her school. I certainly would love to reach out to many more nursing and medical schools. It is much needed because patient modesty is rarely discussed on a deep level in nursing and medical schools. One of MPM’s goals is to educate medical professionals about how to be more sensitive to patient modesty.
Would anyone here be interested in volunteering their time to distribute brochures to medical professionals?
Misty
Misty, WELCOME BACK. Sorry to read that you have a hearing problem..I don't think you mentioned it previously..but it is the contents and goals you are describing which are most important. Thanks for returning and filling us in regarding your latest project.
..Maurice.
Misty,
It would be nice if you can make the entire brochure available to all you site visitors. I know some people that I would like to send it too.
I hope that you address the need for consent prior to exposure as well. One of my criticisms of the whole modesty/dignity conversation is that it implies that the intimate exposure MUST happen.
Just like I had mentioned, a transgender friend is now being prescribed hormones WITHOUT blood work. The assumption among the LGBT+ community is that you MUST have blood work. I showed her that was NOT necessary under the ADA and she was accommodated.
I hope that you cover the necessity of doing the procedure and the manner in which it is done. I would IMPLORE you to put in a section for patients to request accommodations under the Americans with Disabilities Act.
I would be happy to help you with the information regarding the ADA.
Finally, I hope that you also include the concept of trauma informed care (assume ALL patients are abuse survivors).
-- Banterings
In discussing "patient dignity", perhaps it really shouldn't be "one-sided" with "medical professional personal dignity" also be part of the consideration and which is accepted by the patient and family. What I am getting at is that both the patient and health-care providers are humans. Physicians investigate and monitor the behavior of their patients but patients should do likewise in terms of their health-care provider. Understanding each other and accepting the views of each other is and should be part of the clinical and human relationship.
What I plan to do is to post a personal experience of a clinician as written for
Doximity Network. It is titled "My Patient Came to See Me for HIV. His Gravest Concern Was My Split Ends".
Because of its length, I will attempt to present it here in multiple postings.
May be we should, in our responses, look to the patient and physician as two humans, each with their own aspects of dignity, thoughts and behaviors which should be considered as we discuss this subject. ..Maurice.
My Patient Came to See Me for HIV. His Gravest Concern Was My Split Ends
Vidhya Prakash, MD avatar
Vidhya Prakash, MD • Infectious Disease
Nov 20, 2020
Op-Med is a collection of original articles contributed by Doximity members.
He was 5 feet, 5 inches tall, sporting black leather pants and a matching vest. He sat erect on the examination table, his hair stylishly coiffed and his arms crossed, as he huffed with an air of indignation. After briefly locking eyes, I focused on his chest to make sure he was breathing. He appeared more like the statue of a monarch than a patient. In a word, he was fierce. This was his third visit to my infectious diseases clinic over the past several months. When I saw his name on my list of patients for the day, I sighed and prepared myself mentally. Mr. B was a person living with HIV. He had not taken any antiretroviral therapy over the past several years and had been doing “just fine.” Our pattern had been a cursory greeting followed by a verbal ping-pong match on the question of the importance (or lack thereof) of antiretroviral therapy. Despite multiple conversations discussing the natural history of HIV and the myriad negative consequences of not taking HIV medications, the major one being death, Mr. B continued to remain non-compliant.
I knocked on the door, waited for a few seconds, and then walked into the room with an internal medicine resident who was rotating through the clinic.
“Good morning, Mr. B,” I said.
There was a pregnant pause, followed by a slow, deliberate “Mmmhmmmmm.” When I asked him if he had started taking his medication, our battle picked up where it had left off during our last visit. “No,” he replied.
But this time, I was ready. I stood my ground, figuratively and literally, with my feet firmly planted on the linoleum floor, arguing that he was putting himself at risk for opportunistic infections and describing the gory, painful details of each and every one, including death. I was on a roll and knew there was no way he was not going to be convinced, or so I thought.
It became a bit heated, and in the midst of our duel, he abruptly raised his hand and declared, “And by the way, you have split ends.”
Being the ever dignified and erudite physician that I am, I immediately retorted, “No, I don’t!”
“Yes, you do,” he said. “I’m a stylist, I notice these things.”
There was an awkward pause, as I thought about this for a bit longer. “I do not have split ends, Mr. B,” I stammered, mindful of my resident who was now eyeing the back of my head.
He shrugged and said, “Turn around.”
I reluctantly obeyed, and Mr. B asked my resident to stand by him as he gave her a tutorial on the ABC’s of bad hair, my mangy mop serving as the example. My resident, ever eager to learn, paid close attention and responded, “Oh yeah!” as Mr. B identified split end after split end.
I was mortified, but I maintained my composure and thought about how I would reply. Do I walk away? Do I get angry? Do I politely say, Mr. B, this is not about my hair, it’s about you not taking your medications, and if you continue along this path, you’re going to die?
After some thought, I said, “OK, Mr. B. Let’s make a deal. I will clean up my act with my hair if you take your medications.”
He thought about it for a minute and then said, “OK.” We shook on it and scheduled our next appointment.
Over the next several months, our appointments did not start in the typical manner. There were no casual “good mornings” or generic greetings. Instead, after prepping my student or resident about our unique situation, I knocked on the door, walked into the room, and nodded once in his direction. He nodded back, and, after a few seconds, I walked up to him and turned around. Then he carefully inspected my hair and gave me my hair grade — which, by the way was horrendous in the beginning — and then I would give him his test results, which indicated a high HIV viral load, initially. Over time, as my hair began to improve, I noticed that my patient’s HIV viral load began to drop, suggesting that he was taking his medications. More importantly, I got to know my patient. He loved being a stylist and was a good one, though he had to change shops due to hostile coworkers. He had a good relationship with his partner, who took good care of him and was supportive of his career. I found out he used to have a beloved daughter who died in an accident when she was very young, an incident that left him shattered and with a wound that still felt fresh.
During one of our later visits, he looked me up and down and plainly stated, “You’re pregnant.”
“Excuse me, Mr. B?”
“You’re pregnant. I saw in my dream that you were expecting twins.”
I paused for a moment. “Mr. B, I have my two children and you. The last thing I need is twins!” We erupted into a fit of laughter, his partner having to catch him from falling off the exam table.
I will never forget the day Mr. B finally gave me a passing grade on my hair. I excitedly turned around and gave him a high-five, ecstatic that I finally had finally done it.
“Great! Now what’s that zit on your face?” he said.
I can now say that my hair finally meets Mr. B’s high standards, and his HIV is well- controlled. Some time later, I paid him a surprise visit at his salon, where he treated me like royalty, giving me the best haircut I have ever had.
“Just remember that, if you move, I’m moving with you,” he said softly, as he snipped away my split ends. I couldn’t reply, as I was too busy holding back my tears.
Dr. Prakash is an associate professor and member of the infectious diseases faculty at Southern Illinois University School of Medicine. She serves as Vice Chair for Clinical Affairs in the Department of Medicine, Associate Program Director for the Internal Medicine Residency Program, and Director of SIU Medicine's Alliance for Women in Medicine and Science.
This message is just for a wonderfully frequent and daily visitor from Huntington Beach, California to our current dignity blog threads. I really would like to know privately who you are and to read any suggestions you may have. I might have asked this previously but with your frequent surveys of our blog thread you may have some worthwhile suggestions.
Please write me e-mail doktormo@aol.com and identify yourself to the extent you wish and I will be pleased but will never make public your identification or comments without your specific written permission.
Please write me. Doktormo@aol.com.
..Maurice.
Dr. Bernstein, in that story you posted, the doctor and patient found a way to see each other as people, which in their case enabled them to work together for the patient's benefit. It had a happy ending so to speak. I don't doubt but that many patients are difficult or non-compliant and perhaps becoming friends might change that, but that's a question I can't answer.
I had a successful career in part due to an ability to read people. In medical settings I don't need to know anything about the doctor's personal life or background in order to know if they are paying attention to me as a patient vs just going through the motions. I am a generally compliant patient but I try harder when I think the doctor truly wants to address whatever my issue might be. I know when they see me as a person vs as the appt. @ 1:45 that afternoon. The same goes with the support staff. As far as the sharing of personal thoughts or life goes, I follow their lead whether it is responding in kind or answering questions. I go with the flow so to speak deferring to the doctor as being in charge of that interaction. Some end up knowing a lot about me, others not so much. Whatever works for them. It doesn't matter to me. I just want to be listened to and treated in a respectful manner.
I am going to introduce another aspect to the current discussion. It is the use of names in the doctor-patient relationship.
It has become routine to be asked if I want to be called by my proper first name or by the common nickname associated with it. They never ask if I want to be called Mr. "Biker", and that's the one I actually prefer in healthcare settings. If I am calling you Dr. so and so rather than by your 1st name, then I should get some formality in return as Mr. Biker. It serves to lessen the power imbalance.
Note that I am a very informal person in my private life which is in keeping with the cultural norms of rural New England. I just see healthcare as one of the exceptions to the rule.
I was talking to my female Philly friend who is refusing all blood draws. (This is the trans woman, but I will just refer to her as a female.) She had an appointment this week with her ADHD (PCP) doctor. Again they were pushing flu shot, blood tests, colonoscopy, etc. She told them due to the PTSD she is not doing any preventative care.
She said that she was disappointed because they push this preventative care and know what happened to her (in hospital abuse), but there were no offers as to is there a way to make any of these procedures tolerable.
She said that if her PCP suggested doing the blood draw in his office by a nurse who was skilled in blood draws, if he offered to be present, she would have strongly considered it. She might need a couple days of anti-anxiety meds afterwards, but having people who care about her as a person is more important. What triggered her PTSD was she allowed herself to be treated that way, NOBODY ever apologized for what happened, and she was treated like a warm cadaver and not a person.
Even her therapist asked that if a session before a blood draw and maybe some meds might help her get through it. The therapist tried to make accommodations. The PCP is just take it or leave it...
She says that she gets a certain satisfaction out of "punishing" her PCP by making him feel that he has failed her because she is refusing preventative care. She makes a very valid point that it is unfair to a new doc to burden him with the mess that her current doc created.
She wants him to acknowledge that he sent her inpatient when she did not want to go (and did not need to go). Granted he could not control what happened to her there, but at least acknowledge his actions contributed to what happened to her.
He did not even ask, is there anything that can be done to have you do ANY preventative care. She has told them that she is in therapy for iatrogenic PTSD, but no concern on their part. I support the decisions that she is making.
-- Banterings
If a patient is comfortable with their present general medical physician and the physician shows no signs of discomfort with that patient and, in fact, demonstrates signs of comfort, how should this bilateral "comfort" be further enhanced by both parties? When does the "professionalism vs patient" become "two friends working toward common goals"? Or was the published narrative I presented above really some anomaly and cannot and should not be a consideration in the maintaining of the patient-doctor relationship? What is wrong with the concept of patient and physician becoming and being "two friends"? ..Maurice.
Dr B. I loved that story about Dr Prakash and her patient. She had really good intuition to come up with such a brilliant response. A lot of people botch those kind of opportunities. That lady was a genius!
Dr. Bernstein, if both patient and doctor are comfortable in their interactions the relationship doesn't have to be enhanced further. Great if it does become a friendship, but it isn't necessary not does it have to be the goal.
A piece of me also thinks that sometimes doctors need to tell patients what the patient doesn't want to hear, and I would think it would be all the harder for the doctor to do that if they were friends outside the underlying doctor-patient relationship. Sometimes some emotional distance in that regard is best.
A good friend of mine is good friends with his next door neighbor that is a doctor. I forget what the specific issue was but my friend was in need of some medical assistance/advice and the scenario involved the doctor coming to his house and my friend being seen by him while completely nude & in the bathtub. My friend said it wasn't awkward given his friend is a doctor, but the manner in which he said it told me that it was awkward and that he was really trying to convince himself that it wasn't. A classic manning up & making believe. My point here is that the doctor-patient friendship can be awkward in ways that a simple doctor-patient relationship wouldn't be. Now how would that transaction have gone had his doctor friend been a woman? Would my friend's wife have felt awkward about the woman next door seeing her husband naked?
JF, do you think developing a "closer" relationship between physician and patient should be something all patients and professionals should attempt and that should be an "ideal" goal between the two, And an attempt or attempts to develop such a relationship should always be an attempt and part of what is called "the doctor-patient relationship"?
JR, remind me.. was there any point in your husband's interaction with physicians over the years which was attempted, did or potentially lead to such an ideal goal as finally reached by the physician and patient in the presentation by Dr, Prakash? ..Maurice.
I don't think patients should try to strike up a friendship with their doctors. I would more often then not create problems. Who hasn't been cornered by a person who talks their ear off? Possibly trying to cut the conversation short in a nice way because they have something else they have to get to? Doctors have to move on just like any other person who is at work. Dr Prakash just had that knack and accomplished her goal almost accidentally.
Tomorrow, November 26 is Thanksgiving day holiday in the United States of America. Unfortunately, the long enjoyed holiday has been restricted in its personal celebrations and gatherings by the current pandemic.
But on this blog thread, I can still give my written expression of thanks to all the participants (and I mean ALL) who have contributed their understandings and thoughts to this bioethics topic. Without your contributions, simple writings by me alone would be absent the importance of how our topic is publicly understood and expressed. Our topic here of patient dignity and its preservation is not something automatic but needs the feeling and expressions by all patients (and there are no humans alive who can avoid the identification at some time as "a patient".)
It is your contributions, knowledge and experiences, to this blog thread that has led me to acknowledge and to say "thanks".
..Maurice.
Banterings,
We are only making the electronic format of the brochure available to medical and nursing school students or medical professionals who choose to participate in the password protected web site.
I have a lot of the brochures. Are you interested in distributing them in person?
You can email me by going to Medical Patient Modesty's contact form.
Misty
I would like to get into an area of patient dignity which can affect the actions and perhaps the outcomes of medical treatment and management. Personal religious beliefs of a patient is a component of the patient's dignity. The question is DOES RELIGIOUS BELIEFS TRUMP PUBLIC HEALTH AND MEDICAL BELIEFS? Can there or should there be any EXCEPTIONS to this question if the conclusion to the question is YES? If so, what would be the criteria of such exceptions.
One example, in today's news, is the U.S. Supreme Court, in a decision made public today, sided with the requests of religious groups with regard to rejecting governmental criteria for the details of the holding of public gatherings in churches or other indoor religious services. Specific criteria appears then appropriate for businesses including restaurants but not religious gatherings.
Should there be any governmental limits set for religious beliefs and behaviors set by the government even presented with the excuse of maintaining public health both those of the members of the religious gathering but also the outside public? How would setting such limits hurt the religious component of patient dignity?
..Maurice.
Dr. Bernstein. at a fundamental public health level religious institutions should be subject to the same rules as everybody else, no different than churches have to meet the same building codes as any other building. The issue as I understand it in NY is that religious organizations were being subjected to different and more stringent covid-19 standards than non-religious organizations.
If you carry the discussion over to healthcare itself, I personally would not automatically advantage or disadvantage patients based on religious beliefs. Instead I would suggest that to the extent reasonable accommodations could be made that they be made without regard for the basis of the request. For example a request from a Muslim for same gender intimate care is neither a higher or lower priority than a request from someone else that does not have a religious basis to it.
