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)
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Let's get started on Volume 116 with this video from YouTube.
It's about 4 minutes or so in length but clearly shows a potentially upsetting relationship between a patient and his physician and physician's office. On completion of the story, consider whose dignity has been preserved and which has been degraded. If degraded, then tell us: by whom? ..Maurice. P.S.- You can click again when the first video is completed to see more patient-doctor relationship issues as presented on YouTube.
TIME TO MOVE ON TO VOLUME 117 https://bioethicsdiscussion.blogspot.com/2021/02/preserving-patient-dignity-formerly.html. I HAVE COPIED MY LAST POSTING REGARDING "HEALTH CARE BLOG" ARTICLE TO START THE NEW VOLUME AND WE CAN CONTINUE THE DISCUSSION THERE. ..Maurice.
Moderator's Note Regarding Participation Here: I really am thankful for the continued participation and issue insight presented to us by a small series of contributors of their views on the various aspects of preserving patient dignity. However, I know that there are a number of visitors who come to this topic without expressing their opinions as Comments. I encourage them to "join the conversation" and present their views to the rest of us. You can sign on anonymously but use a persistent pseudonym. Again, I thank those who have persistently participated in presenting their acquired information and views here. You are keeping these Volumes "going" and providing us views worthy of considering or debating. But I hope visitors who have "something to say" on the various aspects presented here will put their views in "words which we can read" on this blog thread. If anyone wants to reach me by e-mail (and contents will not be published without the writer's permission), my address is doktormo@aol.com
Both doctor and patient were polite, but the doctor didn't seem to understand that perhaps a patient wouldn't want to be left waiting for a couple hours w/o anyone telling him anything, nor even the doctor offering a perfunctory "sorry" for being late followed by explaining he had an emergency situation that had to be tended. I see it as not much different than staff thinking they've been respectful if they're polite while they needlessly expose patients.
A year or so ago I had a routine appt. with my primary care. Upon arrival I was told she was running about 45 minutes late. I said no problem, I can entertain myself, thank you for letting me know. It ended up being a couple hour delay but a couple times along the way a medical asst. came out to the waiting area to keep me informed & apologizing. I said no need to apologize, I appreciate you keeping me informed. When I finally got in to see the PA, she was stressed over whatever went on that day and apologized for being so late, and again I said nothing to apologize for, it is good you spent time with whatever patient needed it. So in summary, something happened that seriously disrupted the schedule, they recognized I was kept waiting and communicated with me appropriately. I in turn graciously accepted the situation at face value.
Biker, you know.. I interpret the delay in a scheduled patient appointment without prompt patient disclosure and presenting the patient alternate options except "just wait" is not attending to the patient as a "subject" but as an office "object". Biker. I am also pleased that the office was sufficiently keeping you informed about the delay and later the PA'a recognition of her responsibility to you in this matter.
In this and all other responsibilities of the medical system "perfunctory 'sorry'" is often not sufficient. ..Maurice.
Dr. Bernstein, another example from last year occurred to me. This was my annual cystoscopy visit where I always say I want a male nurse when making the appt. and then again when I check in.
Last year I found myself waiting well past my appt. time and nobody was saying anything, but being observant I never saw a male nurse coming to the waiting area for any patients while I was waiting. Finally he came for me and when we got to the room he apologized for the delay. I gave him the standard "no problem, I'm glad you spent time with whoever needed it more, someday perhaps I'll be that patient." He was so relieved and pleased to see I wasn't upset that he said, he appreciated my comments, that people rarely are that understanding.
In this instance I suspect the delay was because he was the only male nurse and that he was tied up elsewhere, and that they didn't want to tell me a male nurse wasn't available when I checked in. Coming back to the conversation this week about hidden records, I suspect it was the coding of my records that precluded anyone suggesting I just go with a female nurse for my prep. Now of course this interfered with the doctor's schedule too but he came in as if nothing had happened at all.
May I make a suggestion to our participants here. After you have finished expressing your opinion regarding the opening YouTube doctor-patient video, proceed to look at the other doctor-patient interaction short videos presented in this section of YouTube, provide us with the link so that we all can go and look and think and also write your view here about how you interpret the video you selected. My scanning of YouTube on this general topic can provide a source for discussion of what the various scenarios are trying to tell us. ..Maurice.
I watched some of the videos that you recommended. Their common theme seemed to be "How to deal with the difficult patient". However, nowhere in the videos was "difficult patient" defined. Nevertheless, from the videos, one could intimate that a difficult patient was one who was agitated, emotional, angry or non-compliant. Unless I'm grossly mistaken, all of the videos seemed to concentrate on "diffusing" the situation via empathy or communication skills. Again, correct me if I'm wrong, there was no mention of conflict resolution. No mention was made of resolving a situation in which the patient asked for a change of protocol (the main thrust of our blog – changing dignity/ modesty protocols). Most of the videos mentioned that the doctors should "know your boundaries". That is, know what you (the doctor) are willing to tolerate from the patient before the patient is ultimately asked to seek another physician. All the videos seemed to indicate that doctors should be empathic, listening, etc. in an effort to ultimately get to the physical part of the office encounter.
In the video you presented above, the doctor indicated disappointment and regret re Joe's wait. There was no mention of changing protocol so that Joe might be periodically informed re his (Joe's) wait time. Furthermore, Joe indicated that he owed the receptionist an apology. Why? From the video, Joe seemed to merely ask the receptionist re the wait time. No mention was made of Joe upbraiding the receptionist. Joe's "venting" seemed to be with the doctor. The apology should have been to the doctor. Moreover, the doctor should have mentioned that he would be certain to change protocol so that patients would be periodically informed re delays. This apology and protocol change would have indicated a mutual respect for doctor and patient. As the video ends, one might summarize the doctor's statements as "see it from my perspective". Isn't that what many bloggers are deploring – the doctor's perspective is always paramount?
I found this worthy YouTube video in the series of YouTube medical video presentations regarding the professional behaviors with a hospital setting (example bad followed by example proper) at this address:
https://www.youtube.com/watch?v=r842Ylpa-nQ
I am absolutely sure that amongst the numbers of bad hospital professional behavior you may find some which fits with your personal or family member experience. But I think you will find that the examples of "proper" professional behavior immediately supports the dignity of the patient, family member or visitor involved. I am sure that the examples of "improper" professional behavior portrayed will bring "that's what happened to us" recall to JR and the others who write on this thread. Very worthy video.
Note for each video in the series, there is the date of presentation and the number of visitors who approve/disapprove of the presentation. I wonder what the statistical distribution between the two is set by hospital professionals who watch the videos and agree with each segment's "proper" examples. ..Maurice.
My thanks to Misty for providing this link https://www.lansingstatejournal.com/story/news/2020/12/29/sparrow-hospital-covid-patient-visitors-policy/4071841001/ to an article in the Dec. 29 2020 news article which describes a Michigan hospital who is permitting family members to visit their COVID hospitalized patient. I think more hospitals, who are able provide the appropriate precautions as described in the article should also consider the presence of a family member within the patient's room. This permission may provide the ill patient an additional therapeutic agent. Again, thanks Misty. ..Maurice.
Hello Dr. Bernstein, After watching the primary video you provided, I came away frustrated by the patient-doctor interaction. Although the doctor appeared to be deferential to the patient as he tried to understand and then explain the cause of the problem, as the patient, I would have been annoyed with the doctor's manipulating approach. As Biker's experiences implied, a patient will be much more forgiving if the doctor would just cut to the chase and apologize for the delay, rather than taking minutes to suss out all the patient's various feelings. My advice to doctors would be: "read the room" and go straight to the apology/problem-solving part rather than conduct a lengthy psychoanalysis of the patient's demeanor. Just my two cents. KB
KB, your "two cents", is worthy of at least a "dollar". Thanks and welcome to this blog thread.
May I ask you to disclose your gender since disclosure to the viewers of this blog thread gender of potential patients and medical care workers seems to be of discussion importance. However, regardless of your gender, it does seem to me that a succinct resolution of the "waiting, waiting patient's complaint and personal concerns is more of immediate value than a delay directed toward the physician's personal excuse which can be detailed, if necessary, later. So.. an apology and immediate handing over the bottle of pills (the reason for the visit) would be more appropriate than "psychoanalysis of the patient's demeanor". ...Maurice.
I want you all to know that I have been re-thinking about what I wrote to KB when I said to KB "May I ask you to disclose your gender" and defended the request with "May I ask you since disclosure to the viewers of this blog thread, gender of potential patients and medical care workers seems to be of discussion importance." I should now ask our readers "or does it?" Does it matter whether the writer to this blog thread assumed the at birth gender or later another gender in terms of expressing a view of how patients should be treated in terms of preserving the patient's inherent dignity? ..Maurice.
Dr. Bernstein, I don't feel a need to know the gender of a poster. We all share a common goal of receiving healthcare in a dignified and respectful manner.
And yet, Biker, what has been written here in the past suggests that female patients have, in these days, become "winners" with regard to the way they are treated generally properly by medical professionals (except for the news worthy presented "misbehavior or worse" of male physicians to women( such as here at University of Southern California.) Misty, am I wrong in this assumption? Could there be a "patient gender bias" with regard to which gender is "suffering more"? ..Maurice.
Thank you for the URL to the video re patient hospital experience. I noted that the video was posted in Nov 2013. I'm wondering why, in 2021, 7 yrs after the video posting we're still discussing patient indignities, especially since over one and a half individuals have viewed the video. Do you have any ideas why this "problem" of disrespectful treatment hasn't been resolved? Are we to believe that hospital personnel slow learners?
JF, excellent question. The medical rationale for having the patient present for being presented with a refill of the medication is for a necessary physical examination, along with check for side-effects to verify the need or safety for continuing the medication. None of this was present in the scenario as presented. There was no sign of such clinical motivation for that visit. ..Maurice.
p.s.- JF, what is your view, understanding the goal of this blog thread (preservation of patient dignity) as to whether the gender of the pseudonym commenter is important to be disclosed. As you see from above, unlike you and JR whose gender is "out in the open" is it really proper and functional for a visitor entering into a discussion here to disclose their gender if not apparent from their narratives?
Dr. Bernstein, yes the day to day experience for women in the healthcare system is markedly different than for men if for no other reason due to non-phyisican staffing being overwhelmingly female. By default and often by plan the non-physician staff for intimate exposure matters for women is almost always female. Female patients also benefit from the societal norm that calls for female privacy to be protected while perpetuating the mantra that privacy and modesty don't matter for male patients. This does not mean that women aren't also subject to indignities but rather that the odds are far greater that male patients will have their modesty and privacy ignored, mocked, or bullied.
That healthcare is female-centric does not mean that the solutions and discussions must be segregated or identified by gender. I very much welcome anyone to the discussion without regard for their gender.
Both male and female patients are violated. Men have a harder time finding an urology practice that can accommodate their wishes for an all-male team (both male doctor and male nurse) while it is easier for a woman to find an all-female ob/gyn practice where she can be guaranteed that she would only have female medical personnel present for her gynecological procedures in office. There are hundreds of all-female ob/gyn practices in America while there are almost no all-male urology clinics in America.
I feel both male and female surgery patients are vulnerable if they are under anesthesia because the hospital often assigns the surgical team and they often do not think about the sex of the medical personnel even for surgeries that may involve patients’ private parts. Men do have a harder time getting an all-same sex surgical team than women at some hospitals that do not employ enough male nurses.
I believe in some cases men have a harder time communicating with their doctors because some doctors take men less seriously than women. This doctor in the video sounds arrogant and I am not sure if he would be different with a female patient.
Misty, I agree that men and women are on comparable ground in OR scenarios, and to a degree in the ER as well. For most men however, the majority of their healthcare experience of an intimate nature is not in the OR or ER. Even when they have a male doctor, men are likely to have at least one female present for vasectomies, testicular ultrasounds, cystoscopies, urodynamic studies, prostate biopsies, prostate cancer treatment, bed baths, showering assistance, catheterizations, full skin exams and so forth.
Oh, oh..the upcoming "21 Century Cures Act" is disturbing some doctors as patient gain full access to the physicians' notes and writings about that patient. Read the details of the Act itself which will take effect in April 2021.
And then there is the issue of patient, not only having access and record to what the physician writes but also what the physician and others vocalize and do by taping and visual recording. Here is MDedge Internal Medicine current article on this patient power.
Now, let's discuss what patient's will legally now have with this power to redesign medical system behavior and identify misbehavior. ..Maurice.
Biker: I think all urology practices should actively hire male nurses. I think they should go to the local nursing home and offer the male nursing student a job. This would help a lot. I also believe that all hospitals should have male nurses available at all times to do intimate procedures on male patients such as urinary catheterizations.
Dr. Bernstein: I like the idea of patients being able to record conversations with doctors. I am sure that some won't like this because it will open the doors for some law suits. But I believe every patient has the right to record his/her conversation with medical professionals.
I wanted to share with you all that there is an article about Modesty in medical settings - Wikipedia. I find it interesting the web site for Medical Patient Modesty is mentioned at the end of the article.
I found this fact interesting: In 1816, male physician René Laennec invented the stethoscope as a way to respect the modesty of a female patient, as it would have been awkward for him to put his ear on her chest.
Based on my research, medical professionals seemed to be more sensitive to patient modesty in the early 1800s and before. I know that over 40 years ago, that male doctors and orderlies did intimate procedures on male patients. I am thankful that modern medicine has brought many improvements that have saved people’s lives, but I wish they had stayed with strict patient modesty rules.
Misty, congratulations on being recognized by Wikipedia and your good work.
The urology practice where I go is large. 11 physicians (8 male, 3 female), a female PA, female NP, and 10 Residents (6 male, 4 female), 2 each year for a 5 year program. As best I know there is only one male RN. I get assigned him each time and as I noted recently last year's appt. was delayed I think because this male RN was probably requested by someone else that conflicted with my appt. However this is one more male RN than most urology practices have. I am unaware of what their use is of medical assistants, scribes or other non-physician staff but I haven't seen any other male staff.
My prior urology practice at a large hospital in Boston never had any male non-physician staff, so switching to this one was a big step forward.
It is frustrating that so many urology practices do not recognize how important male nurses and assistants are. About 75% of urology patients are males.
I am not sure who submitted Medical Patient Modesty's web site to Wikipedia. But I am glad that there is some information there about history of medicine and patient modesty.
It is so heartbreaking that a number of hospitals in America have reinstated the no visitor policy. Most hospitals in Western North Carolina currently have this no visitor policy. I have heard horror stories of patients suffering. At one hospital, the nurses are so overworked that they cannot devote much time to patients at all and they barely have time to call family members to update.
I agree that COVID-19 is serious and we must do whatever we can to control spread of COVID-19, but the no visitor policy is not the answer. I believe that each support person should follow strict infection control measures such as wearing required masks and temperature checks.
I wanted to encourage everyone to read this excellent article by an ICU nurse in California, Nurse: Despite coronavirus pandemic, hospital patients need their loved ones at their side. I agree with this nurse. She has many excellent insights. She shared that even the most experienced RNs can make medical mistakes and how loved ones often double check medications and dosing.
No Visitor policies at hospitals open the doors for more patient modesty violation cases and sexual abuse since patients have no one to advocate for them. Also, the fact that more nurses will be overworked will open the doors for them to not take patient modesty concerns seriously. A family member helps the nursing staff in many ways. Many husbands prefer that their wives help them with personal care. This No Visitor policy even prohibit spouses from being present.
Misty, as has been discussed here at various times, urologists staff their offices for the comfort of that 25% of the patients that are female. They know female patients would speak up directly or vote with their feet if forced to endure male staff for intimate exposure procedures. The entire healthcare industry knows that most men will just quietly accept being embarrassed and will quickly become compliant if subjected to "you don't have anything I haven't seen" mocking or bullying type statements.
Another reality is comparatively few men seek non-physician careers in healthcare. Even for those doctors brave enough to hire male staff, the pool of applicants simply does not include very many men. My understanding is that male nurses are often concentrated in OR & ER roles and rarely seek work in outpatient office practices. More money & excitement, and greater cultural acceptance.
Given the greater convenience of female-only staffing, few urologists are going to be proactive in seeking male staff for the comfort of their male patients for as long as male staff continue to quietly accept the status quo.
Misty I agree that there needs to be family present for sick or injured patients at the hospitals. The other thing that I'm thinking might seem a little off the wall. There needs to be more ventalators manufacturered. And buildings other than hospitals used for Covid patients. And people trained and hired to attend to the patients that aren't doctors or nurses. I know that currently that's probably illegal. Then vote that legality away. I don't mean just any #!$@ hole should be hired, but with doctors and nursing staff being pushed beyond their strength, what else can be done?
JF, I am just presenting my suggestion under current changes within the United States: the philosophy and actions of a new United States Presidential administration with regard to the specific issues you mentioned. I have hope. ..Maurice.
And then, of course, is the issue "Should Anti-Maskers Refuse COVID-19 Treatment if They Become Ill?" You will find your own answer if you read the Sept 14 2020 article in Medscape: https://www.medscape.com/viewarticle/937362#vp_3
Biker, you are spot on with the staff gender issue in Urology practices. One of my best friends brother was a Urologist, I say was because he is now retired. When I met him some years ago I discussed with him the problem we men face with an all female assistive staff in Urology clinics and other places.
He quite openly agreed with me. The practice he was involved with was in Atlanta, GA. As most here know Atlanta is a large metroplex. The practice had a male side and a female side. If a male patient arrived he signed in and went to the male waiting room. It had male decor and men's interest magazines (Fishing, Hunting, Guns, Sports) and so on. If a female patient came in she went to the female side with feminine decor and women's interest magazines (Good Housekeeping, Ladies Home Journal) and so on. All assistive staff on the men's side was male, medical assistants and nurses. On the women's side, all female. The assistive medical staff did not cross to the other side. Additionally, the non-clinical staff was restricted to the office area and did not go into the clinical areas during business hours. Given the big city availability of personnel choice and the presence of several small community colleges, they had no problem attracting appropriate personnel to the hiring role. Most of the country is not like that however.
The problem men face today in most of the USA is severalfold. First is that the medical staff is not involved with the hiring decisions. That is done by the corporate staff. Most, if not all of the staff are employees, including physicians. That's the problem that I had with my last Urology practice. Patients needs are not known to the hiring staff. Secondly, there is the perception that female ancillary staff can work with both male and female patients, but male staff is limited to male only patients . Thirdly, men don't communicate well when it comes to emotional concerns.
So in most of America the problem for men is basically this: As men age, their need for Urology services increases. Therefore they present for Urolologic care in increasing numbers. This is good because it means more BUSINESS. Another problem for men is ....women. Not blaming anything on women but they have a need for Urologic care too. Women have a need for OB-GYN services. Men do not...it is strictly for women. You see no men competing for OB-GYN care. But women constitute about 25% of Urolologic care. In my past experience I have seen many women in the same waiting room as me. It comes down to the issue of liability. Men never (or rarely) complain about sexual abuse, but women do so more often. Easy solution: all female ancillary staff. When men face the female staff they are forced to shut up and put up, or go elsewhere, or delay care. Most Urology practices are smug in their belief that the male patient who walks out today will be back when he is chronic or stage 4. And that's what is really sad. His life could have been saved had he presented for treatment sooner. This is what my Urologist brother of a friend told me. Again, this is why men don't go to the doctor.
It all comes down to MONEY. As long as the waiting room is full, there is no need to change anything.
I've said it before here and I will say it again, it will take LEGISLATION to fix the problem faced with the practice of Urology. At least at the state level, but most appropriately at the national level. MANDATE that any Urology practice have gender appropriate personnel sufficient to care for all male patients who come into that practice. Even more, ALL medical care that men face should have gender concordant staff.
58flyer . You said that it would need to be MANDATED at the national level . Those idiots in Washington can't get anything right . Using your Atlanta Urology clinic . Which side would our new Assistant Health Secretary use ? That clinic sounds like one of a kind . So glad there are places like that . I personally would travel to a place like that even though it was a thousand miles away . I won't hold my breath waiting for the perverts in Washington to help . AL
58Flyer, I fully agree with your above analysis and advice even though I am perfectly satisfied with the female assistant nurse who monthly changes my urethral catheter. Of course, you may say, she knows I am a physician but her behavior is exactly what I would expect occurs with non-medical profession patients. ..Maurice.
AL, the Washington perverts in medical care are gone from the Biden medical professional staff. He announced such ignorance and misbehavior under the prior Administration would lead to immediate firing. The current news of the misbehavior of those in charge regarding the production and distribution of COVID vaccines is an example of what will not be tolerated in the new federal administration. Your pessimism may end up not warranted. ..Maurice.
Dr. Bernstein, there may be a new administration in DC but it will not represent any change from the last when it comes to mandating anything that improves care for male patients. Women's groups simply would not tolerate it. Disadvantages are to be remedied. Advantages are to be maintained. That is the state of modern day feminism. 58flyer may be right that it will take legislation, but culturally it just is not feasible at present. This is especially so when men are reluctant to speak up. Silence is taken as acceptance of the status quo.
Maurice . You miss the whole point of my post . There have been numerous perverts in Washington from both parties . Need examples . LBJ used to run around naked on Air Force One with media present . Joe Biden used to swim naked in the WH pool while female guards were present . Good old Hunter was banging his dead brothers wife before the ground had settled on his grave . Joe and Jill thought that was just fine . They said they were so glad they found each other. I guess I have a different set of morals than most people . My brothers wife is off limits . Period . I don't find any of the above to be morally right . I have zero faith that they will do something right in regards to the modesty issue . Don't forget old Anthony wiener with his below the belt pictures . Are these the people we really want making up rules about modesty issue's ? AL
So the "Washington perverts in medical care are gone"? Really, are you so naive or have you drank too much blue kool-aid? Of course, they are still there bc there is really no change except to worsen. Biden tolerates his own habit of feeling up little girls as well as his son's habits (just news for this as there are plenty of pics). My husband was medically and sexually assaulted by a group of your progressive nurses/doctors so perverts are alive and well within your political party. As a matter of fact, they exist in all political parties as well in all walks of life. However, positions of power and control are more likely to attract them which politics and medicine both fit that definition. Of note, your YouTube videos do not at all pertain to what happened to my husband bc his situation was not an "oops" but rather intentional acts of harm. The only thing that will address that is jail time and to lose their license(s).
On the not addressing the medical needs of those not wearing masks, we have been through this before. Should the treatment ban also not extend to those involved in wrecks where speeding or drinking caused their injuries? What about those who smoke? Should the medical provider also let them go untreated? Why even bring this up again? Are you assuming only Trump supporters are the only ones not wearing masks so therefore like many in the Dem party, they deserve to die. I live close to a major liberal university which looking at those on campus including those so enlightened professors, I am not seeing them wearing masks. Would this thought also apply to them?
And this is how medical patients get mistreated and abused. It is because close-minded people who believe they are superior also believe they have total right of power and control. They believe their philosophy is the only one that matters and the patient must abide by what happens to them. Sexual assault--no problem except if it would happen to a nurse in a parking lot. Then and only then would it be wrong. Forcing someone to have something done to their body if they are a patient, no problem except if at the local mall a store clerk decided you needed triple piercings rather than the single one.
As for AL's pessimism, it will end up to be very warranted as the new Resident Biden has made it clear the common person who didn't vote for him is not a priority but even though he has called us names and such, we should unite. As long as we agree with him, we will be fine otherwise....or as AOC said we should basically disappear from earth which also they may do as the do control the healthcare system. As HRC said, "Control the healthcare, control the people" and they the swamp part of government has controlled healthcare for many years which does explain why there is so much patient harm happening. There is no hope.
You are delusional about the new administration. The states had almost 9 months to get a plan to distribute the COVID vaccine. The federal government does not have jurisdiction in the states for certain matters. That is why only the national guard (under the direction of the governor) are deployed and not federal troops (unless protecting ONLY a federal institution).
Healthcare, medicine, public health are all the domains of the state the federal government did its job; it got ventilators and PPE produced as well of creating multiple vaccines at "warp speed" AND they were all sent to the states.
As for our new Assistant Health Secretary, she is a disgrace to the Great State of Pennsylvania. My friend, a transwoman says that she is a disgrace to all transgender people as well.
I proudly stood on the steps of our state capital with my friend (the transwoman), with rifles slung over our shoulders, protesting for the rights of the citizens of Pennsylvania, the Pennsylvania Constitution, and the US Constitution to be RESPECTED.
The new administration will be worse. Just look at the media bias: How is it the Ayatollah of Iran, who has called for violence against the people of Israel and the United States still maintain his Twitter account, but President Trump's is deleted and he is banned?
Talk about human rights and dignity violations like we discuss on this thread...
As to the new administration, read my post on the Bioethics and Dealing with the COVID-19 Pandemic thread, and what the new administration has to deal with and the consequences of keeping their promise and letting almost 10,000 illegal immigrants from Honduras into our country in the time of COVID.
WOW! National governmental change seems to yield no change to the challenges in the preservation of patient dignity. If that is so, then what is the mechanism all patients of all genders and all politics should take to attempt to meet the goal of this Volume thread title? We need answers to this challenge. ..Maurice.
From a recent Medscape article. If you were the employer of a healthcare worker and the employee refused to take the required COVID-19 vaccine, how would you respond to the following situations?
Is an employer exempt from paying workers' compensation to an employee who refuses to be vaccinated and then contracts the virus while on the job?
Can a prospective employer require COVID-19 vaccination as a pre-condition of employment?
Is it within a patient's rights to receive an answer to the question: Has my healthcare worker been vaccinated against COVID-19?
If a hospital allows employees to refuse vaccination and keep working, and an outbreak occurs, and it is suggested through contact tracing that unvaccinated workers infected patients, will a court hold the hospital liable for patients' damages?
And Mr. or Mrs. Employer, what would be your reaction? ..Maurice.
"Is an employer exempt from paying workers' compensation to an employee who refuses to be vaccinated and then contracts the virus while on the job?"
No, same as employees who violate a corporate safety rule are still entitled to worker's comp if they get hurt on the job. One caveat though is the employee proving that they contracted covid-19 at work is not automatic given they could have contracted it anywhere that they were.
"Can a prospective employer require COVID-19 vaccination as a pre-condition of employment?"
Yes
"Is it within a patient's rights to receive an answer to the question: Has my healthcare worker been vaccinated against COVID-19?"
No. Patients are not entitled to staff health histories. There are endless reasons that a nosy patient might pose in order to get the personal health histories & conditions of the staff. Wanting to know about covid-19 vaccinations may be reasonable on the surface but the general topic is a slippery slope of who gets to determine what is reasonable and to what extent.
"If a hospital allows employees to refuse vaccination and keep working, and an outbreak occurs, and it is suggested through contact tracing that unvaccinated workers infected patients, will a court hold the hospital liable for patients' damages?"
Courts make reasonable and unreasonable determinations so it is anyone's guess what any given court might do. At issue is proving that this employee was the source of the patient's infection. Contact tracing is an imprecise science and relies upon a lot of assumptions. To the extent the infection can survive for a period on a surface, it could have come into the facility via a package delivery rather than an employee for example.
Biker, I took the Moderator's liberty to publish your comment on the blog thread regarding ethics and COVID-19 as your response to the same posting there of mine regarding employees vs COVID immunization.
For those who write here on the topic, you are certainly welcome to copy your post here to the blog topic "Bioethics and Dealing with the the COVID-19 Pandemic" where I had posted this topic yesterday. https://bioethicsdiscussion.blogspot.com/2020/05/bioethics-and-dealing-with-covid-19.html
I want to thank Banterings again for setting up the broader topic to this long series of blog threads with his "Preserving Dignity".
Looking back to a blog thread started July23, 2013 with the title "Extra-Marital Sex: Sex By The Demented in Nursing Homes" the issue of preservation of patient dignity comes face to face with where does patient dignity begin and end. If you click on the above title link, read the introduction and read the Comments you may find some familiar names of our contributors. Read the blog introduction, links and Comments and you may want to write a comment there but also return and write a comment here.
Compared to the recent comments here which seem politically loaded, I find no politics but simply ethics in that topic. ..Maurice.
JF, I look to your experience, which I presume was potentially attending to the patients described in the blog thread. How would you feel if you were aware two demented patients were engaged in a sexual activity seemingly accepted by both? ..Maurice.
Dr B. It has happened at past jobs. One nursing home where I worked at, their families were consulted and both families were OK with it so they were moved into the same room. At my current job one female patient and a male friend would go into her room together. Some of the staff would separate them and the female would get really agitated/enraged. She thought he was her husband. I would leave them alone because of how it was treated at my earlier job. Plus the fact that I believe in patients rights ( so long as they're not bothering other people.
Perhaps, nobody here remembers this news report from November 13 2007 via CBS News: The husband of retired Supreme Court Justice Sandra Day O'Connor has struck up a romance with a woman who is a fellow Alzheimer's patient and lives at the same assisted living center as him, according to a television news report. The retired justice isn't jealous about the relationship and is pleased that her husband is comfortable at the center, the couple's son, Scott O'Connor, told KPNX in Phoenix in a broadcast that aired Thursday.
"Mom was thrilled that dad was relaxed and happy," Scott O'Connor said. An effort by The Associated Press to reach Scott O'Connor on Tuesday morning was unsuccessful.
An official with the assisted living center was quoted as saying people with Alzheimer's need intimacy and sometimes develop romantic attachments with fellow patients.
John O'Connor was diagnosed with Alzheimer's 17 years ago and was sad when he moved into the assisted living center, his son said.
"Forty-eight hours after moving into that new cottage he was a teenager in love," Scott O'Connor said. "He was happy."
The news report showed video footage of John O'Connor holding hands with a woman identified only as "Kay." The retired justice wasn't shown in footage taken at the center.
Though Sandra Day O'Connor, 77, did not appear in the television report, it gave a rare look at the life of the nation's first female justice, USA Today reported. The family's willingness to highlight an aspect of a heart-wrenching illness recalled O'Connor's decision in 1994 to go public with her feelings about breast cancer.
In a speech to the National Coalition for Cancer Survivorship, she spoke about discovering the cancer in 1988 and undergoing a mastectomy, the paper reported.
Scott said, "For Mom to visit when he's happy … visiting with his girlfriend, sitting on the porch swing holding hands," was a relief after a painful period, according to USA Today.
The O'Connors, who have three children, met at Stanford Law School and married in 1952, according to the paper. John O'Connor left a partnership at a Phoenix law firm to come to Washington with his wife in 1981. He worked for D.C. law firms but was limited in his ability to take on matters that could come before the justices.
As her husband's disease became more difficult to handle, O'Connor retired, the paper reports.
Does this acceptance of assisted living centers as noted in this news article and even JF's experience cause any concern from our visitors here regarding personal and patient dignity? ..Maurice.