Maurice, Biker, et al,
There are certain laws that trump ALL other laws. Consider my friend getting HRT without ANY blood work by invoking the Americans with Disabilities Act.
Consider The Constitutional Reckoning of State Lockdown Orders (i.e. being declared unconstitutional).
Then we have:
California remains firm in keeping establishments, such as churches, schools, and gyms, closed even as as the court allowed strip clubs to reopen last Friday.
This is a First Amendment (Constitutional) issue.
Even the Second Amendment (as a Constitutional issue) has come into play in the lockdowns; Businesses Chafing Under Covid-19 Lockdowns Turn to Armed Defiance.
Even law enforcement is refusing to enforce lockdown orders:
(California) Local enforcement agencies and citizens resist state's limited stay-at-home order
Sheriffs Buck the Law, Refuse to Enforce Lockdown Orders
The Rise of the
Anti-Lockdown
Sheriffs
Law enforcement is even refusing to enforce limits on Thanksgiving limits on the number of people in attendance:
New York City Police, Sheriff Won’t Enforce Thanksgiving Covid-19 Limits
Cuomo blasts police for saying they won't enforce Thanksgiving gathering limits
Of course there is the religious defiance: New virus restrictions in New York spark anti-lockdown protests in Orthodox Jewish community
.
Our country is ruled by the US Constitution, NOT science or medicine. The people, in armed rebellion are the 4th type of checks and balances of the US government. I stood on the steps of the Pennsylvania state capital with a sniper rifle slung over my shoulder in protest of our useless and corrupt governor and secretary of health.
Reckoning has come to religious organizations and law enforcement. The people are speaking up and defying governments that try to abuse the citizenry and the economy. The next institution that abuses its members is healthcare. The day is coming.
-- Banterings
Biker, you write: "For example a request from a Muslim for same gender intimate care is neither a higher or lower priority than a request from someone else that does not have a religious basis to it." Biker, are you saying that a patient's inherent dignity regarding their religious beliefs is not a factor in the professional's making a medical or surgical decision about the care of that or any patient? In general, should the medical profession install vs ignore the patient's expressed religious beliefs on presenting any patient their clinical options? ..Maurice.
But Banterings, when the U.S. Constitution was written were all the challenges of personal and public health issues were anticipated and considered by the writers?
Isn't that updating of the Constitution the rationale for the Constitutional Amendments.. the later "adding on" as new events of one sort or the other appear and need Constitutional support? Wouldn't, for example, the pandemics of 1918 and 2020 be examples to consider? They were not trivial events in American history but have brought up issues of American needs and actions which our original Constitution fails to provide? Perhaps now is the time and great need for the passage of an emergency Constitutional Amendment (beyond what to do with a "sick" President). There is no reason why a Pandemic Constitutional Amendment based on past and current epidemiology and science couldn't be emergently passed by the States and added
beyond what to do if a President becomes ill or incapacitated for his or her duties (25th Amendment) but the documentation of what to do when our whole nation becomes medically ill with a yet fully uncontrolled and unpreventable illness. Surely, all states will legally provide guidance and support in an emergent fashion. If one ill or grossly unfit President can be removed utilizing the 25th Amendment's certainly another Amendment can be promptly passed setting the standards for attention and protection of a medically unfit national population. What do you think? ..Maurice.
Dr. Bernstein, what I am saying in that a patient's religious views are not more or less important than anyone else's non-religious views as pertains to their dignity. A hospital should not accommodate a Muslim's desire for same gender care based on their religion while denying me the same accommodation. My reasons are just as valid and important as theirs. Religion should not confer special rights that others aren't entitled to.
Dr. Bernstein, on the constitutional aspect of the pandemic, I don't think the primary conflict has so much been constitutional limitations but rather politics trumping science and when there has been science behind edicts, politicians (and public health "experts" not presenting the science behind the edicts but instead just using a "trust me" approach even when an edict made no sense to the casual observer.
It comes down to much of the essential vs non-essential designations never making any sense to the general public. How could a liquor store be deemed essential but the property mgt company that cares for my property be forced shut? Indoors buying booze vs outdoors spread across many acres doing my spring cleanup? I doubt there is any science to explain that. An ironic piece of that is it was deemed safe for me to go inside an "essential" equipment rental company to rent a sweeper to sweep the winter's gravel & sand off my frontage back onto the road.
In NJ last spring a large tulip farm that annually did public driving tours as part of their business model was ordered shut despite ticket sales being handled online and the customers never leaving their cars. It was simply a driving tour. The authorities never explained the science of how it was a public health risk, nor initially why a competing tulip farm doing the exact same tours (but whose owners were politically connected) was allowed to remain open. In that case the ensuing public uproar forced the authorities to treat both the same.
Last spring here in VT farmer's markets weren't allowed to open but the authorities didn't explain why it was safe to buy food indoors in a grocery store but not safe to buy food outdoors at a farmer's market. When farmer's markets were subsequently allowed to open, one restriction was they could sell food only, specifically mentioning no soaps or crafts etc. Again they didn't explain the science behind why it was safe to buy soap made in China in a grocery store but not soap at a farmer's market made on a local farm.
I think it was in Michigan where you could go out on a lake fishing from a non-motorized boat but you couldn't do so from a motorized boat, again without an explanation of the science as to what it was about motors on a boat spread the virus.
You could fill a book with examples of covid-19 edicts seemingly devoid of any scientific basis, or at least any basis that authorities ever explained. For all the money spent on public health in this country they failed the public in a major way. Lacking those explanations, the result was people ignoring that which didn't logic check to them and in some cases court challenges ensued. Politicians ignoring their own edicts hasn't helped either in that it sends a message that they don't believe what they're telling the public.
By treating people as if they're incapable of logic checking edicts and understanding science-based explanations, city, State, & Federal authorities did not respect the inherent dignity of the general public. They made it worse than it had to be.
And Biker as a follow-up to your last posting statement, this recent news article about our California governor's admitted personal behavioral error despite his state-wide mandate actually, I think, supports my advice for science researched appropriate national Constitutional directives..in writing for pandemics such as our current COVID-19. Or am I putting too much into our Constitution. ..Maurice.
Oops! I forgot to include the news article link to my last posting. Here it is:
https://apnews.com/article/gavin-newsom-california-coronavirus-pandemic-57c512f74f73f628ed5eee52ae62ced7 ..Maurice.
Sorry for all the typos in my last long missive but I think people can get the gist of what I was trying to say.
Dr. B.,
Are you asking prior to his medical abuse? Because if so, no. After his prostate surgery, he decided to totally skip an additional medical treatment. Doctor(s) said if he didn't follow their mandates, then he should seek another doctor. There wasn't any discussion so he didn't see a doctor for 12 or so years until when he was medically & sexually violated. They never asked him why but rather it was their way or the highway type of attitude. Looking back, he now realizes their reasons primarily consisted of being able to maintain power, control, and greed over him. He also didn't engage in small talk with medical personnel because all he needed from them was to do their job in an ethically, moral and competent fashion. Their attitude about being intolerable of patients who didn't follow their orders started changing around 2008 when the talk abt. healthcare for all became a hot topic. Hospitals started being swallowed up by bigger hospitals although because they were already inflexible in 2006 around here is why he chose to have his cancer surgery out of state. Didn't sit too well with them. Prior to this time, he always went without complaint to annual exams but since that time, he no longer does follow up care. If he does, it is just to make the appearance but silently does none of the orders. Hope this answers what you were asking.
JR, based on the experience of you and your husband, could you prognosticate there will ever come a time when your confidence in a physician or medical professional regarding their beneficent knowledge, behavior and intent will ever be one of full acceptance. Or will "doctor", "nurse" or "tech" will never be one of uncertainty and suspicion? And, if so the latter, is this what "rational uncertainty" you are, in your current public presentations trying to express and propagate?
I look forward toward the time when we produce physicians and nurses who would avoid the misbehavior or worse which you amply describe and they become full supporters of maintaining their patient's (and family members) dignity. ..Maurice.
Maurice,
The context of the Constitution is freedom (NOT safety). If we had such an amendment, if Trump runs again in 2023, Biden could say that Trump supporters tend not to wear masks, so all gatherings in support of Trump are illegal thus hindering his run for the presidency.
Even more than healthcare providers, the phrase "power corrupts; absolute power corrupts absolutely" more so applies to politicians. Our Founding Fathers knew human nature better than we know it TODAY.
Once you make ANY exception, it can be abused. For that reason, the Founding Fathers made freedom paramount; NO EXCEPTIONS.
-- Banterings
For those interested, here is the entire Constitutional Amendment
AMENDMENT XXV
Passed by Congress July 6, 1965. Ratified February 10, 1967.
Note: Article II, section 1, of the Constitution was affected by the 25th amendment.
Section 1.
In case of the removal of the President from office or of his death or resignation, the Vice President shall become President.
Section 2.
Whenever there is a vacancy in the office of the Vice President, the President shall nominate a Vice President who shall take office upon confirmation by a majority vote of both Houses of Congress.
Section 3.
Whenever the President transmits to the President pro tempore of the Senate and the Speaker of the House of Representatives his written declaration that he is unable to discharge the powers and duties of his office, and until he transmits to them a written declaration to the contrary, such powers and duties shall be discharged by the Vice President as Acting President.
Section 4.
Whenever the Vice President and a majority of either the principal officers of the executive departments or of such other body as Congress may by law provide, transmit to the President pro tempore of the Senate and the Speaker of the House of Representatives their written declaration that the President is unable to discharge the powers and duties of his office, the Vice President shall immediately assume the powers and duties of the office as Acting President.
Thereafter, when the President transmits to the President pro tempore of the Senate and the Speaker of the House of Representatives his written declaration that no inability exists, he shall resume the powers and duties of his office unless the Vice President and a majority of either the principal officers of the executive department or of such other body as Congress may by law provide, transmit within four days to the President pro tempore of the Senate and the Speaker of the House of Representatives their written declaration that the President is unable to discharge the powers and duties of his office. Thereupon Congress shall decide the issue, assembling within forty-eight hours for that purpose if not in session. If the Congress, within twenty-one days after receipt of the latter written declaration, or, if Congress is not in session, within twenty-one days after Congress is required to assemble, determines by two-thirds vote of both Houses that the President is unable to discharge the powers and duties of his office, the Vice President shall continue to discharge the same as Acting President; otherwise, the President shall resume the powers and duties of his office. ..Maurice.
I want to repeat what I wrote 2 days ago.
There is no reason why a Pandemic Constitutional Amendment based on past and current epidemiology and science couldn't be emergently passed by the States and added
beyond what to do if a President becomes ill or incapacitated for his or her duties (25th Amendment) but the documentation of what to do when our whole nation becomes medically ill with a yet fully uncontrolled and unpreventable illness. Surely, all states will legally provide guidance and support in an emergent fashion. If one ill or grossly unfit President can be removed utilizing the 25th Amendment's certainly another Amendment can be promptly passed setting the standards for attention and protection of a medically unfit national population.
The medical status of the American public, particularly in a pandemic, should have no less Constitutional concern as the same medical/associated behavioral as for the President. The health and behavioral status of the American people should have the same attention and concern as that of the American country's president. There should be strict and defined plans for resolution of disruption of American life by behavior and needs and health of the people of America as that given to the President. The President is or should be one alive human being as each of us and we deserve as much Constitutional concern with regard to our health in a pandemic as the President has with his heart attack or clearly demonstrating mental illness while in office.
Yes, Banterings, the Constitution is regarding FREEDOM but that FREEDOM to carry out our lives and responsibilities in a pandemic is just as important for our nation as the preservation of the life and responsibilities of a President who is physically or mentally/behaviorally clinically disabled. Anyway, that is my supporting argument for including the concept of safety and preservation of the society of America beyond freedom in our concept of our Constitution. ..Maurice.
I am not a constitutional scholar by any stretch but it seems govt. entities, especially Governors, had rather extensive emergency powers with which to manage the impact of the pandemic for the common good, and most of them failed miserably to exercise those powers wisely or fairly. Instead of focusing on the means of transmission and on at risk populations they primarily focused on the nature of businesses/organizations.
Things like the nature of HVAC systems, occupant density, disinfection protocols, and PPE usage impact viral spread. They instead focused on essential (things like booze) and non-essential (things like bluejeans and books), except that you could order bluejeans and books via Amazon because somehow Amazon's distribution facilities with thousands of employees wouldn't spread the virus but the men's clothing store in town in which only the two brothers that own it work was not safe and had to stay closed. A 1000 person protest would be deemed too important to restrict but send in the police if 100 people are in their cars with the windows shut listening to a church service in a parking lot. I could go into an equipment rental store & rent a sweeper but the people I hired to do that can't come do it for me, outside with each guy working alone along my 1/3 mile frontage on a dirt road in the countryside. There was no science behind any of that. Giving more power to people issuing nonsensical non-science based directives would not result in better directives.
The President also has emergency powers under certain conditions that more or less allow suspension of the constitution. I'm not seeing where another constitutional amendment is necessary, especially when our political leaders have proven to be as inept as they have been at every level.
Back around 2006 or so there was a lot of pandemic discussion and preparedness going on. I was charged with putting together the plan for my employer. Not wanting to reinvent the wheel I went to my State's plan only to find it was utter nonsense and not a real plan at all. I then went to State after State after State only to find none of them had a real plan, nor did the federal govt. Then early this year as covid-19 unfolded, those lack of plans become very apparent. I mean how could it have come as a surprise to them that in a worldwide pandemic that just-in-time supply procurement systems would fail? How could it have come as a surprise to them how reliant we are on manufacturing in China and that it takes X days for items to arrive here by boat? How could any State Health Dept. not know how many (functional) ventilators were at each hospital in their States? Again, these are competency problems that more power isn't going to solve.
As an FYI, the Strategic National Stockpile is sized for regional disasters, not national, apparently something else State Health Depts and large hospital systems somehow didn't know. Yet I knew that before the term covid-19 was ever coined.
Biker, you wrote "Governors, had rather extensive emergency powers with which to manage the impact of the pandemic for the common good, and most of them failed miserably to exercise those powers wisely or fairly. Instead of focusing on the means of transmission and on at risk populations they primarily focused on the nature of businesses/organizations."
That example is an appropriate rationale for setting a unified national approach to the approach and management of such a catastrophic attack on our Constitution's goal to permit, without political "this or that", "freedom" in the vast majority of the times when the goals of our Constitution can being daily followed. A pandemic (and perhaps even lesser epidemics) can without Constitutional legal unity and protocol fail to set the standards and "do it's job". ..Maurice.
Dr. Bernstein, I don't know what the answer is but if a constitutional amendment somehow vested the right kind of authority in the federal govt. for events such as we've been living through most of this year, the question that remains is how do you get the public to go along with it. Allowing that somehow the political class would set aside their usual animosities for the common good, which I'm not convinced is even possible anymore, we would still be faced with the need for fundamental competence that we have not seen at the federal level or in our high population States that have vast public health infrastructures. Nonsensical non-science based mandates coming out of a centralized federal source will still be nonsensical non-science based mandates, no different than if they came from State govts.
Not to derail the current discussion but to come back to an old discussion, there is now a woman playing football for Vanderbilt University. What are the odds that she is required to let reporters, male & female, into her locker room while she is changing & showering? 0% is my guess but I'd love to see a male reporter demand access after a game on the same terms women reporters have to the male players. I'd love to see a judge tiptoe around an equal treatment lawsuit that gets filed.