Do you want another matter of "preservation of patient dignity" to argue over? How about the loss of dignity presented to a patient who was born with a defect at birth which could have been anticipated by the parents prior to fertilization? The dignity is the faith of the patient's parents in preventing a congenital abnormality of the yet to be conceived child.
Here is a current United Kingdom trial on this very subject."Wrongful Life Revisited". In Evie Toombes v. Dr. Philip Mitchell [2020] EWHC 3506 the High Court has given renewed consideration to claims for, so called, “wrongful life”. Can a disabled person ever claim damages on the basis that they would not have been born but for the defendant’s negligence? The Court answered that question with a resounding “yes”.
Doesn't a patient have the right to sue the parents for creating the patient knowing full well that their child will be disabled? ..Maurice.
I wanted to let you all know we have a new video, Assisting Male Patients With Personal Care. Robin Lenart, the executive director of Dignity Resource Council demonstrated how Honor Guard garments can help to protect the dignity of male patients who need assistance with bathing and other personal care in this video.
Robin mentioned Medical Patient Modesty in this video.
Visitors and Contributors, I would like some suggestions regarding the editing of this blog thread "Preserving Patient Dignity".
Though I have been very pleased with the commenters varying approaches and discussions to the issues that mostly I have brought up relating to the blog thread topic, I know that there are much more visitors to this blog thread than contributing participants.
Is there anything I should do or not do as Moderator to stimulate a greater population of writer participants here? For example, am I presenting too many examples which I relate to the blog thread title "dignity"?
I want to emphasize that this request is not to criticize those my relatively short list of contributors but I would like suggestions regarding this thread format and how greater active participation by more visitors would be encouraged. You can write it for publication here or write me privately to doktormo@aol.com ..Maurice.
This past Friday I met with the director of the health sciences program for the high school that the female student (allegedly) attended who was present with the female doctor during my hospital stay which occurred on 10/31/2020. Here we are almost 3 months later, it has taken that long to get the appointment to see that person.
That director is a former nurse. She was pleasant to me and I was to her. She has had no success in locating the alleged female student who took part in the encounter. My suspicion is that the juvenile was not on any program and may well have been a relative of the doctor.
The director said that they have no policy on who rounds with doctors and are just happy that someone will allow a student to do that. She said that good judgement should be used when it comes to what the student sees. I asked if she considered it appropriate that the student was presented as a chaperone. She said that would be grossly inappropriate. I pressed her with the example of how she would feel if a male gynecologist came into her room with a juvenile male and she could only say "I see your point". We talked further and she said that it is apparent that they will have to come up with a policy on what the student takes part in, and that it should not involve exposure of genitalia of any patient of either sex as there is no way to ascertain the maturity level of high school students during the time of adolescence. Of course she agreed that there is no way they could hold a juvenile to HIPAA confidentiality agreements.
While I came away with the feeling that she was sincere, I have no way to verify if anything we discussed would be taken seriously, let alone acted upon.
The Governor of my state (Florida) recently signed into law legislation relating to non consensual pelvic exams and the state legislator behind that action is well known. She is female, but not from my district. I am thinking of meeting with her to further refine the law and giving protection to male patients, particularly as it relates to the sex of chaperones. It should also allow patients to "opt out" of student participation, without being denied care.
Thanks for the update 58flyer. Though you may not have gotten definitive answers, the doctor in question, the practice she is part of, the hospital itself, and the school the girl attended all know that something unprofessional and inappropriate occurred. Some degree of change will occur with all of the above even if you are never told precisely what that is. This is why we must speak up. Any changes you caused by speaking up will benefit many men for years to come. There is a ripple effect.
Assuming the woman at the school was being truthful, the student in question surely was a relative of the doctor, a relative of someone in the doctor's social circle, or the child/grandchild of a local VIP of some sort. Regardless, it still astonishes me that the doctor thought it was OK to lie to you and be intimately exposing male patients to a high school girl. I pity her patients if her regard for patient privacy and dignity is that low.
I assume the girl attended a large high school. Around here it would be unlikely that the staff didn't know who students were related to and who their families were connected to socially.
Thank you for sharing your story and for doing the followups that you did. Let us know if you do get to speak with that state legislator. In a high population state like Florida it might not be easy. State legislators here don't have staff and must answer their own phones, letters, and emails so they're pretty accessible.
CS gave me a copy of the paper she had to sign after this law passed in FL. To tell you the truth, I was not impressed with it.
The paper starts out saying you give permission to receive pelvic exams "performed by my physician or other health care practitioner, any medical student or any student receiving training as a health care practitioner." It goes on to define what a pelvic exam involves for a female patient and for a male patient. In the the end it states, "I consent to receive pelvic examination as described above, and all my questions have been answered to my satisfaction." This entire statement is in caps. There is a signature and date line. There is a place for interpreter and translation services to be noted. What is very glaring in what is missing is any place on the form for the patient to "opt out" of any particular part of the exam. In other words, it has been the experience of myself and many others that what you agree to verbally with the physician does not translate to what actually happens. This means if you state verbally you do not accept medical students and sign the form feeling confident you stipulation has been received, if you are sedated you may have a medical student present because you signed the form saying you accepted them present. Many of us have learned the hard way with devastating consequences that what is said verbally is not adhered to by the medical community. As for the director of the school, you probably did know the identity of the student but would not admit it to you as there are specific laws protecting the identity of students. As with most school systems, I imagine this type of behavior of the physician in charge not caring about what is proper for the student to see or not will continue to happen. In reality, most medical providers basically do not respect the bodily dignity or autonomy of any patient but especially male patients. Most medical providers feel entitled to use the body of any patient in any manner in which they see fit which also includes actions which are in direct violation of basic human rights documents.
Dr. B., There is a recent case in the UK of a mother of a 10 yr old disabled boy killing him bc during the lockdown she couldn't take the 24 hr care he needed. It was in the telegraph.co.uk. She plead to manslaughter charges. Because of the lockdown, he was no longer attending school 5 days a week giving her a break in his care. So what abt the patient dignity of this woman being forced by the govt to give 24 hr care without any help? Should she also be able to sue? What abt all the aborted kids? Shouldn't they be able to bring civil charges resulting in loss of life? Are you proposing like Hitler only the fittest should survive? What abt ppl like me? I don't think I should have to pay to support ppl who intentionally harm themselves or just don't think they have to support themselves? Who can I sue? What you were talking abt is a very slippery slope.
I agree that dignity includes more than just bodily dignity issues. However, I have found that most do not want to discuss medical harm issues as they would rather put their head in the sand until it happens to them or someone they love. I have found most are aware of how badly patients will be treated but accept it as something you have to endure to get medical treatment. I believe in what now is occurring in our society--the cancel culture--many more will be afraid to speak out because they see the power and control those possessing those tools have and will use to destroy those who have opposite views. Freedom is dying as well as free speech. Because patients know they will be vulnerable and entirely dependent on an absolute stranger during medical care, many will not speak out because they can see retribution does exist so therefore they could suffer medical retribution.
JR, here are two major articles by the same author regarding "Unresolved Disrespectful Behavior in Health Care followed by "...Its Impact, Why It Arises and Persists, And How to Address It--Part 2" I think what was written in these two parts of the subject presents the socio-pathology of what you were writing about and is something that should be emphasized to medical student education as a possible socio-pathology (and I am afraid is not currently emphasized) as important as patient clinical pathology which is, of course, the routine subject. ..Maurice.
The law should be "opt in" for patients; unless they are or were a licensed healthcare provider.
I say that because providers tell patients it is acceptable to do this, they are professionals, they have a magic white coat or magic stethoscope, they are gender neutral, etc.
Because of their special training AND because they owe a debt to society (the patients that they learned on, they are assumed to consent.
Those articles drive home exactly my point that if they think they can disrespect one another, why does anyone not acknowledge it is happening to the patient too. In the article, it mentions the medical atmosphere basically fosters this toxic atmosphere. I clearly believe certain patients are selected to become victims of medical bullying. If they cannot prevent medical providers from harming one another, how can we continue to believe patients aren't being harmed too?
I believe my husband was one of the them. I know of some others like CS who was medically bullied which also turned into sexual medical bullying. It is more common than you think or even want to admit. Most patients will not remember it because of the sedation but a few will as sedation affects them differently like it did my husband and CS. Not to mention I personally witnessed some of it too. Their bullying also extended to me and my son. He is still quite angry about how he and I were treated that night along with what was done to his father. For him to harbor such anger when he is a type 1 diabetic & needs ongoing medical interventions is very dangerous for him as he has no trust of them. He sees we no longer have trust in them.
There needs to be a real study like the ones you highlighted only done from the patient's perceptive. I saw a group associated with the NHS is asking for patient harm stories but here in the US, patient harm is a rarely mentioned topic. They don't want to acknowledge any type of harm either accidental or intentional happens which is allowing the harm to grow. Every time a medical provider gets away with patient harm not only emboldens them but it also teaches those around them they too can do the same.
The question is how to interest the right people to conduct a study?
Dr. B., Regarding the case of the disabled person who sued for wrongful life, it is my understanding that the defendant is the doctor who did not adequately inform the mother, and not the parents themselves. I believe that the judge in this case decided correctly that the disabled person has claim to compensation for the malpractice inflicted on her mother. Both the disabled person and her mother suffered the indignity of inadequate attention/counsel by the physician. KB
KB, what exactly is a "wrongful life" as defined by the disabled claimant? And what is a "wrongful birth"? And to whom should the claimant be directing the accusation? Is the parents' physician the "guilty party" or the parents who created or participated in the fertilization or delivery?
With regard to the general topic of "preservation of patient dignity" don't you all think that the patient has the ethical and legal power to make legal accusations with regard to "wrongful birth" or "wrongful life"? ..Maurice.
Following up on the scope of "Patient Dignity" and the individual's "unwanted birth" into his or her life with its personal illnesses or "harms" can be considered an issue of being morally and ethically appropriate for that individual to hold and act on that view. Who is responsible for the consequences of that individual's birth?
Read an interesting short article on this very subject is presented by an article in Quartz.com/ and concluding with this interesting finale "These philosophical arguments may be logical, but they result in extreme conclusions, and seem unlikely to be applied by many potential parents evaluating their life decisions. But, for all those angry teenagers who shout “I never asked to be born!,” their reasoning is surprisingly well supported by philosophers." ..Maurice.
JR, going back to your comments from Tuesday, when Governor De Santis signed the medical consent issue into law, most medical practices were thrown into a tizzy about how to comply. Google it up and you will see what I mean. There is still a lot of questions and the matter is still not resolved.
When I did some of my Urologic procedures I was given a form to sign that simply stated that my procedure would involve the genitalia and rectal areas. The form only asked if I consented to this. It didn't state that students would be involved. For my colonoscopy, it did state that students could be involved which is where we had the issue of me crossing out the student participation. For my Greenlight Laser prostate procedure, there was a student clause and I objected and they crossed it out without argument. For my ER visits the forms were on a tablet that you signed with your finger. There was no way to alter the form and it did state that they are associated with a teaching hospital and students could be involved. I signed it knowing I would be alert and would have objected had there been students. I suspect the tablet signing will become the way of the future, there being no way to alter the form.
That is why I want to approach the legislator involved and get the law to include that any patient could opt out of students, observers, and shadowers without being denied care. They need my permission to treat me, but I shouldn't be required to allow students and observers as the price of receiving treatment. I am a paying customer, between me and the insurance company.
The other big problem I noticed is that they give you the consent form to sign right before the treatment, even though there was a pre-op visit and other forms were signed then. I think this is wrong because it makes patients feel obligated to consent. On the day of your procedure/surgery many arrangements have been made, like with sick leave from your employer, child care arrangements, pre-procedure prep, and so on. You are at a disadvantage when confronted with a consent for student or observer involvement. The consent form could have been presented during the pre-op visit, when the patient is not under the stress and pressure of the treatment. I asked that very question when I have had been presented with consent forms on the day of the procedure. I have never received an acceptable answer.
58flyer, I think they give consent forms just before procedures because they know most people will sign them without even looking at them. Once when my wife was having surgery and they did that to her I asked why. The doctor said they want to make sure the patient had a chance to ask the doctor questions before signing.
Once when I was having a colonoscopy they did that to me after they took my glasses. They were a bit put out when I made them give me back my glasses so that I could read it, and that I in fact read it. Apparently in their world I was supposed to just sign wherever they pointed to on the paper.
For just a routine office visit, the receptionist handed me page 2 of a 2 page consent and expected me to sign it. She was quite put out when I made her give me the 1st page and then stood there and read both pages. She said it just gives us permission to do any procedures and bill your insurance. I replied if that is all it says it wouldn't take 2 pages to say it. She was not happy.
Dr. Bernstein, on the wrongful birth/unwanted birth thing, while I agree that physicians should be liable for demonstrable malpractice that caused a child to be born disabled, going beyond that is akin to the extremes society has taken political correctness. Disabled children have always been born without it being the fault of anyone.
My nephew & his wife had a child born with the most extreme form of muscular dystrophy that died before his first birthday. It turned out both he and his wife were carriers of the gene which gave a 1 in 4 chance of this happening. In theory if they had genetic testing before she got pregnant they'd of known they were carriers and maybe they'd of decided not to have a baby, or if the baby had been genetically tested early in the pregnancy maybe they'd of decided to abort so as to spare the baby the never ending pain of his short life. Is society ready to spend what it takes to prevent this extremely rare event from happening? Is society ready to blame the doctor for not testing for every possible genetic anomaly that might happen? Sometimes bad things happen in life which if expense were no object might be prevented. Where I worked we had heated sidewalks at great expense to keep them ice-free. Should society spend trillions to have all roadways heated so as to avoid winter driving accidents? My point is there are limits to risk mitigation, including in healthcare.
Request a paper copy under your rights granted by the Americans with Disability Act (ADA).
They can print out the form to be signed. I have seen it. I write software, I know that this can be done. Ask for a supervisor.
Right after you sign the form, call a nurse over, have a witness, and tell them to change your consent verbally that you do NOT allow students and asked that it be updated in the EMR.
By law, they have to do this.
I wish that the sheeple will start standing up for themselves.
Banterings, sounds like a good plan. I hope I am never confronted with another ER situation in the future but if I am, I will put your advice into action.
A funny thing happened today. At my family practice place, they had a new doctor hired to replace the prior one. That was my Dermatologist. The male doctor left and a female was hired in his place. The practice called and left a message on my cell phone to call them back. When I did they advised me that they had a new doctor since the prior one was no longer there. My next appointment is scheduled for July and would I agree to the new doctor or be seen by the nurse practitioner, a female. I asked for the sex of the new doctor and was advised she was a woman. I said that would not work as I was not comfortable with a woman since I would be having a complete skin assessment. I then cancelled the July appointment and thanked her for advising me of the change in doctors. She said she understood, of course I had no idea of the qualifications of the person I was talking to.
I got to wondering, is this normal when there is a change of doctors to call patients who are scheduled for an exam to see if they are OK with the replacement doctor? I would think at the least it is a good courtesy. If I had shown up in July and was then surprised by a female doctor when I was expecting a male I most certainly would have cancelled on the spot. Did they anticipate that most everybody would want to know if there is a new doctor or is there something in my records that flagged them that I preferred a male doctor? On my last visit I requested that the doctor be by himself with no assistants or scribe when he came in to examine me.
I wonder if I was flagged because of my earlier request or if they are calling all scheduled patients out of courtesy.
58flyer, I agree with your conclusions. A patient's knowledge about his or her physician is just as important as knowing the benefit limits and clinical hazards of their prescribed medications. If there may be potential physical or emotional problems related to a healthcare provider, it is the responsibility of the healthcare system to accept this as a clinical or even legal issue. A physician "opening the door" into a clinical relationship attending a patient is not the same as a bus driver opening the door for a passenger to simply enter to take a seat and await the service of the driver. Yes, in both cases there are financial costs and even, for the passenger, rarely physical risks but there are ethical, personal and legal differences. ..Maurice.
I don't know if it's okay to post this or not. It doesn't have to do with dignity but it has to do with Covid. I saw on Google that within 6 months 40% of nursing homes could be forced to close down because of the cost of the Covid testing.
JF, when you state "for the cost of COVID testing", do you mean that the nursing homes would have to pay money to have their patients tested or that those patients who tested positive would have to be taken away from the nursing home elsewhere as precaution or to a hospital for treatment and there would be insufficient patient replacement placements for that nursing home. I thought that COVID testing was a free service as it was for me and my family. ..Maurice.
CS also is trying to get in touch with that same legislator. The form she had bothers me as it refers to verbal conversations which most of us know, if there is a difference of opinion the medical provider is almost 100% taken as gospel. There was nowhere on her form to opt out but said you were informed and by signing you agreed. So if you said verbally no students but signed the form as is how would you show you verbally said no students. Medical providers seems to have a nasty habit of leaving out what they don't want in medical records. They are only a record of the medical encounter they think it should be rather than what it really was. The large university teaching hospital here uses the electronic version so in the signature space you must squeeze in what you want to refuse. They try their best to make sure you don't have options.
I have to disagree you cannot have a procedure done without consent as it happened to my husband and a host of others on my Twitter following. Rarely will the law side with a patient over this as the medical community is allowed to falsified and lie their way out of being charged with what really happened and that is medical assault. Lack of consent is a rime that has become legalized. You also should be able to opt out of whatever part of any exam you do not want like if during your physical you do not want the prostate exam you should be able to on the form opt out. There would be less malpractice and feelings of being violated if the medical community would just learn to respect patient dignity such as autonomy and bodily privacy. Patients who feel respected and not harmed are less likely to sue or bad-mouth the medical providers. Why are they unable to learn this?
The nursing homes and assisted living homes have to pay to get patients and staff tested. It always costs $100 plus even tbough it takes less than a minute to swab. WE are being tested twice a week now.
JR, At the recent ER visit with their form signing on a tablet, I signed but verbally told the admissions person that I would not allow students but there was no way to alter the form. I wasn't worried since I was to be alert during the whole process. No students were involved as it turned out. Just me and the male nurse, and the doctor was male also. I agree that there needs to be changes in the law to allow patients to opt out of anything they don't want, such as students and observers. Unfortunately, sometimes you have to experience the bad behaviors to develop your voice. I have been taken advantage of and the perpetrators got away with it. But I learned. I have also had 3 nurses arrested, but I had the advantage of being a police officer, and 2 of them knew that and still acted stupidly. Another occasion I caused an ER nurse to be disciplined and transferred to a floor assignment, and she knew I was a police officer but thought it OK to do me harm. But I digress. In your descriptions of what happened to your husband I find that terrible. In my police training we discussed what to do if called into a medical facility when a patient makes a charge of impropriety. It gets complicated. There are a lot of variables to consider. Some people do make false charges and others are actually harmed. By that time in my life I had already experienced medical harm so I knew it was a reality. As it turned out, I was never called to investigate a case of medical harm to a person other than myself.
58flyer, obviously some of the medical staff who attended you knew you were a police officer. I am surprised, as with physicians as patients or governmental officials or movie stars as patients, you were not given VIP treatment. Perhaps the most essential VIP treatment would simply to be listening to your requests and attending to them so as to provide VIP patient comfort and yet still provide the clinically necessary services. ..Maurice.
58flyer, if it is OK to ask, on what premise would a police dept. arrest a nurse or other healthcare staff member? It seems in the egregious cases discussed here that there are never any legal ramifications for healthcare staff. For example, the Denver 5 voyeurism, Mr. Kirschner out at Olympia Urology, Twana Sparks, that hospital in PA where the staff all barged into the OR to photograph and ogle some guy who apparently had his penis stuck in some fashion, the hospital in Maine where photos of patients were posted in lockers and so forth. It just seems that police never see anything illegal in what healthcare staff do.
From CS: Regarding the FL Pelvic Exam Consent Form, at my most recent exam at a doctor's office, "they" "assume" you just sign. That this new form is another "formality" and not necessarily to be taken seriously. At Cleveland Clinic, and I can furnish a copy of that pelvic consent form, you are consenting "for life," when you sign it. When I went for a pelvic procedure, I crossed out any and all of what I was NOT consenting to, initialed it at each place, then had them make a copy of my amended form right then and there and hand it to me before I actually had the procedure. Mind you, this wasn't surgery, or in a hospital, it was a female Gyn doctor's office and I point blank told them I had been medically raped for my lung cancer surgery and I was NOT consenting to anything other than what I'd written on the form.
On a tablet consent form, I had the administrator alter the wording and had check marked boxes added or deleted before I signed anything. It CAN BE DONE. Sure it's a pain in the neck, and they'll tell you they can't alter anything, they can. You can also have that form printed out, put in your alterations/changes, and have it copied and get a copy immediately. Again, a pain, but stick to your hunches and MAKE them do it. The more people who do it the better for all of us. They do NOT have you between a rock and a hard place, forced to put up with their BS. You can assert your rights. I just did it at a cardiologist's office for an endocardiogram. Female doc insisted I use her male tech. "No, I don't use any male techs for intimate procedures doc." I went to an off site imaging center, insisted on a female tech and had the procedure. Was the original cardio doc piqued? yes. Too bad. "I was medically raped by male techs doc. And I don't use them. They are NOT licensed or certified and when I get raped again everyone will deny it again. So NO, No male techs." After I explained it like that she agreed on different care for me.
The only link to the Cleveland Clinic which discusses "Pelvic Exams Under Anesthesia Are Only for Clinical Indications, According to Cleveland Clinic Care Path".
CS, I couldn't find the actual Cleveland Clinic pelvic exam consent form but if you have a copy to contribute for inspection here, that contribution would be welcome for further discussion. ..Maurice.
Dr Bernstein says, "I am surprised, as with physicians as patients or governmental officials or movie stars as patients, you were not given VIP treatment."
It's a double edged sword. The VIP status can get you privileged care, but at the same time it can cause unwanted attention. After rescuing 6 children (and a dog) from a burning house I was taken to the ER where I worked security as secondary employment. To my right was a nurse who said that as a first responder I should have known the dangers of rushing in and thereby making myself a casualty. On my left was a nurse who argued that had I not taken action and waited for the arrival of the fire department, those 6 kids would not be alive. Their arguing was quite violent with me literally caught in between. It almost came to blows between a cop lover and a cop hater.
I still shake my head at that memory. The cop hater got transferred to the floor.
From Biker, "58flyer, if it is OK to ask, on what premise would a police dept. arrest a nurse or other healthcare staff member? It seems in the egregious cases discussed here that there are never any legal ramifications for healthcare staff."
The short answer, a violation of state law. There has to be something in the books declaring a certain activity a violation of law. It also takes that activity coming to the attention of a law enforcement officer. Some activity, though really egregious by any standard, is not technically a violation, because there is not a law on the books to address it. In the Kirschner case, there may not be a law saying it is illegal to use a patient as a "prop" for initiating a new employee, even though it is a really bad idea. There has to be a law for a police officer to take action, and for someone to even know that it is a violation. As to video voyeurism, many states have enacted laws to address that. Those can be acted upon. As to the Sparks situation, there may not have been a violation of law, but certainly of ethics. As bad as she was, those around her who ignored her conduct were as guilty as she was and should have had any medical licenses revoked.
From Banterings, "Can you write a piece and give some references about what police are taught about patient complaints of impropriety by healthcare providers?"
I can only speak of my training from my own police agency in my own state. Laws vary.
In the sex crimes section of the police academy, we were told that in medical facilities there may be accusations of improprieties from patients regarding their attending staff. Of most concern, oddly enough, was the conduct of male staff with female patients. That involved both nursing homes as well as hospitalized patients. If the accusation was accusatory towards the male staff, and there existed no other factors, like physical evidence, the investigating officer would write a report stating "Information sexual assault" and not make any arrest. The report would be picked up by the sex crimes unit for further investigation. The medical facility would likely separate the accused staff from the accuser. In my personal experience, as stated earlier, I never was assigned such an investigation. Compared to all other crimes, sex crimes are really uncommon. The sex crimes unit of my agency was not very busy, despite being a very large city.
Despite that, we know that sexually inappropriate behaviors are mostly unreported. Sexual violations are hard to talk about for anybody. In my case it was nearly 30 years before I could relate my experience to a therapist.
58flyer et al, ..and then there is the issue of the role of community police practicing within the hospital (ER and wards) and its effect on the hospital staff's professional dignity as well as in certain cases the dignity of the patients themselves.
From July 14 2020 online Scientific American is the emergency room physician's personal experience and discussion writing the article titled "Get Armed Police Out of Emergency Rooms". One case which is noted in the article and I recall, maybe you do too, is "A viral video from 2017 showed Utah nurse Alex Wubbels being assaulted and arrested by Detective Jeff Payne after she refused to draw blood on an unconscious patient."
Medical care and law enforcement can be an ethically complicated relationship. ..Maurice.
Thank you for that information. I advise patients that a uniform officer will be the first to respond and they need to request a detective that deals with sex crimes.
Banterings, Unfortunately I have not seen anything like that for something that specific. As I went through my career, with my own past abuse experience that occurred before I went into law enforcement, I was very attuned to investigations of medical abuse. I found very little. I considered going into sex crimes investigations and I did a brief stint in homicide, but I just couldn't wrap my brain around the idea of being impartial to sex crimes. So, I flew helicopters instead.
Dr. Bernstein, police is ER's is not a patient dignity issue but rather a symbol of urban dysfunction. The article included NYC as one of the examples. NYC has 36,000 police. Adjusted for population, they would only need 2,000 if the police to population ratio was similar to my town. Why do they need 18X more police per unit of population? The article mentions people living in poverty, people unemployed due to the pandemic, and people with mental health issues. We have all that too and yet crime is almost unheard of. Why the difference? Something is fundamentally wrong with urban society. Police w/guns in ER's is just one of the reactions to it.
Dr B Ive been having difficulty getting to this group. in the past I could scroll down from an earlier volume. But anyway I got my first vaccine Tuesday. it wasnt manatory though and a lot of people didnt get it. staff or patients. we'll be getting our second shot in three weeks.
I am shocked somewhat that you are still engaging yourself with this blog. Please, retire from this and enjoy your life, cooking, golf,birdwatching, coffee shops etc. We learned years and years ago that our healthcare industry is managed by the female SS Nazi staff and as such nothing is going to change, at least with this blog. I’m concerned about you! End this blog! You’ve carried mess on your shoulders long enough!
If you are the PT who has wonderfully contributed to this blog Bioethics Discussion over the many, many years this blog has been present, I appreciate your current comment (and I am glad to see that you are still around) and I think it poses an important issue to discuss by the other contributors of their views here. I would sincerely like to know how the others feel about your comments, presumably referring to the entire blog and not just this topic on "patient dignity/modesty."
I want you to know that I am continuing to have numbers of visitors to this entire blog from all over the world. What is most interesting is the recurrent clusters of separate visitors from one geographic area within a period of a few days or so to one specific blog thread topic. These observations suggest that some of the topics originally published years and years ago are being used for highschool or college research discussion challenges.
With regard to the "Preserving Patient Dignity (Formerly Patient Modesty)" maybe, despite published variations in attributed relationships to the main topic has reached an endpoint for further contributions and provide nothing further worthy of value. What do others writing here think of PT's impressive and conclusion? ..Maurice.
I quote what a doctor friend of me said about retirement - "Why should I waste all this knowledge (of 50 yrs)? They're going to carry me out of my practice feet first!" Bravo !!! I would say the same to you. You can enjoy your other retirement activities AND continue moderating the blog. Via this blog you are contributing (in many unrealized ways) to the health (physical, mental, emotional and spiritual) of an extraordinary number of individuals. I applaud you, and ask you to continue your fine work!
Dr B I say do what works best for you. There's a difference between you quitting this.blog and PT quitting. For PT it is a sore spot, the mistreatment that patients are forced to endure ( or don't get care ) For you it's just something you've heard about but never experienced it. And you had a hard time wrapping your head around that abuse and harm was or is occurring.
I do want to repeat to PT who "wonderfully contributed to this blog Bioethics Discussion over the many, many years this blog has been present."
I have a suggestion. Rather than turning off the blog itself with its hundreds of topics.. not only strictly related to "medical practice" but about many other experiences with ethical issues attached and I bet I could find examples where you PT gave us your "two cents" on the topic.
My suggestion to all is the screen some of the "old" blog threads (other than modesty or dignity) worthy of further discussion and then instead of referring our current readership back down to the earlier era when the topic was first published, reignite the topic here at the 2021 top display as a "Volume 2" on the selected topic published years and years ago.. remember this blog started in 2004 on blogspot.com but for a number of years appeared on University of Southern California public website (and a number of topics were moved over to this blog site which I felt were worthy of further input and discussion.)
PT, how about the ethics of gardeners reshaping another biologic creature..trees. For example simply go to https://bioethicsdiscussion.blogspot.com/search?q=tree and scroll down and take a look at all the blog thread presentations regarding the ethics of trees. Well, lets put these other bioethics topic as followups here at the top of blog itself awaiting updated commenting and discussion of 2021. After all, life isn't all about modesty and medical management.. there are still some other aspects worthy of looking at their ethics. ..Maurice.
If there is a bit of consensus by the participants or other readers here, post your suggestions or those who would rather write me e-mail: doktormo@aol.com and I will not identify you but mention here your suggestion. ..Maurice.
Yes, I am the PT who contributed to this blog for many years. If you recall I am the one who researched the issue about mammography and that there were no male mammographers. I got as I recall a lot of hate and flak for that as well as other truths as well as other observations I saw and experienced while working in healthcare. I’m happy to say that despite looking over the last volume here and seeing the word Covid19 which truly has no business being mentioned here, I actually made money during the time this fake plandemic has been in effect. Hospitals and the femme nazi have rejoiced over their FAKE hero status all the while medical facilities have systematically been charging $13,000 for each patient presenting to the ER with symptoms related to Covid WITHOUT actually having COVID and $39,000 for a one time fee for being placed on a ventilator only because their symptoms appear Covid like. If that’s not Medicare fraud I don’t know what is. But, I’m not here to discuss the femme nazi and their double standard roles they invent and implement in healthcare. I’m back and only temporarily to discuss you Maurice, for the reason being that I want you to end this blog. No one on this blog wants change, they like the status quo, as well as the fetish seekers who peek in on here to read this fodder. End this blog, take a stroll up the beach with your sandals in hand. Breath in that ocean air,fabulous isn’t it. The sand carressing your feet, seagulls flying overhead. Look,up ahead a coffee kiosk. You stop,buy yourself an expresso and take a break, resupplying those Cyclic AMP energy in your mitochondria, that’s what coffee does. Exhault in the vastness of the ocean as all the stress of 15 years of this blog just rolls off your shoulders as if, it was never there.
PT, for me, this blog, in its whole, has never been stressful for me. It truly provided me a source of ventilation but also self-education. And it is these two "therapeutic" values which is also a value for others who come here to read and write. And even if some who arrive here only to find "fodder", this finding may be the basis for writing something more tasty and intellectually more nourishing than fodder. ..Maurice. p.s.- Oh..and I never have drunk coffee and yet I have reached 90 years, still with functioning mitochondria.
Dr. Bernstein, you have done far more than could be asked of a person, and it is appreciated. You don't owe anyone anything and are under no obligation to continue your work here. Do what is right for you.
In a healthcare system that seemingly cares little for the inherent dignity of patients, helping people find their voice is a good thing. Modern day feminism and political correctness ensure that the interests of male patients will not even be up for discussion anytime soon on the public square. At the same time the squeaky wheel of individual patients speaking up does at the micro level create some degree of change that benefits those that follow. I doubt that female urologist will try doing to another male patient what she tried doing to 58flyer. I expect that hospital will put into place some controls on student shadows as well. Many will benefit from 58flyer having spoken up, and that is something this forum has given some of us the courage to do.
There is more to bioethics than the miserable medical experiences and residuals described on this blog thread subject. Take this poem for example: Joyce Kilmer has humanized trees in this well known poem “Trees”
I think that I shall never see A poem lovely as a tree, A tree whose hungry mouth is prest Against the earth's sweet flowing breast; A tree that looks at God aft day, And lifts her leafy arms to pray; A tree that may in Summer wear A nest of robins in her hair; Upon whose bosom snow has lain; Who intimately lives with rain. Poems are made by fools like me, But only God can make a tree.
As I was hiking today through Towsley Canyon in Southern California, I came upon this tree clinging on to the rocky side of a mountain and I wondered if there was a common yearning between man and tree for longevity and/or immortality. Any thoughts? ..Maurice.
More to come from Moof, a frequent writer to my blog in the past. ..Maurice.
Since I'm fairly certain that you're not anthropomorphizing trees - even with quoting Kilmer's stirring poem - I have to wonder exactly what you are asking.
In front my ancient house, is one half of a very old hickory tree. When my husband's father was just a tiny boy, the hickory tree which had been there for generations before had been reduced by time to a dying old stump. From this stump grew flexible, firm shoots, which the children were loathe to ignore. They made fine bows, or whips ... or so very many entertaining things. This young fellow's mother finally "persuaded" him to stop cutting them down for use in his games with his brothers.
Two saplings grew, and as the seasons turned into years, became a very large double trunked tree, which provided shade for the house, and which scattered its hard, unbreakable fruit on the lawn every other year.
The little boy grew along with the tree, and became a strapping young man who fell in love with a beautiful young lady ... married, settled down, and had a son of his own. This little son, his namesake, played underneath the tree ... picked the nuts to be used in cookies. In time, he also grew into a fine, strong adult.
By now, the hickory tree was so large, that it covered the roof of the house, and had become a shelter from the storm for many tiny creatures.
The young namesake found a woman to love, and the cycle began all over again - all under the same tree.
And now we come full circle, and this latest young man's children have themselves become adults. One night, during a terrible storm, the 2nd namesake of the first little boy heard the tree come crashing down, shaking the ground in its final agony ... and taking with it the dreams and memories of 4 generations.
And then, less than a year ago, the first little boy followed the tree ... tired after a long life of bearing fruit for everyone in his shade.
Maurice, trees are no more immortal than little boys - but they're wiser than little boys. They "rejoice" in what they have, when they have it; they only ask for sunshine and rain ... and they hide any thoughts of immortality within the hearts of little saplings which are cut down to be used as a plaything by little boys.
If we are trying to somehow draw parallels between trees and healthcare, I have thousands of trees on my property. How many thousands I could not say. Most are anonymous and if they fall in a storm I don't much care and likely wouldn't even notice. A few are VIPs though.
I favor the sugar maples for their beauty and don't violate them with taps for sugaring. I like the fruit trees because they pay me well with their produce, and every few years my small apple orchard will get some professional pruning so as to best care for them. The eastern cottonwoods towering in the yard I tolerate for their majestic size that make for a park-like feeling, but I don't really like them and was quick to have a couple taken down that I determined might crush the house some day. The nicer looking or strategically located ash trees are on the VIP list and for them I will be incurring great expense to save a few from the emerald ash borer that has finally made it to my area and will cause ash trees to go the way of the elms and chestnuts. I don't plan on saving them all though, just the nicer ones along the stone wall and one in the middle of a field by my garden. In the woods is a truly ancient yellow birch that I came across one day. I suspect it might be one of those prize specimens for its sheer size that researchers record. It's branches spread out far too wide for a forest tree which tells me it was left to grow a couple hundred years ago when the forest had been cleared for animal pasture, and now again finds itself in the midst of the forest. That tree I simply admire. Some trees I see as potentially useful like the white cedar that make good fence posts and the white pine, some of which the people who built my log home harvested from my woods. Others are useful for the critters like the black cherries, oaks, and the black walnut in my yard, so they're on my OK list too.
So, I don't treat all of my trees equally nor do I like them all equally.
This is and always has been a "bioethics blog" and not a discussion site limited to human medical care and its "goods" or its "bads".
However, continuing on this blog thread with a "tree" example of potential diversity of ethics considerations available to discuss on the "Bioethics Discussion Blog" just click on "Can a Tree Experience Hurt? If It Can, Do Ethics and Law Apply?" June 12, 2014. And read the worthy discussions and discussants which even includes our Banterings. ..Maurice.
My friend has been doing therapy for the abuse that she has received by doctors and nurses. I have been accompanying her on this journey. She found an online community that has validated and helped her understand her feelings on her abuse. She says that it has helped her move forward.
She was on a thread where one survivor was complaining that his employer mandates flu shots and was assuming the same would be true of the COVID vaccine. There were mixed views about mandating vaccines. Many said "you need to do it," shamed her about protecting other people, etc.
She stepped up to tell how saying "need to" revictimizes and retraumatizes abuse survivors (including herself) because the trauma came from them having control of their own body taken away. She even showed exceptions under religious freedom and ADA. Others agreed with her.
One of the ADMINISTRATORS (not just a moderator) defended the "need to," even this was triggering to many survivors. She quickly figured out that he was a physician (U of Penn med school).
My point is that again, the profession of medicine feels exempt from society's rules. What they feel is more important than triggering, revictimizing, and retraumatizing abuse survivors in a place that is supposed to be safe.
This person flagged her. She was not sitting back and taking it. She fought back against the warning and the whole thread is "under review."
I have done a lot of research about bullying. However, what is most glaring is there is no studies that I have found about medical providers bullying patients. There are an abundant amount of articles about staff bullying within the system. Coming from an educational background, I know bullying extends beyond just peers. A bullied child will often bully another. Why do none of these articles touch upon that patients may also become victims of bullying rather than just saying peer bullying may lead to making mistakes in patient care? Why not state the obvious that medical providers do bully patients? We know that during pre-op if an oddity in a patient's body is found, they will call in staff to take a look. We know they make comments as even Dr. B. found those training videos that hammered home that point. We know that actions just as speech point to bullying (ie. you don't have something I haven't seen before). So why are there no articles about medical staff bullying patients?
Consistent with discussions we have had I wanted to pass along a passage in a book just published a week or so ago and been reviewed by the New York Times. The book is "Between Two Kingdoms" by Suleika Jaouad about her 4 year journey being treated for a rare form of leukemia that she came down with in her senior year at Princeton, and upon recovery her "Travels With Charlie" type journey across the country with her dog. She had previously won an EMMY for her writings during her treatment. I know Suleika on account the "family cabin" in Vermont noted in the book and where much of the book itself was written is just a few houses up the road from my place. I used to bring her veggies from my garden when she was there recovering before beginning her road journey.
The passage speaks to the patient ceasing to be a person but rather the disease itself:
In the transplant unit, I was surrounded by people who were concerned, first and foremost, with what I had - not necessarily who I was. Doctors and nurses in masks stood over my hospital bed, peering down at me, discussing me as if I weren't in the room. They gave the Patient a hospital gown. The Patient was talked at, looked at, probed, prodded, and whispered about. They had a singular goal - to cure the Patient so she could go back to being herself. In all this lay a strange irony: It had only been a year since my diagnosis, but I could hardly remember what being myself was like.
You know.. what is necessary for all patients to present to their doctor or nurse or tech is an advance directive and not necessarily related to some oncoming potentially fatal disease.. but a directive made by the patient to the staff regarding how to be treated and how to be not treated.
I think you will find this YouTube short video not just amusingly realistic but also convertible to all which has been discussed here. It is_ Dr. Seuss Does Advance Directives: A Tim Boon Poem Listen to the words..and think about how a "directive" could apply to your concerns about need for a revision of "professional behavior". ..Maurice.
Of course patients are bullied! You read about it happening in nursing homes. The saying “ nurses eat their young” . That in and of itself confers that patients will be bullied. Remember the purpose of risk management is to contain all bad things that happen in hospitals, issue a gag order etc. Hospital hierarchy is viscious with much backstabbing, jealousy and hate. The knife throwing, backstabbing while throwing fellow coworkers under the bus is legendary stuff not suitable for anyone under 18. The hate flows over onto patient care not necessarily from workers being competitive for attention from one another. Collateral damage results from people who just hate their jobs.
One of the methods that I have the most trouble with is saying that the patient "needs to." My transgender friend gets her hormones without any bloodwork (under an Americans with Disabilities accommodation). There is no "need to," EVER!
I read that article you cited by Joan Emerson "Behavior in Private Places" and what stands out is where it is stated plainly "how to control the encounter" and "keeping the patient in line", and "other people go through this all the time." We have talked about some of the actions they use to in order to do this such as their language "you must", "It is the doctor's order", "Strip!" etc. so clearly they know what is it they are doing. For those who didn't read the article it is about gyn exams. Their attitude is supposed to conveyed no one is embarrassed and all sexual thoughts are left at the door of the hospital but is it really? No, and it is clear by the Nassars and all, this is not the case. If it is not sexual in nature than why do they not keep those areas covered? Why do they take pics and call in others to take a look-see? The article goes on to say that excluding the patient's support person during the intimate exam makes it more a medical exam than a sexual setting which how they came to conclude this is beyond me. It does say the draping and chaperone lends itself to making it more medical so that beg the question of why the obvious difference in how the conduct a female and male intimate exam? Are they secretly announcing to all they in fact do not believe males have the right to dignity? If you read and believe what this article is saying, that is the only conclusion you can reach. This article even goes as far as saying how the patient should act during the course of the exam like avoiding eye contact when the doctor is actually performing the vaginal exam but the patient should be pleasant acting as if she was fully dressed. Really?
I would suggest all read it. I am going to re-post it again on Twitter as I want several of the ladies to read it. Of course, I will give credit to Archie for bringing it to our attention. It is articles like this that bring about good discussion. I think I will also post it on my Facebook. I haven't done much posting on FB because they are such (almost put a K rather than a h).....but I think I will break my self-imposed ban to post it on my PatientRightsInfo page. Thanks, Archie, for this great article.
I totally agree with everything you said. Before I started doing so much research, I didn't realize that internally a hospital would have so much turmoil which leads to patient harm. Being that so many of them have such large egos, it makes sense there is so much fighting from within as everyone believes they are the best and therefore entitled.
Yes, I believe much care in nursing homes is abusive. (JF, please do not take offense as I am not saying all or you are guilty of this as I believe you are one of the compassionate ones. See I have learned over the period of time to make a note clarifying what I am saying with my broad brush.) Some of the stories JF has told comes to mind as well as what has happened during COVID. The thing in charge of New York should have warned all of us of what the politicians thinks about what happens to our older citizens. The "they have to die sometime" dance defines just about how they feel. While it is true they would have died sometime, they didn't have to die then. He can't even apologized but rather is victim blaming/shaming which is making the whole situation that much worse. Own it as the longer he doesn't the more convincing it becomes by the coverup that is was an intentional "I don't care about them" occurrence.
In nursing homes, the ones who cannot defend themselves are left exposed, intimate care is not private nor do they attempt same gender care. Patient's possessions are stolen. Things donated to patients in general sometimes never make to any patient rather the staff takes them. They are ignored or left unsafely attended. All these things plus more demonstrate how very abusive the care of nursing homes patients is. I absolutely will not be parked in a nursing home to wait to die a death without dignity. A small part of what I am doing on Twitter is abusing how the elderly are more likely to be victims of medical abuse.
Nice to see you back. You have a lot to add and I always am looking for information to share as we have a long, long, long road to bring about any change.
The stats do seem low which the article addressed. I think the percentage of elders being abused by family members may be higher as I think the number being abused in care facilities should be higher. From my experience, oftentimes when a family member abuses an elder it is for financial purposes and most of the time the abuser has a drug or alcohol issue. Those stories I personally know of have the Stockholm Syndrome as the abused usually will not do anything or cooperate with authorities to prosecute.
I actually think the sexual abuse part is very much higher as leaving a patient exposed such as not making sure a door or curtain is closed when dressing/undressing them is sexual abuse. I have seen males doing intimate care for females and I have seen females doing the same. This is concerning as I have read several articles where felons are specifically recruited to fill these type of jobs. They specifically mention they are needed to fill what they term as "low level patient care" mentioning both senior care facilities and hospitals. Also, people with active addiction problems can readily get jobs in these facilities making the elderly prime candidates for theft of money, any valuables, and even their medicine depending on the facility's medicine protocol. Again, the Stockholm Syndrome protects the abuser or the patient is unable to communicate they are being abused so it becomes a "silent" crime.
Abuse from other residents also happen which can be bullying, sexual to physical abuse. We saw last year the clip of the one young man beating an elderly senseless. When you have young mixed in with old that is a recipe for disaster. Many care facilities have a mixture and no separation between the mentally challenged and the seniors. Many also handle rehab patients sent from hospitals. There needs to be complete separation for the protection of the elderly.
I have witnessed seniors being put into wheelchairs and just left parked. One such was there in the lobby for hours, screaming while we visited my sister while she was recovering from a fall having been released from hospital to rehab. Same when my father was rehabbing from a fall.
I had a hospital tell me that as a person ages, they will have more medical encounters and should in effect become used to being thought of as a non-person and be willing to be exposed because after all, they are old and need more help more often. With this as their underlying service tag line, are you surprised to know that elderly abuse in hospitals is far greater than abuse of others in hospitals? The elderly population is their bread and butter but yet they think they are entitled to abuse them? Studies have also been done to back this up and of course, sedation plays a major part in all of this as a sedated patients are more likely to be abused. Sedation also seems to have long term effects on elderly from which many may never become "normal" in functioning again. This also has been studied.
Again, the Governor's attitude in New York about the killing of over 15,000 nursing home residents should be shedding a light on how this country allows the abuse and even murder of our seniors. We need major reform but then we have needed major reform of the healthcare system in general and I am not talking about the making of healthcare accessible to everyone because in Indiana it is already accessible if they want it. It is called HIP.
I have branched out from our original healthscare issues and have become more aware of what is going on in general in the entire system. There is so much room for improvement and those improvements would not only help the patients but would also make the work atmosphere better for the healthcare workers.
Dr B. Nobody likes my solution to what I believe should be done. There needs to be hidden cameras just about everywhere or at least hidden tape recorders. I think it should be hidden from the staff therefore not every little wrong thing said and done would get confronted and the staff would need to believe they were caught by a snitching coworker or a patient. Or the abusive employee just be terminated for trump upped reasons. THAT happens often anyway.
JF, while cameras might catch certain inappropriate staff behavior, it would only be caught if someone else was tasked with reviewing the recordings. That means appropriate & necessary patient exposure would be viewed by people that did not need to see it.
The other issue is that cameras would create a whole new source of inappropriate behavior. Nothing electronic is secure. It all gets hacked eventually if someone wants to hack it bad enough. And voyeurs, internal or external to the healthcare setting, would see in these hidden cameras an opportunity.
There is no way I would trust any hospital system to secure these recordings nor would I want some minimally paid non-clinical staff person watching a recording of me being examined or prepped for surgery so as to affirm nothing was done wrong.
But Biker, how can the best supervision of a medical-clinical or surgical interaction with a patient be documented without something like a video of one sort or another? Yes, you might suggest another physician to be present monitoring the interaction but that is one set of eyes, ears and one perception to carry out to provide the "documentation". ..Maurice.
Dr. Bernstein, in a world where the military, govt. entities at every level, and businesses large & small get hacked despite all of the supposed expertise protecting their networks, there is no reason to expect any hospital could adequately secure these recordings from hacking. We have seen again and again where the medical records of celebrities get viewed by unauthorized staff despite the many rules and controls prohibiting such. Staff curiosity will most definitely result in unauthorized staff taking a look at these recordings within hospitals.
The other thing is that it is highly unlikely that medical staff viewing such recordings are going to see anything wrong with patients being casually exposed more than necessary in terms of extent, duration, or audience. Yes they would react to a classic sexual assault that might get someone arrested, but not the everyday needless exposure that patients experience.
Standards of care do not include minimizing patient exposure. Let's use a doctor or nurse needing to examine a patient's abdomen as an example. When is the last time anyone got in trouble for lifting a gown exposing the patient's genitals and then covering the genitals with a towel? No exposure is needed in order to view the abdomen. A sheet could instead be pulled up covering the patient's genital area and then the gown lifted from underneath the sheet so as to only expose the abdomen. My guess is no doctor or nurse has ever gotten in trouble for needlessly exposing a patient in that scenario. Why? Because standards of care do not require minimizing exposure. Standards of care instead err on the side of staff convenience.
Cameras won't address the vast majority of everyday needless exposure but would instead only increase the audience that is looking.
Exposing a patient's genitals to examine their abdomen is sexual abuse because someone in power is exposing the genitals for their gain. More patients need to speak up and out when this is about to happen or has happened. Unnecessary exposure of genitals is a SEXUAL CRIME. It needs to stop!!! It is a gateway offense that lead to them thinking they can do bigger harm to a patient like false documentation and consent issues.
I haven't make up my mind about cameras. I see the pros and cons. Maybe the patient should wear the camera. Certainly, it is who views the footage which is an issue and hacking is another issue but that already is as many hospitals employ the use of cameras most everywhere anyhow. Many already film operative procedure for round table discussion so who are seeing it and where is this footage ending up? Most consent forms allow for this to happen.
Dr. B.,
There are so many articles available that address the "doctors code of silence" that even suggesting that another doctor witness isn't a real solution. Even chaperones don't generally protect the patient because 1) they are employed by the medical provider 2) they generally don't whistleblow until they become mad at the offender. Paid advocates such as Trish Torrey (sp) think patients seeking dignity (modesty) have something wrong with them rather than protecting the patient like they have been paid to do. One solution is to have someone trusted in the room like a spouse. It can be done. Men are present during c-sections so most any procedure could be accommodated if they wanted to do it. It would boost patient's confidence in the procedure to know someone was there just for them.
JR, I think the majority of needless exposure, whether in terms of extent, duration, or audience, is for staff convenience. Sometimes it is for prurient reasons or to exercise their power over the patient. The common theme across the convenience, prurience, and power themes is they simply don't care if the patient is needlessly embarrassed. What the reason behind their needless exposure doesn't matter to the patient of course as the result is the same, embarrassment that either didn't need to happen or that is worse than it had to be.
My focus is on the everyday routines patients experience more than on the egregious cases. This is because it is this culture that doesn't give needless exposure a second thought that creates the atmosphere where the more egregious cases can more readily occur.
I am suggesting here for example that the staff at Olympia Urology were blind to the horror they inflicted on Mr. Kirschner with their initiation prank because the culture of that practice had become numb to the very concept of respecting the privacy and dignity of patients. The slippery slope of ever lower standards spun out of control. This is why the underlying standards that play out every day in routine interactions matters regardless of the motivation behind those interactions. If you can't figure out how to examine an abdomen without exposing the patient's genitals, or worse, you expose that patient's genitals without even thinking it matters, you are on the precipice of that slippery slope that can lead to the truly egregious Denver 5 and Twana Sparks type cases.
In all my 35 years of active practice of internal medicine and subsequent 17 years of volunteer internal medicine practice and all of my over 30 years of first and second year medical student clinical education, I have never practiced, seen nor was personally closely related or involved in Sparks, Denver 5 nor Mr. Kirshner's alleged experience.. nor, the University of Southern California male GYN misbehavior. I have not witnessed any behaviors practiced upon me as a patient which I could prove inflicted indignity or unnecessary loss of privacy.
I think these horrid behaviors are personal medical system provider anomalies which never should have happened but I doubt most caregivers in the medical system have such personal misbehaviors or worse in mind as they proceed with patient interaction.
But that is my experience. I do believe that if any patient or family member finds evidence of or actually observes such misbehaviors which are aimed at some personal "mal-benefit" to healthcare provider and insults the personal dignity of the patient, these observations should not be ignored but "brought to light' for investigation, remediation and punishment of the documented healthcare provider. And, if it is a system deficiency, active steps should be taken to change the system.
What has been discussed on this blog thread regarding preservation of patient dignity should not..NOT be ignored. ..Maurice.
1.) It's healthy to talk about bodily functions - This is an article that a doctor wrote about how he worked as an orderly many years ago. This was the era when male doctors and orderlies did intimate procedures on men. I feel that the medical community was much more sensitive to male patient modesty then. Of course, today it is an accepted practice for female nurses to do intimate procedures on male patients.
Dr. Bernstein: Did you ever serve as an orderly? If so, did you do intimate procedures on male patients at the hospital such as inserting urinary catheters and bathing them. Do you have any colleagues who served as orderlies in the 1970s and before that?
Dr. Bernstein, I agree that the egregious cases are the outliers that most patients never experience. As I have said, the larger problem is the day to day routine transactions that err on the side of staff convenience that is the larger problem.
The sonographer that fully exposed me for my 1st bladder ultrasound likely thought she respected my privacy by giving me a towel to cover myself after she exposed me. That there was no need to expose me at all likely never even occurred to her.
It similarly likely never occurred to the doctor and his nurse that did my vasectomy that I could have at least been partially covered with a sheet, towel, or gown. If they saw anything disrespectful or undignified with me lying there wearing just socks and a polo shirt, it didn't go as far as giving me anything to cover myself.
Surely the sonographer that did my testicular ultrasound thought she was fully professional when she lifted my gown up to my chest before giving me a towel to cover myself.
For the many cystoscopies I had with my former urologist, his ever so polite and well trained female nurses that did the prep, each one in identical fashion, didn't include in their protocol covering me once the prep was complete & we waited for the doctor, unlike the male nurses at my current urologist that do cover me. Those female nurses as well stayed at my hip never losing eye contact during the procedure itself vs the male nurses where I go now busying themselves elsewhere in the room. Believe me it was pretty embarrassing if we had to wait 5 or 10 minutes for the doctor to arrive while the nurse stood right at my hip the entire time.
I would never allow anyone to get away with doing these kinds of things today, but back then I was too embarrassed to speak up and was still under the thrall of manning up socialization. Everything I describe here is day to day routine that most in healthcare don't give a 2nd thought to. This is the larger problem.
Misty, no experience, to my recollection, with "orderlies" or named to me as such. But I suspect, with my brief professional "ins and outs" to see my patients "orderlies" were there as they are present now as "patient care assistants" or "Certified nursing assistants" or more. Last year, last time I was hospitalized, the toilet room was cleaned but the clock on the wall of my one patient room was not working throughout my entire several day stay. Frustrating to both me and my nurses but where was the "orderly" to have the clock fixed? ..Maurice.
I beg to differ with you. You experienced mistreatment twice, there seems to be some discussion if it rises to the level of abuse. The first that comes to mind is the nursing student that attended to you alone. While YOU didn't feel it was abusive (the majority of us who post here feel it was), you admit by your own words that the manner that she conducted the visit definitely violated hospital policy.
WRONG IS WRONG!
Then there was the incident of photographing you with a personal cell phone. While you do not consider it abusive, it was definitely a HIPAA violation (was that cell phone a secured device?).
I also ask, do you teach at Keck? There have been some very high profile cases of misconduct/abuse recently (last few years) that involved licensed medical providers who were also employees. Admittedly, you did not witness these events, but I am sure that these had repercussions with the internal training of medical employees.
Am I to believe that there was no scuttlebutt in the halls or the teachers' lounge? I cannot believe that there was no institution wide audit to see if anyone was aware of these cases or any other cases.
I know from personal experience that the risk management team/department would REQUIRE an investigation into how prolific the abuses were, who else might have been aware, and if there are more related (or unrelated) incidents and more perpetrators.
There is also the requirement to do training with staff and students to change policy and procedures to prevent this from happening again. There are many drivers that make these actions a necessity. They range from insurance carriers to the law, both civil and criminal. These apply to the issues of safety and liability. Failure to do this would constitute gross negligence if another incident were to occur.
For those reasons, and I mean no disrespect to you, I must question if you would recognize such an event? Again, no offense, because of the number of years that you have been practicing medicine, what is considered medically/socially acceptable has greatly evolved.
Have you ever questioned this of yourself (how is it that you have been unaware the scope of this problem and you have been so unaware)? I continually question myself in the goal of improving myself and my skills.
Many providers attribute many of the changes that the profession of medicine has gone through on "non-medical" people. I have documented on this blog how many providers still support the paternalistic practice of medicine.
Then there is the issue of intimate exams on anesthetized patients without consent. The majority of physicians today have participated in this practice (this is only a recent societal issue). Many students and physicians defend this practice to this day (as document on this thread) to this very day.
One can only conclude that the medical education and culture is what causes (or allows) these abuses of human dignity.
Furthermore, intimate exams on anesthetized patients is NOT an anomaly, it is a SYSTEMIC PRACTICE. Is this NOT abuse? Can you defend this practice? Is this NOT proof enough of the corruption of the profession.
Any exam or any procedure performed by members of the medical profession which is not accepted by the patient involved or accepted by the patient's surrogate (if the patient is, at the time, unable to express their decision) is worthy of ethical, professional and perhaps legal concern. All examinations, physical or technical, must have the patient's (or surrogate, if necessary) understanding and approval. Except in true clinical emergency situations where the patient has no capacity to learn and respond and no available surrogate, should the medical profession carry out procedures under methods accepted by science and law.
Elective surgery and all the issues that surgery and its participants involved should be detailed to the patient and the patient's decision to accept should be also related to those details. ..Maurice.
Dr. Bernstein, the point I have been trying to make is that the routine needless exposure is not anything that ever gets discussed with patients. It just happens. Healthcare staff never ask the patient which method the patient would prefer, observing the abdomen without genital exposure or observing it w/exposure, clipping groin hair with exposure or without exposure, positioning the scribe with full view or without full view, pulling the curtain/closing the door or not pulling the curtain/closing the door, walking uninvited into exam rooms when patients are exposed vs asking permission to enter, and on and on. They just do it within the context of whatever the culture of their workplace allows without ever giving it a thought. Most would likely take offense at the suggestion that they have needlessly exposed patients.
I totally accept necessary exposure, including to female staff if male staff aren't available, but I do object to needless exposure and I do object to any request I make for male staff being dismissed or otherwise handled in anything less than a professional manner.
I don't care the about the reason they are exposing patients unnecessarily rather it is the fact they are doing it. Robbing a bank because you need money to feed your kids or make a house payment doesn't make you not guilty of committing a crime. I have checked in textbooks and have talked to many nurses, and yes, they were taught to respect patient dignity by keeping the genitals from being unnecessarily exposed, to cover, and to keep any necessary exposure to the minimum. Yes, the crime is more severe if they are purposely meaning to harm a patient by exposing them. However, to the patient, the result of the exposure is the same feeling of violation although probably with vicious, malicious exposure the patient may suffer more of a reaction.
For patients undergoing a procedure, the risks to their health by unnecessary exposure is great as it can cause complications but this is when many patients seem to be unnecessarily exposure for more prolonged periods of time. It is a known fact that patients kept warm are patients who recover better. However, many feel since the patient is unaware, unnecessary exposure of the patient does not matter or even count for that matter. Drugs are used to erase memory but these very same drugs also have a side effect of making the patient colder too so that exposure side effects are worsened.
Even during most ER treatments, care can be taken to make sure a patient's bodily privacy is respected unless it is a true emergency where someone will die within the next second and their injuries need to be checked. Otherwise, bodily dignity should be respected. There should be quota hiring of male and female staff in order to provide the best care of bodily dignity.
Banterings,
I agree with you that even if Dr. B. doesn't realize he was violated at least twice that we know of, he was violated. Just because he doesn't feel violated doesn't erase the fact that violation occurred to even him. The use of a privately owned cell phone to take bodily compromising pics or even any patient info at all, should be completely taboo. Supposedly, it is but it seems to be an acceptable fact. I have even read articles encouraging the use of private cell phones usage for medical apps and so forth.
Misty,
There is no thought in the medical community to provide bodily dignity to male patients. There is some thought to provide it to women but even at that, it is still not enough as it is only sometimes provided. For males, most intimate care will be forced done on them by female staff. On my Twitter feed, I had a great GIF of 2 females nurses trying to hold down a poor male patient when trying to perform an exam. Got a lot of feedback as many were shocked. However, this is common for men.
I think the approach to resolve these issues of misbehavior within the medical system is to instill (by medical boards) and the patient and family themselves that patients are not at any time "objects" of the medical system and their professional or workers but are subjects . You know, I would appreciate a nurse who says to the roomed patient "I am here to check your blood pressure, may I come in?" or the technician who states to the patient "I have come in to get some blood tests, is that OK with you now?" These simple explanations and requests by the medical system participants would go a long way in diminishing the frequency of the documented here "abuses of human (patient) dignity" ..Maurice.
Medical rape is ONLY worthy of ethical, professional and perhaps legal concern...
Why can't you call this deviant behavior what it really is? This behavior that you exhibit is exactly what is wrong with the profession of medicine. No offense to you, it was how you were trained.
This is giving abhorrent behavior a pass. It should be prosecuted to the fullest extent of the law.
How do you feel as a provider if patients said in regards to threatening/physically abusing providers that it is only a response to the stress of the situation that they are in. Perhaps the providers need to be more understanding.
As to an emergency situation: If it truly is an EMERGENCY, then allowing a student to have a learning experience would be malpractice because it would put the patient's health in jeopardy.
If there is time to allow a student to have a learning experience, then it is NOT an emergency situation.
Just an addendum to my observations regarding 2 of my recent hospital room admissions which has raised the issue that with each time the nurse took a photo with a cell phone of my lower back and buttocks after explanation and with my approval: the argument presented here is whether the cell phone with camera was part of hospital equipment or the nurse's private property. I assumed both times that the phone was hospital property and the reason for the photography was for legal documentation. In neither time had I some reason to think or respond otherwise.