Maurice,
The holocaust was based on science.
Tuskegee was based on science.
The right of absolute power of monarchs was based on science.
Rwanda and colonialism was based on science.
Atrocities at Gitmo were based on science.
Thalidomide was based on science.
Dr. Fauci refusal to publish interim use of Bactrim to prevent death by pneumonia in AIDS patients (which cost the lives of over 30,000 people) was based on science.
The Blank Slate theory (or Tabula rasa) was based on science.
There is a reason that our society is NOT based on science. The polar opposite of science is faith. Our country was founded upon Judeo BELIEFS (not science).
You can NOT base rule on science because science is NOT absolute. Remember when the Earth was the center of the universe?
FREEDOM IS ABSOLUTE.
You failed to mention that the 25 th amendment is being lead by the ultra-leftist (and fellow Californian of the VP elect), Nancy Pelosi. It is widely viewed as na means to get Kamala Harris the presidency (or even herself) by circumventing the electoral process. That puts the amendment into context.
-- Banterings
Banterings, here is a fair description (https://www.vox.com/2020/10/9/21509661/pelosi-25th-amendment-trump) of Pelosi's support of a Congressional bill first introduced by Democrat Rep. Jamie Raskin (D-MD) in 2017 that would potentially provide a better (perhaps clinical yet not partisan evaluation of a President's physical and mental capacity to continue in office. Sounds non-partisan (you may disagree) and set decisions based on current medical science and not pure politics which one might interpret as the result of the current 25th Amendment.
This seems a fair way to preserve the "patient dignity" especially where the "patient" is the President of the United States.
Golly, we have very interesting discussion ongoing on this blog thread! ..Maurice.
Hello Dr. Bernstein,
Relative to your consideration of a "Pandemic Amendment" (If I understand you correctly), I ask you to consider the following: What will constitute a pandemic? Who will determine when a disease, virus, etc. becomes a pandemic? Will a severe outbreak of Tay-Sachs disease or Sickle Cell disease constitute an actionable pandemic? What steps will be taken to "eradicate" such a pandemic? (I hope you know to what I'm alluding.) You may wish to reread Martin Niemoller's "First They Came" and the 10 th Amendment (especially the last four words). There are many reasons why the framers wanted a LIMITED federal government.
Reginald
Banterings, but is personal freedom under the Constitution absolute? Read this from Loma Linda University "the Constitution is a living referee over those who run the government from day to day, designed to ensure that everyone has an equal say about who should be in charge (the vote), and that everyone’s rights to express their views, to advocate for change, to believe and worship according to their convictions, and to pursue the “good life” as they see it, are respected.
But there are times, such as a lethal infectious pandemic, where citizens and their government have to exchange the views of all citizens and their Constitutional Freedom to the current established medical science. We are a nation of independent citizens but at some time, like currently, our Constitutional individual Freedom must loosen and attempt to protect the lives of all the others living under our national Constitution. ..Maurice.
Dr. Bernstein, if we are to give up freedoms for the common good as dictated by science, then the powers-that-be have an obligation to present that science to the public rather than simply using a "trust me" methodology such as we have seen this year. Then there is the question of who gets to determine what the science is saying. That last point is particularly important given the tendency of scientists to quickly fall in line behind whatever those doling out the money say the answer must be.
To make my point one needs only look to Gov. Cuomo in NY's policy of sending infected patients into nursing homes. He has had some Presidential aspirations in the past. Had he been President with power to dictate "scientific solutions" nationwide, how many more would have died if every State forced infected patients into nursing such as they did in NY and a couple other States? It may have earned him an EMMY for his new conference performances, but thousands died because of it. Where were the public health and other scientists in NY protesting his directive? Where was the media questioning him? The end result is NY at 177 deaths per million is the 2nd worst in the nation, NJ that had the same policy being the worst at 191. Meanwhile NY's next door neighbor, VT, that locked down nursing homes instead has the nations lowest death rate at 10 per million. We don't remotely have the resources for a huge public health infrastructure like NY has and had to use common sense instead to protect our elderly.
Until such point as there is competence within the political class and true independence (from politics) of the scientific & public health class, another constitutional amendment is not going to make things better and may make it worse.
Oops. My covid-19 death statistics in my last post are per 100,000, not per million.
Banterings, each examples you gave was based on the "science" and "political" or " plain irrational" views a few (a few) doctors or "scientists" or money interested pharmaceutical companies and dictators who had a previous set goals to meet. I am not sure one can compare a world-wide (including America) pandemic with a clear prophylaxis (yes, based on science, long known epidemiology and not politics, religious hate, personal gain or worry about the possibility of dangerous behavior of another country.
And with regard to Dr. Fauci, the following is from the Infectious Disease Society of America https://www.idsociety.org/news--publications-new/articles/2020/isda-statement-in-support-of-anthony-fauci-m.d.-fidsa/
IDSA Statement in Support of Anthony Fauci, M.D., FIDSA
As 12,000 medical doctors, research scientists and public health experts on the front lines of COVID-19, the infectious diseases community will not be silenced nor sidelined amidst a global pandemic. Reports of a campaign to discredit and diminish the role of Dr. Fauci at this perilous moment are disturbing.
Despite the nation’s vast resources and abilities, more than 135,000 people in America have died from COVID-19 – more than any other country, and the numbers keep rising. Every day now brings a new high in the number of newly infected people and deaths. This is a full-blown crisis unlike any America has ever faced and it needs to be treated as such.
The only way out of this pandemic is by following the science, and developing evidence-based prevention practices and treatment protocols as new scientifically rigorous data become available. Knowledge changes over time. That is to be expected.
If we have any hope of ending this crisis, all of America must support public health experts, including Dr. Fauci, and stand with science.
-IDSA President Thomas File, Jr., M.D., MSc, FIDSA
The current pandemic public health decisions are not being made by a Hitler, a few biased and ignorant "scientists" or a few military physicians, it is being made by many, many physicians and scientists on the "front line" who are immersed in the pandemic and using logic and long-standing epidemiology to pull us out of this and not some political hidden motivations.
Banterings, have you talked to your own physicians about the world and American response to the pandemic? Do they think, the cautions presented by science are realistic and not some political directives to gain political attention and approval and political value? ..Maurice.
Ah! I found a current (September) article in the Lancet medical magazine which defines what is happening throughout the world not as a PANDEMIC but more realistically a SYNDEMIC.
And defining what is happening to the world now in that term should explain why what is happening is more complex than a highly infectious virus.
The notion of a syndemic was first conceived by Merrill Singer, an American medical anthropologist, in the 1990s. Writing in The Lancet in 2017, together with Emily Mendenhall and colleagues, Singer argued that a syndemic approach reveals biological and social interactions that are important for prognosis, treatment, and health policy. Limiting the harm caused by SARS-CoV-2 will demand far greater attention to NCDs and socioeconomic inequality than has hitherto been admitted. A syndemic is not merely a comorbidity. Syndemics are characterized by biological and social interactions between conditions and states, interactions that increase a person's susceptibility to harm or worsen their health outcomes. In the case of COVID-19, attacking NCDs will be a prerequisite for successful containment.
This relationship between a wide-spread infectious disease and the race, gender, background work and lives of each and every person facing and suffering from this infection should be emphasized since this is the potential explanation why attacking this harm to our country is much more than prescribing medications or vaccines but full national governmental entry into both the medical treatment and the actual lives of each of us. And that is why it is necessary to consider our American Constitution not purely "freedom" for all but ways (some governmental) to preserve that personal "freedom" when danger encompasses our country and all the people.
..Maurice.
ADDENDUM: NCD in the above article is defined as
"non-communicable diseases". ..Maurice.
Dr. Bernstein, if all those thousands of scientists had developed evidence-based prevention practices, then their voices were ignored by the political class. It would seem that evidence based prevention practices would have focused on the mechanisms of disease transmission, yet what we got from the politicians was essential vs non-essential w/o any explanations beyond "trust me".
I come back to my examples. Safe to buy food indoors in a grocery store last spring but not outdoors at a farmer's market. Subsequently safe to buy food at a farmer's market but not homemade soap. Booze is essential & safe to buy but not bluejeans. However, it was safe to have massive Amazon distribution centers with thousands of people filling orders for bluejeans & everything else you couldn't buy at the small proprietor stores that were forced closed. Why? I'm sure all those small proprietors that may never recover would love to know the science-based evidence behind those decisions. Safe for me to go into an equipment rental store for a sweeper but not safe for a property mgt guy to operate one by himself on my large property in the countryside. Where were the scientists while the politicians were doing this stuff? Where were the scientists when Cuomo and a few other Governors were sending infected people into nursing homes? Maybe some of these scientists needed to call competing news conferences if the politicians weren't listening to them.
As I said in an earlier post, focusing on HVAC systems, disinfecting protocols, PPE, # of people relative to space, and on vulnerable populations would have been things that the public would have understood. But that's not what happened. By time they finally got around to telling everyone to wear masks and to social distance a lot of people had stopped listening. And of course the sheer number of politicians & their families that have gotten caught ignoring their own mandates didn't help either.
The problem is far more how govt. used the authorities they had more than it was whether they needed more authority. Competence is what was in short supply.
Biker, my impression from what I read, hear and see on TV is that politics dealing with this pandemic is oriented to Constitutional "freedom" in a life-threatening and life=losing attack on our country and way of life.
There is limits to personal and governmental "freedom" when in such attacks. The "freedom" of speech is governmentally limited when it comes to "yelling out. as a joke, FIRE in a crowded theater. Freedom for some person to think that they are free to shoot somebody on 5th avenue without immediate and later police and court consequences is not an example that "freedom" is free of public and governmental limits and concerns.
There are limits to the freedom, full and complete freedom when the country and the world is facing the consequences of a deadly infection pandemic. And the preservation of human and patient dignity in a nation and the world must be additionally guided by more than assurance of full personal freedom. One man alone on the moon or Mars, yes.. but those living on our current planet, full personal freedom is a dream and when that is politicized within an ongoing pandemic, there is danger to us all and it is happening right now. ..Maurice.
Dr. Bernstein, I'm not disagreeing that there are limits on freedom and that govt. providing for the common good provides valid basis in establishing some limits. I am simply saying govt. doesn't need more authority to manage the pandemic but rather that they need more competence.
The current conditions where some are rejecting any and all pandemic limitations has largely arisen out of what has increasingly been seen as govt. incompetence. It didn't have to happen this way. The utter nonsensical dictates such as I have provided several examples of in combination with real economic impact upon innocent victims of those dictates has slowly pushed more and more people to the point that they have nothing more to lose.
I see a slow drip locally of restaurants and sole proprietor businesses closing their doors permanently because they just couldn't hang on any longer. That will eventually ripple through to some of the owners of those buildings being unable to hold on any longer with no rental income coming in. Meanwhile the politically-favored class (Amazon & the other multinationals) are booming despite no scientific evidence that supports favoring them over small businesses.
Maurice,
While a pandemic amendment sounds good, like sitting in a drum circle singing Kumbaya, it undermines the context of the US Constitution. The majority of amendments protects INDIVIDUAL FREEDOMS by expanding protections to cover "all US citizens" or to clarify important areas that the Preamble may be vague on.
Many protect INDIVIDUAL FREEDOMS by defining due process and LIMITING government's powers. Finally, they fix some problems with the electoral process. This also includes the definition of sovereign immunity of the states.
The ONLY amendment that restricts individual freedom, the 18th Amendment (alcohol prohibition) was repealed by the 21st Amendment.
Yes, there are limits to personal freedoms, but they should be at the state level, not the federal level. Even then, they are rejected by the people.
The Pennsylvania House and Senate passes Constitutional Amendment to limit the governor's emergency powers.
It sounds good, but runs contrary to the context of the US Constitution. You may know bioethics and medicine, but you do not know Constitutional law.
-- Banterings
Yes, Biker, there has been evidence of a failure in this critical time for the preservation of the physical lives and economic lives of all the people living in the United States. And I am blaming both the Democratic and Republican parties for their mishandling of the financial needs of all the people in America and not just attending to the financially rich as individuals or big businesses. Financial suffering for the vast majority of the American population is a sign of serious pathology beyond the pathology expressed by the COVID statistics.
We must have American governance beyond political or self-interest concerns of the leaders or others in the government and business.
Speaking about preservation of dignity, what has been going on throughout the political body has been a loss of dignity for that body and for the country. Self-interest as a primary political goal is of no value but harmful when the country is undergoing an ever more destructing pandemic.
Anyway, that is my opinion. ..Maurice.
Banterings, I am concerned since I think that politics and "freedom" has directly accelerated the progressive consequences of the pandemic in the United States. Politics and personal self-interests of our leaders, both state and federal must take a back seat to well established science and medicine.
Yes, you can be a physician and end up as a member of government but nobody can learn the knowledge and skills and current science of medicine just from an elected seat in state or federal government. The politics of a pandemic should first begin with current science and not someone's intended personal political goals. ..Maurice.
Dr. B.,
No, there will not come a time when either of us will again trust the medical community to do the right thing as things currently stand within the medical system. Up to that point, my husband trusted them at least not to intentionally harm him. Now that trust has been broken, it is a permanent break. There is no going back from harm so deep. He suffered not just one harm during that encounter but multiple harms and has seen the system does nothing to address or correct these harms. Why I do what I do is to educate potential patients of harm so they don't have to be blind -sided by what happened to him and us during that encounter. At the moment, education is the best weapon we have. The public needs to be aware of what are perceived as little offenses such as lack of allowing patients dignity during care turns into bigger offenses such as sexual assault. Although, I myself view lack of allowing bodily dignity during care as a sexual offense bc there is NO valid reason bodily dignity should not be protected. So until real progress is made, we have no reason to believe that others do not have the ability or need to harm.
As far as freedom, you gave examples of govt prohibiting certain behaviors which is true. But also we have seem examples of govt allowing certain unlawful behaviors such as violent rioting in which they not only burnt, destroyed, beat people but also kill a few. Certain areas allowed them to basically lay claim to those areas without interference. So it is hard for any govt to impose restrictions knowing not all are fairly imposed or followed. I am not religious but I see how unfairly sanctions against going to church have been vs going to just abt any other public event. The funeral of a civil rights leader & court justice are examples of dual standards as it was allowed but others weren't allowed to have funerals for their loved ones. Justice is supposed to be blind but it does seem to show favoritism. I also agree w/ Biker w/ his business analysis. Many small businesses have disappeared never to come back and many more are on their last gasp of air. Certainly, the if there is a Biden term, large businesses will grow even larger choking out small businesses.
There is a pandemic of medical harm in this country and has been for years but yet no extreme measures have been taken to curb it. Why should be the question but we all know why as the medical industry is big business and is a protected entity. All the deaths and long-term side effects to the survivors (being both patient and family) mean nothing as clearly witnessed by this very much politicized virus. I am not willing to give up my freedom for a virus that most likely I will survive when the harm imposed on me when seeking medical care is more likely to kill or severely damage me.
As Biker said "competence is in short supply" and clearly that shows in how this virus has been managed by science and how science actually knowingly inflicts medical harm.
I have been keeping quiet the past few weeks because I didn't want to shift focus from some very important issues that were being discussed here. I have had some health concerns that I want to bring up now and how the medical community responded.