With regard to the earlier hospital admission (and I haven't tried to find my previous comments in the earlier Volume), my concern was not that the nursing student was looking at me out of sexual interest (!) but based on my own medical student teaching, her exam of me was cursory for my clinical condition and there was no professional supervision. It seemed to me she was just checking me off her list. And the action was not a properly executed supervisory teaching tool since there was no supervision. ..Maurice.
You want another subject to discuss the unethical and perhaps illegal use of the physician's own semen for a patient's request for semen from an anonymous source semen bank? You all knew this was going on.. didn't you? To begin this topic, pertinent to preservation of patient dignity, read this presentation "Uncommon Misconceptions: Holding Physicians Accountable for Insemination Fraud" ..Maurice.
On the fraudulent insemination matter, certainly the law needs to catch up with this and treat it like the crime that it is. A glaringly missing piece however is medical licensing boards need to take a stand and immediately take away the licenses of these doctors. I sometimes wonder why licensing boards even exist if they have no moral or ethical expectations of doctors. Fraudulently inseminating someone is a slam dunk ethical violation of the gravest kind. Have they no standards?
My guess is the incidence of this conduct has likely greatly diminished given the rise of genetic testing amongst the general population. Some doctors might still think they can get away with it if they don't get tested themselves, but the results of their relatives that have done the testing will incriminate them anyway.
Here is a link to a more current article regarding law suits in California relative to physicians using their own semen without patient's permission, "fraudulent insemination":
Last week marked the second anniversary of my initiation into the world of Patient Dignity/Modesty. My initiation occurred when I, a 70+ year old male, visited my Dermatologist for a Full Body Exam. Obviously I was aware that my doctor was female and I had made peace in my mind that I could accept that she would see my fully exposed genitals. The visit proceeded as normal with an assistant initially taking vitals and giving me an all-too-short gown to wear for the exam. She left the room for me to get undressed saying the doctor would be in momentarily. Parenthetically, I should add that the assistant never introduced herself nor said what her role was/was going to be in my care. The doctor came without delay, but to my absolute horror and dismay, she was accompanied by the female assistant who took my vitals! The doctor began the examination without asking permission to conduct the exam nor for permission for the additional female to be present during my intimate exposure.
This was my first, only and perhaps my last full body exam. It was one of the worst days of my life. I was caught totally off guard by what was happening to me. Here I am standing fully exposed in front of TWO females whose combined ages did not equal mine—and one of them had an iPod in her hand capable of taking pictures. As I said, it was perhaps the worst day of my life.
When this “ambush” was all over, I began to think about what had just happened. I was very angry, but that anger was directed at me. How did I, an educated and competent person, allow this to happen—and to me? It was during this aftermath that I found this blog. I began doing a lot of reading from all of you, from Misty and from as many other sources as I could find. Your words and experiences have helped me along the way and given me a plan to insure that never again will this happen to me, but I started working to see to it that it will never happen to other unsuspecting souls as well.
Since February 13, 2019, not a day has passed that I have not revisited, reviewed, and critiqued what happened to me that day. Two days after my exam I wrote my now-ex Dermatologist to explain how she made me feel and to courteously offer true suggestions on strategies she and her clinic could undertake to improve this encounter. She would not meet with me in person. Her Practice Manager sent me a certified letter discharging me as her patient. I wrote to the Virginia Medical Board. I met with several local and state officials, including members of both the State House and Senate promoting legislation that would help address matters such as this. Patient Modesty/Dignity continues to be a work in progress, but “continues” is the operative word.
Thanks to all of you for what you do to advance public awareness of our travails, our needs and our rights to insure dignity for all.
Welcome Starboy to our blog thread. It was unfortunate that you were examined in an environment and a manner for which you were not explained in advance to make your own personal decision. How the examination is performed and who else will be present should be information presented to the patient in advance and this is what had been teaching our medical students. For example, we had the examining student get the patient's approval before we were allowed to come into the room with 5 other students to review a specific physical finding.
Also, as our teacher staff was informed by our school's dermatologist, worthy examination can be performed with systematic sequential skin exposure and not examine the patient nude and subject to embarrassment or chilling.
Unfortunately, physician behavior, at times, is so unsettling, it does require entailment of government to set acted-upon standards which should have been already settled upon by the medical profession itself. ..Maurice.
I am sorry to hear about your traumatic experience.
One of my concerns at Medical Patient Modesty is that there is too much unnecessary exposure. The truth it most full body exams are not necessary because most patients have zero risk of having skin cancer on their genitals unless their genitals have been exposed to the sun.
I did not know about full body exams until a number of years ago. One lady brought to my attention that some dermatologists did full body skin exams. She shared that she told the dermatologist that they could only examine parts of her skin that were concerning (ex: moles).
I agree that some patients may need full body skin exams depending on their risk factors. But an "one fit size" approach is not the answer.
Yes, there is evidence that physicians lie for one reason or another..but a 2018 survey suggests that patients lie to their doctors. Isn't health so important to everyone (patients and medical professionals) that for one party to lie to the other is a personal or professional "wrong" that should be scrutinized and re-considered by both parties? Read the brief description of the survey and present your final opinion here... and I am sure none of my visitors will be avoiding presentation to the rest of us the truth of their conclusions. ..Maurice.
Starboy, thank you for sharing your experience. That is why I avoid female doctors for anything that might involve intimate exposure. They just don't understand that men don't want their exam to be turned into a spectator sport. Like you I might be OK with just the female doctor, but bringing in an audience is a deal breaker. Women who only want female staff are celebrated as empowered. Men who want male staff for intimate matters are deemed sexist. And they don't see the inherent double standard in the treatment of male patients vs female.
It is unfortunate that you had to be introduced to patient dignity in such a negative and, dare I say, traumatic manner.
The thing is, your situation isn't all that infrequent. You were "ambushed" by your former dermatologist who neglected to inform you that she had every intention of having a chaperone present for the exam.
The truth is care providers knows that many patients don't want a chaperone present. So what they do is "sneak" that person in without telling you in hope that a) the patient isn't going to object or b) the patient is going to be too shocked/ intimidated to object. Either way, it's a win for the provider as they get what they want out of it (because they aren't going to ask your opinion about it).
I have said it before, the option of having a chaperone present should always be offered in a plain and obvious way, and never imposed. It is the patient's right to decide if they agree to the presence of one or not.
Stick around, Starboy. There's a good bunch of people here.
Dr. Bernstein, another piece of why patients lie to their doctors is the electronic medical records systems. Everyone that you interact with in the system has access to everything about you. Yes in some cases it can be a good thing for all of your providers to have your full history but it also means that the days of private patient-doctor discussions are gone. A patient might be comfortable talking with their primary care provider about an issue but not sharing it with every other doctor they interact with let alone all of the nurses, medical assistants and others.
Another aspect of this is that govt. is slowly weaponizing medical records so to speak. I have heard people say that they would never seek counseling for a substance abuse or mental health issue because some govt entities are beginning to use those records against people for things like gun ownership, child custody, or employment matters. It is as if they are saying "get the help you need, but we're then going to pry into those records and use it against you".
If patients cannot talk privately with their doctor, they are not going to be entirely truthful. I've led a rather straightforward life and don't have a lot of secrets, but it shocks me in my mid to late 60's to see a surgery I had at age 11 appearing on the summary notes of the NP I see for sleep apnea, when that surgery has absolutely nothing to do with any current aspect of my healthcare. It is nothing we've ever discussed but the system thinks my entire health history since childhood needs to be presented to every provider I see, as well as their staff. I can see why people are shy about divulging that which they'd like to keep private.
Welcome and sorry. Never let it happen again. You can now tell your providers that you a survivor of abuse and request accommodations under the Americans with Disabilities Act (and by federal law they must accommodate you).
In a survey of more than 1,800 practicing physicians, about one-third of respondents did not completely agree with disclosing serious medical errors to patients, one-fifth did not completely agree that physicians should never tell a patient something that is untrue, and approximately two-fifths did not completely agree that they should share their financial industry relationships with patients. Source: When is it ethically acceptable to lie to your patient?
Dr B. Often people have it locked in their heads that they want a baby of a certain gender. But generally when they baby is born they're happy anyway. The doctor who used his sperm to make his patient pregnant? That wasn't good, but a loving parent would love and accept the baby anyway, because if different sperm was used it may have produced a different kid. Anyway thats how I beleive I would respond.
As long as we're talking about doctors lying, it happened to me at my recent dermatology appt. The certified medical asst. who updated history and who gave me a gown to change into said the doctor had a Resident with him today and was it OK if she accompanied him. I said yes, thinking to myself that I would just decline the genital part of the exam.
For reasons unknown to me they were running very late and during the hour I was in that room waiting, the CMA and the doctor each came by to apologize for being so late. Each and every time they waited for an OK from me before entering the room and so I thought to myself they're getting better at this patient respect stuff.
In walks the doctor with a young woman and the same CMA who is now serving as the scribe. The doctor doesn't introduce the Resident and her name tag is turned around. That's when I made my big mistake. I should have asked for her to be introduced but I didn't. That's a mistake I won't make again. It being this late in the Resident-year I figured he must be observing her doing an exam as part of her evaluation.
The doctor then starts his exam, not her, and that's when I realized she wasn't a Resident. My guess is she was a medical student on her dermatology rotation. The doctor skipped the genital part of the exam without me even saying anything. I am labeled in their system in red bolded capital letters "PREFERS MALES PROVIDERS, ASK ABOUT RESIDENTS" and so he knew not to go there with this young woman in the room.
I chose not to make a complaint as my belly twitch said it was the CMA that would take the fall. She struck me as fairly new and trying very hard to do everything right and perhaps it was an innocent mistake on her part. Certainly she could have been instructed to say Resident and not known the young woman wasn't. I liked the CMA and didn't want to risk her being the one to get in trouble. I knew the doctor (who is the head of dermatology there) would easily get away with saying he forgot to introduce her and that he didn't know her name tag was turned around. A judgment call on my part picking and choosing my battles.
As an aside I may just stop doing these annual exams. The doctor is a nice guy but his exams are very cursory and incomplete. Being he is the head of the dept. I am not sure it would go over well saying I want to be assigned to someone else.
Anyway, even folks like me who think they're ready to advocate for ourselves can still be taken by surprise. Live and learn.
As I have stated previously, I see nothing wrong in "lying" to a medical provider. They lie all the time. Just get a copy of your medical records and you will probably find lie after lie--some intentional and some not but rather a signal the EHR system is corrupt.
We lie for self-protection. We tell them what we want them to know. Like he is prescribed meds that he will not take but he no longer argues because when he said he didn't believe in taking RX meds, he was purposely harmed. He takes the RX and has them filled and throws them away (as they do check to see if RX was taken to pharm). They also are using skewed info abt him for their studies but that is just the "cost of doing business" which is what they label selling the info you give them. All that info gleamed from you in H&Ps is used and generally is not pertinent to your current condition. Most of the time, they don't believe info you give them and will instead insert what they want in the MRs.
As for personal info, he tells them want he wants as we know from experience they do not listen or they put in what they want. He now gives an incorrect SSN as he was a medicare number and SSN is not needed but they insist so again, he won't argue because he has other bigger arguments to face like no female care and his support person present during all encounters.
So yes, lying as the medical community does, is now standard practice.
The article/survey about patients lying to doctors is interesting. Both medical professionals and patients are guilty of lying.
I feel honesty is the best policy and I wish that both medical professionals and patients would quit lying. I have seen many cases of medical professionals deceiving patients that their wishes for modesty and same gender team would be honored. Patients’ wishes were disregarded once they were under anesthesia and this is why I strongly recommend that surgery patients opt for regional anesthesia and no sedation such as Versed.
Sadly, it so common for some patients to lie. This actually hurts other patients who are honest. It also can hinder patients from getting the right treatment. I watch the 600 LB. show often and many of those obese patients lie about their diet and exercise when they do not lose the necessary weight. I like how Dr. Nowzaradan is blunt with those patients who do not lose the weight. I believe his blunt approach has pushed some obese patients to rethink their lifestyles.
Sadly, it is common for some patients to abuse drugs. I was bothered when a medical assistant or nurse questioned me again if I used any drugs one time when she was taking my medical history. I understand that they’ve had a lot of patients who are addicted to drugs. But I wish they would drop the one assumption that all patients lie.
I address the fact that some women may not be honest about their sexual history and this is why it is recommended that all women get a pap smear beginning at the age of 21 even if they have never engaged in any sexual activity in this article, Are Pap Smears Necessary For Virgins? . This is not fair to women who are actually honest.
Banterings, I have duly noted your suggestion to use the "accommodation" provision of the ADA and have also so informed my wife. Thanks.
As I mentioned in my initial post, I have been working with some willing state lawmakers to craft some legislation regarding the use/or not of chaperones during intimate exams. Basically, we've thought that anyone who WANTS a chaperone should get one--provided the chaperone's gender suits the PATIENT. More importantly, anyone who does not want a chaperone, should be allowed to make that choice without bullying or prejudice from the medical staff.
Do you guys have any suggestions/comments in this regard? Your input would be much appreciated. Thanks, in advance, for your input.
The ADA is a very powerful means to protect patients. Under federal ADA, you are under no obligation to disclose your disability (in your case, mine, and those harmed it is PTSD), it is illegal for the one that you are requesting accommodations from to ask what it is, and you do not have to prove that you are disabled. All you have to do is ask for it.
You can also point to the issue of intimate exams by med students without consent happening today:
There are also a lot of good suggestions for patients to protect themselves.
One final suggestion: your state's justice department should set up a special department for investigation of medical "sexual" abuse. If you read above, (I believe) 58flyer said that law enforcement doesn't know what healthcare providers can or cannot do legally.
Also, the licensing board should be obligated to report those cases to the justice department's new medical abuse department.
Starboy, you wrote " More importantly, anyone who does not want a chaperone, should be allowed to make that choice without bullying or prejudice from the medical staff."
Actually, throughout all my years of medical practice, it has been to most all physicians including me, out of concern for the female patient's interpretation of my behavior during a pelvic exam as "sexual" even though each move I explained to the patient. No chaperone, no pelvic exam. And the chaperone was always female. ..Maurice.
I accept that doctors may feel the need to protect themselves from unfounded claims too and so it would seem that the compromise position is that if doctors want chaperones that the chaperone must be the same gender as the patient.
Dr. Bernstein, how is it that students emerge from their years of medical school and residency without grasping the fundamental concept of patient privacy and dignity? Being polite is not synonymous with respecting privacy and dignity. Sequentially exposing patients is not synonymous with respecting privacy and dignity if the end result was the patient was needlessly exposed in terms of extent, duration, or audience. Female chaperones for male exams violate this concept by their mere presence.
Starboy, when making appts. with urology or dermatology practices, just say upfront that you want a male provider. It is also OK to ask if they have male staff. When I grew weary of doing the 4+ hour drive to Boston for my annual cystoscopy I called the urology dept at the local hospital and asked about whether they had male staff for the prep. I expected the answer to be no, which it was, but they were hostile to me even asking the question. I also put in a call to the ultrasound dept. asking if they had male staff for things like testicular ultrasounds. Again the answer was no, as I expected, and again the person I spoke with was hostile to the question even being asked. I took those responses as indicative of the culture at that hospital. Asking questions upfront potentially saved me from future unpleasant interactions.
What I ended up doing was moving all of my healthcare to a large teaching hospital 1.5 hours away that did have some male staff in these areas and where there was no hostility to me asking these types of questions. Thus far I have been very happy with how I've been treated there, with the exception of dermatology that I am thinking I may give up on as noted recently. Traveling further than you might otherwise do in exchange for having your privacy and dignity respected is well worth it to me.
Biker you ask "how is it that students emerge from their years of medical school and residency without grasping the fundamental concept of patient privacy and dignity?"
As I have many times stated on this blog thread, my experience in teaching the first two years of medical school is that the concept of "patient privacy and dignity" is stressed to the students and I see that they understand and follow the concept. But they will leave our supervision and followup as soon as they enter the "hidden curriculum" period of the 3rd and 4th years and into residency where those of us teaching in the earlier years have no personal supervision of the behavior of the men and women moving on into this much less supervised clinical experience. Behavior may or "have to" change when the former students of mine move on into less or no almost "minute by minute" type of supervision that are provided to first and second year medical students.
My suggestion is that hopefully most patients will be able to be the "teachers" and speak up to the students or early residents and not wait for more professional supervision, if even that is practical. ..Maurice.
Chaperones are useless. Doctors have chaperones to protect themselves (as Dr. Bernstein confirmed). The truth is opposite sex intimate medical care should have never been invented. I appreciate that modern medicine has brought many improvements that have saved many patients’ lives, but they should have stayed with the rule: medical professionals only doing intimate procedures on patients of the same gender.
Look at this article, History of Modern Gynecology. Before modern medicine was invented, males were not allowed to do any intimate procedures on women. Also, more than 40 years ago, male doctors and orderlies usually did intimate procedures on male patients.
I am saddened that our culture has taught us that we should let go of our dignity/modesty in medical settings and that we should focus on the skills of a medical professional rather than their gender. This is why so many patients are violated today.
It does not surprise me at all that sexual abuse by medical professionals is common.
Check out this article, Do Chaperones Really Protect Patients? Make sure you all read the article by Ellen Cater, one of the patients Dr. James Heaps abused. A chaperone was actually present. Ellen Cater made some good points about a chaperone. Look at the picture of a chaperone present as the doctor is performing a pap smear on a female patient. Look at how she is distracted. Even just the presence of a chaperone in the room helps to reduce liability for doctors. Presence of a chaperone makes things worse because it enables the doctor to get away more since the chaperone can defend the doctor.
... concern for the female patient's interpretation of my behavior during a pelvic exam as "sexual"...
Is that really fair to ascribe YOUR feelings to the patient when you DO NOT KNOW?
Yet, you have stated so many times (along with the profession of medicine) that it is NOT sexual and that medicine is GENDER NEUTRAL. How do you reconcile this? You (and the profession of medicine) have contradicted yourselves.
And the chaperone was always female. Yet no provision for male chaperones.
You know that there is a problem here and both you and the profession refuse to admit it. The profession makes no provision for it either if it is not convenient. How can anyone trust any member of this profession then?
I guess this means that most providers are sexual predators and patients must assume and treat everyone as such.
Behavior may or "have to" change when the former students of mine move on into less or no almost "minute by minute" type of supervision that are provided to first and second year medical students.
Again you give a pass on abhorrent behavior. What is right and what is wrong must be absolute. This has been tried with the protests against law enforcement where they try to defend their actions by the present dangers on the streets.
No chaperone, no pelvic exam. How is this NOT bullying and NOT paternalism? On top of your assumption that the patient is somehow going to file a fraudulent report against you, you now bully them?
I understand protecting yourself, but why must the patient bear the cost of this? Physicians have a fiduciary duty to patients meaning that they must do what is in the best interest of the patient even if it is at a cost to the physician.
I would argue that LEGALLY and ETHICALLY, if a patient refuses a chaperone, that must be respected even above self protection of the physician against false claims. Yet, it is justified in the self serving interests of the profession.
Misty, in your last referenced article on the subject of unnecessary pelvic and breast examinations by male physicians, you referred to the issue of performing a breast exam for detecting a lesion in a female complaining of jaw pain. Sorry to your assumptions, there are exceptions. In a 2016 article "Jaw Pain as a First Presentation in the Diagnosis of Breast Cancer" from the Iran Journal of Pathology. The article concludes with " Manifestations of malignancy including breast are not always straightforward. Therefore, in the presence of an ambiguous sign in the oral cavity, such as jaw pain or paresthesia, a differential diagnosis must include metastatic dissemination, and diagnostic examination is highly recommended." Unfortunately, there are always clinical exceptions to what might seem at first consideration "unrelated" and unexplained symptoms clinically pursued may lead to patient benefit. ..Maurice.
Dr. Bernstein, I suspect much of the problem is that the medical education community is not about to tell female medical students and residents that it is a violation of their male patient's privacy and dignity to bring female chaperones into the room. We all know the screams of sexism and misogyny would be loud and clear. The two underlying rules of the game are:
1) Female patients are entitled to same gender privacy. 2) Female staff are entitled to full access to male patients.
Any suggestion otherwise would not end well for the male professor or doctor that said it.
Commenting on a chaperone in the exam room: After my pre-surgery discussion appointment with my thoracic surgeon for lung cancer, in which he yelled and bullied me throughout, seemingly purposely avoiding answering questions, his RN, who was the "chaperone," vehemently stated to me, "I heard everything Dr. So and So said to you! I know what he has said," To which I replied, "Well then you heard how he bullied and yelled the entire time." She didn't care about helping me whatsoever. She was there as HIS witness and to defend him at all costs. I was totally blind-sided by his bullying me into an operation and at her coercion! Never again will I blindly trust any doctor. It's sad for me to have been unnerved by their "practiced" cruelty. CS
Biker et al, want a change for the managing and meeting the needs and desires of male patients?
There is also a demand for more male nurses in the healthcare field, as providers and patients alike become aware of the many benefits male-identifying nurses can provide. For instance, the presence of more male-identifying nurses can help ensure that male patients feel represented. And for certain sensitive procedures, patients might prefer a nurse of a certain sex, particularly for procedures such as inserting a catheter, using the bathroom or bedpan, or giving an enema.
The above narration comes from an article in the publication June 2020 from Nurse.org
The article really supports and encourages men to join the profession not only for their own benefit but as noted above for all you male patients. Isn't that what we all want? ..Maurice.
Yes it is good to see an article encouraging men to go into nursing. In more rural areas such as I live, the nurses at the local hospital are roughly in the 90th percentile for wages in this county. I would think that in itself would be encouragement for guys graduating high school who want to stay in the area. There is even a state college in this county with a BS RN major, making it that much easier to pursue such a career while staying local.
The local ER nursing mix is probably somewhere between 1/3 and 1/2 male, but not near that many in most other areas. I don't know about the ICU. The urology practice in this county will soon be 100% female when the older male doctor retires. His recently hired replacement is female as is all of the staff. The sole dermatologist at the hospital is female as well with an all-female staff.
If more men went into nursing, eventually we'll start seeing more in these other areas. It's not just nurses though. We need more male CNA's, medical assistants, and techs in every area.
It always assumed that using a chaperone is doing US a favor and done for our benifit. I'm okay with her being in the room so long as she isn't at the foot end of the table. THAT makes a huge difference.
I'll take a try at it. I see dignity as internal to the person feeling that they have value and autonomy and are worthy of respect. Not being treated with respect is essentially being told that your dignity is not valued or that you are not seen as being worthy of having dignity.
The problem within healthcare is thinking being polite is synonymous with being respectful. They are not the same. Using a recent example, starboy's former dermatologist may have been polite throughout the encounter but she was disrespectful to a major degree. In not asking if it was OK for the chaperone to be present for an intimate exam, or even introducing her, she conveyed that he was not worthy of the very basic autonomy of having any say in or control over who he was intimately exposed to. Ambushing patients is always an assault on patient dignity.
Showing a patient respect is only part of the dignity definition. Dignity encompasses many different roles such as how care is delivered: does the provider value the patient as the ultimate decision-maker or do they believe the patient is more like a toddler to be shaped, molded and coerced into agreeing to what they the medical provider provider thinks? Dignity is recognizing the patient is a mother, father, son, daughter, etc. and not just an object to use as the medical provider sees fit. Acknowledging a patient's right to dignity is showing respect for the patient as a person who is on equal footing as the medical provider.
Biker is right. Being polite is not good enough. I was polite with my classroom students when I was trying to control their actions such as you must read this chapter during this time. Medical providers generally in a polite manner do the same by trying to manipulate patients into doing what they believe needs to be done by how they do it like for instance the words and actions. Words like: order, you must, you shall not. Actions like: flimsy gowns, not respecting the basic human dignity that every human is entitled to--bodily privacy. I can be polite in telling someone off so polite doesn't do it for me. I need a respectful attitude meaning they do not act as if they are in charge of me because they are not. If they give their advice to me in a respectful and truthful manner, I would be more likely to trust their judgment. If they come across as superior in their attitude, I immediately distrust them.
You don't have to respect me but you must not believe you have the right to disallow me the basic right every human being has and that is dignity. Why is that concept so hard for so many medical providers to understand? They are supposed to be the educated ones but that basic elementary concept they cannot comprehend.
Human dignity is the innate value of each human being endowed on us by our Creator and/or because we are self aware, sentient beings possessing consciousness.
Respect is due regard (how one responds) for/to the human dignity.
The profession of medicine systematically disregards human dignity out of its own self interest and for efficiency (intimate exams on anesthetized patients w/o consent easy to do medical training).
Let's consider the definitions set by the professor in the YouTube video https://www.youtube.com/watch?v=wSosTocATEA and apply it to much, if not all, of the discussions on this blog thread.
What is the differences between "patient dignity", the dignity of each "medical or surgical provider" and of the entire medical system?
If it is "inherent value and worth" defining "dignity", should it not just to be applied to the subjects of the medical system (the patients),but also to all parties involved?
With regard to "respect", is "respect" to be earned"? Should "respect" be part of the behavior to be "earned" by each and EVERY participant, including the patient (and family) within the medical system? Are not "we all" in this exercise for health TOGETHER? ..Maurice.
The patient is a paying customer. For a customer, politeness is all that is needed. I really don't think you understand the patient point of view at all because being a physician you automatically receive the VIP treatment just as most politicians and celebrities do. I expect anyone I hire to do any type of job to acknowledge my dignity and wishes. I, in turn, make sure they have clear instructions, are paid on time, am polite to them, make sure their work environment is safe, etc. That is how I acknowledge my dignity to them. With medical providers I am polite, pay on time, have clear instructions, listen politely to what they say, etc. However, it is my body they are dealing with not just an object. I have greater ownership over my body than anything else in life. My house can be taken away, my car, even my family but my body is something I personally can retain until I die. The exception to that is most medical providers when you enter their door believe they have ownership over your body. That is completely wrong. No person owns another person. Once you become a convicted criminal and are put into the prison system, the government does come close to owning your body but in recent years even that has changed. Even in prison you cannot be made to have just anything done to your against your will. Again, though there are many similarities between being a prison and being a hospital patient except prisoners commit crimes knowing prison could and loss of bodily rights and freedom could happen. Not so for patients. They have committed no crime and still should be in control of their body and their rights but yet they loose more rights than prisoners. Just ask my husband about that.
We have retained our view of dignity for the ones who purposely harmed my husband even though they did not allow him to have his right to dignity. In how medical treatment is delivered to someone is telling how they feel about patients and even how much they "love" their job. Is their job to attend to all aspects of human wellness or just "cure" the present "illness" while causing other harm to the patient? That is the interesting question. How much time and effort does it really take to teach and then to treat all patients as if they are humans? How is there any defense of the crimes done to humanity by something as simple as bringing in a opposite gender chaperone to the more heinous crime of sexually assaulting a patient?
I have read numerous definitions of what dignity of care means. I am sure most of the offending medical providers have read them too but the question is why don't they care? Why is wrong with them that they don't care? And it is something wrong with them and not wrong with the patient expecting to be treated completely in a humane manner. I don't appreciate the ploy to bring in dignity and respect for the medical provider when dignity/respect for the patient is not contingent upon them having the same for the medical provider. I know my husband did not grab for their clothes and rip them off of them nor did he hold them captive while doing sexually entertaining things to them. He was completely innocent. The men in this blog who have been ambushed by their medical providers--what did any of these men do to deserve the treatment they received? We know dignity in care is taught but the effort and time would be better spent on trying to figure out what is wrong with how the healthcare industry is delivering intimate care to patients especially to male patients and why female patients are still being sexually abused like CS was.
The dignity of the providers, system, etc. is IRRELEVANT.
The previous all choose to be there. The patient usually does not choose to be there or needs to be there by necessity (preventative care). The provider choose their career long before encountering they encounter the patients.
There is also the power differential. Human dignity is to allow the weaker party to be treated in a certain, humane manner.
The dignity of the providers is an issue when dealing with the facility or the system. That is because of the power differential between the provider and the facility or the system.
A primary care physician writing an article in 2010 on the "Health Care Blog" wrote the following and much more. Read it and read the interesting back and forth discussion by the responders to the article.
Here is one paragraph from the writing. JR and others: will this view be acceptable to you coming from a physician?
I am not sure why people bristle at calling patients consumers; that’s what they are. They are also customers, participants, autonomous, and humans in need. This is not an “or” proposition. If we forget the humanity of patients and just treat them as customers, they lose. But they also lose if we forget that they are paying us and demand our respect and our attention to their needs. We are as much servants as we are professionals. Signing up to be a doctor means you agree to give yourself to your patients. All of them. It’s hard, and it’s complicated. It’s a human-human relationship.
WE ARE NOW AT 171 COMMENTS AND I THINK IT IS TIME TO MOVE ON TO VOLUME 117 https://bioethicsdiscussion.blogspot.com/2021/02/preserving-patient-dignity-formerly.html I HAVE COPIED MY LAST POSTING REGARDING "HEALTH CARE BLOG" ARTICLE TO START THE NEW VOLUME AND WE CAN CONTINUE THE DISCUSSION THERE. ..Maurice.
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172 Comments:
Moderator's Note Regarding Participation Here: I really am thankful for the continued participation and issue insight presented to us by a small series of contributors of their views on the various aspects of preserving patient dignity. However, I know that there are a number of visitors who come to this topic without expressing their opinions as Comments. I encourage them to "join the conversation" and present their views to the rest of us. You can sign on anonymously but use a persistent pseudonym. Again, I thank those who have persistently participated in presenting their acquired information and views here. You are keeping these Volumes "going" and providing us views worthy of considering or debating. But I hope visitors who have "something to say" on the various aspects presented here will put their views in "words which we can read" on this blog thread. If anyone wants to reach me by e-mail (and contents will not be published without the writer's permission), my address is doktormo@aol.com
..Maurice.
Both doctor and patient were polite, but the doctor didn't seem to understand that perhaps a patient wouldn't want to be left waiting for a couple hours w/o anyone telling him anything, nor even the doctor offering a perfunctory "sorry" for being late followed by explaining he had an emergency situation that had to be tended. I see it as not much different than staff thinking they've been respectful if they're polite while they needlessly expose patients.
A year or so ago I had a routine appt. with my primary care. Upon arrival I was told she was running about 45 minutes late. I said no problem, I can entertain myself, thank you for letting me know. It ended up being a couple hour delay but a couple times along the way a medical asst. came out to the waiting area to keep me informed & apologizing. I said no need to apologize, I appreciate you keeping me informed. When I finally got in to see the PA, she was stressed over whatever went on that day and apologized for being so late, and again I said nothing to apologize for, it is good you spent time with whatever patient needed it. So in summary, something happened that seriously disrupted the schedule, they recognized I was kept waiting and communicated with me appropriately. I in turn graciously accepted the situation at face value.