As related earlier on this forum, on September 4th I had the Greenlight Laser treatment for my BPH symptoms. The results were good. I was doing very well and the urinary stream was just like when I was a teenager. Time went on and I thought I was done with this. On the 21st of October I noticed particulates in my pee and that continued for several days. I had resumed taking fish oil as part of my vitamin regimen and aspirin for my heart health. On Oct 27th at 4 AM I awoke with the need to pee. This was new as I was usually able to go through the night without that concern. As I started to pee I felt as if the urine was much more thick than usual and then I felt some clumps in the stream. I looked down into the toilet and found, much to my surprise, a LOT of blood! It was as if I was peeing blood. About 2 hours later, same thing. I drove my son to his bus stop later that morning and hoped things would get better. When I got home I had to go and couldn't. I knew the clotting had stopped me up and I had to get to an ER right away.
I was fortunate that the local ER was not busy at that time of morning. I was greatly relieved that a male nurse was assigned to my care. I knew that a catheter was in my future. Sure enough, the doctor ordered it. Many attempts to reach my Urologist's practice went unanswered. I asked for and received the Lidocaine gel to help ease the pain. I walked out with a Foley inserted. We were finally able to reach my Urologist and they said we can get you in next week! At the rate I was bleeding I would not be alive at that point. Using my old phone contacts at the practice I was finally able to be seen on the 29th of October.
Continued...
58Flyer
58Flyer, from the narrative you already presented, it would seem, if prostate surgery is out of the question, that you would be a candidate for a continuous indwelling Foley catheter with prophylactic periodic instillation of preparation to prevent stone obstruction. This is just my evaluation of what you have written so far about your urologic status. As you know from my personal health descriptions on this blog thread, an indwelling catheter has been my final decision.
Have you felt that your urologist could have been more "available" for appropriate needed therapy? ..Maurice.
Maurice,
You keep saying what all public health and medical providers say; "follow the science." Too bad the professionals are NOT following themselves. Just read:
Newsweek Op-Ed; The Key to Defeating COVID-19 Already Exists. We Need to Start Using It, by HARVEY A. RISCH, MD, PHD
Open letter to Dr. Anthony Fauci regarding the use of hydroxychloroquine for treating COVID-19, by George C. Fareed, MD Brawley, California Michael M. Jacobs, MD, MPH Pensacola, Florida Donald C. Pompan, MD Salinas, California
The Tragic Hydroxychloroquine Debate and Dr. Fauci's Denial of Evidence By Mikko Paunio
The politics of freedom as you allude to are those who would deny the citizenry their Constitutional right to freedom and those who defend those freedoms. It is that simple.
Those who wold deny the Constitutional right to freedom fall back on "follow the science" and "we need to give up some of our freedoms for the good of all."
The Erosion of Freedom
What they fail to realize is that this thinking will cause more harm in the future. This happened after 9/11.
We can't let the coronavirus lead to a 9/11-style erosion of civil liberties
In a November post on Kevin MD, We are making sacrifices for you. Please make a sacrifice for us, I expected comments to be lockstep, but I was quite surprised:
Why not impose other limits on our freedoms which can certainly reduce illness and injury? For example ban alcohol - reduced auto accidents due to DWI and less liver disease... (Drbedbug)
As a physician, I am grateful to have a job. Unfortunately my daughter and son in law lost their jobs and health insurance in the pandemic... Luckily my job as a physician pays their household expenses, and their health insurance. Most Americans are not so fortunate as we are...
...America has been making sacrifices. Those sacrifices are as burdensome and probably more burdensome than the sacrifice that physicians must make. Enough. Let us not add insult to their injuries by dwelling on our sorrows... (abbey beagle-terrier)
You still get to go to work and see people, and despite the risks there, there's an interaction there with people. Those who are holed up at home for 9 months? They don't have that luxury, and yes its a luxury in 2020 to see a human being. That doesn't cheapen what you do in the clinic, but it is unrealistic, unpractical, and unethical to ask and expect that people will never see another human being for 18 full months. (joehardy12_3)
I think the medical community needs to remember there are ethical concerns and public health consequences with mass quarantines. When we advocate for mass indefinite shutdowns we appear tone-deaf to the economic damage and social isolation that they cause... (guest)
-- Banterings
Banterings, on the other hand: From the Yale News, Risch's own school for his research and professorial educator:
Yale School of Public Health professor Harvey Risch has been a vocal supporter of the use of hydroxychloroquine to treat COVID-19, despite a lack of scientific evidence that it works.
In a July 23 opinion piece in Newsweek, Risch argued for the use of hydroxychloroquine, in combination with the antibiotic azithromycin, to treat high-risk COVID-19 patients without waiting for further testing on the effectiveness of the treatment. He published this piece after his May 27 paper in the American Journal of Epidemiology was widely criticized due to a lack of evidence from randomized trials. Both articles argued this combination of drugs can effectively prevent hospitalization for most symptomatic high-risk outpatients and that it is safe for short-term use early in the course of infection. This claim is now widely disputed. ....
In a statement released on Medium on Aug. 4, members of the Yale scientific and medical community voiced concern over Risch’s ardent advocacy of hydroxychloroquine. It is signed by more than 20 Yale faculty members.
“As his colleagues, we defend the right of Dr. Risch, a respected cancer epidemiologist, to voice his opinions,” the letter states. “But he is not an expert in infectious disease epidemiology and he has not been swayed by the body of scientific evidence from rigorously conducted clinical trials, which refute the plausibility of his belief and arguments.”
Being an expert in one medical science subject does not necessarily carry that expertise into an entirely different medical research specialty.
Also, do we know if "politics" was a component of Risch's conclusions? ..Maurice.
Dr. Bernstein,
I would have to say availability was a problem. My Doctor later blamed it on failure of their answering service. I would add that staff casualness is more of a problem. Some of the people I was dealing with were non-medical schedulers. One even asked me "oh, you have a little blood in your pee?" I said "no, I have a little pee in my blood!" it was that bad. Clotting was the reason for the blockage, I haven't had any stones.
So, I go to the office of my Urologist, but it was a different office in a nearby town. The practice has many offices all over Florida. This office was much smaller. Once in the exam room my doctor comes in and we discuss things. He recommends I go with a larger Foley since I was leaking around the current one. When he starts prepping a female medical assistant comes in bringing supplies. My doctor remembered my situation and advised the medical assistant to leave. She looked startled and asked if he needed assistance. He said no and again asked her to leave. She looked perplexed and offended but she left. I am glad my doctor remembered. I asked him to please use the Lidocaine gel and he said they had none. That bigger Foley really hurt. The doctor said the bigger Foley was for the tamponade effect, sealing things up so the bleeding would stop and the site would heal. Made sense to me.
So, I go home with a new Foley. In a short time I realized there was no pee going into the bag and my bladder was getting fuller. I called the clinic and the doctor said to go to the ER of the hospital he was affiliated with. That too was in another town. By the time I arrived I was in considerable distress with bladder pain. I advised the check in nurse that I was in 9/10 pain and needed to be irrigated desperately. She seemed to understand and said she would do everything she could to get me seen. I was taken back for little things like a bladder scan, blood draw, a CT scan, and so on. But nothing to relieve by bulging bladder. Finally, I was taken back after 5 HOURS to the room. I was really squirming at this point. By then I didn't care who did the irrigation, I was not going to risk a delay by asking for a male nurse, I was that desperate. After being seen by all kinds of male medical personnel, a female nurse shows up! She was very competent and wasted no time upon seeing how much pain I was in. I was wearing loose sweatpants and had them pushed down to my knees but I was also wearing undershorts so I wasn't exposed. I kept those on as she could get to the Foley port that was attached to my right leg with adhesive tape. Upon clearing the clog, blood and pee spewed everywhere, on my underwear, my shirt, her scrubs, the gurney, and the floor. She caught most of it in a plastic jug but still a lot went everywhere. I had instant relief! She told me she had spoken to my doctor and he directed that a CBI (Continuous Bladder Irrigation) Foley be inserted and I was to be admitted to the hospital. That's when I told her of the abuse past and even before I could ask she offered to trade with a male nurse.
Continued...58flyer
banterings and Dr. Bernstein have made the point that science is also governed by politics. That scientists profess to be non-political in matters of public health policy does not make it so. It is no different than nurses and other healthcare workers professing to be asexual in performing their duties does not make it so.
The point I have tried making is that the mgt of the pandemic has been a disaster due to lack of competence on the part of politicians and on the lack of science behind public policy. How could the "science" of protecting elders in nursing homes be the polar opposite when you go from the nursing homes in my county's shire town to nursing homes just 35 miles to the west in NY State? Science in my state said to lock down the nursing homes and rigorously work to keep anyone infected out but cross the border into NY and the "science" said it was safe to place infected elders into nursing homes. The mountains between here and there don't somehow change how viruses spread, yet somehow the scientists in NY saw it very different than the scientists in VT. Or the politicians in NY chose to ignore the scientists and the scientists in NY chose to sit back silently and not risk their careers and funding while thousands died in their nursing homes.
At this point politicians should not be surprised if many in the general public just don't trust what they say anymore as concerns the science of pandemic mgt. This is especially so when the ones shouting the loudest are the ones with the worst records. Using the most recent data NY is #2 @ 178 deaths per 100,000 vs VT is #50 @ 12 per 100,000. Just because Gov. Cuomo talks loudly and often does not make him a reputable source for pandemic mgt. yet the major media hang on his every word at the same time they express no interest in hearing from Governors with vastly better results.
58flyer, I look forward to your 2nd installment of your recent experience. I had been wondering how things were going with you.
Scientists within their specialty field of knowledge and experience are clearly limited in carrying out their public practical functions by politics and the public and the public's politicians where science can be twisted for what is felt to be "practical" or even "supporting some political view ". It is unfortunate that "politics" has to be "politics" and validated science within a population of humans has to be twisted and "unhooked" to become part of cultural reaction to their human dangers.
There should be some educated, unbiased cultural mechanism to assure the best in health and all the functions of living in a country or the world. Unfortunately, we don't as yet have such a mechanism to guide us. And sometimes it feels that politics and individual goals "Trumps" science. ..Maurice.
Dr. B.,
Even you cannot be unbiased as you couldn't resist your stab at '"Trumps" scienc' when Fauci has his brand of science of don't wear a mask then wear a mask--don't go to school then school is the best place for kids all politically convenient for the tiny man in more ways than just size. Why didn't you mention Cuomos who however he spells his name of science of killing the seniors in nursing homes or the CA governor who don't eat out or drink in a crowd but does the very same thing with the medical board of all people. Is this a "Newsome" kind of science? or does branding science as politics only one-sides? "Newsome" science is the type that says if you do it--it's wrong but if I do it--it is fine. In fact, it is so fine the San Fran mayor did the same a couple of nights ago. Science and all its glory. Really not hard to imagine why so many people of leery of science after seeing all the fine examples coming out of the state of CA.
Don't forget my husband was sexually assaulted by a Bernie worshipper in the midst of the Kavanaugh hearing. Was that her science of punishing an older white man for supposed crimes against women? Unfortunately, most people cannot be pure enough not to involve politics into what they do including the medical community that also consists of scientists. They all have agendas just like expert witnesses in a malpractice case have an agenda. It is clear that one side has trouble admitting to their manipulations.
JR, there are always exceptions which can occur with or without full thoughtfulness in many aspects of life but it is the goal (even political goals) behind those decisions which tell the story. ..Maurice.
JF, I and we all here hope you are well especially if you are continuing your important participation in nursing home environment.
I was wondering what do you think of the public health considerations going on now about utilizing the COVID vaccine first to those living in nursing homes and to their caregiver professionals working there. Do you agree that this group needs the value of vaccine first along with those attending patients in acute care hospitals? ..Maurice.
Dr. B.,
But your cute little "trumps" science jab shows there certainly are exceptions when you did not expend the same type of effort/jab at others on the other political spectrum who are exhibiting their lack of belief in the "science" they are trying to use to curb our freedoms and rights. Only pointing out your bias presentation of the facts. Everyone has a political agenda nowadays. The loser is the common person in all aspects. Because the medical & science community has decided to weaponize themselves against us using their political views as their compass, it has become a very dangerous time to be a normal person. For those of us who dare to disagree, medical retribution can be expected. The world needs to listen to those of us who do have stories to be told.....
A week ago my assistant director of nursing and one patient care tech tested positive for the Covid. None of our patients did though. So maybe having had it before does sheild us a bit. We're being tested every week now. I'll be so glad when this chapter in our lives is OVER!
JR, picture this: an apartment house containing many families is on fire, a real bad fire and the fire companies are arriving to help evacuate the families and to with experience and plans and personal risks to put out the fire. Those firemen enter the flaming building with no display of their own political interests: Trumps vs Biden, Republican vs Democrat. Their goal on entry is to save lives and put out the fire so that other buildings and lives are no longer at risk.
This analogy is the basis for my advice: this is a time for everyone to work together to "put out the fire". That should be the goal for all of us, Democrat, Republican or other.
There are many other issues in American life that may have mixed political concerns and problem treatment methodology but right now the goal is to "put out the fire and save the residents' lives". An apartment on fire or deadly widespread COVID infections should not be politicized. ..Maurice.
A male nurse came in and we talked about what was ahead. I asked for Lidocaine gel and he said it was available. He DC'd the Foley taking out 30cc from the retaining balloon. He said that was normal. The insertion of the new CBI Foley wasn't bad after using the Lidocaine. It should be a crime to insert Foley's without Lidocaine! In my case I had gross hematuria, which caused clotting and therefore retention. The purpose of the CBI (Constant Bladder Irrigation) is to allow for the bladder to be frequently flushed. But, you had to be admitted for that. Most Foleys have 2 lines in, one for passage of urine, the other for release of the retention balloon. The CBI has a third line, for the input of saline into the bladder for a constant flow and therefore expecting and hoping for continual release of urine and saline to monitor for retention. With gross hematuria, clotting is a possibility and is relieved with a plunger to clear the clot.
My underwear had to come off, it was wet anyway. The male ER nurse put me in a gown and removed everything below the waist except socks. I watched my clothing put in a plastic bag. I was sent up to the second floor by way of a transporter guy. He was really fun to talk with, lots of humor. Once in my room, he introduced me to my nurse, a seemingly nice girl named Angela. She said she would be back with me shortly, and disappeared. The CBI was filling, and I was clotting, and stopping up. It wasn't long before I was back in 10/10 suprapubic pain, expecting my nurse would be back. She was gone only a short time but I was in distress! In desperation I pushed the call button and reported I was hurting. Angela came in in a casual way, saying she was going as fast as she could. She brought with her a plunger and some saline in a bottle, and a plastic container. She lifted my gown, exposing me, at this point I didn't care, then put a cloth towel over my genitals. She then connected the plunger and pulled it back along with the clot. I let go a huge amount of blood, saline, and clots into the collection bag. It measured a 1000 cc's! I think a mistake was made. The irrigation was started too soon back in the ER. So, by the time I was on the floor, I was in extremis. I feel that the irrigation should have been started once on the floor after being brought up from the ER, after the irrigation supplies were on hand. At that point, I didn't know how to stop the flow, I learned that later by clamping off the valve. As to the exposure, she exposed my penis and scrotum, and in the moment, I didn't care. Later, I regretted it.