Biker, you know.. I interpret the delay in a scheduled patient appointment without prompt patient disclosure and presenting the patient alternate options except "just wait" is not attending to the patient as a "subject" but as an office "object". Biker. I am also pleased that the office was sufficiently keeping you informed about the delay and later the PA'a recognition of her responsibility to you in this matter.
In this and all other responsibilities of the medical system "perfunctory 'sorry'" is often not sufficient. ..Maurice.
Dr. Bernstein, another example from last year occurred to me. This was my annual cystoscopy visit where I always say I want a male nurse when making the appt. and then again when I check in.
Last year I found myself waiting well past my appt. time and nobody was saying anything, but being observant I never saw a male nurse coming to the waiting area for any patients while I was waiting. Finally he came for me and when we got to the room he apologized for the delay. I gave him the standard "no problem, I'm glad you spent time with whoever needed it more, someday perhaps I'll be that patient." He was so relieved and pleased to see I wasn't upset that he said, he appreciated my comments, that people rarely are that understanding.
In this instance I suspect the delay was because he was the only male nurse and that he was tied up elsewhere, and that they didn't want to tell me a male nurse wasn't available when I checked in. Coming back to the conversation this week about hidden records, I suspect it was the coding of my records that precluded anyone suggesting I just go with a female nurse for my prep. Now of course this interfered with the doctor's schedule too but he came in as if nothing had happened at all.
May I make a suggestion to our participants here. After you have finished expressing your opinion regarding the opening YouTube doctor-patient video, proceed to look at the other doctor-patient interaction short videos presented in this section of YouTube, provide us with the link so that we all can go and look and think and also write your view here about how you interpret the video you selected. My scanning of YouTube on this general topic can provide a source for discussion of what the various scenarios are trying to tell us. ..Maurice.
Hello Dr. Bernstein,
I watched some of the videos that you recommended. Their common theme seemed to be "How to deal with the difficult patient". However, nowhere in the videos was "difficult patient" defined. Nevertheless, from the videos, one could intimate that a difficult patient was one who was agitated, emotional, angry or non-compliant. Unless I'm grossly mistaken, all of the videos seemed to concentrate on "diffusing" the situation via empathy or communication skills. Again, correct me if I'm wrong, there was no mention of conflict resolution. No mention was made of resolving a situation in which the patient asked for a change of protocol (the main thrust of our blog – changing dignity/ modesty protocols). Most of the videos mentioned that the doctors should "know your boundaries". That is, know what you (the doctor) are willing to tolerate from the patient before the patient is ultimately asked to seek another physician. All the videos seemed to indicate that doctors should be empathic, listening, etc. in an effort to ultimately get to the physical part of the office encounter.
In the video you presented above, the doctor indicated disappointment and regret re Joe's wait. There was no mention of changing protocol so that Joe might be periodically informed re his (Joe's) wait time. Furthermore, Joe indicated that he owed the receptionist an apology. Why? From the video, Joe seemed to merely ask the receptionist re the wait time. No mention was made of Joe upbraiding the receptionist. Joe's "venting" seemed to be with the doctor. The apology should have been to the doctor. Moreover, the doctor should have mentioned that he would be certain to change protocol so that patients would be periodically informed re delays. This apology and protocol change would have indicated a mutual respect for doctor and patient. As the video ends, one might summarize the doctor's statements as "see it from my perspective". Isn't that what many bloggers are deploring – the doctor's perspective is always paramount?
Reginald
I found this worthy YouTube video in the series of YouTube medical video presentations regarding the professional behaviors with a hospital setting (example bad followed by example proper) at this address:
https://www.youtube.com/watch?v=r842Ylpa-nQ
I am absolutely sure that amongst the numbers of bad hospital professional behavior you may find some which fits with your personal or family member experience. But I think you will find that the examples of "proper" professional behavior immediately supports the dignity of the patient, family member or visitor involved. I am sure that the examples of "improper" professional behavior portrayed will bring "that's what happened to us" recall to JR and the others who write on this thread. Very worthy video.
Note for each video in the series, there is the date of presentation and the number of visitors who approve/disapprove of the presentation. I wonder what the statistical distribution between the two is set by hospital professionals who watch the videos and agree with each segment's "proper" examples. ..Maurice.
My thanks to Misty for providing this link
https://www.lansingstatejournal.com/story/news/2020/12/29/sparrow-hospital-covid-patient-visitors-policy/4071841001/
to an article in the Dec. 29 2020 news article which describes a Michigan hospital who is permitting family members to visit their COVID hospitalized patient.
I think more hospitals, who are able provide the appropriate precautions as described in the article should also consider the presence of a family member within the patient's room. This permission may provide the ill patient an additional therapeutic agent. Again, thanks Misty. ..Maurice.
Hello Dr. Bernstein,
After watching the primary video you provided, I came away frustrated by the patient-doctor interaction. Although the doctor appeared to be deferential to the patient as he tried to understand and then explain the cause of the problem, as the patient, I would have been annoyed with the doctor's manipulating approach. As Biker's experiences implied, a patient will be much more forgiving if the doctor would just cut to the chase and apologize for the delay, rather than taking minutes to suss out all the patient's various feelings. My advice to doctors would be: "read the room" and go straight to the apology/problem-solving part rather than conduct a lengthy psychoanalysis of the patient's demeanor. Just my two cents.
KB
KB, your "two cents", is worthy of at least a
"dollar". Thanks and welcome to this blog thread.
May I ask you to disclose your gender since disclosure to the viewers of this blog thread gender of potential patients and medical care workers seems to be of discussion importance.
However, regardless of your gender, it does seem to me that a succinct resolution of the "waiting, waiting patient's complaint and personal concerns is more of immediate value than a delay directed toward the physician's personal excuse which can be detailed, if necessary, later. So.. an apology and immediate handing over the bottle of pills (the reason for the visit) would be more appropriate than "psychoanalysis of the patient's demeanor". ...Maurice.
I want you all to know that I have been re-thinking about what I wrote to KB when I said to KB "May I ask you to disclose your gender" and defended the request with "May I ask you since disclosure to the viewers of this blog thread, gender of potential patients and medical care workers seems to be of discussion importance." I should now ask our readers "or does it?" Does it matter whether the writer to this blog thread assumed the at birth gender or later another gender in terms of expressing a view of how patients should be treated in terms of preserving the patient's inherent dignity? ..Maurice.
Dr. Bernstein, I don't feel a need to know the gender of a poster. We all share a common goal of receiving healthcare in a dignified and respectful manner.
Dr B
Why couldn't that patient have been given a refill without an appointment? His doctor didn't do any care anyway.
And yet, Biker, what has been written here in the past suggests that female patients have, in these days, become "winners" with regard to the way they are treated generally properly by medical professionals (except for the news worthy presented "misbehavior or worse" of male physicians to women( such as here at University of Southern California.)
Misty, am I wrong in this assumption? Could there be a "patient gender bias" with regard to which gender is "suffering more"? ..Maurice.
Hello Dr. Bernstein,
Thank you for the URL to the video re patient hospital experience. I noted that the video was posted in Nov 2013. I'm wondering why, in 2021, 7 yrs after the video posting we're still discussing patient indignities, especially since over one and a half individuals have viewed the video. Do you have any ideas why this "problem" of disrespectful treatment hasn't been resolved? Are we to believe that hospital personnel slow learners?
Reginald
JF, excellent question. The medical rationale for having the patient present for being presented with a refill of the medication is for a necessary physical examination, along with check for side-effects to verify the need or safety for continuing the medication. None of this was present in the scenario as presented. There was no sign of such clinical motivation for that visit. ..Maurice.
p.s.- JF, what is your view, understanding the goal of this blog thread (preservation of patient dignity) as to whether the gender of the pseudonym commenter is important to be disclosed. As you see from above, unlike you and JR whose gender is "out in the open" is it really proper and functional for a visitor entering into a discussion here to disclose their gender if not apparent from their narratives?
Dr. Bernstein, yes the day to day experience for women in the healthcare system is markedly different than for men if for no other reason due to non-phyisican staffing being overwhelmingly female. By default and often by plan the non-physician staff for intimate exposure matters for women is almost always female. Female patients also benefit from the societal norm that calls for female privacy to be protected while perpetuating the mantra that privacy and modesty don't matter for male patients. This does not mean that women aren't also subject to indignities but rather that the odds are far greater that male patients will have their modesty and privacy ignored, mocked, or bullied.
That healthcare is female-centric does not mean that the solutions and discussions must be segregated or identified by gender. I very much welcome anyone to the discussion without regard for their gender.
Both male and female patients are violated. Men have a harder time finding an urology practice that can accommodate their wishes for an all-male team (both male doctor and male nurse) while it is easier for a woman to find an all-female ob/gyn practice where she can be guaranteed that she would only have female medical personnel present for her gynecological procedures in office. There are hundreds of all-female ob/gyn practices in America while there are almost no all-male urology clinics in America.
I feel both male and female surgery patients are vulnerable if they are under anesthesia because the hospital often assigns the surgical team and they often do not think about the sex of the medical personnel even for surgeries that may involve patients’ private parts. Men do have a harder time getting an all-same sex surgical team than women at some hospitals that do not employ enough male nurses.
I believe in some cases men have a harder time communicating with their doctors because some doctors take men less seriously than women. This doctor in the video sounds arrogant and I am not sure if he would be different with a female patient.
Misty
Misty, I agree that men and women are on comparable ground in OR scenarios, and to a degree in the ER as well. For most men however, the majority of their healthcare experience of an intimate nature is not in the OR or ER. Even when they have a male doctor, men are likely to have at least one female present for vasectomies, testicular ultrasounds, cystoscopies, urodynamic studies, prostate biopsies, prostate cancer treatment, bed baths, showering assistance, catheterizations, full skin exams and so forth.
Oh, oh..the upcoming "21 Century Cures Act" is disturbing some doctors as patient gain full access to the physicians' notes and writings about that patient. Read the details of the Act itself which will take effect in April 2021.
And then there is the issue of patient, not only having access and record to what the physician writes but also what the physician and others vocalize and do by taping and visual recording. Here is MDedge Internal Medicine current article on this patient power.
Now, let's discuss what patient's will legally now have with this power to redesign medical system behavior and identify misbehavior. ..Maurice.
Biker: I think all urology practices should actively hire male nurses. I think they should go to the local nursing home and offer the male nursing student a job. This would help a lot. I also believe that all hospitals should have male nurses available at all times to do intimate procedures on male patients such as urinary catheterizations.
Dr. Bernstein: I like the idea of patients being able to record conversations with doctors. I am sure that some won't like this because it will open the doors for some law suits. But I believe every patient has the right to record his/her conversation with medical professionals.
I wanted to share with you all that there is an article about Modesty in medical settings - Wikipedia. I find it interesting the web site for Medical Patient Modesty is mentioned at the end of the article.
I found this fact interesting: In 1816, male physician René Laennec invented the stethoscope as a way to respect the modesty of a female patient, as it would have been awkward for him to put his ear on her chest.
Based on my research, medical professionals seemed to be more sensitive to patient modesty in the early 1800s and before. I know that over 40 years ago, that male doctors and orderlies did intimate procedures on male patients. I am thankful that modern medicine has brought many improvements that have saved people’s lives, but I wish they had stayed with strict patient modesty rules.
Misty
Misty, congratulations on being recognized by Wikipedia and your good work.
The urology practice where I go is large. 11 physicians (8 male, 3 female), a female PA, female NP, and 10 Residents (6 male, 4 female), 2 each year for a 5 year program. As best I know there is only one male RN. I get assigned him each time and as I noted recently last year's appt. was delayed I think because this male RN was probably requested by someone else that conflicted with my appt. However this is one more male RN than most urology practices have. I am unaware of what their use is of medical assistants, scribes or other non-physician staff but I haven't seen any other male staff.
My prior urology practice at a large hospital in Boston never had any male non-physician staff, so switching to this one was a big step forward.
Biker,
It is frustrating that so many urology practices do not recognize how important male nurses and assistants are. About 75% of urology patients are males.
I am not sure who submitted Medical Patient Modesty's web site to Wikipedia. But I am glad that there is some information there about history of medicine and patient modesty.
Misty
I posted this on Dr. Bernstein's blog about COVID.
I wanted to encourage everyone to read an article I wrote about No Visitor Policy During a Pandemic .
It is so heartbreaking that a number of hospitals in America have reinstated the no visitor policy. Most hospitals in Western North Carolina currently have this no visitor policy. I have heard horror stories of patients suffering. At one hospital, the nurses are so overworked that they cannot devote much time to patients at all and they barely have time to call family members to update.
I agree that COVID-19 is serious and we must do whatever we can to control spread of COVID-19, but the no visitor policy is not the answer. I believe that each support person should follow strict infection control measures such as wearing required masks and temperature checks.
I wanted to encourage everyone to read this excellent article by an ICU nurse in California, Nurse: Despite coronavirus pandemic, hospital patients need their loved ones at their side. I agree with this nurse. She has many excellent insights. She shared that even the most experienced RNs can make medical mistakes and how loved ones often double check medications and dosing.
No Visitor policies at hospitals open the doors for more patient modesty violation cases and sexual abuse since patients have no one to advocate for them. Also, the fact that more nurses will be overworked will open the doors for them to not take patient modesty concerns seriously. A family member helps the nursing staff in many ways. Many husbands prefer that their wives help them with personal care. This No Visitor policy even prohibit spouses from being present.
Misty
Misty, as has been discussed here at various times, urologists staff their offices for the comfort of that 25% of the patients that are female. They know female patients would speak up directly or vote with their feet if forced to endure male staff for intimate exposure procedures. The entire healthcare industry knows that most men will just quietly accept being embarrassed and will quickly become compliant if subjected to "you don't have anything I haven't seen" mocking or bullying type statements.
Another reality is comparatively few men seek non-physician careers in healthcare. Even for those doctors brave enough to hire male staff, the pool of applicants simply does not include very many men. My understanding is that male nurses are often concentrated in OR & ER roles and rarely seek work in outpatient office practices. More money & excitement, and greater cultural acceptance.
Given the greater convenience of female-only staffing, few urologists are going to be proactive in seeking male staff for the comfort of their male patients for as long as male staff continue to quietly accept the status quo.
Misty
I agree that there needs to be family present for sick or injured patients at the hospitals. The other thing that I'm thinking might seem a little off the wall. There needs to be more ventalators manufacturered. And buildings other than hospitals used for Covid patients. And people trained and hired to attend to the patients that aren't doctors or nurses. I know that currently that's probably illegal. Then vote that legality away. I don't mean just any #!$@ hole should be hired, but with doctors and nursing staff being pushed beyond their strength, what else can be done?
JF, I am just presenting my suggestion under current changes within the United States: the philosophy and actions of a new United States Presidential administration with regard to the specific issues you mentioned. I have hope. ..Maurice.
And then, of course, is the issue "Should Anti-Maskers Refuse COVID-19 Treatment if They Become Ill?" You will find your own answer if you read the Sept 14 2020 article in Medscape: https://www.medscape.com/viewarticle/937362#vp_3
..Maurice.
Biker, you are spot on with the staff gender issue in Urology practices. One of my best friends brother was a Urologist, I say was because he is now retired. When I met him some years ago I discussed with him the problem we men face with an all female assistive staff in Urology clinics and other places.
He quite openly agreed with me. The practice he was involved with was in Atlanta, GA. As most here know Atlanta is a large metroplex. The practice had a male side and a female side. If a male patient arrived he signed in and went to the male waiting room. It had male decor and men's interest magazines (Fishing, Hunting, Guns, Sports) and so on. If a female patient came in she went to the female side with feminine decor and women's interest magazines (Good Housekeeping, Ladies Home Journal) and so on. All assistive staff on the men's side was male, medical assistants and nurses. On the women's side, all female. The assistive medical staff did not cross to the other side. Additionally, the non-clinical staff was restricted to the office area and did not go into the clinical areas during business hours. Given the big city availability of personnel choice and the presence of several small community colleges, they had no problem attracting appropriate personnel to the hiring role. Most of the country is not like that however.
The problem men face today in most of the USA is severalfold. First is that the medical staff is not involved with the hiring decisions. That is done by the corporate staff. Most, if not all of the staff are employees, including physicians. That's the problem that I had with my last Urology practice. Patients needs are not known to the hiring staff. Secondly, there is the perception that female ancillary staff can work with both male and female patients, but male staff is limited to male only patients . Thirdly, men don't communicate well when it comes to emotional concerns.
Continued...
58flyer
To Biker continued,
So in most of America the problem for men is basically this: As men age, their need for Urology services increases. Therefore they present for Urolologic care in increasing numbers. This is good because it means more BUSINESS. Another problem for men is ....women. Not blaming anything on women but they have a need for Urologic care too. Women have a need for OB-GYN services. Men do not...it is strictly for women. You see no men competing for OB-GYN care. But women constitute about 25% of Urolologic care. In my past experience I have seen many women in the same waiting room as me. It comes down to the issue of liability. Men never (or rarely) complain about sexual abuse, but women do so more often. Easy solution: all female ancillary staff. When men face the female staff they are forced to shut up and put up, or go elsewhere, or delay care. Most Urology practices are smug in their belief that the male patient who walks out today will be back when he is chronic or stage 4. And that's what is really sad. His life could have been saved had he presented for treatment sooner. This is what my Urologist brother of a friend told me. Again, this is why men don't go to the doctor.
It all comes down to MONEY. As long as the waiting room is full, there is no need to change anything.
I've said it before here and I will say it again, it will take LEGISLATION to fix the problem faced with the practice of Urology. At least at the state level, but most appropriately at the national level. MANDATE that any Urology practice have gender appropriate personnel sufficient to care for all male patients who come into that practice. Even more, ALL medical care that men face should have gender concordant staff.
58flyer
58flyer .
You said that it would need to be MANDATED at the national level . Those idiots in Washington can't get anything right . Using your Atlanta Urology clinic . Which side would our new Assistant Health Secretary use ? That clinic sounds like one of a kind . So glad there are places like that . I personally would travel to a place like that even though it was a thousand miles away . I won't hold my breath waiting for the perverts in Washington to help . AL
58Flyer, I fully agree with your above analysis and advice even though I am perfectly satisfied with the female assistant nurse who monthly changes my urethral catheter. Of course, you may say, she knows I am a physician but her behavior is exactly what I would expect occurs with non-medical profession patients. ..Maurice.
AL, the Washington perverts in medical care are gone from the Biden medical professional staff. He announced such ignorance and misbehavior under the prior Administration would lead to immediate firing. The current news of the misbehavior of those in charge regarding the production and distribution of COVID vaccines is an example of what will not be tolerated in the new federal administration. Your pessimism may end up not warranted. ..Maurice.
Dr. Bernstein, there may be a new administration in DC but it will not represent any change from the last when it comes to mandating anything that improves care for male patients. Women's groups simply would not tolerate it. Disadvantages are to be remedied. Advantages are to be maintained. That is the state of modern day feminism. 58flyer may be right that it will take legislation, but culturally it just is not feasible at present. This is especially so when men are reluctant to speak up. Silence is taken as acceptance of the status quo.
Maurice .
You miss the whole point of my post . There have been numerous perverts in Washington from both parties . Need examples . LBJ used to run around naked on Air Force One with media present . Joe Biden used to swim naked in the WH pool while female guards were present . Good old Hunter was banging his dead brothers wife before the ground had settled on his grave . Joe and Jill thought that was just fine . They said they were so glad they found each other. I guess I have a different set of morals than most people . My brothers wife is off limits . Period . I don't find any of the above to be morally right . I have zero faith that they will do something right in regards to the modesty issue . Don't forget old Anthony wiener with his below the belt pictures . Are these the people we really want making up rules about modesty issue's ? AL
Dr. B.,
So the "Washington perverts in medical care are gone"? Really, are you so naive or have you drank too much blue kool-aid? Of course, they are still there bc there is really no change except to worsen. Biden tolerates his own habit of feeling up little girls as well as his son's habits (just news for this as there are plenty of pics). My husband was medically and sexually assaulted by a group of your progressive nurses/doctors so perverts are alive and well within your political party. As a matter of fact, they exist in all political parties as well in all walks of life. However, positions of power and control are more likely to attract them which politics and medicine both fit that definition. Of note, your YouTube videos do not at all pertain to what happened to my husband bc his situation was not an "oops" but rather intentional acts of harm. The only thing that will address that is jail time and to lose their license(s).
On the not addressing the medical needs of those not wearing masks, we have been through this before. Should the treatment ban also not extend to those involved in wrecks where speeding or drinking caused their injuries? What about those who smoke? Should the medical provider also let them go untreated? Why even bring this up again? Are you assuming only Trump supporters are the only ones not wearing masks so therefore like many in the Dem party, they deserve to die. I live close to a major liberal university which looking at those on campus including those so enlightened professors, I am not seeing them wearing masks. Would this thought also apply to them?
And this is how medical patients get mistreated and abused. It is because close-minded people who believe they are superior also believe they have total right of power and control. They believe their philosophy is the only one that matters and the patient must abide by what happens to them. Sexual assault--no problem except if it would happen to a nurse in a parking lot. Then and only then would it be wrong. Forcing someone to have something done to their body if they are a patient, no problem except if at the local mall a store clerk decided you needed triple piercings rather than the single one.
As for AL's pessimism, it will end up to be very warranted as the new Resident Biden has made it clear the common person who didn't vote for him is not a priority but even though he has called us names and such, we should unite. As long as we agree with him, we will be fine otherwise....or as AOC said we should basically disappear from earth which also they may do as the do control the healthcare system. As HRC said, "Control the healthcare, control the people" and they the swamp part of government has controlled healthcare for many years which does explain why there is so much patient harm happening. There is no hope.
Maurice,
You are delusional about the new administration. The states had almost 9 months to get a plan to distribute the COVID vaccine. The federal government does not have jurisdiction in the states for certain matters. That is why only the national guard (under the direction of the governor) are deployed and not federal troops (unless protecting ONLY a federal institution).
Healthcare, medicine, public health are all the domains of the state the federal government did its job; it got ventilators and PPE produced as well of creating multiple vaccines at "warp speed" AND they were all sent to the states.
As for our new Assistant Health Secretary, she is a disgrace to the Great State of Pennsylvania. My friend, a transwoman says that she is a disgrace to all transgender people as well.
Biden HHS nominee moved mother out of care facility as she directed nursing homes to take COVID patients. Her mother was safe, but the mothers of the citizenry of Pennsylvania were expendable, political pawns.
A confidential agreement was uncovered which allowed Pa. car show to happen despite all other businesses being closed for COVID-19 restrictions.
COVID restrictions put in place by our governor, and supported by Levine, had been ruled unconstitutional.
These are just her most recent blunders.
I proudly stood on the steps of our state capital with my friend (the transwoman), with rifles slung over our shoulders, protesting for the rights of the citizens of Pennsylvania, the Pennsylvania Constitution, and the US Constitution to be RESPECTED.
The new administration will be worse. Just look at the media bias: How is it the Ayatollah of Iran, who has called for violence against the people of Israel and the United States still maintain his Twitter account, but President Trump's is deleted and he is banned?
How is it that the Chinese Communist Party, which is guilty of genocide and human rights violations, still has its Twitter account?
The state regularly subjects minority women to pregnancy checks, and forces intrauterine devices, sterilization and even abortion on hundreds of thousands...
Talk about human rights and dignity violations like we discuss on this thread...
As to the new administration, read my post on the Bioethics and Dealing with the COVID-19 Pandemic thread, and what the new administration has to deal with and the consequences of keeping their promise and letting almost 10,000 illegal immigrants from Honduras into our country in the time of COVID.
-- Banterings
WOW! National governmental change seems to yield no change to the challenges in the preservation of patient dignity. If that is so, then what is the mechanism all patients of all genders and all politics should take to attempt to meet the goal of this Volume thread title? We need answers to this challenge. ..Maurice.
From a recent Medscape article. If you were the employer of a healthcare worker and the employee refused to take the required COVID-19 vaccine, how would you respond to the following situations?
Is an employer exempt from paying workers' compensation to an employee who refuses to be vaccinated and then contracts the virus while on the job?
Can a prospective employer require COVID-19 vaccination as a pre-condition of employment?
Is it within a patient's rights to receive an answer to the question: Has my healthcare worker been vaccinated against COVID-19?
If a hospital allows employees to refuse vaccination and keep working, and an outbreak occurs, and it is suggested through contact tracing that unvaccinated workers infected patients, will a court hold the hospital liable for patients' damages?
And Mr. or Mrs. Employer, what would be your reaction? ..Maurice.
"Is an employer exempt from paying workers' compensation to an employee who refuses to be vaccinated and then contracts the virus while on the job?"
No, same as employees who violate a corporate safety rule are still entitled to worker's comp if they get hurt on the job. One caveat though is the employee proving that they contracted covid-19 at work is not automatic given they could have contracted it anywhere that they were.
"Can a prospective employer require COVID-19 vaccination as a pre-condition of employment?"
Yes
"Is it within a patient's rights to receive an answer to the question: Has my healthcare worker been vaccinated against COVID-19?"
No. Patients are not entitled to staff health histories. There are endless reasons that a nosy patient might pose in order to get the personal health histories & conditions of the staff. Wanting to know about covid-19 vaccinations may be reasonable on the surface but the general topic is a slippery slope of who gets to determine what is reasonable and to what extent.
"If a hospital allows employees to refuse vaccination and keep working, and an outbreak occurs, and it is suggested through contact tracing that unvaccinated workers infected patients, will a court hold the hospital liable for patients' damages?"
Courts make reasonable and unreasonable determinations so it is anyone's guess what any given court might do. At issue is proving that this employee was the source of the patient's infection. Contact tracing is an imprecise science and relies upon a lot of assumptions. To the extent the infection can survive for a period on a surface, it could have come into the facility via a package delivery rather than an employee for example.
Biker, I took the Moderator's liberty to publish your comment on the blog thread regarding ethics and COVID-19 as your response to the same posting there of mine regarding employees vs COVID immunization.
For those who write here on the topic, you are certainly welcome to copy your post here to the blog topic "Bioethics and Dealing with the the COVID-19 Pandemic" where I had posted this topic yesterday.
https://bioethicsdiscussion.blogspot.com/2020/05/bioethics-and-dealing-with-covid-19.html
..Maurice.
I want to thank Banterings again for setting up the broader topic to this long series of blog threads with his "Preserving Dignity".
Looking back to a blog thread started July23, 2013 with the title "Extra-Marital Sex: Sex By The Demented in Nursing Homes" the issue of preservation of patient dignity comes face to face with where does patient dignity begin and end. If you click on the above title link, read the introduction and read the Comments you may find some familiar names of our contributors. Read the blog introduction, links and Comments and you may want to write a comment there but also return and write a comment here.
Compared to the recent comments here which seem politically loaded, I find no politics but simply ethics in that topic. ..Maurice.
JF, I look to your experience, which I presume was potentially attending to the patients described in the blog thread. How would you feel if you were aware two demented patients were engaged in a sexual activity seemingly accepted by both? ..Maurice.
Dr B.
It has happened at past jobs. One nursing home where I worked at, their families were consulted and both families were OK with it so they were moved into the same room. At my current job one female patient and a male friend would go into her room together. Some of the staff would separate them and the female would get really agitated/enraged. She thought he was her husband. I would leave them alone because of how it was treated at my earlier job. Plus the fact that I believe in patients rights ( so long as they're not bothering other people.
Perhaps, nobody here remembers this news report from November 13 2007 via CBS News:
The husband of retired Supreme Court Justice Sandra Day O'Connor has struck up a romance with a woman who is a fellow Alzheimer's patient and lives at the same assisted living center as him, according to a television news report.
The retired justice isn't jealous about the relationship and is pleased that her husband is comfortable at the center, the couple's son, Scott O'Connor, told KPNX in Phoenix in a broadcast that aired Thursday.
"Mom was thrilled that dad was relaxed and happy," Scott O'Connor said. An effort by The Associated Press to reach Scott O'Connor on Tuesday morning was unsuccessful.
An official with the assisted living center was quoted as saying people with Alzheimer's need intimacy and sometimes develop romantic attachments with fellow patients.
John O'Connor was diagnosed with Alzheimer's 17 years ago and was sad when he moved into the assisted living center, his son said.
"Forty-eight hours after moving into that new cottage he was a teenager in love," Scott O'Connor said. "He was happy."
The news report showed video footage of John O'Connor holding hands with a woman identified only as "Kay." The retired justice wasn't shown in footage taken at the center.
Though Sandra Day O'Connor, 77, did not appear in the television report, it gave a rare look at the life of the nation's first female justice, USA Today reported. The family's willingness to highlight an aspect of a heart-wrenching illness recalled O'Connor's decision in 1994 to go public with her feelings about breast cancer.
In a speech to the National Coalition for Cancer Survivorship, she spoke about discovering the cancer in 1988 and undergoing a mastectomy, the paper reported.
Scott said, "For Mom to visit when he's happy … visiting with his girlfriend, sitting on the porch swing holding hands," was a relief after a painful period, according to USA Today.
The O'Connors, who have three children, met at Stanford Law School and married in 1952, according to the paper. John O'Connor left a partnership at a Phoenix law firm to come to Washington with his wife in 1981. He worked for D.C. law firms but was limited in his ability to take on matters that could come before the justices.
As her husband's disease became more difficult to handle, O'Connor retired, the paper reports.
Does this acceptance of assisted living centers as noted in this news article and even JF's experience cause any concern from our visitors here regarding personal and patient dignity? ..Maurice.
Do you want another matter of "preservation of patient dignity" to argue over? How about the loss of dignity presented to a patient who was born with a defect at birth which could have been anticipated by the parents prior to fertilization? The dignity is the faith of the patient's parents in preventing a congenital abnormality of the yet to be conceived child.
Here is a current United Kingdom trial on this very subject."Wrongful Life Revisited".
In Evie Toombes v. Dr. Philip Mitchell [2020] EWHC 3506 the High Court has given renewed consideration to claims for, so called, “wrongful life”. Can a disabled person ever claim damages on the basis that they would not have been born but for the defendant’s negligence? The Court answered that question with a resounding “yes”.
Doesn't a patient have the right to sue the parents for creating the patient knowing full well that their child will be disabled? ..Maurice.
Hi everyone,
I wanted to let you all know we have a new video, Assisting Male Patients With Personal Care. Robin Lenart, the executive director of Dignity Resource Council demonstrated how Honor Guard garments can help to protect the dignity of male patients who need assistance with bathing and other personal care in this video.
Robin mentioned Medical Patient Modesty in this video.
Misty
Visitors and Contributors, I would like some suggestions regarding the editing of this blog thread "Preserving Patient Dignity".
Though I have been very pleased with the commenters varying approaches and discussions to the issues that mostly I have brought up relating to the blog thread topic, I know that there are much more visitors to this blog thread than contributing participants.
Is there anything I should do or not do as Moderator to stimulate a greater population of writer participants here? For example, am I presenting too many examples which I relate to the blog thread title "dignity"?
I want to emphasize that this request is not to criticize those my relatively short list of contributors but I would like suggestions regarding this thread format and how greater active participation by more visitors would be encouraged. You can write it for publication here or write me privately to doktormo@aol.com ..Maurice.
This past Friday I met with the director of the health sciences program for the high school that the female student (allegedly) attended who was present with the female doctor during my hospital stay which occurred on 10/31/2020. Here we are almost 3 months later, it has taken that long to get the appointment to see that person.
That director is a former nurse. She was pleasant to me and I was to her. She has had no success in locating the alleged female student who took part in the encounter. My suspicion is that the juvenile was not on any program and may well have been a relative of the doctor.
The director said that they have no policy on who rounds with doctors and are just happy that someone will allow a student to do that. She said that good judgement should be used when it comes to what the student sees. I asked if she considered it appropriate that the student was presented as a chaperone. She said that would be grossly inappropriate. I pressed her with the example of how she would feel if a male gynecologist came into her room with a juvenile male and she could only say "I see your point". We talked further and she said that it is apparent that they will have to come up with a policy on what the student takes part in, and that it should not involve exposure of genitalia of any patient of either sex as there is no way to ascertain the maturity level of high school students during the time of adolescence. Of course she agreed that there is no way they could hold a juvenile to HIPAA confidentiality agreements.
While I came away with the feeling that she was sincere, I have no way to verify if anything we discussed would be taken seriously, let alone acted upon.
The Governor of my state (Florida) recently signed into law legislation relating to non consensual pelvic exams and the state legislator behind that action is well known. She is female, but not from my district. I am thinking of meeting with her to further refine the law and giving protection to male patients, particularly as it relates to the sex of chaperones. It should also allow patients to "opt out" of student participation, without being denied care.
58flyer
Thanks for the update 58flyer. Though you may not have gotten definitive answers, the doctor in question, the practice she is part of, the hospital itself, and the school the girl attended all know that something unprofessional and inappropriate occurred. Some degree of change will occur with all of the above even if you are never told precisely what that is. This is why we must speak up. Any changes you caused by speaking up will benefit many men for years to come. There is a ripple effect.
Assuming the woman at the school was being truthful, the student in question surely was a relative of the doctor, a relative of someone in the doctor's social circle, or the child/grandchild of a local VIP of some sort. Regardless, it still astonishes me that the doctor thought it was OK to lie to you and be intimately exposing male patients to a high school girl. I pity her patients if her regard for patient privacy and dignity is that low.
I assume the girl attended a large high school. Around here it would be unlikely that the staff didn't know who students were related to and who their families were connected to socially.
Thank you for sharing your story and for doing the followups that you did. Let us know if you do get to speak with that state legislator. In a high population state like Florida it might not be easy. State legislators here don't have staff and must answer their own phones, letters, and emails so they're pretty accessible.
58flyer,
CS gave me a copy of the paper she had to sign after this law passed in FL. To tell you the truth, I was not impressed with it.
The paper starts out saying you give permission to receive pelvic exams "performed by my physician or other health care practitioner, any medical student or any student receiving training as a health care practitioner." It goes on to define what a pelvic exam involves for a female patient and for a male patient. In the the end it states, "I consent to receive pelvic examination as described above, and all my questions have been answered to my satisfaction." This entire statement is in caps. There is a signature and date line. There is a place for interpreter and translation services to be noted. What is very glaring in what is missing is any place on the form for the patient to "opt out" of any particular part of the exam. In other words, it has been the experience of myself and many others that what you agree to verbally with the physician does not translate to what actually happens. This means if you state verbally you do not accept medical students and sign the form feeling confident you stipulation has been received, if you are sedated you may have a medical student present because you signed the form saying you accepted them present. Many of us have learned the hard way with devastating consequences that what is said verbally is not adhered to by the medical community. As for the director of the school, you probably did know the identity of the student but would not admit it to you as there are specific laws protecting the identity of students. As with most school systems, I imagine this type of behavior of the physician in charge not caring about what is proper for the student to see or not will continue to happen. In reality, most medical providers basically do not respect the bodily dignity or autonomy of any patient but especially male patients. Most medical providers feel entitled to use the body of any patient in any manner in which they see fit which also includes actions which are in direct violation of basic human rights documents.
Dr. B., There is a recent case in the UK of a mother of a 10 yr old disabled boy killing him bc during the lockdown she couldn't take the 24 hr care he needed. It was in the telegraph.co.uk. She plead to manslaughter charges. Because of the lockdown, he was no longer attending school 5 days a week giving her a break in his care. So what abt the patient dignity of this woman being forced by the govt to give 24 hr care without any help? Should she also be able to sue? What abt all the aborted kids? Shouldn't they be able to bring civil charges resulting in loss of life? Are you proposing like Hitler only the fittest should survive? What abt ppl like me? I don't think I should have to pay to support ppl who intentionally harm themselves or just don't think they have to support themselves? Who can I sue? What you were talking abt is a very slippery slope.
I agree that dignity includes more than just bodily dignity issues. However, I have found that most do not want to discuss medical harm issues as they would rather put their head in the sand until it happens to them or someone they love. I have found most are aware of how badly patients will be treated but accept it as something you have to endure to get medical treatment. I believe in what now is occurring in our society--the cancel culture--many more will be afraid to speak out because they see the power and control those possessing those tools have and will use to destroy those who have opposite views. Freedom is dying as well as free speech. Because patients know they will be vulnerable and entirely dependent on an absolute stranger during medical care, many will not speak out because they can see retribution does exist so therefore they could suffer medical retribution.
JR, here are two major articles by the same author regarding "Unresolved Disrespectful Behavior in Health Care followed by "...Its Impact, Why It
Arises and Persists, And How to Address It--Part 2"
I think what was written in these two parts of the subject presents the socio-pathology of what you were writing about and is something that should be emphasized to medical student education as a possible socio-pathology (and I am afraid is not currently emphasized) as important as patient clinical pathology which is, of course, the routine subject. ..Maurice.
w
"
58flyer,
The law should be "opt in" for patients; unless they are or were a licensed healthcare provider.
I say that because providers tell patients it is acceptable to do this, they are professionals, they have a magic white coat or magic stethoscope, they are gender neutral, etc.
Because of their special training AND because they owe a debt to society (the patients that they learned on, they are assumed to consent.
-- Banterings
Dr. B.,
Those articles drive home exactly my point that if they think they can disrespect one another, why does anyone not acknowledge it is happening to the patient too. In the article, it mentions the medical atmosphere basically fosters this toxic atmosphere. I clearly believe certain patients are selected to become victims of medical bullying. If they cannot prevent medical providers from harming one another, how can we continue to believe patients aren't being harmed too?
I believe my husband was one of the them. I know of some others like CS who was medically bullied which also turned into sexual medical bullying. It is more common than you think or even want to admit. Most patients will not remember it because of the sedation but a few will as sedation affects them differently like it did my husband and CS. Not to mention I personally witnessed some of it too. Their bullying also extended to me and my son. He is still quite angry about how he and I were treated that night along with what was done to his father. For him to harbor such anger when he is a type 1 diabetic & needs ongoing medical interventions is very dangerous for him as he has no trust of them. He sees we no longer have trust in them.
There needs to be a real study like the ones you highlighted only done from the patient's perceptive. I saw a group associated with the NHS is asking for patient harm stories but here in the US, patient harm is a rarely mentioned topic. They don't want to acknowledge any type of harm either accidental or intentional happens which is allowing the harm to grow. Every time a medical provider gets away with patient harm not only emboldens them but it also teaches those around them they too can do the same.
The question is how to interest the right people to conduct a study?
Dr. B.,
Regarding the case of the disabled person who sued for wrongful life, it is my understanding that the defendant is the doctor who did not adequately inform the mother, and not the parents themselves. I believe that the judge in this case decided correctly that the disabled person has claim to compensation for the malpractice inflicted on her mother. Both the disabled person and her mother suffered the indignity of inadequate attention/counsel by the physician.
KB
KB, what exactly is a "wrongful life" as defined by the disabled claimant? And what is a "wrongful birth"? And to whom should the claimant be directing the accusation? Is the parents' physician the "guilty party" or the parents who created or participated in the fertilization or delivery?
With regard to the general topic of "preservation of patient dignity" don't you all think that the patient has the ethical and legal power to make legal accusations with regard to "wrongful birth" or "wrongful life"? ..Maurice.
Following up on the scope of "Patient Dignity" and the individual's "unwanted birth" into his or her life with its personal illnesses or "harms" can be considered an issue of being morally and ethically appropriate for that individual to hold and act on that view. Who is responsible for the consequences of that individual's birth?
Read an interesting short article on this very subject is presented by an article in Quartz.com/ and concluding with this interesting finale "These philosophical arguments may be logical, but they result in extreme conclusions, and seem unlikely to be applied by many potential parents evaluating their life decisions. But, for all those angry teenagers who shout “I never asked to be born!,” their reasoning is surprisingly well supported by philosophers." ..Maurice.
JR, going back to your comments from Tuesday, when Governor De Santis signed the medical consent issue into law, most medical practices were thrown into a tizzy about how to comply. Google it up and you will see what I mean. There is still a lot of questions and the matter is still not resolved.
When I did some of my Urologic procedures I was given a form to sign that simply stated that my procedure would involve the genitalia and rectal areas. The form only asked if I consented to this. It didn't state that students would be involved. For my colonoscopy, it did state that students could be involved which is where we had the issue of me crossing out the student participation. For my Greenlight Laser prostate procedure, there was a student clause and I objected and they crossed it out without argument. For my ER visits the forms were on a tablet that you signed with your finger. There was no way to alter the form and it did state that they are associated with a teaching hospital and students could be involved. I signed it knowing I would be alert and would have objected had there been students. I suspect the tablet signing will become the way of the future, there being no way to alter the form.
That is why I want to approach the legislator involved and get the law to include that any patient could opt out of students, observers, and shadowers without being denied care. They need my permission to treat me, but I shouldn't be required to allow students and observers as the price of receiving treatment. I am a paying customer, between me and the insurance company.
The other big problem I noticed is that they give you the consent form to sign right before the treatment, even though there was a pre-op visit and other forms were signed then. I think this is wrong because it makes patients feel obligated to consent. On the day of your procedure/surgery many arrangements have been made, like with sick leave from your employer, child care arrangements, pre-procedure prep, and so on. You are at a disadvantage when confronted with a consent for student or observer involvement. The consent form could have been presented during the pre-op visit, when the patient is not under the stress and pressure of the treatment. I asked that very question when I have had been presented with consent forms on the day of the procedure. I have never received an acceptable answer.
58flyer
58flyer, I think they give consent forms just before procedures because they know most people will sign them without even looking at them. Once when my wife was having surgery and they did that to her I asked why. The doctor said they want to make sure the patient had a chance to ask the doctor questions before signing.
Once when I was having a colonoscopy they did that to me after they took my glasses. They were a bit put out when I made them give me back my glasses so that I could read it, and that I in fact read it. Apparently in their world I was supposed to just sign wherever they pointed to on the paper.
For just a routine office visit, the receptionist handed me page 2 of a 2 page consent and expected me to sign it. She was quite put out when I made her give me the 1st page and then stood there and read both pages. She said it just gives us permission to do any procedures and bill your insurance. I replied if that is all it says it wouldn't take 2 pages to say it. She was not happy.
Dr. Bernstein, on the wrongful birth/unwanted birth thing, while I agree that physicians should be liable for demonstrable malpractice that caused a child to be born disabled, going beyond that is akin to the extremes society has taken political correctness. Disabled children have always been born without it being the fault of anyone.
My nephew & his wife had a child born with the most extreme form of muscular dystrophy that died before his first birthday. It turned out both he and his wife were carriers of the gene which gave a 1 in 4 chance of this happening. In theory if they had genetic testing before she got pregnant they'd of known they were carriers and maybe they'd of decided not to have a baby, or if the baby had been genetically tested early in the pregnancy maybe they'd of decided to abort so as to spare the baby the never ending pain of his short life. Is society ready to spend what it takes to prevent this extremely rare event from happening? Is society ready to blame the doctor for not testing for every possible genetic anomaly that might happen? Sometimes bad things happen in life which if expense were no object might be prevented. Where I worked we had heated sidewalks at great expense to keep them ice-free. Should society spend trillions to have all roadways heated so as to avoid winter driving accidents? My point is there are limits to risk mitigation, including in healthcare.
58flyer,
Request a paper copy under your rights granted by the Americans with Disability Act (ADA).
They can print out the form to be signed. I have seen it. I write software, I know that this can be done. Ask for a supervisor.
Right after you sign the form, call a nurse over, have a witness, and tell them to change your consent verbally that you do NOT allow students and asked that it be updated in the EMR.
By law, they have to do this.
I wish that the sheeple will start standing up for themselves.
-- Banterings
Banterings, sounds like a good plan. I hope I am never confronted with another ER situation in the future but if I am, I will put your advice into action.
58flyer
A funny thing happened today. At my family practice place, they had a new doctor hired to replace the prior one. That was my Dermatologist. The male doctor left and a female was hired in his place. The practice called and left a message on my cell phone to call them back. When I did they advised me that they had a new doctor since the prior one was no longer there. My next appointment is scheduled for July and would I agree to the new doctor or be seen by the nurse practitioner, a female. I asked for the sex of the new doctor and was advised she was a woman. I said that would not work as I was not comfortable with a woman since I would be having a complete skin assessment. I then cancelled the July appointment and thanked her for advising me of the change in doctors. She said she understood, of course I had no idea of the qualifications of the person I was talking to.
I got to wondering, is this normal when there is a change of doctors to call patients who are scheduled for an exam to see if they are OK with the replacement doctor? I would think at the least it is a good courtesy. If I had shown up in July and was then surprised by a female doctor when I was expecting a male I most certainly would have cancelled on the spot. Did they anticipate that most everybody would want to know if there is a new doctor or is there something in my records that flagged them that I preferred a male doctor? On my last visit I requested that the doctor be by himself with no assistants or scribe when he came in to examine me.
I wonder if I was flagged because of my earlier request or if they are calling all scheduled patients out of courtesy.
58flyer
58flyer, I agree with your conclusions. A patient's knowledge about his or her physician is just as important as knowing the benefit limits and clinical hazards of their prescribed medications. If there may be potential physical or emotional problems related to a healthcare provider, it is the responsibility of the healthcare system to accept this as a clinical or even legal issue. A physician "opening the door" into a clinical relationship attending a patient is not the same as a bus driver opening the door for a passenger to simply enter to take a seat and await the service of the driver. Yes, in both cases there are financial costs and even, for the passenger, rarely physical risks but there are ethical, personal and legal differences. ..Maurice.
I don't know if it's okay to post this or not. It doesn't have to do with dignity but it has to do with Covid. I saw on Google that within 6 months 40% of nursing homes could be forced to close down because of the cost of the Covid testing.
JF, when you state "for the cost of COVID testing", do you mean that the nursing homes would have to pay money to have their patients tested or that those patients who tested positive would have to be taken away from the nursing home elsewhere as precaution or to a hospital for treatment and there would be insufficient patient replacement placements for that nursing home. I thought that COVID testing was a free service as it was for me and my family. ..Maurice.
58flyer,
CS also is trying to get in touch with that same legislator. The form she had bothers me as it refers to verbal conversations which most of us know, if there is a difference of opinion the medical provider is almost 100% taken as gospel. There was nowhere on her form to opt out but said you were informed and by signing you agreed. So if you said verbally no students but signed the form as is how would you show you verbally said no students. Medical providers seems to have a nasty habit of leaving out what they don't want in medical records. They are only a record of the medical encounter they think it should be rather than what it really was. The large university teaching hospital here uses the electronic version so in the signature space you must squeeze in what you want to refuse. They try their best to make sure you don't have options.
I have to disagree you cannot have a procedure done without consent as it happened to my husband and a host of others on my Twitter following. Rarely will the law side with a patient over this as the medical community is allowed to falsified and lie their way out of being charged with what really happened and that is medical assault. Lack of consent is a rime that has become legalized. You also should be able to opt out of whatever part of any exam you do not want like if during your physical you do not want the prostate exam you should be able to on the form opt out. There would be less malpractice and feelings of being violated if the medical community would just learn to respect patient dignity such as autonomy and bodily privacy. Patients who feel respected and not harmed are less likely to sue or bad-mouth the medical providers. Why are they unable to learn this?
The nursing homes and assisted living homes have to pay to get patients and staff tested. It always costs $100 plus even tbough it takes less than a minute to swab. WE are being tested twice a week now.
JR,
At the recent ER visit with their form signing on a tablet, I signed but verbally told the admissions person that I would not allow students but there was no way to alter the form. I wasn't worried since I was to be alert during the whole process. No students were involved as it turned out. Just me and the male nurse, and the doctor was male also. I agree that there needs to be changes in the law to allow patients to opt out of anything they don't want, such as students and observers. Unfortunately, sometimes you have to experience the bad behaviors to develop your voice. I have been taken advantage of and the perpetrators got away with it. But I learned. I have also had 3 nurses arrested, but I had the advantage of being a police officer, and 2 of them knew that and still acted stupidly. Another occasion I caused an ER nurse to be disciplined and transferred to a floor assignment, and she knew I was a police officer but thought it OK to do me harm. But I digress. In your descriptions of what happened to your husband I find that terrible. In my police training we discussed what to do if called into a medical facility when a patient makes a charge of impropriety. It gets complicated. There are a lot of variables to consider. Some people do make false charges and others are actually harmed. By that time in my life I had already experienced medical harm so I knew it was a reality. As it turned out, I was never called to investigate a case of medical harm to a person other than myself.
58flyer
58flyer, obviously some of the medical staff who attended you knew you were a police officer. I am surprised, as with physicians as patients or governmental officials or movie stars as patients, you were not given VIP treatment. Perhaps the most essential VIP treatment would simply to be listening to your requests and attending to them so as to provide VIP patient comfort and yet still provide the clinically necessary services. ..Maurice.
58flyer, if it is OK to ask, on what premise would a police dept. arrest a nurse or other healthcare staff member? It seems in the egregious cases discussed here that there are never any legal ramifications for healthcare staff. For example, the Denver 5 voyeurism, Mr. Kirschner out at Olympia Urology, Twana Sparks, that hospital in PA where the staff all barged into the OR to photograph and ogle some guy who apparently had his penis stuck in some fashion, the hospital in Maine where photos of patients were posted in lockers and so forth. It just seems that police never see anything illegal in what healthcare staff do.
From CS: Regarding the FL Pelvic Exam Consent Form, at my most recent exam at a doctor's office, "they" "assume" you just sign. That this new form is another "formality" and not necessarily to be taken seriously. At Cleveland Clinic, and I can furnish a copy of that pelvic consent form, you are consenting "for life," when you sign it. When I went for a pelvic procedure, I crossed out any and all of what I was NOT consenting to, initialed it at each place, then had them make a copy of my amended form right then and there and hand it to me before I actually had the procedure. Mind you, this wasn't surgery, or in a hospital, it was a female Gyn doctor's office and I point blank told them I had been medically raped for my lung cancer surgery and I was NOT consenting to anything other than what I'd written on the form.
From CS:
On a tablet consent form, I had the administrator alter the wording and had check marked boxes added or deleted before I signed anything. It CAN BE DONE. Sure it's a pain in the neck, and they'll tell you they can't alter anything, they can. You can also have that form printed out, put in your alterations/changes, and have it copied and get a copy immediately. Again, a pain, but stick to your hunches and MAKE them do it. The more people who do it the better for all of us. They do NOT have you between a rock and a hard place, forced to put up with their BS. You can assert your rights. I just did it at a cardiologist's office for an endocardiogram. Female doc insisted I use her male tech. "No, I don't use any male techs for intimate procedures doc." I went to an off site imaging center, insisted on a female tech and had the procedure. Was the original cardio doc piqued? yes. Too bad. "I was medically raped by male techs doc. And I don't use them. They are NOT licensed or certified and when I get raped again everyone will deny it again. So NO, No male techs." After I explained it like that she agreed on different care for me.
58flyer,
Can you write a piece and give some references about what police are taught about patient complaints of impropriety by healthcare providers?
This will be extremely helpful.
BTW, you are my hero for holding those providers accountable.
-- Banterings
CS, thanks for providing us with your own experience at the Cleveland Clinic. For furthering this discussion of your personal experience, I think it would be proper to present a link to the Cleveland Clinic Patient Acknowledgment and Consent Form.
The only link to the Cleveland Clinic which discusses "Pelvic Exams Under Anesthesia Are Only for Clinical Indications, According to Cleveland Clinic Care Path".
CS, I couldn't find the actual Cleveland Clinic pelvic exam consent form but if you have a copy to contribute for inspection here, that contribution would be welcome for further discussion. ..Maurice.
Dr Bernstein says,
"I am surprised, as with physicians as patients or governmental officials or movie stars as patients, you were not given VIP treatment."
It's a double edged sword. The VIP status can get you privileged care, but at the same time it can cause unwanted attention. After rescuing 6 children (and a dog) from a burning house I was taken to the ER where I worked security as secondary employment. To my right was a nurse who said that as a first responder I should have known the dangers of rushing in and thereby making myself a casualty. On my left was a nurse who argued that had I not taken action and waited for the arrival of the fire department, those 6 kids would not be alive. Their arguing was quite violent with me literally caught in between. It almost came to blows between a cop lover and a cop hater.
I still shake my head at that memory. The cop hater got transferred to the floor.
58flyer
From Biker,
"58flyer, if it is OK to ask, on what premise would a police dept. arrest a nurse or other healthcare staff member? It seems in the egregious cases discussed here that there are never any legal ramifications for healthcare staff."
The short answer, a violation of state law. There has to be something in the books declaring a certain activity a violation of law. It also takes that activity coming to the attention of a law enforcement officer. Some activity, though really egregious by any standard, is not technically a violation, because there is not a law on the books to address it. In the Kirschner case, there may not be a law saying it is illegal to use a patient as a "prop" for initiating a new employee, even though it is a really bad idea. There has to be a law for a police officer to take action, and for someone to even know that it is a violation. As to video voyeurism, many states have enacted laws to address that. Those can be acted upon. As to the Sparks situation, there may not have been a violation of law, but certainly of ethics. As bad as she was, those around her who ignored her conduct were as guilty as she was and should have had any medical licenses revoked.
58flyer
From Banterings,
"Can you write a piece and give some references about what police are taught about patient complaints of impropriety by healthcare providers?"
I can only speak of my training from my own police agency in my own state. Laws vary.
In the sex crimes section of the police academy, we were told that in medical facilities there may be accusations of improprieties from patients regarding their attending staff. Of most concern, oddly enough, was the conduct of male staff with female patients. That involved both nursing homes as well as hospitalized patients. If the accusation was accusatory towards the male staff, and there existed no other factors, like physical evidence, the investigating officer would write a report stating "Information sexual assault" and not make any arrest. The report would be picked up by the sex crimes unit for further investigation. The medical facility would likely separate the accused staff from the accuser. In my personal experience, as stated earlier, I never was assigned such an investigation. Compared to all other crimes, sex crimes are really uncommon. The sex crimes unit of my agency was not very busy, despite being a very large city.
Despite that, we know that sexually inappropriate behaviors are mostly unreported. Sexual violations are hard to talk about for anybody. In my case it was nearly 30 years before I could relate my experience to a therapist.
58flyer
58flyer et al, ..and then there is the issue of the role of community police practicing within the hospital (ER and wards) and its effect on the hospital staff's professional dignity as well as in certain cases the dignity of the patients themselves.
From July 14 2020 online Scientific American is the emergency room physician's personal experience and discussion writing the article titled "Get Armed Police Out of Emergency Rooms".
One case which is noted in the article and I recall, maybe you do too, is "A viral video from 2017 showed Utah nurse Alex Wubbels being assaulted and arrested by Detective Jeff Payne after she refused to draw blood on an unconscious patient."
Medical care and law enforcement can be an ethically complicated relationship. ..Maurice.
58flyer,
Thank you for that information. I advise patients that a uniform officer will be the first to respond and they need to request a detective that deals with sex crimes.
-- Banterings
58flyer,
One other question; is there any publication that you may have seen online that is used to train detectives on how to investigate medical assaults?
I suspect that is part of the problem for law enforcement. Lack of training and written instructions "how too."
-- Banterings
Certainly Banterings there must be literature regarding how to train detectives investigating police assaults within hospital environments. ..Maurice.
Banterings,
Unfortunately I have not seen anything like that for something that specific. As I went through my career, with my own past abuse experience that occurred before I went into law enforcement, I was very attuned to investigations of medical abuse. I found very little. I considered going into sex crimes investigations and I did a brief stint in homicide, but I just couldn't wrap my brain around the idea of being impartial to sex crimes. So, I flew helicopters instead.
58flyer
Dr. Bernstein, police is ER's is not a patient dignity issue but rather a symbol of urban dysfunction. The article included NYC as one of the examples. NYC has 36,000 police. Adjusted for population, they would only need 2,000 if the police to population ratio was similar to my town. Why do they need 18X more police per unit of population? The article mentions people living in poverty, people unemployed due to the pandemic, and people with mental health issues. We have all that too and yet crime is almost unheard of. Why the difference? Something is fundamentally wrong with urban society. Police w/guns in ER's is just one of the reactions to it.
Dr B Ive been having difficulty getting to this group. in the past I could scroll down from an earlier volume. But anyway I got my first vaccine Tuesday. it wasnt manatory though and a lot of people didnt get it. staff or patients. we'll be getting our second shot in three weeks.
Maurice
I am shocked somewhat that you are still engaging yourself with this blog. Please, retire from this and enjoy your life, cooking, golf,birdwatching, coffee shops etc. We learned years and years ago that our healthcare industry is managed by the female SS
Nazi staff and as such nothing is going to change, at least with this blog. I’m concerned about you! End this blog! You’ve carried
mess on your shoulders long enough!
PT
If you are the PT who has wonderfully contributed to this blog Bioethics Discussion over the many, many years this blog has been present, I appreciate your current comment (and I am glad to see that you are still around) and I think it poses an important issue to discuss by the other contributors of their views here. I would sincerely like to know how the others feel about your comments, presumably referring to the entire blog and not just this topic on "patient dignity/modesty."
I want you to know that I am continuing to have numbers of visitors to this entire blog from all over the world. What is most interesting is the recurrent clusters of separate visitors from one geographic area within a period of a few days or so to one specific blog thread topic. These observations suggest that some of the topics originally published years and years ago are being used for
highschool or college research discussion challenges.
With regard to the "Preserving Patient Dignity (Formerly Patient Modesty)" maybe, despite published variations in attributed relationships to the main topic has reached an endpoint for further contributions and provide nothing further worthy of value. What do others writing here think of PT's impressive and conclusion? ..Maurice.
Hello Dr. Bernstein,
I quote what a doctor friend of me said about retirement - "Why should I waste all this knowledge (of 50 yrs)? They're going to carry me out of my practice feet first!" Bravo
!!! I would say the same to you. You can enjoy your other retirement activities AND continue moderating the blog. Via this blog you are contributing (in many unrealized ways) to the health (physical, mental, emotional and spiritual) of an extraordinary number of individuals. I applaud you, and ask you to continue your fine work!
Reginald
Dr B I say do what works best for you. There's a difference between you quitting this.blog and PT quitting. For PT it is a sore spot, the mistreatment that patients are forced to endure ( or don't get care ) For you it's just something you've heard about but never experienced it. And you had a hard time wrapping your head around that abuse and harm was or is occurring.
Reginald,
I applaud your comment! Couldn't have said it better myself!
Keep up the good fight Dr. Bernstein!
58flyer
I do want to repeat to PT who "wonderfully contributed to this blog Bioethics Discussion over the many, many years this blog has been present."
I have a suggestion. Rather than turning off the blog itself with its hundreds of topics.. not only strictly related to "medical practice" but about many other experiences with ethical issues attached and I bet I could find examples where you PT gave us your "two cents" on the topic.
My suggestion to all is the screen some of the "old" blog threads (other than modesty or dignity) worthy of further discussion and then instead of referring our current readership back down to the earlier era when the topic was first published, reignite the topic here at the 2021 top display as a "Volume 2" on the selected topic published years and years ago.. remember this blog started in 2004 on blogspot.com but for a number of years appeared on University of Southern California public website (and a number of topics were moved over to this blog site which I felt were worthy of further input and discussion.)
PT, how about the ethics of gardeners reshaping another biologic creature..trees.
For example simply go to
https://bioethicsdiscussion.blogspot.com/search?q=tree and scroll down and take a look at all the blog thread presentations regarding the ethics of trees. Well, lets put these other bioethics topic as followups here at the top of blog itself awaiting updated commenting and discussion of 2021. After all, life isn't all about modesty and medical management.. there are still some other aspects worthy of looking at their ethics. ..Maurice.
If there is a bit of consensus by the participants or other readers here, post your suggestions or those who would rather write me e-mail: doktormo@aol.com and I will not identify you but mention here your suggestion. ..Maurice.
Maurice
Yes, I am the PT who contributed to this blog for many years. If you recall I am the one who researched the issue about mammography and that there were no male mammographers. I got as I recall a lot of hate and flak for that as well as other truths
as well as other observations I saw and experienced while working in healthcare. I’m happy to say that despite looking over the last
volume here and seeing the word Covid19 which truly has no business being mentioned here, I actually made money during the time
this fake plandemic has been in effect. Hospitals and the femme nazi have rejoiced over their FAKE hero status all the while medical
facilities have systematically been charging $13,000 for each patient presenting to the ER with symptoms related to Covid WITHOUT
actually having COVID and $39,000 for a one time fee for being placed on a ventilator only because their symptoms appear Covid like.
If that’s not Medicare fraud I don’t know what is. But, I’m not here to discuss the femme nazi and their double standard roles
they invent and implement in healthcare. I’m back and only temporarily to discuss you Maurice, for the reason being that I want you to
end this blog. No one on this blog wants change, they like the status quo, as well as the fetish seekers who peek in on here to read this
fodder. End this blog, take a stroll up the beach with your sandals in hand. Breath in that ocean air,fabulous isn’t it. The sand carressing
your feet, seagulls flying overhead. Look,up ahead a coffee kiosk. You stop,buy yourself an expresso and take a break, resupplying those
Cyclic AMP energy in your mitochondria, that’s what coffee does. Exhault in the vastness of the ocean as all the stress of 15 years of
this blog just rolls off your shoulders as if, it was never there.