Angela was with me every hour through the night. I did develop a report with her, learning she was 5 months along in her pregnancy by way of a sperm donor, as her clock was ticking and she wasn't successful in finding a suitable mate. I connected with her as I recalled my wife's and I's experience with infertility and in-vitro. We had lots of conversation that night, and little sleep for me. When she did come to remove my clots, I would place my hand over the gown which was over my genitals, and let her plunge. I think the only exposure occurred during the first plunging, as I didn't allow any more exposure after that. Later, before she did report with the follow-on nurse, I asked if she was aware of the abuse history. She said she was, and asked if I was OK with what went on during the shift. I said I was OK with it, but I was really bothered by the unnecessary exposure. She exposed me once, and not again during the subsequent events. Why did she need to expose me at all? She said to me that my upcoming nurse was a male.
Continued, 58flyer
Then take your own advice and stop with the petty political insults.
58Flyer, your experiences show how the patient specific pathophysiology can impact on the preservation of an individual patient's dignity. Often, no single patient can be evaluated and treated as others even if the gross pathologic diagnosis may be the same. No proper physician should assume any specific pathologic diagnosis with symptoms is "standard" and their patient will follow the textbook. Each patient and their symptoms and pathology are a bit or more different from the other and this is something all physicians and their nursing staff should bear in mind with every patient.
My urologic problem, as I have previously described here was tiny stone formations over the balloon and end of the Foley catheter which mechanically prevented the balloon to be deflated and the catheter replaced. It took puncturing the balloon of the catheter by a needle passed through the abdominal wall and bladder under CAT scan visualization that solved the clinical issue. Since then twice daily instillation of a magnesium containing liquid has for the past year prevented stone formation.
But the clinical issues in the diagnosis and treatment of obstructive uropathology must be considered separately in each patient. And preservation of dignity can follow..without such considerations, the consequences can become patient undignified leading to potentials described by 58Flyer.
..Maurice.
..Maurice.
JR, as with the apartment house fire example all petty political directives not in full keeping with the obvious threat and "cure" of the fire should as you rightly say "stop".
Let's all "spread" that advice. ..Maurice.
JR. How can you think Bernie is somehow to blame for how that horrible nurse abused your husband? Or that Bernie supporters would generally speaking act that way? I would seriously harm that nurse for what she did to your husband if I had the ability. A 15 year prison sentence comes to mind. I actually voted for Biden ( or more accurately against Trump ) but Bernie would have been my first choice. If I thought he could have won. MANY of the staff were complincent in your husband's abuse. Nobody stepped up to the plate for his rights. Do you think all of them were Bernie supporters? We can't any of us accurately sterio type any group, I don't think.
58flyer, while awaiting the rest of your story, I want to comment on the nurse having needlessly lifted your gown. It is certainly possible that at that time she didn't know of your abuse history and only learned of it afterwards. Even if that was the case, your question is valid. Why did she need to lift your gown at all?
Failing any other logical explanation, I assume that she simply wanted to get a look. This is my fundamental problem with female staff and male intimate care. It is the needless exposure.
Since we seem to be entering into political discussion regarding how patients are treated in the medical system with concern about still preserving patient dignity, let me pose here an analogy reflected a view, perhaps a political view.
Continuing with the apartment house which is on fire and the firemen are arriving to rescue those who are still within the burning building and to bring an end to the fire.
What if there was a fire department principle passed to all firemen that on entering the building to rescue inhabitants still present there should be a rescue criteria in place: Rescuing, attempting to remove or removing from the fire, the very elderly or invalided, those who could not on their own or were seen unable to do so, the fireman should allow them to remain in place and let them perish.. but actively assist by directions to remove themselves from the fire those individuals who were younger and energetic and who had the potential for self-help in another unfortunate fire.
Does this analogy sound familiar in these days of "medico-political" approaches to the COVID 19 pandemic? So-called "Herd Immunity" (Dr. Scott Atlas). The analogy--those occupants who the firemen direct out (not carry out) of the burning apartment have the potential to self-rescue while the others, without the potential for self-help..well..let the fire take it's course for them.
Or have I totally misunderstood Dr. Atlas' approach toward the management of the CORONA-19 "fire"? Herd "capacity" (potentially self-survive now able to get out for any next fire.) ..Maurice.
Maurice,
Here is what happens when we "follow the science." It is human nature to be social. Quarantine and lockdowns will NOT work.
The Constitution rules this country, NOT science. In this country, most of the voters, who ultimately determine such policy, are not doctors or scientists.
US Surgeon General Jerome Adams recognizes that nationwide mask mandate and lockdowns would be counterproductive and cause rebellion.
You talk about following the science, but most physicians and scientists are NOT. Those who are include
Harvey Risch, MD, PhD, an epidemiologist at Yale University and
former Yale University Professor, David Katz.
Your analogy of fighting fires fails to make your point, in fact, just the opposite. There is most definitely a political side, just look at your home state of California. Look at the issue of forest management and wild fires; EXTREMELY POLITICAL.
Your issue of the fire fighters running in the burning house is also political. At the lowest level is the issue of jurisdiction and establishing command of the incident.
I think the best explanation is the fire scene in the movie, "Gangs of New York." Those fire fighters that you speak of, do not run in the house willy nilly, they are dispatched by the incident commander who authority to do so via political means. In deed conflict arises in the fire services, conflict which is driven by POLITICAL and personal motives.
-- Banterings
I am intrigued with JR's suggestion that perhaps a piece of her husband's abuse was possibly based on the nurse's politics and him being stereotyped in a way not favorable to those politics. I supposed that is just another way of saying what has been said here a number of times, that some modern day feminists might enjoy exercising their power over male patients.
My guess is that those women are the minority rather than the majority; that the majority instead simply believe the old mantra that men have no modesty, or alternatively, they enjoy the view and selectively take advantage when & as they can.
In any event, partisan politics has no place in the frontline delivery of healthcare. Partisan politics of course does play a role in determining how to fund it and with certain prioritizations, but the doctors, nurses & techs must be apolitical in their delivery of healthcare. I think for the most part they are.
Regretfully, public health policy is very much politicized as can be seen with the covid-189 fiasco.
JF,
We have had some detective work done on what happened to my husband that night. The cardiac nurse's social media profiles speaks volumes abt her and her beliefs. First, she loves Mollys and drinking. Molly's make the user very sexually charged. It is dopamine high. Working in a cardiac unit is very beneficial as there is actual dopamine being used along with drugs such as fentanyl and versed. For a sexually aggressive woman, there is no short supply of sedated men. My husband was literally unable to move or speak bc of how severely the drugs affected him. On her profile, she is a Bernie supporter who is very outspoken abt her hatred of Trump/Republicans. She also thinks old, white men are the scourge of the earth & need punishment for all their crimes. She is very outspoken abt #MeToo. He was mistakenly labeled as being gay and her social medial acct have negative remarks abt gay ppl. Versed acts as a truth serum & he could have been asked what his political leanings were. I have read articles from nurses and heard from others who say staff ask pts personal things while under sedation for the fun of it. There are a lot of red flags in the nurse's social media who took part in the abuses heaped upon my husband that night. It really is chilling to think that people who have so much hate and contempt for fellow humans are alone and basically in charge of those same defenseless people.
Some, not all Bernie supporters are violent as riots and other footage have proved especially the younger supporters. You have some calling for harm to Trump supporters. Around the time of my husband's harm, there was so much going on such as the Kavanaugh hearings. We moved to an area years ago that is known for its politics so that is another label.
I have many friends from all political sides. As long as everyone remains respectful and realize there is good and bad in all politics there are no problems. However, there are some who cannot remain civil and polite in their politics. I firmly believe politics has no room in the medical community. I believe with so much divisiveness hate for our fellow humans from different political beliefs have become commonplace and has carried over into medicine. I am not sure whether what the nurse's issue was for sure but there are many different possibilities. There is so much hate that now I look for that hate because I expect it. When you see ppl beaten in the street by ppl supposedly protecting injustice, it drives homes the hate. When you see nurses out joining the rioting, spewing hatred you have to wonder if they should even be around defenseless people who represent those they have just been joining in hatred of?
What many ppl don't realize is that medical providers are humans first. They may like to be viewed as heroes or gods but they all possess in them the ability to do good or bad. The medical community itself fosters the atmosphere for those who choose to do harm to be protected as it is their belief as evidenced by several articles I have posted from doctors that they are taught to protect their peers. There also seems to be an inherent belief by the medical community that a patient within their care is someone they own so to speak. Many do not acknowledge the owner of the body is the patient who therefore is the one who chooses what happens to their body, who touches their body, etc.
Biker, I do firmly believe the personal convictions of many female medical workers carryover into how they deliver healthcare to male patients. Females are supposed to be nurturing, kind, etc. but when it comes to male patients especially the older ones, this doesn't hold true. I think it is because for so long women felt like they were abused during medical care they are now giving back medical retribution.
JR, how do you judge the behavior and expressed feeling of nurses working hours over the complex management of multiple COVID patients during their long work shifts, many of those patients dying "in the arms", not arms of the patient's family, but in the arms of the patient's attending nurses? What personal "benefit" (of one sort or another) is given to their daily experience? Is all the videos of these nurses we see on TV news a political concoction? ..Maurice.
Dr. B.,
Hopefully, those pics are just not publicity shots. Those patients are dying without their families because their families have been forbidden to be there or they would be. I hope the nurses are actually doing their jobs correctly and with humanity. Some of them are but some aren't I am sure judging by many of the past stories of patient harm I have come across during the few years I have been involved in patient rights. I have not said all nurses are bad but have said there is no way to tell who is bad or who is good before the harm is done. There are no families present to see everything that goes on. There is that old saying while the big cats are away the rats will play which I hope is not the case but rather the exception but there is no true way of knowing because everything is behind a closed wall and the only glimpses we are allowed are the ones they want us to see. Also, those who take jobs in the medical community should already be aware there is death that happens. It is part of the job just like the birth of baby or new life happens. I think more abt the dying patient having no family present and I think more abt the harm of the family not being able to be with the dying person. Where's all the sympathy for all the other workers in world who do their jobs, put in long hours but seem to get no appreciation? Since the torture of my husband, I have little sympathy for nurses as I have no way of telling which of them are monsters.
JR, would you agree that nurses and even physicians who spend their working hours attending to sick COVID-19 patients even wearing masks or masks and shields are putting themselves and later their family members when they return home at a risk to this fatal disease. What could possibly be a motivation for them to accept and participate in this potentially dangerous and emotionally challenging work? It is very hard to believe that something beyond humanism and devotion to save a life and begin to restore the life of each patient they attend.
I can understand why one could have mixed feelings about nurse motivations in common routine clinical situations such as you and others here have described. But it is hard for me to suspect personal sexual or other non-medical motivations within the mind of those nurses or physicians which we see and hear on these TV news videos.
..Maurice.
Dr. Bernstein,
Your description of passing a needle through the abdominal wall to puncture the balloon sounds painful. I hope you had some good anesthesia for that.
Biker,
In thinking about the night in question, I don't know for sure what her motivations were. At my age, with age spots, wrinkles, belly fat, and gray hair, I am not exactly the hot physical male specimen I was once was. So I doubt she was expecting to see some eye candy. She put the towel over me to absorb what ever leaked out when she had to remove the saline line and poke in the plunger. She could have laid the towel over my gown and then lifted the gown from underneath that, which she subsequently did in future irrigations. For that first one I was in extreme bladder pain and just wanted to get relief as soon as possible. No sooner had she left the room after I was rolled into it, I was on the call button within 30 seconds voicing my extreme condition. Maybe she at first thought I was just some PITA whiney patient. But once she saw the volume that came out she realized I wasn't playing around. You may have a point that she might not have been advised of the abuse history at that time. The exposure was only momentary, so she just may have been trying to get in there as fast as she could to relieve my pain. Who knows? She does for sure. I just think the bladder irrigation should have been held off until until the means to irrigate was in place. I can see testing the CBI in the ER, but turn it off until upstairs.
The bladder irrigation occurs very fast. The output line is a clear tube about 3/8 inch diameter. So you can see what's going through it, clots and all. It's a fast trickle when cleared, but let it clot off and there is no fluid coming through. That first night was a long sleepless night. I clotted frequently and had to be plunged often. So I saw a lot of Angela that night. I have learned that if one is pleasant and not any trouble, people will just treat you better. Common sense really. As a police officer, I was always more caring and respectful of people who were respectful to me. As a patient I strive to be as pleasant as I can, not kiss ass, but pleasant. Most of my caregivers reciprocate. In my law enforcement career, I have had the full range of interrogation and interview techniques. I have a knack for getting to know people. It's mostly a habit now. People appreciate when someone shows interest in them. So in my many conversations with Angela that first night, I got to know her very well, and I convinced her that I am really a very nice guy.
After that first night was about to end, Angela told me that my day nurse was a guy. He was a real interesting black man, but his competence left much to be desired. I had to show him how to do the plunging. Fortunately, he only had to plunge me once. The bleeding had stopped by this point. Angela was back the second night and since I was in no need of plunging, I saw very little of her. I did hear her give report outside my room to the oncoming shift nurse and she mentioned my abuse past. That second day my nurse was a hispanic male. I was discharged during that shift, Halloween Day.
58flyer
I don't remember the name of the African American male nurse I was assigned with the morning of October 30th. He came into my room and introduced himself as my caregiver for the day. He was really smart and in those first 30 minutes, with my talent for getting people to talk about themselves, told me all about his life. Then he disappeared for the next 4 hours. I pushed the call button when it was apparent that I had clogged up. He came in and I had to tell him how to plunge out the clot, educated as I was by my night nurse. After that my bleeding had stopped.
About mid-afternoon the on call Urologist from my doctor's office paid me a visit. He knocked before coming in and introducing himself. A much older man than me or my Urologist, we discussed many issues. He questioned why I had a CT done in the ER when the presence of a Foley would not allow the CT to discover the reason for my bleeding. I complained to him about the 5 hour wait which he noted on my visit report. He stood by for about 20 minutes watching for any change in the color of my urine in the Foley bag. There was none. He recommended that the next day the Foley should be stopped and removed and see what would come out of the bag. If I was clear, then go home. If not, another cath (ouch) and go from there, and stay over for more irrigation. Towards the end of his visit, he (a male like me) asked if he could take a look. I agreed, he then lifted the gown and looked things over. He saw that the valve arrangement on the patch was wrong and corrected it. The visit ended and he left.
That night Angela came in and relieved my male nurse. I was actually happy to see her. Since my wife had stopped by and brought clean clothing and some books, I was in good spirits. I saw little of Angela that night, but I slept really well. Since I usually shower every day, I was feeling rather grungey. I contemplated advising Angela that I wanted to shower, but I also wanted to be left alone to do that. I decided to wait 1 more day as my wife had brought me some flushable wipes, so I could clean up. It was that morning I overheard Angela reporting to the follow on shift my abuse past. She came into the room to say good bye, and as it was likely that I would go home before she returned, I thanked her for her time with me. That brought tears to her eyes. I asked her to drop her mask as I had not seen her without it. She did and I sensed a really caring person.
The relief nurse was a male. He was much more competent. He was from Puerto Rico. No plunging was required on his shift. I was nervous as the on call Urologist was female. I sensed that she would be removing my Foley. My mind was in a swirl as I awaited her visit.
Continued,
58flyer
Dr. B., it could also be said the same of many different career choices that they put themselves in harm's way every day. Police, firefighters, road construction crews, soldiers, trash collectors, etc. do it daily. In today's world, other service industry workers besides medical workers do it and take the chance of bringing back the germ to their families. Grocery store clerks, food service workers, IT techs, etc. but yet only medical workers are thought to be "special" when all are just doing their jobs knowing the risks. So many others are out of work so they are indeed lucky to still have jobs. And you are correct, not all medical workers have "sexual or other non-medical motivations" on their minds but again tell me the magic formula to extract the bad from the good. Do you have an answer for that that guarantees there will not ever be another night full of psychos? No, I didn't think you would and for that reason, I stand behind my line of thought that I view each and every one as being bad until that prove otherwise. No more believing in good only to be severely harmed. This seems to be a thought process that can only be understood by those who have suffered severe harm by the medical community. It changes the way the medical harm victim and their family thinks forever. You can compare it to back in the day when no one worried abt locking their doors especially when home but when crime started an uptick, people started locking their doors. It is not because everyone is a criminal and is coming to rob their house but because there is enough crime out there to justify the precaution. What I do and preach is a cautionary tale of not blindly trusting because look how it turned out. No, they did not directly kill him but they literally destroyed the person he was before they decided to harm him that night.
Also, it could be said of many why do they go into a job that is challenging and dangerous? The answer is because that is what they choose to do. I wouldn't drive cars at 200mph but some do. I wouldn't work as a high-rise construction worker but some do. Maybe it is hard for you to believe but today many kids especially those who go into nursing go in it for the money. They start out in 1st or 2nd grade saying they want to help ppl but over the years that changes into going into to it for the money. Some even say they like the power of the job. I have heard that many, many times having been in a school system for over 20 years helping young people get that little extra "push" they need just to complete school.
58Flyer, the thinnest of needles was used to enter the abdomen and bladder, the entry into the abdomen was via a simple local anesthetic to the spot of entry.. and most interesting, I and the radiologist could easily watch the procedure via large screen CAT scam. The process was benign but effective and the only clinical outcome was extensive bleeding into the urine from the bladder trauma but that was spontaneously terminated and no replacement blood was necessary. The catheter quickly removed from the bladder after the balloon was puncture was indeed fully encrusted with stones externally and confirmed why the balloon could not be made to collapse as needed for catheter exchange. No problems in the past year with the twice a day 10 minute 30cc instillation of magnesium solution into the bladder.
Male urology is a potentially complicated specialty with potentials for enlarged prostate, bladder stones, bleeding tendencies and need for intermittent or chronic urethral catheter presence. Every patient will be clinically different. And, on top of that, is the psychologic issues some patients carry with them regarding the gender and assumed motivations of those doctors, nurses or techs attending. I enjoyed internal medicine as my profession with the role of understanding my patient, helping to make a diagnosis and provide therapy to the extent of my knowledge and skills and leave the rest (but with my attention) to my referred consultants. ..Maurice.
JR, the difference between the COVID clinical staff and the other "first responders et al" is the intimate clinical relationship with each COVID patient, the potential for greater personal clinical risk to themselves and family associated with intimacy and duration of exposure to the established COVID patient. To be on a nursing shift with perhaps more than one patient dying in your presence is something those other service workers during a pandemic will never experience. Much difference. ..Maurice.
JR. If you're referring to me ( in part ) to calling nurses super heroes, I'm not. I was praising the RETIRED nurses for stepping up to the plate in a time of crisis. THOSE nurses. As a healthcare worker I know that a large number of nurses are sociopaths.
Today I heard on the TV news that more people died of Covid today than any other cause.
One poster here once criticized people for naming nurses as the most trusted professions. I think it was an off the top of the head response myself. Or maybe they meant trust as an action and not a feeling. If somebody goes to a hospital they are trusting the nurses to take care of them. They aren't possibly trusting them emotionally. They just don't have any choice. Or very little anyway.
58flyer, had you pursued taking a shower I imagine they would have allowed you do it w/o an observer standing guard. My understanding is observers are their for patients that either need assistance or that are otherwise a fall risk. The reason you were there would not have tagged you as a fall risk and your condition would not have prompted the need for any assistance.
JF, No I was not specifically referring to you but the media and the signs I see at different places. So far, the number of COVID deaths in the US is still lower than some of the data of patient deaths from medical harm but there is no alarm bells being sounded on this. Wonder why? Not a real mystery because medical $$$$$ talk louder than the screams and cries of harmed patients and their families. One legislature who had a horror of their own abt nurses summed it us best when they said that: "It is assumed nurses are angelic but that is far from the truth."
I have mentioned that for many years in a row, nurses have been named the most trusted profession. You can search for it and read the criteria they used but for me, in general I do not trust them. My trust has been forever broken and now each and every one of them must prove they will do no harm but still I will not let my guard down thinking they will do the right thing. The consequence of drinking the kool-aid is too great.
Dr. B.,
If the pandemic is as bad as it is being said, most nurses are too busy to spend much time getting to know a patient who is medicated and on a ventilator. Yes, they are experiencing deaths more than usual but they chose to take a job that deals with people dying. I also take offense at your term of nurses having "intimate" contact with patients bc you are well aware my husband was a victim of sexual assault by nurses so that term is very offensive to me. If the medical staff is not willing to accept greater risk they should find another job. They know their job has dangers and supposedly medical community has trained for extremely dangerous situations. Not one staff member showed any compassion for my husband when he needed protection in a situation not of his making or choosing--none helped him. Where was the compassion then? I trusted them to help him not harm him. Therefore, I turn a cold shoulder to their situation.
JR, my use of the word "intimacy" was used in the definition "Intimate care is defined as the nursing care that involves psychological, emotional and/or physical closeness" And certainly the word is appropriate for it's use as amply visualized on the news videos regarding professional life within a COVID therapy environment. Holding the hand of a soon to be dead COVID patient is part of the "therapeutic" and emotional part of attending patients with their terminal disease.
I know I have written this previously on this blog thread in the years past. I know much about nursing behaviors from my experience as physician for many, many years. I also know about nursing and nursing behaviors from my wife of many years whose profession was a hospital registered nurse. I trust nurses including the one monthly replacing my urethral catheter.
Yes, I am willing to admit there may be nurses whose emotional goals go beyond beneficent individual patient care. But this behavior is not a common and visible (I have not seen it..only read about it here and, of course, occasional newspaper documentation which has included physicians.)
..Maurice.
Continuing
The female urologist is in the same practice as my regular urologist. They share the same suite at Advanced Urology Institute. Though I was aware of her presence, I had yet to see her at the office. She had the hospital duty on that Saturday morning of Oct 31st. I was sweating her arrival. I contemplated putting on my underwear but didn't. I regret that now. The prior day the on call urologist came in during the early afternoon, about 2 PM. So that's when I was expecting her. I had requested that the staff keep my door shut at all times mostly for privacy, but also because of the noise. The room was a little warm even with the temp set at the lowest setting. I had pushed my bedsheet down to the bottom of the bed and all I had on was the gown, and it went past my knees. The doctor came breezing in at about 1030 without knocking. Tagging along with her was a very young female wearing pink scrubs. As she introduced herself I muted the TV and put on my face mask. No sooner had she introduced herself and as I was putting on the mask, she leaned forward and reached for the gown and started pulling it up! I shoved it back down ripping it out of her hands. She looked startled. I asked "what are you doing?" She said "I need to have a look." So, within seconds of meeting her for the first time in my life she was trying to expose me! (remember, the male male urologist the day before asked first before lifting the gown, and he was a guy like me) I said hold on, and moved my bed to the more upright position. I asked who the second female was. The doctor said she was a nursing student. I then asked the young girl, "what school of nursing do you go to and do you have an ID card." There were a few more testy exchanges between me and the doctor with her wanting to know what my problem was. She was apparently unaware of the past abuse or didn't care. I got her finally to admit that the young girl was a student in her high school health sciences program. I said to the doctor, "you told me she was a nursing student when that was not true. What does that make you?" After a long silence she said she wanted her to stay as a chaperone. I told the doctor that I did not allow females to chaperone females and if she really felt she needed a chaperone my assigned (male) nurse would do just fine. The poor student looked like she was about to cry. I asked her to step outside please and she did. That's when I noticed that the door had been left standing open. I said to the doctor "I know you don't go to the restroom with the door open so why would you try to expose me with the door standing open ?" All I got was a sigh. I offered to press the call button to get my nurse to come in and she said "can I just have a look?" I said "only after you shut the damn door!" She shut it in a huff and I said OK and she lifted the gown for about 3 seconds and put it down. I tried to have a reasonable conversation with her about my concerns but I was never able to complete a single sentence with her interrupting me. Her responses were so condescending. She finally said that I could be discharged with the Foley in place and have it taken out on Monday. She then walked out without so much as a good-bye. My nurse walked in shortly after she left. He said to me "I was standing outside the door listening and she was really pissed about something." I told him the whole story and he was incredulous that she acted that way. He said the high school student looked uneasy. He agreed with me that juvenile females have no business seeing adult male genitalia. I was still cooling down when the doctor suddenly appeared back in my room. I was thinking she was coming back for round 2 when she said she was looking for her lost car keys. What a moron!
Continued...
58flyer
Biker and Dr. Bernstein,
Thanks for your comments.
In regards to COVID-19, read this article on All Nurses:
Hospitals and MDs forcing #nurses to place patients on vents even if they do not meet criteria
Don't tell me it isn't all about money...
And they mentally justify it as "just in case" OR "some care is good, a whole lote of care is better."
-- Banterings
58flyer,
File a complaint with the hospital about a minor child being brought in as part of your care team and introduced as a nursing student. Also, file a complaint with the high school.
This constitutes fraud on the part of the hospital's and high school's liability insurances.
I am sure that your state, like here in Pennsylvania has a law that all providers must have a name tag with their position displayed. Complain about that as well.
This is how you bring about change.
-- Banterings
58flyer, I look forward for the rest of your story & will only offer a couple related comments for now.
Dr. Bernstein, what that female urologist did to 58flyer just walking in, leaving the door open, and lifting his gown w/o asking or even saying what she needed to do speaks to a gross unprofessionalism on her part. That she thought it was OK to not introduce the girl (and I am purposely not saying woman) she brought with her and then lied about what she was carries it to a whole other level. Her not even apologizing for lying to him says everything we need to know about her. This is why so many people don't trust the medical profession. If there is nothing wrong with bringing high school kids in to observe urology exams then they shouldn't be trying to hide the fact that it is what they are doing.
It is certainly possible the urologist was harried and having a bad day that brought out the worst in her. My guess is there is a greater chance that she is one of the new breed of feminists that see men not as equals but rather as the enemy. She is the all-powerful doctor and he is the object mandated to accept however she chooses to treat him.
I have commented in the past that my local hospital allows kids as young as 9th grade be observers in the OR w/o any requirement that informed consent be obtained. They hide behind the stock "student" language buried in the consent forms. Just how common is it for high school kids to be given intimate access to patients? Here in VT you can drop out of high school on your 16th birthday and be working as a licensed LNA a few months later. The county's tech high school has an LNA program for 11th & 12th graders in which students do their clinicals in the hospital (including the OR) as well as in the nursing homes.
58flyer,
Following up on my last comments, I would also contact the District Attorney's office. What the urologist did is paramount to showing a child pornography.
If the girl was 18, then she participated in fraud. Presenting as a licensed medical professional (students are licensed as medical professionals) is a felony in all states.
Furthermore, states afford special protections to senior, institutionalized (hospitalized), disabled, and VULNERABLE individuals. You (assuming your age) qualify for ALL those categories. The fact that this was done by deception constitutes multiple crimes.
There is plenty of evidence between video surveillance and witnesses. What would one expect with someone shadowing a urologist?
I would bet that this girl is a relative of the urologist.
I am sorry, but after being formally diagnosed as an abuse victim with PTSD, I have no mercy for abusive medical practices.
I am the strong one. The one who takes care of everyone else. I get in the fight with 5 guys to protect my friends. I hate that I allowed myself to become a victim. That is something that I am dealing with as part of my therapy.
I will not allow anyone else to be harmed by such practices either.
How many other patients that day were abused by them both and did NOT speak up, just suffered in silence?
YOU OWE IT TO THOSE PATIENTS TO STOP THE ABUSE!
-- Banterings
Hello 58flyer,
Thank you very, very much for your extended description of your medical experiences. First, I thank you for having the fortitude to stand by your convictions. The "mourning" in silence has to end for all of us, both male and female. Secondly, I thank you for sharing your experiences with us (And, of course, an additional thank you to Dr. Bernstein for hosting this blog). I'm sure that I speak for others when I say that reading your experiences emboldens us for any future encounters we might have in a similar setting. I would encourage you to contact Misty at Medical Patient Modesty. I'm sure that she would appreciate publishing your story on her site. Additionally, is there any reason why you can't send this last part of your story to the head of nursing at to the hospital administer? The doctor lied to you within the hospital confines. Others should be informed of this and, for the lack of caring for your dignity. Hopefully, in the future, you will deal solely with your regular urologist and have no more contact with this individual. I wish you well.
Reginald
I wanted encourage everyone to watch this video that I recently completed, Zero Visitor Policy During Coronavirus Pandemic. Sadly, a number of hospitals are starting to implement the zero visitor policy again. This is ridiculous and inhumane. The policy also makes it harder for medical professionals to be as effective because they do not have family members tell them important information such as allergies to certain medications. Also, even the best medical professionals cannot give personalized attention to patients as their own support person. Every patient has the right to a support person with him/her at all times. We all must challenge this horrible policy.
I understand the importance of helping to control spread of COVID-19, but the zero visitor policy is never the answer for any pandemic. The truth is medical professionals are more likely to have COVID than the patient's support person since they are around numerous patients.
Misty
Banterings, if that nurse's "observation" Hospitals and MDs forcing #nurses to place patients on vents even if they do not meet criteria is valid, what she observed was beyond simple malpractice, but for physician or institutional financial benefit, but criminal and she should be brought to court. Just writing to "allnurses" internet is insufficient. Certainly, the author who allegedly has a bachelor of science in nursing should have the nursing practice education to follow through beyond "allnurses". Putting a patient, intubated and on a ventilator just for financial gain as the primary rationale is beyond malpractice but a felony. ..Maurice.
Correction to above "she should be brought to court". I meant "She should bring her observations to court." ..Maurice.
I fully agree with Misty. No doctor or nurse can learn about the views, expectations, more complete background history including medical history and other history that may be pertinent in developing a medical treatment program about which family or close friend can provide. And why can't the patient provide this information? Too sick to talk, too distracted by his or her symptoms or memory is missing. History can be as critical in developing a course of therapy as the patient's pO2. The clinical risks of family members cannot and should not override the clinical information they can provide and the special love (perhaps therapeutic) no nurse holding the patient's hand can provide.
..Maurice.
Maurice,
Hospitals get paid more if patients listed as COVID-19, on ventilators.
Doctors say ventilators are being overused for COVID-19.
A colleague's father died and his death was listed as COVID-19, which meant no wake for his large, Italian family. He pushed for an autopsy and the coroner listed he died "WITH" COVID-19 (NOT from COVID-19). I have seen LTC facility orders that say test all patients until they test positive, then to the COVID ward. I wonder how many false positives?