PT
PT, for me, this blog, in its whole, has never been stressful for me. It truly provided me a source of ventilation but also self-education. And it is these two "therapeutic" values which is also a value for others who come here to read and write. And even if some who arrive here only to find "fodder", this finding may be the basis for writing something more tasty and intellectually more nourishing than fodder.
..Maurice. p.s.- Oh..and I never have drunk coffee and yet I have reached 90 years, still with functioning mitochondria.
Maurice
Fair enough, your mitochondria have served you well.
PT
Dr. Bernstein, you have done far more than could be asked of a person, and it is appreciated. You don't owe anyone anything and are under no obligation to continue your work here. Do what is right for you.
In a healthcare system that seemingly cares little for the inherent dignity of patients, helping people find their voice is a good thing. Modern day feminism and political correctness ensure that the interests of male patients will not even be up for discussion anytime soon on the public square. At the same time the squeaky wheel of individual patients speaking up does at the micro level create some degree of change that benefits those that follow. I doubt that female urologist will try doing to another male patient what she tried doing to 58flyer. I expect that hospital will put into place some controls on student shadows as well. Many will benefit from 58flyer having spoken up, and that is something this forum has given some of us the courage to do.
There is more to bioethics than the miserable medical experiences and residuals described on this blog thread subject. Take this poem for example:
Joyce Kilmer has humanized trees in this well known poem “Trees”
I think that I shall never see
A poem lovely as a tree,
A tree whose hungry mouth is prest
Against the earth's sweet flowing breast;
A tree that looks at God aft day,
And lifts her leafy arms to pray;
A tree that may in Summer wear
A nest of robins in her hair;
Upon whose bosom snow has lain;
Who intimately lives with rain.
Poems are made by fools like me,
But only God can make a tree.
As I was hiking today through Towsley Canyon in Southern California, I came upon this tree clinging on to the rocky side of a mountain and I wondered if there was a common yearning between man and tree for longevity and/or immortality. Any thoughts? ..Maurice.
More to come from Moof, a frequent writer to my blog in the past. ..Maurice.
And the response from Moof:
My thoughts are: was that a rhetorical question?
Since I'm fairly certain that you're not anthropomorphizing trees - even with quoting Kilmer's stirring poem - I have to wonder exactly what you are asking.
In front my ancient house, is one half of a very old hickory tree. When my husband's father was just a tiny boy, the hickory tree which had been there for generations before had been reduced by time to a dying old stump. From this stump grew flexible, firm shoots, which the children were loathe to ignore. They made fine bows, or whips ... or so very many entertaining things. This young fellow's mother finally "persuaded" him to stop cutting them down for use in his games with his brothers.
Two saplings grew, and as the seasons turned into years, became a very large double trunked tree, which provided shade for the house, and which scattered its hard, unbreakable fruit on the lawn every other year.
The little boy grew along with the tree, and became a strapping young man who fell in love with a beautiful young lady ... married, settled down, and had a son of his own. This little son, his namesake, played underneath the tree ... picked the nuts to be used in cookies. In time, he also grew into a fine, strong adult.
By now, the hickory tree was so large, that it covered the roof of the house, and had become a shelter from the storm for many tiny creatures.
The young namesake found a woman to love, and the cycle began all over again - all under the same tree.
And now we come full circle, and this latest young man's children have themselves become adults. One night, during a terrible storm, the 2nd namesake of the first little boy heard the tree come crashing down, shaking the ground in its final agony ... and taking with it the dreams and memories of 4 generations.
And then, less than a year ago, the first little boy followed the tree ... tired after a long life of bearing fruit for everyone in his shade.
Maurice, trees are no more immortal than little boys - but they're wiser than little boys. They "rejoice" in what they have, when they have it; they only ask for sunshine and rain ... and they hide any thoughts of immortality within the hearts of little saplings which are cut down to be used as a plaything by little boys.
And such is life.
Yes, Moof.. "And such is life". ..Maurice.
If we are trying to somehow draw parallels between trees and healthcare, I have thousands of trees on my property. How many thousands I could not say. Most are anonymous and if they fall in a storm I don't much care and likely wouldn't even notice. A few are VIPs though.
I favor the sugar maples for their beauty and don't violate them with taps for sugaring. I like the fruit trees because they pay me well with their produce, and every few years my small apple orchard will get some professional pruning so as to best care for them. The eastern cottonwoods towering in the yard I tolerate for their majestic size that make for a park-like feeling, but I don't really like them and was quick to have a couple taken down that I determined might crush the house some day. The nicer looking or strategically located ash trees are on the VIP list and for them I will be incurring great expense to save a few from the emerald ash borer that has finally made it to my area and will cause ash trees to go the way of the elms and chestnuts. I don't plan on saving them all though, just the nicer ones along the stone wall and one in the middle of a field by my garden. In the woods is a truly ancient yellow birch that I came across one day. I suspect it might be one of those prize specimens for its sheer size that researchers record. It's branches spread out far too wide for a forest tree which tells me it was left to grow a couple hundred years ago when the forest had been cleared for animal pasture, and now again finds itself in the midst of the forest. That tree I simply admire. Some trees I see as potentially useful like the white cedar that make good fence posts and the white pine, some of which the people who built my log home harvested from my woods. Others are useful for the critters like the black cherries, oaks, and the black walnut in my yard, so they're on my OK list too.
So, I don't treat all of my trees equally nor do I like them all equally.
This is and always has been a "bioethics blog" and not a discussion site limited to human medical care and its "goods" or its "bads".
However, continuing on this blog thread with a "tree" example of potential diversity of ethics considerations available to discuss on the "Bioethics Discussion Blog" just click on "Can a Tree Experience Hurt? If It Can, Do Ethics and Law Apply?" June 12, 2014. And read the worthy discussions and discussants which even includes our Banterings.
..Maurice.
This is interesting.
My friend has been doing therapy for the abuse that she has received by doctors and nurses. I have been accompanying her on this journey. She found an online community that has validated and helped her understand her feelings on her abuse. She says that it has helped her move forward.
She was on a thread where one survivor was complaining that his employer mandates flu shots and was assuming the same would be true of the COVID vaccine. There were mixed views about mandating vaccines. Many said "you need to do it," shamed her about protecting other people, etc.
She stepped up to tell how saying "need to" revictimizes and retraumatizes abuse survivors (including herself) because the trauma came from them having control of their own body taken away. She even showed exceptions under religious freedom and ADA. Others agreed with her.
One of the ADMINISTRATORS (not just a moderator) defended the "need to," even this was triggering to many survivors. She quickly figured out that he was a physician (U of Penn med school).
My point is that again, the profession of medicine feels exempt from society's rules. What they feel is more important than triggering, revictimizing, and retraumatizing abuse survivors in a place that is supposed to be safe.
This person flagged her. She was not sitting back and taking it. She fought back against the warning and the whole thread is "under review."
-- Banterings
Banterings Where I work the vaccine is OFFERED. Not mandated. People would leave otherwise. Both patients AND staff. A large number refused.
JF,
God bless America.
-- Banterings
I have done a lot of research about bullying. However, what is most glaring is there is no studies that I have found about medical providers bullying patients. There are an abundant amount of articles about staff bullying within the system. Coming from an educational background, I know bullying extends beyond just peers. A bullied child will often bully another. Why do none of these articles touch upon that patients may also become victims of bullying rather than just saying peer bullying may lead to making mistakes in patient care? Why not state the obvious that medical providers do bully patients? We know that during pre-op if an oddity in a patient's body is found, they will call in staff to take a look. We know they make comments as even Dr. B. found those training videos that hammered home that point. We know that actions just as speech point to bullying (ie. you don't have something I haven't seen before). So why are there no articles about medical staff bullying patients?
Consistent with discussions we have had I wanted to pass along a passage in a book just published a week or so ago and been reviewed by the New York Times. The book is "Between Two Kingdoms" by Suleika Jaouad about her 4 year journey being treated for a rare form of leukemia that she came down with in her senior year at Princeton, and upon recovery her "Travels With Charlie" type journey across the country with her dog. She had previously won an EMMY for her writings during her treatment. I know Suleika on account the "family cabin" in Vermont noted in the book and where much of the book itself was written is just a few houses up the road from my place. I used to bring her veggies from my garden when she was there recovering before beginning her road journey.
The passage speaks to the patient ceasing to be a person but rather the disease itself:
In the transplant unit, I was surrounded by people who were concerned, first and foremost, with what I had - not necessarily who I was. Doctors and nurses in masks stood over my hospital bed, peering down at me, discussing me as if I weren't in the room. They gave the Patient a hospital gown. The Patient was talked at, looked at, probed, prodded, and whispered about. They had a singular goal - to cure the Patient so she could go back to being herself. In all this lay a strange irony: It had only been a year since my diagnosis, but I could hardly remember what being myself was like.
You know.. what is necessary for all patients to present to their doctor or nurse or tech is an advance directive and not necessarily related to some oncoming potentially fatal disease.. but a directive made by the patient to the staff regarding how to be treated and how to be not treated.
I think you will find this YouTube short video not just amusingly realistic but also convertible to all which has been discussed here. It is_ Dr. Seuss Does Advance Directives: A Tim Boon Poem
Listen to the words..and think about how a "directive" could apply to your concerns about need for a revision of "professional behavior". ..Maurice.
P.S.-On entry to the YouTube video click to sign off the entry advertisement and begin the video. ..Maurice.
JR@rights4patients
Of course patients are bullied! You read about it happening in nursing homes. The saying “ nurses eat their young” . That in and of itself confers that patients will be bullied. Remember the purpose of risk management is to contain all bad things that happen in hospitals, issue a gag order etc. Hospital hierarchy is viscious with much backstabbing, jealousy and hate. The knife throwing, backstabbing while throwing fellow coworkers under the bus is legendary stuff not suitable for anyone under 18. The hate flows over onto patient care not necessarily
from workers being competitive for attention from one another. Collateral damage results from people who just hate their jobs.
PT
JR,
Joan Emerson's paper, Behaviour in Private Places is a "how to" on bullying by healthcare providers.
One of the methods that I have the most trouble with is saying that the patient "needs to." My transgender friend gets her hormones without any bloodwork (under an Americans with Disabilities accommodation). There is no "need to," EVER!
-- Banterings
PT.. it pleases me to see you have returned and setting forth your views. ..Maurice.
Banterings,
I read that article you cited by Joan Emerson "Behavior in Private Places" and what stands out is where it is stated plainly "how to control the encounter" and "keeping the patient in line", and "other people go through this all the time." We have talked about some of the actions they use to in order to do this such as their language "you must", "It is the doctor's order", "Strip!" etc. so clearly they know what is it they are doing. For those who didn't read the article it is about gyn exams. Their attitude is supposed to conveyed no one is embarrassed and all sexual thoughts are left at the door of the hospital but is it really? No, and it is clear by the Nassars and all, this is not the case. If it is not sexual in nature than why do they not keep those areas covered? Why do they take pics and call in others to take a look-see? The article goes on to say that excluding the patient's support person during the intimate exam makes it more a medical exam than a sexual setting which how they came to conclude this is beyond me. It does say the draping and chaperone lends itself to making it more medical so that beg the question of why the obvious difference in how the conduct a female and male intimate exam? Are they secretly announcing to all they in fact do not believe males have the right to dignity? If you read and believe what this article is saying, that is the only conclusion you can reach. This article even goes as far as saying how the patient should act during the course of the exam like avoiding eye contact when the doctor is actually performing the vaginal exam but the patient should be pleasant acting as if she was fully dressed. Really?
I would suggest all read it. I am going to re-post it again on Twitter as I want several of the ladies to read it. Of course, I will give credit to Archie for bringing it to our attention. It is articles like this that bring about good discussion. I think I will also post it on my Facebook. I haven't done much posting on FB because they are such (almost put a K rather than a h).....but I think I will break my self-imposed ban to post it on my PatientRightsInfo page. Thanks, Archie, for this great article.
PT,
I totally agree with everything you said. Before I started doing so much research, I didn't realize that internally a hospital would have so much turmoil which leads to patient harm. Being that so many of them have such large egos, it makes sense there is so much fighting from within as everyone believes they are the best and therefore entitled.
Yes, I believe much care in nursing homes is abusive. (JF, please do not take offense as I am not saying all or you are guilty of this as I believe you are one of the compassionate ones. See I have learned over the period of time to make a note clarifying what I am saying with my broad brush.) Some of the stories JF has told comes to mind as well as what has happened during COVID. The thing in charge of New York should have warned all of us of what the politicians thinks about what happens to our older citizens. The "they have to die sometime" dance defines just about how they feel. While it is true they would have died sometime, they didn't have to die then. He can't even apologized but rather is victim blaming/shaming which is making the whole situation that much worse. Own it as the longer he doesn't the more convincing it becomes by the coverup that is was an intentional "I don't care about them" occurrence.
In nursing homes, the ones who cannot defend themselves are left exposed, intimate care is not private nor do they attempt same gender care. Patient's possessions are stolen. Things donated to patients in general sometimes never make to any patient rather the staff takes them. They are ignored or left unsafely attended. All these things plus more demonstrate how very abusive the care of nursing homes patients is. I absolutely will not be parked in a nursing home to wait to die a death without dignity. A small part of what I am doing on Twitter is abusing how the elderly are more likely to be victims of medical abuse.
Nice to see you back. You have a lot to add and I always am looking for information to share as we have a long, long, long road to bring about any change.
JR and JF et al, here is more (and with statistics) regarding nursing home abuse presented by Nursing Home Abuse.Org
JR and JF, does this documentation correspond with your understanding and/or experience? ..Maurice
Dr. B.,
The stats do seem low which the article addressed. I think the percentage of elders being abused by family members may be higher as I think the number being abused in care facilities should be higher. From my experience, oftentimes when a family member abuses an elder it is for financial purposes and most of the time the abuser has a drug or alcohol issue. Those stories I personally know of have the Stockholm Syndrome as the abused usually will not do anything or cooperate with authorities to prosecute.
I actually think the sexual abuse part is very much higher as leaving a patient exposed such as not making sure a door or curtain is closed when dressing/undressing them is sexual abuse. I have seen males doing intimate care for females and I have seen females doing the same. This is concerning as I have read several articles where felons are specifically recruited to fill these type of jobs. They specifically mention they are needed to fill what they term as "low level patient care" mentioning both senior care facilities and hospitals. Also, people with active addiction problems can readily get jobs in these facilities making the elderly prime candidates for theft of money, any valuables, and even their medicine depending on the facility's medicine protocol. Again, the Stockholm Syndrome protects the abuser or the patient is unable to communicate they are being abused so it becomes a "silent" crime.
Abuse from other residents also happen which can be bullying, sexual to physical abuse. We saw last year the clip of the one young man beating an elderly senseless. When you have young mixed in with old that is a recipe for disaster. Many care facilities have a mixture and no separation between the mentally challenged and the seniors. Many also handle rehab patients sent from hospitals. There needs to be complete separation for the protection of the elderly.
I have witnessed seniors being put into wheelchairs and just left parked. One such was there in the lobby for hours, screaming while we visited my sister while she was recovering from a fall having been released from hospital to rehab. Same when my father was rehabbing from a fall.
I had a hospital tell me that as a person ages, they will have more medical encounters and should in effect become used to being thought of as a non-person and be willing to be exposed because after all, they are old and need more help more often. With this as their underlying service tag line, are you surprised to know that elderly abuse in hospitals is far greater than abuse of others in hospitals? The elderly population is their bread and butter but yet they think they are entitled to abuse them? Studies have also been done to back this up and of course, sedation plays a major part in all of this as a sedated patients are more likely to be abused. Sedation also seems to have long term effects on elderly from which many may never become "normal" in functioning again. This also has been studied.
Again, the Governor's attitude in New York about the killing of over 15,000 nursing home residents should be shedding a light on how this country allows the abuse and even murder of our seniors. We need major reform but then we have needed major reform of the healthcare system in general and I am not talking about the making of healthcare accessible to everyone because in Indiana it is already accessible if they want it. It is called HIP.
I have branched out from our original healthscare issues and have become more aware of what is going on in general in the entire system. There is so much room for improvement and those improvements would not only help the patients but would also make the work atmosphere better for the healthcare workers.
Dr B. Nobody likes my solution to what I believe should be done. There needs to be hidden cameras just about everywhere or at least hidden tape recorders. I think it should be hidden from the staff therefore not every little wrong thing said and done would get confronted and the staff would need to believe they were caught by a snitching coworker or a patient. Or the abusive employee just be terminated for trump upped reasons. THAT happens often anyway.
JF, while cameras might catch certain inappropriate staff behavior, it would only be caught if someone else was tasked with reviewing the recordings. That means appropriate & necessary patient exposure would be viewed by people that did not need to see it.
The other issue is that cameras would create a whole new source of inappropriate behavior. Nothing electronic is secure. It all gets hacked eventually if someone wants to hack it bad enough. And voyeurs, internal or external to the healthcare setting, would see in these hidden cameras an opportunity.
There is no way I would trust any hospital system to secure these recordings nor would I want some minimally paid non-clinical staff person watching a recording of me being examined or prepped for surgery so as to affirm nothing was done wrong.
Hello Biker,
I TOTALLY AGREE with your sentiments re cameras in the medical setting. Well done!
Reginald
But Biker, how can the best supervision of a medical-clinical or surgical interaction with a patient be documented without something like a video of one sort or another? Yes, you might suggest another physician to be present monitoring the interaction but that is one set of eyes, ears and one perception to carry out to provide the "documentation". ..Maurice.
Dr. Bernstein, in a world where the military, govt. entities at every level, and businesses large & small get hacked despite all of the supposed expertise protecting their networks, there is no reason to expect any hospital could adequately secure these recordings from hacking. We have seen again and again where the medical records of celebrities get viewed by unauthorized staff despite the many rules and controls prohibiting such. Staff curiosity will most definitely result in unauthorized staff taking a look at these recordings within hospitals.
The other thing is that it is highly unlikely that medical staff viewing such recordings are going to see anything wrong with patients being casually exposed more than necessary in terms of extent, duration, or audience. Yes they would react to a classic sexual assault that might get someone arrested, but not the everyday needless exposure that patients experience.
Standards of care do not include minimizing patient exposure. Let's use a doctor or nurse needing to examine a patient's abdomen as an example. When is the last time anyone got in trouble for lifting a gown exposing the patient's genitals and then covering the genitals with a towel? No exposure is needed in order to view the abdomen. A sheet could instead be pulled up covering the patient's genital area and then the gown lifted from underneath the sheet so as to only expose the abdomen. My guess is no doctor or nurse has ever gotten in trouble for needlessly exposing a patient in that scenario. Why? Because standards of care do not require minimizing exposure. Standards of care instead err on the side of staff convenience.
Cameras won't address the vast majority of everyday needless exposure but would instead only increase the audience that is looking.
Biker,
Exposing a patient's genitals to examine their abdomen is sexual abuse because someone in power is exposing the genitals for their gain. More patients need to speak up and out when this is about to happen or has happened. Unnecessary exposure of genitals is a SEXUAL CRIME. It needs to stop!!! It is a gateway offense that lead to them thinking they can do bigger harm to a patient like false documentation and consent issues.
I haven't make up my mind about cameras. I see the pros and cons. Maybe the patient should wear the camera. Certainly, it is who views the footage which is an issue and hacking is another issue but that already is as many hospitals employ the use of cameras most everywhere anyhow. Many already film operative procedure for round table discussion so who are seeing it and where is this footage ending up? Most consent forms allow for this to happen.
Dr. B.,
There are so many articles available that address the "doctors code of silence" that even suggesting that another doctor witness isn't a real solution. Even chaperones don't generally protect the patient because 1) they are employed by the medical provider 2) they generally don't whistleblow until they become mad at the offender. Paid advocates such as Trish Torrey (sp) think patients seeking dignity (modesty) have something wrong with them rather than protecting the patient like they have been paid to do. One solution is to have someone trusted in the room like a spouse. It can be done. Men are present during c-sections so most any procedure could be accommodated if they wanted to do it. It would boost patient's confidence in the procedure to know someone was there just for them.
JR, I think the majority of needless exposure, whether in terms of extent, duration, or audience, is for staff convenience. Sometimes it is for prurient reasons or to exercise their power over the patient. The common theme across the convenience, prurience, and power themes is they simply don't care if the patient is needlessly embarrassed. What the reason behind their needless exposure doesn't matter to the patient of course as the result is the same, embarrassment that either didn't need to happen or that is worse than it had to be.
My focus is on the everyday routines patients experience more than on the egregious cases. This is because it is this culture that doesn't give needless exposure a second thought that creates the atmosphere where the more egregious cases can more readily occur.
I am suggesting here for example that the staff at Olympia Urology were blind to the horror they inflicted on Mr. Kirschner with their initiation prank because the culture of that practice had become numb to the very concept of respecting the privacy and dignity of patients. The slippery slope of ever lower standards spun out of control. This is why the underlying standards that play out every day in routine interactions matters regardless of the motivation behind those interactions. If you can't figure out how to examine an abdomen without exposing the patient's genitals, or worse, you expose that patient's genitals without even thinking it matters, you are on the precipice of that slippery slope that can lead to the truly egregious Denver 5 and Twana Sparks type cases.
In all my 35 years of active practice of internal medicine and subsequent 17 years of volunteer internal medicine practice and all of my over 30 years of first and second year medical student clinical education, I have never practiced, seen nor was personally closely related or involved in Sparks, Denver 5 nor
Mr. Kirshner's alleged experience.. nor, the University of Southern California male GYN misbehavior. I have not witnessed any behaviors practiced upon me as a patient which I could prove inflicted indignity or unnecessary loss of privacy.
I think these horrid behaviors are personal medical system provider anomalies which never should have happened but I doubt most caregivers in the medical system have such personal misbehaviors or worse in mind as they proceed with patient interaction.
But that is my experience. I do believe that if any patient or family member finds evidence of or actually observes such misbehaviors which are aimed at some personal "mal-benefit" to healthcare provider and insults the personal dignity of the patient, these observations should not be ignored but "brought to light' for investigation, remediation and punishment of the documented healthcare provider. And, if it is a system deficiency, active steps should be taken to change the system.
What has been discussed on this blog thread regarding preservation of patient dignity should not..NOT be ignored. ..Maurice.
I wanted to share two links I came across:
1.) It's healthy to talk about bodily functions - This is an article that a doctor wrote about how he worked as an orderly many years ago. This was the era when male doctors and orderlies did intimate procedures on men. I feel that the medical community was much more sensitive to male patient modesty then. Of course, today it is an accepted practice for female nurses to do intimate procedures on male patients.
2.) About Male Modesty in Medical Settings on Reddit
Dr. Bernstein: Did you ever serve as an orderly? If so, did you do intimate procedures on male patients at the hospital such as inserting urinary catheters and bathing them. Do you have any colleagues who served as orderlies in the 1970s and before that?
Misty
Dr. Bernstein, I agree that the egregious cases are the outliers that most patients never experience. As I have said, the larger problem is the day to day routine transactions that err on the side of staff convenience that is the larger problem.
The sonographer that fully exposed me for my 1st bladder ultrasound likely thought she respected my privacy by giving me a towel to cover myself after she exposed me. That there was no need to expose me at all likely never even occurred to her.
It similarly likely never occurred to the doctor and his nurse that did my vasectomy that I could have at least been partially covered with a sheet, towel, or gown. If they saw anything disrespectful or undignified with me lying there wearing just socks and a polo shirt, it didn't go as far as giving me anything to cover myself.
Surely the sonographer that did my testicular ultrasound thought she was fully professional when she lifted my gown up to my chest before giving me a towel to cover myself.
For the many cystoscopies I had with my former urologist, his ever so polite and well trained female nurses that did the prep, each one in identical fashion, didn't include in their protocol covering me once the prep was complete & we waited for the doctor, unlike the male nurses at my current urologist that do cover me. Those female nurses as well stayed at my hip never losing eye contact during the procedure itself vs the male nurses where I go now busying themselves elsewhere in the room. Believe me it was pretty embarrassing if we had to wait 5 or 10 minutes for the doctor to arrive while the nurse stood right at my hip the entire time.
I would never allow anyone to get away with doing these kinds of things today, but back then I was too embarrassed to speak up and was still under the thrall of manning up socialization. Everything I describe here is day to day routine that most in healthcare don't give a 2nd thought to. This is the larger problem.
Misty, no experience, to my recollection, with "orderlies" or named to me as such.
But I suspect, with my brief professional "ins and outs" to see my patients "orderlies" were there as they are present now as "patient care assistants" or "Certified nursing assistants" or more. Last year, last time I was hospitalized, the toilet room was cleaned but the clock on the wall of my one patient room was not working throughout my entire several day stay. Frustrating to both me and my nurses but where was the "orderly" to have the clock fixed? ..Maurice.
Maurice,
I beg to differ with you. You experienced mistreatment twice, there seems to be some discussion if it rises to the level of abuse. The first that comes to mind is the nursing student that attended to you alone. While YOU didn't feel it was abusive (the majority of us who post here feel it was), you admit by your own words that the manner that she conducted the visit definitely violated hospital policy.
WRONG IS WRONG!
Then there was the incident of photographing you with a personal cell phone. While you do not consider it abusive, it was definitely a HIPAA violation (was that cell phone a secured device?).
I also ask, do you teach at Keck? There have been some very high profile cases of misconduct/abuse recently (last few years) that involved licensed medical providers who were also employees. Admittedly, you did not witness these events, but I am sure that these had repercussions with the internal training of medical employees.
Am I to believe that there was no scuttlebutt in the halls or the teachers' lounge? I cannot believe that there was no institution wide audit to see if anyone was aware of these cases or any other cases.
I know from personal experience that the risk management team/department would REQUIRE an investigation into how prolific the abuses were, who else might have been aware, and if there are more related (or unrelated) incidents and more perpetrators.
There is also the requirement to do training with staff and students to change policy and procedures to prevent this from happening again. There are many drivers that make these actions a necessity. They range from insurance carriers to the law, both civil and criminal. These apply to the issues of safety and liability. Failure to do this would constitute gross negligence if another incident were to occur.
For those reasons, and I mean no disrespect to you, I must question if you would recognize such an event? Again, no offense, because of the number of years that you have been practicing medicine, what is considered medically/socially acceptable has greatly evolved.
Have you ever questioned this of yourself (how is it that you have been unaware the scope of this problem and you have been so unaware)? I continually question myself in the goal of improving myself and my skills.
Many providers attribute many of the changes that the profession of medicine has gone through on "non-medical" people. I have documented on this blog how many providers still support the paternalistic practice of medicine.
Then there is the issue of intimate exams on anesthetized patients without consent. The majority of physicians today have participated in this practice (this is only a recent societal issue). Many students and physicians defend this practice to this day (as document on this thread) to this very day.
One can only conclude that the medical education and culture is what causes (or allows) these abuses of human dignity.
Furthermore, intimate exams on anesthetized patients is NOT an anomaly, it is a SYSTEMIC PRACTICE. Is this NOT abuse? Can you defend this practice? Is this NOT proof enough of the corruption of the profession.
-- Banterings
Any exam or any procedure performed by members of the medical profession which is not accepted by the patient involved or accepted by the patient's surrogate (if the patient is, at the time, unable to express their decision) is worthy of ethical, professional and perhaps legal concern. All examinations, physical or technical, must have the patient's (or surrogate, if necessary) understanding and approval. Except in true clinical emergency situations where the patient has no capacity to learn and respond and no available surrogate, should the medical profession carry out procedures under methods accepted by science and law.
Elective surgery and all the issues that surgery and its participants involved should be detailed to the patient and the patient's decision to accept should be also related to those details. ..Maurice.
Dr. Bernstein, the point I have been trying to make is that the routine needless exposure is not anything that ever gets discussed with patients. It just happens. Healthcare staff never ask the patient which method the patient would prefer, observing the abdomen without genital exposure or observing it w/exposure, clipping groin hair with exposure or without exposure, positioning the scribe with full view or without full view, pulling the curtain/closing the door or not pulling the curtain/closing the door, walking uninvited into exam rooms when patients are exposed vs asking permission to enter, and on and on. They just do it within the context of whatever the culture of their workplace allows without ever giving it a thought. Most would likely take offense at the suggestion that they have needlessly exposed patients.
I totally accept necessary exposure, including to female staff if male staff aren't available, but I do object to needless exposure and I do object to any request I make for male staff being dismissed or otherwise handled in anything less than a professional manner.
Biker,
I don't care the about the reason they are exposing patients unnecessarily rather it is the fact they are doing it. Robbing a bank because you need money to feed your kids or make a house payment doesn't make you not guilty of committing a crime. I have checked in textbooks and have talked to many nurses, and yes, they were taught to respect patient dignity by keeping the genitals from being unnecessarily exposed, to cover, and to keep any necessary exposure to the minimum. Yes, the crime is more severe if they are purposely meaning to harm a patient by exposing them. However, to the patient, the result of the exposure is the same feeling of violation although probably with vicious, malicious exposure the patient may suffer more of a reaction.
For patients undergoing a procedure, the risks to their health by unnecessary exposure is great as it can cause complications but this is when many patients seem to be unnecessarily exposure for more prolonged periods of time. It is a known fact that patients kept warm are patients who recover better. However, many feel since the patient is unaware, unnecessary exposure of the patient does not matter or even count for that matter. Drugs are used to erase memory but these very same drugs also have a side effect of making the patient colder too so that exposure side effects are worsened.
Even during most ER treatments, care can be taken to make sure a patient's bodily privacy is respected unless it is a true emergency where someone will die within the next second and their injuries need to be checked. Otherwise, bodily dignity should be respected. There should be quota hiring of male and female staff in order to provide the best care of bodily dignity.
Banterings,
I agree with you that even if Dr. B. doesn't realize he was violated at least twice that we know of, he was violated. Just because he doesn't feel violated doesn't erase the fact that violation occurred to even him. The use of a privately owned cell phone to take bodily compromising pics or even any patient info at all, should be completely taboo. Supposedly, it is but it seems to be an acceptable fact. I have even read articles encouraging the use of private cell phones usage for medical apps and so forth.
Misty,
There is no thought in the medical community to provide bodily dignity to male patients. There is some thought to provide it to women but even at that, it is still not enough as it is only sometimes provided. For males, most intimate care will be forced done on them by female staff. On my Twitter feed, I had a great GIF of 2 females nurses trying to hold down a poor male patient when trying to perform an exam. Got a lot of feedback as many were shocked. However, this is common for men.