I realize what the nurse experienced is fraud, but they are only following orders like the SS was in the death camps. Read my research on the subject.
I reference the Stanford Prison Experiment and Milgram experiment(s) on obedience to authority, which explain how this happens.
-- Banterings
Banterings,
Thanks for your comments. I am aware of Pennsylvania law that requires identification of medical personnel, thanks to your posting a link to the law in that state some months ago. Florida does not have such a law. I frequently see doctors office staff with no identification on their person at all, even more so recently with Covid, as if that's an excuse. I have seen recently in the hospital setting personnel not wearing any identification at all. I think you may have a point that the girl may be related to the doctor. She is about 60 years of age, so it is possible that the girl may have been her granddaughter. The doctor was also wearing pink scrubs, though of a different design. I was thinking of just letting the whole thing go, but the more I think about it the more it angers me. I was going to write a letter to the Chief Clinical Officer but I have found I can also email him as well as other management people. This I will certainly do this coming week. Also, on Tuesday this coming week I have a follow up with my urologist and I plan to give him an earful. With her as his colleague, he is position to confront her, if he is inclined to do so.
58flyer
Reginald,
Thanks for your comments. You also make a valid point for thanking Dr. Bernstein for hosting this blog. It gives us patients a place to relate our experiences. Often hearing or reading of the experience of another person allows us to be better prepared when confronted with a similar situation.
In following your suggestion, I will be sending an email to the Chief Clinical Officer at the hospital this coming week. He is a male RN. We will see how it goes.
58flyer
Biker,
Thanks for your commentary. The Governor of my state has signed off on some recent legislation regarding medical laws, one of those relating to non-consented pelvic exams. His name is DeSantis and you can Google and find some of the legislation he has been involved with. My plan is to meet with my State Rep and maybe introduce a patient protection act which would address things like underage students and consent and many of the issues which we have discussed here. I also want to confront the chaperone issue as well as the lack of male assistive staff in urology clinics. I have said many times here that I think legislation will the key to bring about change.
As to the doctor, I don't think she was harried at all, but you might have a point that she might be feminist angry at men.
58flyer
Continuing...,
It took awhile but I was finally discharged 4 hours later. That was Saturday afternoon on October 31st. With the catheter in I was not able to participate in Trick or Treat with my son in the neighborhood. I could not bring myself to go to church Sunday morning either, so my wife and son went without me. Many folks asked about me.
The prior Thursday when my Urologist placed the Foley we decided then that the Foley would come out on Monday Nov 2nd and an appointment was made at that time. I had asked while making the appt that the male tech be available to remove the Foley. It worked out that I still had the appointment so I was able to keep it. When I arrived at the clinic a female medical assistant called me out of the waiting room. While walking me to the room she said that the male tech was already there for me. They remembered! Sure enough, Eric, the gregarious and funny Puerto Rican surg tech, was already waiting for me. The Cath came out and I was done with it! I cautiously watched for more bleeding but there was none. There hasn't been any bleeding since. I have been careful about avoiding any medications that would thin the blood. So far so good.
This past Thursday I went to the Urology clinic for a blood draw for a PSA. On Tuesday I will go back for an appt with my Urologist. I think we will have much to talk about, especially about his colleague.
58flyer
I received a Comment via e-mail from a reader of this blog thread who had not presented a pseudonym but wanted the Comment published so
here is the view of "anonymous". I know it may be inconsistent with many of the views expressed here but that is fulfilling the title of this blog "Discussion". ..Maurice.
What makes the 2020 Pandemic of Covid-19 a very unique experience in the United States is the manipulation of the population by those at power, which probably is unprecedented historically. Therefore, going forward with more meaningful directives from a new administration perhaps the curve can be better flattened. However, since there will still be a substantial portion of the public which is in denial of the risks and harm of this disease, what should happen to those who put themselves at risk due to their stubbornness and brainwashed condition? Surely they cannot be compared to someone who simply was ignorant of the facts since the CDC and other organizations have made the facts about the transmission and effects of this disease widely available.
58flyer, thank you for sharing your hospitalization saga. The female urologist was the primary downside which is in sharp contrast to the professional manner in which the male doctor and others interacted with you.
I understand completely bringing it up with your doctor at your upcoming visit but I'd tread softly so as not to get fired as a patient again. Maybe you let him ask first. I say this because you can pursue this through the hospital instead.
Her trying to sneak a high school kid into a patient exam by misrepresenting her as being in nursing school has liability written all over it, and it is not the kind of thing the risk mgt people want to be hearing. That she then made it worse by upgrading the girls' status from "shadow" to being an active part of your care team in the capacity of chaperone will really get their attention. You can be absolutely positive that girl is not on the payroll of the hospital or of the urology practice, nor is she certified in anything. Odds are she has not had the hospital's HIPAA training nor has she been trained to function as a chaperone in that hospital. The moment the doctor said she was there as a chaperone, then that was her status even if you asked her to leave. At that moment you weren't asking a fake nursing student to leave but rather the chaperone that the doctor had made part of your care team.
I'd make that girl's presence and her chaperone capacity the primary focus of my complaint. Under no circumstances does the hospital want to be dealing with a licensing authority over their using high school kids as chaperones.
Dr. Bernstein, on the posting from the anonymous person that you did, the person himself/herself is politicizing the pandemic. Governors & mayors are all doing their own thing w/o regard for any direction from the CDC. Using your home itself, LA County, closing outdoor dining is not based on any directive or recommendation from the CDC, especially when it is deemed OK to do outdoor dining if it is associated with the film industry. Either outdoor dining is safe or it isn't. The science behind saying it depends upon who wants to do it is likely a matter of campaign contributions, not scientific studies. It has nothing to do with the federal govt or the CDC, and it won't change when the occupant of the White House changes. States and cities are operating on their own authority based on the whims of the local politicians. Yes the CDC is providing guidance on certain matters, but they aren't directing the absurdities that we have seen and continue to see.
It wasn't the CDC that made NY's chief scientist Gov. Cuomo send infected patients into nursing homes. It wasn't the CDC that said it was safe to buy food indoors at grocery stores in my State last spring but unsafe to buy food outdoors at farmer's markets. As I said in a recent post, you could write a book listing the absurdities of non-science based mandates made at state and local levels. I'm still waiting to hear why it was unsafe for the property mgt company to come sweep the sand and gravel back into the road last spring using equipment they already own but safe for me to go to an equipment rental company (an essential business don't you know) and do it myself. They tell us maintaining 6' social distancing is safe but a couple guys splitting up my 1,600' of frontage on a dirt road in the countryside is unsafe? I'm not a scientist but I'm not seeing how this made sense.
Every level of govt. has failed us. Every level of public health has failed us.
58flyer,
In your emails and discussion with your urologist, take a friendly approach (like a Dutch Uncle), and politely remind him that the practice's/facility's liability insurances probably doesn't cover their people when consent is not valid (introduced as a nursing student instead of a high school student), or high school students (minors).
This is also a HIPAA violation (consent not "INFORMED"). There is also the moral issue (a public relations nightmare) of having a high school student look at the genitals of adults. Most of the pelvic exam laws also reference intimate exams for men, so this may violate state law as well.
Do NOT forget to contact the school either. Again, as a concerned citizen bring up the liability insurance and the PR nightmare. You may reference that some may consider this abusive to the child.
Some may say that this was not school sponsored, but the minute that she was introduced as a student and she confirmed high school, the school was attached.
I am saying take this position as a concerned citizen or Dutch uncle, not to threaten legal action (unless you feel that is necessary. Bringing up the issues of insurance and PR will ensure that your complaint is taken seriously and not swept under the rug.
Finally, I want to personally thank you for standing up for ME! When you stand up for yourself, you are standing up for all patients who have been abused and all future patients. You have shown more concern for me (in your actions) then any other provider has ever shown me (I make my fear and abuse known). The best I ever got was "that's awful" or "that's not right." Never a what can I do to make your experience of my care better?
You are part of the solution.
Maurice,
As to the politicization of the pandemic, this is nothing new.
Those who cannot remember the past are condemned to repeat it. -- George Santayana
Protesting During A Pandemic Isn’t New: Meet The Anti-Mask League Of 1918
History Lesson: SF Had an Anti-Mask League During the 1918 Flu Pandemic Who Rallied Against Face Masks
The times have changed but the right to freedom remained the same...
-- Banterings
Biker, none of the potential nation-wide infectious diseases (including HIV) since 1918 and this COVID-19 has presented the potentials to fully learn to "govern" a pandemic which is so disastrous. Or, at least, it doesn't appear so. It has been an ongoing public fight between maintaining public civil rights and needs and the public's health and clinical survival. This is the result of both political and medical science inexperience or frank attempts by both to meet political and scientific needs. I hope both the government and science, in all of its parts, learn something from this pandemic because I doubt our country can survive another 1918 and 2019. Or can there be optimism? ..Maurice.
Dr. Bernstein, the sad part is I don't detect much learning going on at least at the political side of this. If the science side is learning they're not speaking up, perhaps because they know it would be career suicide. The politicians haven't even figured out that they need to lead by example. Rest assured come Christmas and New Years there will be another whole batch of politicians caught doing what they told the rest of us not to do.
I do question the aspect of this pandemic somehow presenting anything that couldn't be anticipated though. Minor details yes but not the big picture. I forget the precise year but I'm thinking about 2006 there was a big pandemic planning push. Lots of money flowed to State and local govt. to do pandemic planning. If Federal & State public health authorities didn't model disease transmission of airborne viruses with varying incubation periods, case acquisition rate, and case fatality rates, what were they planning for? I include State public health here too because some of the high population States have bigger public health depts than most countries.
What did they do with all that money that we get to 2020 and State public health authorities didn't even know how many working respirators are in their States? How is it possible that it came as a surprise to anyone that just-in-time supply chains would quickly fail in the face of a global pandemic? Why is it a surprise to anyone that little of the PPE and pharmaceuticals we use come from domestic sources? That ramping up production doesn't happen the instant you say it needs to happen? That it takes time for ships to cross the Pacific? How did they not know federal emergency stockpiles were sized for regional events, not national? I knew that and I'm a nobody. How could they have not known to focus on disease transmission (PPE, disinfection protocols, HVAC systems, social distancing & density of people in given spaces etc) rather than go down the road of essential vs non-essential instead? And even then essential came to include what politicians thought was important rather than truly essential. Liquor stores are essential? Really?
Ah! It's all about the basis of our Constitution: FREEDOM. But as the legal profession has shown us in their incarcerations of misbehaving citizens, there are limits and perhaps limits should be set and carried out in pandemics of our country.
But those pandemic based limits should not be ignored by our government and while there is uncertain absolute therapy for those sick with COVID-19 there are governmental prophylaxsis measures which can be carried out by our government:
$$$$$ to those needy. A medicine which should not be ignored. ..Maurice.
Hello 58flyer,
I was appaled by your story. What happened to you is horrible. Please do follow up with the hospital. This sort of things has to be stopped.
I would have gone a step further and refused to let that female Urologist see me. When you stop and think about it, what useful information could be derived from observing external genitalia if the bleeding and clotting came from inside the bladder? Makes little sense to me.
Also, and I am not sure if you have considered it but I would mention to your regular Urologist that, in light of the events your were subjected to, you feel like you cannot bring yourself to trust this doctor and that you wish she never cares for you again.
I hope your actions will rattle some cages.
Dany
Biker, I have thought about the matter of being fired again as a patient by my doctor. I do plan to take it easy when I see him next week. Your points are well taken. Thanks...
Banterings, thanks for the kind words and valuable input. I plan to write yours and Bikers talking points down on a pad so I will remember to cover the many good points brought up. Good idea to contact the school too. I wonder what their policy of kids shadowing doctors with adult patients is. No doubt they will find it interesting that the student went from a fake nursing student to a chaperone.
I will let you all know what kind of response I get.
58flyer
Right after this urology experience, I was scheduled for a colonoscopy. It occurred on November 11th. I was 4 years overdue. I am happy to report that the experience was very positive, everyone involved in my procedure was very professional and concerned for my well being.
The previous colonoscopy was not conducted very well. That's no doubt the reason I held off for the latest one. I won't go into that experience here since I probably related it elsewhere.
Upon meeting the doctor I advised him of the abuse history and he was very concerned. I told him of my need to wear the Prime Pacific procedure shorts. I told him what they were and described them. He said that would be no problem. He assured me that he does the scope and my front would never be exposed. On the day of the procedure everyone was exceptionally nice and seemed to be aware of the past abuse. All the nursing staff I encountered constantly reassured me that I would be well cared for and if I had any concerns they would be happy to hear me out. They were unaware of the procedure shorts and I showed them to my prep nurse and she said she had never seen anything like that but thought they were a great idea. The prep nurse gave me all the privacy I needed and I put on the shorts while undressing. The rest of the staff, the nurse anesthetist, the procedure nurse, and the recovery nurse were all exceptional. I never felt threatened or uncomfortable with them. When I awoke in recovery the shorts were still on me. After dressing I met with the doctor and I learned that he had removed 3 polyps. Later they were determined to precancerous and I will therefore have to have a colonoscopy every 5 years. The staff was interested in the procedure shorts and asked where to buy them. I hope they make them available to all their patients in the future. I gave them a good review on Press Gainey and again emphasized the value of the procedure shorts.
The only not so good thing was the consent. The Governor of my state signed into law measures to protect women from unconsented pelvic exams. So I was asked to sign a form consenting to a pelvic exam with students. I explained that I was not a female and could not consent to a pelvic exam since I do not have female anatomy. I also explained that students were out of the question. After talking to the clinical manager, they allowed me to cross out pelvic exam and write in colonoscopy. I also lined through consent to student presence. I think it's because medical practices are not sure how to deal with the new law. Just google Florida DeSantis medical pelvic exams and you can find plenty of reference to what I am talking about.
58flyer
Hello 58flyer,
I'd like to ditto A. Banterings THANK YOU re your urology "exam". Additionally, I commend you for the colonoscopy pants use and the education of the staff re their use. Maybe those in health care will learn that there are other more dignified approaches available to medical care.
Reginald
Hello Dr. Bernstein,
Regarding the anonymous post stating, "what should happen to those who put themselves at risk due to their stubbornness and brainwashed condition?", I offer the following: walking the plank, the firing squad, burning at the stake or drawing and quartering. In light of the vacillations by ALL of the medical community re the virus, these methods seem most appropriate. How dare anyone be stubborn in the face of SETTLED SCIENCE! Oh wait! Are all the inconsistencies, mentioned by Biker, settled science? Of course it's settled science. It's settled because I said it's settled. And I'll burn down anyone's city who says it isn't. I'm part of the woke generation. They have their science and, I have mine. They have their truth and, I have mine. I cancel them all in an instant. After all, isn't everything relative? Ok. I've answered that question. I'd like to ask my question. By whom were these dastardly individuals "brainwashed"? Oh my oh me. Let me guess. They've been brainwashed by the ... the President. Yes. We've found the evil behind all this. It's not the Wuhan virus. It's the Washington virus. I could go one but, I'm boring myself. I think I'll go find a free joint. I do live in the enlightened state of CA.
Dlaniger (Opps! I hit the ganja too soon. It's Reginwald. I mean Reginald.)
Maurice,
I thought about your (somewhat) snarky comment: "Ah! It's all about the basis of our Constitution: FREEDOM."
It made me reflect upon if freedom was the issue or the means. I think that people losing their businesses and homes use this legal loophole to get what they really need.
Just as I say malpractice is a means of extracting justice (punitive) for dignity violations. If a patient's dignity is violated and they cannot get justice for that, mentally they get (punitive) justice for a malpractice (with merit).
So what are public health officials, politicians, doctors and nurses (pleading for people to wear masks) doing wrong?
They are NOT practicing trauma informed care with the pandemic. They are violating one of the most important tenants of trauma informed care: they are telling, NOT asking and NOT asking permission.
Dr. Jerome Adams, the US Surgeon General saw this when he warned of rebellion over mask mandates.
The pandemic (and handling of it) has caused many people trauma: loss of job, home, business, family, friends, freedom, normality, etc. Then there are those of us traumatized by providers, so we don't trust healthcare professionals to begin with. Then then are those harmed by government: BLM was a prime example of that this year.
Just like me (and others here), we elect to drop out of the system.
As providers say we are professionals and we see providers' hypocrisy, we see the hypocrisy of our leaders who say stay at home then have dinner at the French Laundry.
Biden will be no better. He will flaunt winning the election and take credit for the vaccine. What he should do, is acknowledge that there were election irregularities that may have been orchestrated by rogue individuals, acknowledge that the quick production of the vaccine was due to the Trump administration, and lay out his plan to continue to get the vaccine out.
Instead he is going to focus on his ego and legacy. That is going to further alienate and traumatize half the country. Wait until you see the backlash over his national mask mandate.
Instead of practicing trauma informed care, putting people first, providers see a means to seize the paternalistic power with mask mandates. They are gambling at a losing game all the goodwill they have created in the pandemic.
-- Banterings
But Banterings, we have nothing, nothing to offer to potentially slow the spread of the CORONA virus but masks, social distancing, hand-washing and limitation of public or private gatherings. We have no medication to gulp down and give us prompt protection if the we are in a life-situation where the virus is there, hanging and waiting to be inhaled and settled comfortably within a human body. Sure, we can simply look to the asymptomatic "healthy" and let the infected but with symptoms go ahead and die. Let those with the symptomatic infection die and the asymptomatic folks alive, let them live. Here is an unacceptance of that future philosophy of infection management by the Editors of the Los Angeles Times.
How effective distribution and public acceptability of a vaccine will change the philosophy of "let the infected die--less people around to challenge the efficacy of the vaccine" may continue on. ..Maurice.
Here is a
"current article in NPR which describes the current development of record number of medical school applications. And one motivation "Fauchi effect". Any complaints? ..Maurice.
Just what we need are more arrogant doctors who haven't a clue what they are doing so they make up for it with plenty of arrogance.
JR, in all these years of my teaching first and second year medical students and with their personal relationship with the patients they interviewed and examined, I never found the students to demonstrate arrogance toward their patient. However, I agree with a comment published in Kevin MD from an established physician:
"the emotional and mental health of the provider-in-training should be the top priority of medical schools, teaching students calming techniques to de-stress, positive coping mechanisms, as well as time management and juggling work-life balances that foster healthy families. The emphasis should not be in getting the best grades to acquire entry to top residency programs. Instead, the emphasis should be on becoming a compassionate as well as a competent physician." It is this part which is emphasized in formal education sessions in the first and second years..but it may well be that this emphasis is missing in years 3 and 4 and into residency. I will try to find out more about this area of potential deficiency by writing to the medical education listserv to which I subscribe and write. ..Maurice.
Dr. Bernstein, just speaking for myself, I am fine with masks, social distancing, and washing hands because I can understand how those actions might help slow the spread. Given my wife's sepsis-compromised immune system we try to be careful with our exposure.
My primary issue has been with the nonsensical essential vs non-essential, and even then the uneven application. Again, either it is safe to do outdoor dining or it isn't. Unless you are doing it in LA County where the virus has apparently learned to differentiate between film crews and the general public.
Of course those people who can't engage in the very risky activity of eating outdoors can go over to LAX instead and get crammed into an airplane on account that's safe, and then fly to someplace safer than LA. The examples are endless and here we are 10 months into it w/o any change in their approach.
Here is what I wrote and published in a medical education listserv. ..Maurice.
Teaching "Compassion" as Well As "Competence"
-------
A physician writing to Kevin MD website demonstrated her concern
about medical students and residents missing significant professional
preparation in interaction with their patients; "the emotional and mental health of the provider-in-training should be the top priority of medical schools, teaching students calming techniques to de-stress, positive coping mechanisms, as well as time management and juggling work-life balances that foster healthy families. The emphasis should not be in getting the best grades to acquire entry to top residency programs. Instead, the emphasis should be on becoming a compassionate as well as a competent physician."
My understanding, from my experience in teaching, is that I don't know if what she writes is a deficiency in medical school and residency training experience particularly beyond the first two years of medical school.
Does everyone here feel comfortable with the extent of the "non-technical" aspects of becoming a physician is adequately taught all along the way, certainly in the first 2 years but.. I mean to emphasize also in those latter years? ..Maurice.
One final thought on 58flyer's saga. I doubt you could find a male urologist anywhere in the US that would enter a female patient's room with a high school boy and proceed to try to expose her, and then expect her to agree to let the boy watch her exam in a chaperone capacity. This simply would not occur anywhere anytime. It is unthinkable. Yet that female urologist with her high school girl thought it was OK simply on account of it being a male patient.
Reginald,
Thanks for your comments.
Biker,
I didn't get a chance today to send the email to the hospital, but I will tomorrow. I think I will include your point about the male student example.
58flyer
Was that your wife that her doctor exposed her in front of his 6 year old granddaughter? That was bad to. Treating patients like slabs of meat.
Maurice,
Your response was typical of the follow the science crowd in your response of let all the old and sick die...
We do have things that improve outcomes, HCQ + zinc, Quercetin, Vitamin C, and Vitamin D (among other things).
Read My COVID Cocktail (links to the science provided).
You also validate my point: WE DON"T KNOW. Yet, the best guess is being pawned off as science. Healthcare providers have a hubris about them because of their (supposed) learned profession and they think that the rest of society are simpletons.
With what I do professionally, I have been taught how to go into any facility and assess and recommend the appropriate PPE; and that includes industrial, medical, laboratory, and nuclear.
Doctors and nurses are NOT trained to assess this, their training is in this situation use this. I do not think that ANY medical education has taught them to fashion their own masks and wear them for ANY situation. Yet, this is shoved down our throats as science (the same way pelvic exams were).
Americans are amazing people and will step up when asked (and even when not asked). Just look at how the American people stepped up for providers during the pandemic: fashioning PPE, bringing them food, showing appreciation, etc.
When things are forced upon the American people, it becomes suspect. Asking is another form of checks and balances, ask the people to wear masks and they will, ask them to be implanted with micro chips and they will refuse.
Power corrupts; absolute power corrupts absolutely.
Freedom must be absolute. Just look at the issue of explicit consent of intimate medical exams on anesthetized patients.
The profession of medicine justifies this and it still occurs!!!
So just think what our elected officials can possibly do if be begin to give up freedoms.
As to the Fauci effect, the people applying for medical education today did not experience a time when HIV was a death sentence, when Dr. Ruth said "always wear a condom," have too look things up in a library book, etc. This is why the STI rate is on the rise. (Many 20-somethings don't use condoms for sex.) They also don't remember Fauci killing 30,000+ HIV patients by refusing to publish interim guidance on the use of Bactrim.
They are also unaware of Fauci's financial ties to AIDS research and he has not disclosed his financial relationship to Gilead Sciences or any other pharmaceutical company despite repeated calls to.
Given his position and unique power over the Remdesevir clinical trials, I believe it is Fauci's responsibility to also disclose this information. Without doing so provides for conflict of interest between NIAID, NIH, and Gilead Sciences, the antiviral developer of Remdesevir Fauci is touting. Nine of the experts on the NIH COVID-19 Panel recommending treatment options have disclosed financial support from Gilead Sciences
The Fauci effect would be akin to praising Dr. Josef Mengele for an uptick medical applications in Brazil.
-- Banterings
More politicizing of COVID-19
Rebekah Jones, the Florida data scientist who built the state's COVID-19 dashboard and who claimed to have been fired for refusing to manipulate data, was subject to an armed police raid. (Tallahassee Democrat)
Is this science (manipulation and intimidation)?
-- Banterings
JF, yes it was my wife earlier this year when she was hospitalized with kidney stone induced sepsis that the urologist brought his 6 year old granddaughter with him when he did rounds on a Saturday morning. That visit didn't include any kind of intimate exam but it was still grossly unprofessional.
Of course it was his week long delay in dealing with her kidney stone that allowed the sepsis infection that almost killed her to set in. It may be 1.5 hours minimum to drive to NH but if I have any say in the matter I will not go to the local ER for anything urological or potentially urological related so long as he is there, nor do I want to deal with the female urologist they hired to replace him (retirement pending).
Biker. I misunderstood that she wasn't intimately exposed. That was extremely bad about that female doctor trying to expose 58flyer in front of that female high school student. It was also extremely bad about the door being left open. And it's true that a male doctor wouldn't likely treat a female patient that way. What would/has been done however is pelvic exams with the foot end of the exam table facing the door and the door unlocked. Then a small child opens the door before anyone can stop him. The steps that are taken to prove that medical workers aren't being abusive are abusive ( very much so )
Although this is from earlier this year, it is an excellent article.
Let’s Say it Plainly: Pelvic Exams Without Consent Are Rape
But really, the fact that we need a law at all is troubling. It means that women’s bodies are up for grabs unless we say otherwise — that we have to proactively ask not to be penetrated, that the default assumption is that consent is irrelevant unless a law says otherwise.
This is why the “no means no” model of sexual consent has never been enough; it presupposes that women are open to sex or penetration unless otherwise stated. That’s the reason most sexual assault experts now consider “yes means yes” the gold standard of consent — it’s the idea that the absence of a “no” is not enough; to fully consent there must be the presence of a “yes.”
This article goes further with modern thinking.
-- Banterings
Here is an article that has a map of the country showing the 15 states that prohibit unconsented pelvic exams and 8 States where there is proposed legislation. It does seem that the tide has turned on this issue. I wonder if these States also prohibit unconsented prostate exams.
https://www.epsteinprogram.com/pelvic-exams
I am sad to not see my State amongst the ones that has taken or is taking action.
I want to present here a general issue which stimulated me which I read on a clinical ethics listserv. It led me to consider the issue about whether employers had or should have a public health responsibility to require their employees, particularly those who interact with patients or closely with the public to accept being vaccinated with the COVID-19 vaccine or, if one their refusal being removed from their occupation. Is the employer responsible for the health of their employees and to the public who are exposed to those employees? ..Maurice.
I'll let you know if I'm required to get vaccinated. I've been wondering the same thing.
I had my follow-up appointment with my urologist today. My PSA is 2.6. The doctor is very happy with that. My BPH symptoms are nonexistent. As I reported everything to my doctor he seemed pleased that everything is working out well for me. Taking Biker's advice I waited to see what he brought up about the other 2 doctors who had hospital duty during the time I was there. My doctor is a real multitasker, he is busy entering data into the EMR while carrying on a conversation. As he appeared to be done with the data entry, I revealed to him that I had the misfortune to have met Dr. G, the female urologist in the practice. He stopped cold and looked at me and said "misfortune?" So, I told him the story, starting with the highly professional conduct of the male doctor on the day before to contrast with the opposite conduct of Dr G. Once I went through relating the whole story that I have already related here, he just said " I am so sorry, I told both of them about your past abuse history." Then I was even more incredulous that Dr. G would act that way knowing of the abuse past. I asked my doctor if she may have misinterpreted what my situation was. Of course, that would be pure speculation, so I asked if he intended to talk to her. He basically said that they are all employees of the clinic and he had no real authority to confront her. He said he would think of a way to get her to justify her actions or just maybe report her to the bosses. I had to be careful, I don't want to be fired again. I did not discuss my intention to contact the hospital or the high school where the juvenile female attended.
We concluded on a positive note, I thanked him for all he had done for me. I am back to normal with the BPH issue and we will watch the PSA going forward. My next appointment is scheduled for June 2021.
When I got home I sat down and sent an email to the Chief Clinical Officer. I detailed everything. I haven't heard back yet but it's early. We will see what happens in the coming days.
58flyer
58flyer, are you reporting to us that you are now free of urologic symptoms: normal urine flow and no need for urethral catheter, no blood in the urine or symptoms of urinary tract infection. If so, that's great!! Stay that way and stick to the urologist with whom yoo feel comfortable. Thanks for your personal clinical (good and bad) experiences.
May the good experiences continue. ..Maurice.
Technical Note: In about 10 more postings, I am going to close down Volume 114 for further comments and move on to a Volume 115. I don't want this blog system to suddenly, without informing me, prevent us to Volume posting as it did in Volume 113 when the number postings went into the 200s. I hope this plan satisfies our visitors. ..Maurice.
Another legal-ethical question which was raised by the clinical-ethics lisserv to which I subscribe: Should all patients entering the hospital who have not been recently previously tested for COVID be legally compelled to be tested? Would that be Constitutional under that specific circumstance? In general, should COVID testing be not personally voluntary but be considered a legal requirement, symptomatic or not? ..Maurice.
I don't know the legal aspects of employer-mandated vaccinations, but I think it would be only fair that any employer that mandates it as a condition of employment must assume all liability for adverse reactions, short term or long term, that the employee might experience. They shouldn't be able to hide behind "it was FDA approved" or some such because all medicines and vaccines have some degree of warnings and by mandating vaccination the employer is practicing medicine in that regard even if they hired licensed staff to administer it.
My employer used to annually offer flu shots and on occasion also offered shingles shots and pneumovax shots, all on a voluntary basis for employees and their families. Visiting Nurses would come to give the shots and we always had to sign off on a waiver. In the case of a mandated vaccination it would seem that any waiver would not be deemed voluntary and perhaps not legally binding. Consent under duress is not consent.
This would be especially so in the current situation when despite their best efforts testing these new vaccines, the process was rushed and they likely don't know yet enough about allergic or other reactions that certain classes of people might have.
At this point I plan on taking the shot but not early on in case people start having unexpected reactions.
On mandated vaccinations for entry into hospitals, that concept would quickly morph into mandatory vaccinations for entry into all manner of public transportation and public spaces. Again, who is assuming liability for forced vaccinations? perhaps more importantly, why mandate this vaccination but not vaccinations for other communicable diseases, especially when by any historic measure this is an extremely mild pandemic? In a severe pandemic there would be hundreds of millions dead worldwide by now, including tens of millions in the US.
Biker,
Unfortunately the states make this a license violation to be taken up by state boards and not a criminal assault/battery crime.
Of course, one can assert that since the state has a specific requirement for consent, that failure then would constitute a criminal assault/battery crime.
-- Banterings
I HAVE DECIDED TO MOVE AHEAD TODAY DECEMBER 10 2020 TO CONTINUE THE DISCUSSION HERE ON VOLUME 115 OF "Preserving Patient Dignity (Formerly Patient Modesty).
Here is the link: https://bioethicsdiscussion.blogspot.com/2020/12/preserving-patient-dignity-formerly.html. NO FURTHER COMMENTS ON VOLUME 114. ..Maurice.
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