I think the approach to resolve these issues of misbehavior within the medical system is to instill (by medical boards) and the patient and family themselves that patients are not at any time "objects" of the medical system and their professional or workers but are subjects . You know, I would appreciate a nurse who says to the roomed patient "I am here to check your blood pressure, may I come in?" or the technician who states to the patient "I have come in to get some blood tests, is that OK with you now?" These simple explanations and requests by the medical system participants would go a long way in diminishing the frequency of the documented here "abuses of human (patient) dignity"
..Maurice.
Maurice,
Medical rape is ONLY worthy of ethical, professional and perhaps legal concern...
Why can't you call this deviant behavior what it really is? This behavior that you exhibit is exactly what is wrong with the profession of medicine. No offense to you, it was how you were trained.
This is giving abhorrent behavior a pass. It should be prosecuted to the fullest extent of the law.
How do you feel as a provider if patients said in regards to threatening/physically abusing providers that it is only a response to the stress of the situation that they are in. Perhaps the providers need to be more understanding.
As to an emergency situation: If it truly is an EMERGENCY, then allowing a student to have a learning experience would be malpractice because it would put the patient's health in jeopardy.
If there is time to allow a student to have a learning experience, then it is NOT an emergency situation.
-- Banterings
Just an addendum to my observations regarding 2 of my recent hospital room admissions which has raised the issue that with each time the nurse took a photo with a cell phone of my lower back and buttocks after explanation and with my approval: the argument presented here is whether the cell phone with camera was part of hospital equipment or the nurse's private property. I assumed both times that the phone was hospital property and the reason for the photography was for legal documentation. In neither time had I some reason to think or respond otherwise.
With regard to the earlier hospital admission (and I haven't tried to find my previous comments in the earlier Volume), my concern was not that the nursing student was looking at me out of sexual interest (!) but based on my own medical student teaching, her exam of me was cursory for my clinical condition and there was no professional supervision. It seemed to me she was just checking me off her list. And the action was not a properly executed supervisory teaching tool since there was no supervision. ..Maurice.
You want another subject to discuss the unethical and perhaps illegal use of the physician's own semen for a patient's request for semen from an anonymous source semen bank? You all knew this was going on.. didn't you?
To begin this topic, pertinent to preservation of patient dignity, read this presentation "Uncommon Misconceptions: Holding Physicians Accountable for Insemination Fraud" ..Maurice.
On the fraudulent insemination matter, certainly the law needs to catch up with this and treat it like the crime that it is. A glaringly missing piece however is medical licensing boards need to take a stand and immediately take away the licenses of these doctors. I sometimes wonder why licensing boards even exist if they have no moral or ethical expectations of doctors. Fraudulently inseminating someone is a slam dunk ethical violation of the gravest kind. Have they no standards?
My guess is the incidence of this conduct has likely greatly diminished given the rise of genetic testing amongst the general population. Some doctors might still think they can get away with it if they don't get tested themselves, but the results of their relatives that have done the testing will incriminate them anyway.
Here is a link to a more current article regarding law suits in California relative to physicians using their own semen without patient's permission, "fraudulent insemination":
https://www.ktvu.com/news/california-mother-files-fertility-fraud-suit-alleging-doctor-used-his-own-sperm-to-impregnate-her
..Maurice.
p.s.- It's so interesting how many topics fit and support Banterings advice to change the title here to "Preserving Patient Dignity"
Last week marked the second anniversary of my initiation into the world of Patient Dignity/Modesty. My initiation occurred when I, a 70+ year old male, visited my Dermatologist for a Full Body Exam. Obviously I was aware that my doctor was female and I had made peace in my mind that I could accept that she would see my fully exposed genitals. The visit proceeded as normal with an assistant initially taking vitals and giving me an all-too-short gown to wear for the exam. She left the room for me to get undressed saying the doctor would be in momentarily. Parenthetically, I should add that the assistant never introduced herself nor said what her role was/was going to be in my care. The doctor came without delay, but to my absolute horror and dismay, she was accompanied by the female assistant who took my vitals! The doctor began the examination without asking permission to conduct the exam nor for permission for the additional female to be present during my intimate exposure.
This was my first, only and perhaps my last full body exam. It was one of the worst days of my life. I was caught totally off guard by what was happening to me. Here I am standing fully exposed in front of TWO females whose combined ages did not equal mine—and one of them had an iPod in her hand capable of taking pictures. As I said, it was perhaps the worst day of my life.
When this “ambush” was all over, I began to think about what had just happened. I was very angry, but that anger was directed at me. How did I, an educated and competent person, allow this to happen—and to me? It was during this aftermath that I found this blog. I began doing a lot of reading from all of you, from Misty and from as many other sources as I could find. Your words and experiences have helped me along the way and given me a plan to insure that never again will this happen to me, but I started working to see to it that it will never happen to other unsuspecting souls as well.
Since February 13, 2019, not a day has passed that I have not revisited, reviewed, and critiqued what happened to me that day. Two days after my exam I wrote my now-ex Dermatologist to explain how she made me feel and to courteously offer true suggestions on strategies she and her clinic could undertake to improve this encounter. She would not meet with me in person. Her Practice Manager sent me a certified letter discharging me as her patient. I wrote to the Virginia Medical Board. I met with several local and state officials, including members of both the State House and Senate promoting legislation that would help address matters such as this. Patient Modesty/Dignity continues to be a work in progress, but “continues” is the operative word.
Thanks to all of you for what you do to advance public awareness of our travails, our needs and our rights to insure dignity for all.
Starboy
Welcome Starboy to our blog thread. It was unfortunate that you were examined in an environment and a manner for which you were not explained in advance to make your own personal decision. How the examination is performed and who else will be present should be information presented to the patient in advance and this is what had been teaching our medical students. For example, we had the examining student get the patient's approval before we were allowed to come into the room with 5 other students to review a specific physical finding.
Also, as our teacher staff was informed by our school's dermatologist, worthy examination can be performed with systematic sequential skin exposure and not examine the patient nude and subject to embarrassment or chilling.
Unfortunately, physician behavior, at times, is so unsettling, it does require entailment of government to set acted-upon standards which should have been already settled upon by the medical profession itself. ..Maurice.
Starboy,
I am sorry to hear about your traumatic experience.
One of my concerns at Medical Patient Modesty is that there is too much unnecessary exposure. The truth it most full body exams are not necessary because most patients have zero risk of having skin cancer on their genitals unless their genitals have been exposed to the sun.
I did not know about full body exams until a number of years ago. One lady brought to my attention that some dermatologists did full body skin exams. She shared that she told the dermatologist that they could only examine parts of her skin that were concerning (ex: moles).
I agree that some patients may need full body skin exams depending on their risk factors. But an "one fit size" approach is not the answer.
Misty
Yes, there is evidence that physicians lie for one reason or another..but a 2018 survey suggests that patients lie to their doctors. Isn't health so important to everyone (patients and medical professionals) that for one party to lie to the other is a personal or professional "wrong" that should be scrutinized and re-considered by both parties? Read the brief description of the survey and present your final opinion here... and I am sure none of my visitors will be avoiding presentation to the rest of us the truth of their conclusions. ..Maurice.
Starboy, thank you for sharing your experience. That is why I avoid female doctors for anything that might involve intimate exposure. They just don't understand that men don't want their exam to be turned into a spectator sport. Like you I might be OK with just the female doctor, but bringing in an audience is a deal breaker. Women who only want female staff are celebrated as empowered. Men who want male staff for intimate matters are deemed sexist. And they don't see the inherent double standard in the treatment of male patients vs female.
Hello Starboy and welcome to the blog!
It is unfortunate that you had to be introduced to patient dignity in such a negative and, dare I say, traumatic manner.
The thing is, your situation isn't all that infrequent. You were "ambushed" by your former dermatologist who neglected to inform you that she had every intention of having a chaperone present for the exam.
The truth is care providers knows that many patients don't want a chaperone present. So what they do is "sneak" that person in without telling you in hope that a) the patient isn't going to object or b) the patient is going to be too shocked/ intimidated to object. Either way, it's a win for the provider as they get what they want out of it (because they aren't going to ask your opinion about it).
I have said it before, the option of having a chaperone present should always be offered in a plain and obvious way, and never imposed. It is the patient's right to decide if they agree to the presence of one or not.
Stick around, Starboy. There's a good bunch of people here.
Dany
Dr. Bernstein, another piece of why patients lie to their doctors is the electronic medical records systems. Everyone that you interact with in the system has access to everything about you. Yes in some cases it can be a good thing for all of your providers to have your full history but it also means that the days of private patient-doctor discussions are gone. A patient might be comfortable talking with their primary care provider about an issue but not sharing it with every other doctor they interact with let alone all of the nurses, medical assistants and others.
Another aspect of this is that govt. is slowly weaponizing medical records so to speak. I have heard people say that they would never seek counseling for a substance abuse or mental health issue because some govt entities are beginning to use those records against people for things like gun ownership, child custody, or employment matters. It is as if they are saying "get the help you need, but we're then going to pry into those records and use it against you".
If patients cannot talk privately with their doctor, they are not going to be entirely truthful. I've led a rather straightforward life and don't have a lot of secrets, but it shocks me in my mid to late 60's to see a surgery I had at age 11 appearing on the summary notes of the NP I see for sleep apnea, when that surgery has absolutely nothing to do with any current aspect of my healthcare. It is nothing we've ever discussed but the system thinks my entire health history since childhood needs to be presented to every provider I see, as well as their staff. I can see why people are shy about divulging that which they'd like to keep private.
Starboy,
Welcome and sorry. Never let it happen again. You can now tell your providers that you a survivor of abuse and request accommodations under the Americans with Disabilities Act (and by federal law they must accommodate you).
You can read my friend's story of medical abuse and how she handles her healthcare here:
Maurice,
The difference is that the profession of medicine again, has exempted itself making lying to a patient acceptable.
In a survey of more than 1,800 practicing physicians, about one-third of respondents did not completely agree with disclosing serious medical errors to patients, one-fifth did not completely agree that physicians should never tell a patient something that is untrue, and approximately two-fifths did not completely agree that they should share their financial industry relationships with patients.
Source: When is it ethically acceptable to lie to your patient?
-- Banterings
Dr B. Often people have it locked in their heads that they want a baby of a certain gender. But generally when they baby is born they're happy anyway.
The doctor who used his sperm to make his patient pregnant? That wasn't good, but a loving parent would love and accept the baby anyway, because if different sperm was used it may have produced a different kid. Anyway thats how I beleive I would respond.
Starboy. Medical staff sometimes like to prove they're not abusing patients. and they do it by abusing patients.
As long as we're talking about doctors lying, it happened to me at my recent dermatology appt. The certified medical asst. who updated history and who gave me a gown to change into said the doctor had a Resident with him today and was it OK if she accompanied him. I said yes, thinking to myself that I would just decline the genital part of the exam.
For reasons unknown to me they were running very late and during the hour I was in that room waiting, the CMA and the doctor each came by to apologize for being so late. Each and every time they waited for an OK from me before entering the room and so I thought to myself they're getting better at this patient respect stuff.
In walks the doctor with a young woman and the same CMA who is now serving as the scribe. The doctor doesn't introduce the Resident and her name tag is turned around. That's when I made my big mistake. I should have asked for her to be introduced but I didn't. That's a mistake I won't make again. It being this late in the Resident-year I figured he must be observing her doing an exam as part of her evaluation.
The doctor then starts his exam, not her, and that's when I realized she wasn't a Resident. My guess is she was a medical student on her dermatology rotation. The doctor skipped the genital part of the exam without me even saying anything. I am labeled in their system in red bolded capital letters "PREFERS MALES PROVIDERS, ASK ABOUT RESIDENTS" and so he knew not to go there with this young woman in the room.
I chose not to make a complaint as my belly twitch said it was the CMA that would take the fall. She struck me as fairly new and trying very hard to do everything right and perhaps it was an innocent mistake on her part. Certainly she could have been instructed to say Resident and not known the young woman wasn't. I liked the CMA and didn't want to risk her being the one to get in trouble. I knew the doctor (who is the head of dermatology there) would easily get away with saying he forgot to introduce her and that he didn't know her name tag was turned around. A judgment call on my part picking and choosing my battles.
As an aside I may just stop doing these annual exams. The doctor is a nice guy but his exams are very cursory and incomplete. Being he is the head of the dept. I am not sure it would go over well saying I want to be assigned to someone else.
Anyway, even folks like me who think they're ready to advocate for ourselves can still be taken by surprise. Live and learn.
Dr. B.,
As I have stated previously, I see nothing wrong in "lying" to a medical provider. They lie all the time. Just get a copy of your medical records and you will probably find lie after lie--some intentional and some not but rather a signal the EHR system is corrupt.
We lie for self-protection. We tell them what we want them to know. Like he is prescribed meds that he will not take but he no longer argues because when he said he didn't believe in taking RX meds, he was purposely harmed. He takes the RX and has them filled and throws them away (as they do check to see if RX was taken to pharm). They also are using skewed info abt him for their studies but that is just the "cost of doing business" which is what they label selling the info you give them. All that info gleamed from you in H&Ps is used and generally is not pertinent to your current condition. Most of the time, they don't believe info you give them and will instead insert what they want in the MRs.
As for personal info, he tells them want he wants as we know from experience they do not listen or they put in what they want. He now gives an incorrect SSN as he was a medicare number and SSN is not needed but they insist so again, he won't argue because he has other bigger arguments to face like no female care and his support person present during all encounters.
So yes, lying as the medical community does, is now standard practice.
Dr. Bernstein,
The article/survey about patients lying to doctors is interesting. Both medical professionals and patients are guilty of lying.
I feel honesty is the best policy and I wish that both medical professionals and patients would quit lying. I have seen many cases of medical professionals deceiving patients that their wishes for modesty and same gender team would be honored. Patients’ wishes were disregarded once they were under anesthesia and this is why I strongly recommend that surgery patients opt for regional anesthesia and no sedation such as Versed.
Sadly, it so common for some patients to lie. This actually hurts other patients who are honest. It also can hinder patients from getting the right treatment. I watch the 600 LB. show often and many of those obese patients lie about their diet and exercise when they do not lose the necessary weight. I like how Dr. Nowzaradan is blunt with those patients who do not lose the weight. I believe his blunt approach has pushed some obese patients to rethink their lifestyles.
Sadly, it is common for some patients to abuse drugs. I was bothered when a medical assistant or nurse questioned me again if I used any drugs one time when she was taking my medical history. I understand that they’ve had a lot of patients who are addicted to drugs. But I wish they would drop the one assumption that all patients lie.
I address the fact that some women may not be honest about their sexual history and this is why it is recommended that all women get a pap smear beginning at the age of 21 even if they have never engaged in any sexual activity in this article, Are Pap Smears Necessary For Virgins? . This is not fair to women who are actually honest.
Misty
I have learned so much from you guys!
Banterings, I have duly noted your suggestion to use the "accommodation" provision of the ADA and have also so informed my wife. Thanks.
As I mentioned in my initial post, I have been working with some willing state lawmakers to craft some legislation regarding the use/or not of chaperones during intimate exams. Basically, we've thought that anyone who WANTS a chaperone should get one--provided the chaperone's gender suits the PATIENT. More importantly, anyone who does not want a chaperone, should be allowed to make that choice without bullying or prejudice from the medical staff.
Do you guys have any suggestions/comments in this regard? Your input would be much appreciated. Thanks, in advance, for your input.
Starboy
Starboy,
The ADA is a very powerful means to protect patients. Under federal ADA, you are under no obligation to disclose your disability (in your case, mine, and those harmed it is PTSD), it is illegal for the one that you are requesting accommodations from to ask what it is, and you do not have to prove that you are disabled. All you have to do is ask for it.
You can also point to the issue of intimate exams by med students without consent happening today:
A #MeToo Hospital Movement Is Long Overdue—Here’s What Needs To Happen To Better Hold Abusers Accountable
Finally, here is a lot of info that you can reference on how abuse of patients is a systemically integrated into the profession of medicine:
My Twitter
My Blog
There are also a lot of good suggestions for patients to protect themselves.
One final suggestion: your state's justice department should set up a special department for investigation of medical "sexual" abuse. If you read above, (I believe) 58flyer said that law enforcement doesn't know what healthcare providers can or cannot do legally.
Also, the licensing board should be obligated to report those cases to the justice department's new medical abuse department.
-- Banterings
Starboy, you wrote " More importantly, anyone who does not want a chaperone, should be allowed to make that choice without bullying or prejudice from the medical staff."
Actually, throughout all my years of medical practice, it has been to most all physicians including me, out of concern for the female patient's interpretation of my behavior during a pelvic exam as "sexual" even though each move I explained to the patient. No chaperone, no pelvic exam. And the chaperone was always female. ..Maurice.
I accept that doctors may feel the need to protect themselves from unfounded claims too and so it would seem that the compromise position is that if doctors want chaperones that the chaperone must be the same gender as the patient.
Dr. Bernstein, how is it that students emerge from their years of medical school and residency without grasping the fundamental concept of patient privacy and dignity? Being polite is not synonymous with respecting privacy and dignity. Sequentially exposing patients is not synonymous with respecting privacy and dignity if the end result was the patient was needlessly exposed in terms of extent, duration, or audience. Female chaperones for male exams violate this concept by their mere presence.
Starboy, when making appts. with urology or dermatology practices, just say upfront that you want a male provider. It is also OK to ask if they have male staff. When I grew weary of doing the 4+ hour drive to Boston for my annual cystoscopy I called the urology dept at the local hospital and asked about whether they had male staff for the prep. I expected the answer to be no, which it was, but they were hostile to me even asking the question. I also put in a call to the ultrasound dept. asking if they had male staff for things like testicular ultrasounds. Again the answer was no, as I expected, and again the person I spoke with was hostile to the question even being asked. I took those responses as indicative of the culture at that hospital. Asking questions upfront potentially saved me from future unpleasant interactions.
What I ended up doing was moving all of my healthcare to a large teaching hospital 1.5 hours away that did have some male staff in these areas and where there was no hostility to me asking these types of questions. Thus far I have been very happy with how I've been treated there, with the exception of dermatology that I am thinking I may give up on as noted recently. Traveling further than you might otherwise do in exchange for having your privacy and dignity respected is well worth it to me.
Biker you ask "how is it that students emerge from their years of medical school and residency without grasping the fundamental concept of patient privacy and dignity?"
As I have many times stated on this blog thread, my experience in teaching the first two years of medical school is that the concept of "patient privacy and dignity" is stressed to the students and I see that they understand and follow the concept. But they will leave our supervision and followup as soon as they enter the "hidden curriculum" period of the 3rd and 4th years and into residency where those of us teaching in the earlier years have no personal supervision of the behavior of the men and women moving on into this much less supervised clinical experience. Behavior may or "have to" change when the former students of mine move on into less or no almost "minute by minute" type of supervision that are provided to first and second year medical students.
My suggestion is that hopefully most patients will be able to be the "teachers" and speak up to the students or early residents and not wait for more professional supervision, if even that is practical. ..Maurice.
Chaperones are useless. Doctors have chaperones to protect themselves (as Dr. Bernstein confirmed). The truth is opposite sex intimate medical care should have never been invented. I appreciate that modern medicine has brought many improvements that have saved many patients’ lives, but they should have stayed with the rule: medical professionals only doing intimate procedures on patients of the same gender.
Look at this article, History of Modern Gynecology. Before modern medicine was invented, males were not allowed to do any intimate procedures on women. Also, more than 40 years ago, male doctors and orderlies usually did intimate procedures on male patients.
I am saddened that our culture has taught us that we should let go of our dignity/modesty in medical settings and that we should focus on the skills of a medical professional rather than their gender. This is why so many patients are violated today.
It does not surprise me at all that sexual abuse by medical professionals is common.
Check out this article, Do Chaperones Really Protect Patients? Make sure you all read the article by Ellen Cater, one of the patients Dr. James Heaps abused. A chaperone was actually present. Ellen Cater made some good points about a chaperone. Look at the picture of a chaperone present as the doctor is performing a pap smear on a female patient. Look at how she is distracted. Even just the presence of a chaperone in the room helps to reduce liability for doctors. Presence of a chaperone makes things worse because it enables the doctor to get away more since the chaperone can defend the doctor.
Misty
Maurice,
You state:
... concern for the female patient's interpretation of my behavior during a pelvic exam as "sexual"...
Is that really fair to ascribe YOUR feelings to the patient when you DO NOT KNOW?
Yet, you have stated so many times (along with the profession of medicine) that it is NOT sexual and that medicine is GENDER NEUTRAL. How do you reconcile this? You (and the profession of medicine) have contradicted yourselves.
And the chaperone was always female. Yet no provision for male chaperones.
You know that there is a problem here and both you and the profession refuse to admit it. The profession makes no provision for it either if it is not convenient. How can anyone trust any member of this profession then?
I guess this means that most providers are sexual predators and patients must assume and treat everyone as such.
Behavior may or "have to" change when the former students of mine move on into less or no almost "minute by minute" type of supervision that are provided to first and second year medical students.
Again you give a pass on abhorrent behavior. What is right and what is wrong must be absolute. This has been tried with the protests against law enforcement where they try to defend their actions by the present dangers on the streets.
No chaperone, no pelvic exam. How is this NOT bullying and NOT paternalism? On top of your assumption that the patient is somehow going to file a fraudulent report against you, you now bully them?
I understand protecting yourself, but why must the patient bear the cost of this? Physicians have a fiduciary duty to patients meaning that they must do what is in the best interest of the patient even if it is at a cost to the physician.
I would argue that LEGALLY and ETHICALLY, if a patient refuses a chaperone, that must be respected even above self protection of the physician against false claims. Yet, it is justified in the self serving interests of the profession.
-- Banterings
Misty, in your last referenced article on the subject of unnecessary pelvic and breast examinations by male physicians, you referred to the issue of performing a breast exam for detecting a lesion in a female complaining of jaw pain. Sorry to your assumptions, there are exceptions. In a 2016 article "Jaw Pain as a First Presentation in the Diagnosis of Breast Cancer" from the Iran Journal of Pathology. The article concludes with " Manifestations of malignancy including breast are not always straightforward. Therefore, in the presence of an ambiguous sign in the oral cavity, such as jaw pain or paresthesia, a differential diagnosis must include metastatic dissemination, and diagnostic examination is highly recommended." Unfortunately, there are always clinical exceptions to what might seem at first consideration "unrelated" and unexplained symptoms clinically pursued may lead to patient benefit. ..Maurice.
Dr. Bernstein, I suspect much of the problem is that the medical education community is not about to tell female medical students and residents that it is a violation of their male patient's privacy and dignity to bring female chaperones into the room. We all know the screams of sexism and misogyny would be loud and clear. The two underlying rules of the game are:
1) Female patients are entitled to same gender privacy.
2) Female staff are entitled to full access to male patients.
Any suggestion otherwise would not end well for the male professor or doctor that said it.
Commenting on a chaperone in the exam room: After my pre-surgery discussion appointment with my thoracic surgeon for lung cancer, in which he yelled and bullied me throughout, seemingly purposely avoiding answering questions, his RN, who was the "chaperone," vehemently stated to me, "I heard everything Dr. So and So said to you! I know what he has said," To which I replied, "Well then you heard how he bullied and yelled the entire time." She didn't care about helping me whatsoever. She was there as HIS witness and to defend him at all costs. I was totally blind-sided by his bullying me into an operation and at her coercion! Never again will I blindly trust any doctor. It's sad for me to have been unnerved by their "practiced" cruelty. CS
Biker et al, want a change for the managing and meeting the needs and desires of male patients?
There is also a demand for more male nurses in the healthcare field, as providers and patients alike become aware of the many benefits male-identifying nurses can provide. For instance, the presence of more male-identifying nurses can help ensure that male patients feel represented. And for certain sensitive procedures, patients might prefer a nurse of a certain sex, particularly for procedures such as inserting a catheter, using the bathroom or bedpan, or giving an enema.
The above narration comes from an article in the publication June 2020 from Nurse.org
The article really supports and encourages men to join the profession not only for their own benefit but as noted above for all you male patients. Isn't that what we all want? ..Maurice.
Yes it is good to see an article encouraging men to go into nursing. In more rural areas such as I live, the nurses at the local hospital are roughly in the 90th percentile for wages in this county. I would think that in itself would be encouragement for guys graduating high school who want to stay in the area. There is even a state college in this county with a BS RN major, making it that much easier to pursue such a career while staying local.
The local ER nursing mix is probably somewhere between 1/3 and 1/2 male, but not near that many in most other areas. I don't know about the ICU. The urology practice in this county will soon be 100% female when the older male doctor retires. His recently hired replacement is female as is all of the staff. The sole dermatologist at the hospital is female as well with an all-female staff.
If more men went into nursing, eventually we'll start seeing more in these other areas. It's not just nurses though. We need more male CNA's, medical assistants, and techs in every area.
Too bad that wasn't tape recorded
It always assumed that using a chaperone is doing US a favor and done for our benifit. I'm okay with her being in the room so long as she isn't at the foot end of the table. THAT makes a huge difference.
OK..so what is "Human Dignity" and how is it different than "Respect"? Check the following YouTube brief professorial definition with explanation:
https://www.youtube.com/watch?v=wSosTocATEA
So what are we really talking about here when we are dealing with issues between the patient and the medical profession?
..Maurice.
I'll take a try at it. I see dignity as internal to the person feeling that they have value and autonomy and are worthy of respect. Not being treated with respect is essentially being told that your dignity is not valued or that you are not seen as being worthy of having dignity.
The problem within healthcare is thinking being polite is synonymous with being respectful. They are not the same. Using a recent example, starboy's former dermatologist may have been polite throughout the encounter but she was disrespectful to a major degree. In not asking if it was OK for the chaperone to be present for an intimate exam, or even introducing her, she conveyed that he was not worthy of the very basic autonomy of having any say in or control over who he was intimately exposed to. Ambushing patients is always an assault on patient dignity.
Showing a patient respect is only part of the dignity definition. Dignity encompasses many different roles such as how care is delivered: does the provider value the patient as the ultimate decision-maker or do they believe the patient is more like a toddler to be shaped, molded and coerced into agreeing to what they the medical provider provider thinks? Dignity is recognizing the patient is a mother, father, son, daughter, etc. and not just an object to use as the medical provider sees fit. Acknowledging a patient's right to dignity is showing respect for the patient as a person who is on equal footing as the medical provider.
Biker is right. Being polite is not good enough. I was polite with my classroom students when I was trying to control their actions such as you must read this chapter during this time. Medical providers generally in a polite manner do the same by trying to manipulate patients into doing what they believe needs to be done by how they do it like for instance the words and actions. Words like: order, you must, you shall not. Actions like: flimsy gowns, not respecting the basic human dignity that every human is entitled to--bodily privacy. I can be polite in telling someone off so polite doesn't do it for me. I need a respectful attitude meaning they do not act as if they are in charge of me because they are not. If they give their advice to me in a respectful and truthful manner, I would be more likely to trust their judgment. If they come across as superior in their attitude, I immediately distrust them.
You don't have to respect me but you must not believe you have the right to disallow me the basic right every human being has and that is dignity. Why is that concept so hard for so many medical providers to understand? They are supposed to be the educated ones but that basic elementary concept they cannot comprehend.
Human dignity is the innate value of each human being endowed on us by our Creator and/or because we are self aware, sentient beings possessing consciousness.
Respect is due regard (how one responds) for/to the human dignity.
The profession of medicine systematically disregards human dignity out of its own self interest and for efficiency (intimate exams on anesthetized patients w/o consent easy to do medical training).
-- Banterings
Let's consider the definitions set by the professor in the YouTube video
https://www.youtube.com/watch?v=wSosTocATEA
and apply it to much, if not all, of the discussions on this blog thread.
What is the differences between "patient dignity", the dignity of each "medical or surgical provider" and of the entire medical system?
If it is "inherent value and worth" defining "dignity", should it not just to be applied to the subjects of the medical system (the patients),but also to all parties involved?
With regard to "respect", is "respect" to be earned"? Should "respect" be part of the behavior to be "earned" by
each and EVERY participant, including the patient (and family) within the medical system? Are not "we all" in this exercise for health TOGETHER? ..Maurice.
The patient is a paying customer. For a customer, politeness is all that is needed. I really don't think you understand the patient point of view at all because being a physician you automatically receive the VIP treatment just as most politicians and celebrities do. I expect anyone I hire to do any type of job to acknowledge my dignity and wishes. I, in turn, make sure they have clear instructions, are paid on time, am polite to them, make sure their work environment is safe, etc. That is how I acknowledge my dignity to them. With medical providers I am polite, pay on time, have clear instructions, listen politely to what they say, etc. However, it is my body they are dealing with not just an object. I have greater ownership over my body than anything else in life. My house can be taken away, my car, even my family but my body is something I personally can retain until I die. The exception to that is most medical providers when you enter their door believe they have ownership over your body. That is completely wrong. No person owns another person. Once you become a convicted criminal and are put into the prison system, the government does come close to owning your body but in recent years even that has changed. Even in prison you cannot be made to have just anything done to your against your will. Again, though there are many similarities between being a prison and being a hospital patient except prisoners commit crimes knowing prison could and loss of bodily rights and freedom could happen. Not so for patients. They have committed no crime and still should be in control of their body and their rights but yet they loose more rights than prisoners. Just ask my husband about that.
We have retained our view of dignity for the ones who purposely harmed my husband even though they did not allow him to have his right to dignity. In how medical treatment is delivered to someone is telling how they feel about patients and even how much they "love" their job. Is their job to attend to all aspects of human wellness or just "cure" the present "illness" while causing other harm to the patient? That is the interesting question. How much time and effort does it really take to teach and then to treat all patients as if they are humans? How is there any defense of the crimes done to humanity by something as simple as bringing in a opposite gender chaperone to the more heinous crime of sexually assaulting a patient?
I have read numerous definitions of what dignity of care means. I am sure most of the offending medical providers have read them too but the question is why don't they care? Why is wrong with them that they don't care? And it is something wrong with them and not wrong with the patient expecting to be treated completely in a humane manner. I don't appreciate the ploy to bring in dignity and respect for the medical provider when dignity/respect for the patient is not contingent upon them having the same for the medical provider. I know my husband did not grab for their clothes and rip them off of them nor did he hold them captive while doing sexually entertaining things to them. He was completely innocent. The men in this blog who have been ambushed by their medical providers--what did any of these men do to deserve the treatment they received? We know dignity in care is taught but the effort and time would be better spent on trying to figure out what is wrong with how the healthcare industry is delivering intimate care to patients especially to male patients and why female patients are still being sexually abused like CS was.
The dignity of the providers, system, etc. is IRRELEVANT.
The previous all choose to be there. The patient usually does not choose to be there or needs to be there by necessity (preventative care). The provider choose their career long before encountering they encounter the patients.
There is also the power differential. Human dignity is to allow the weaker party to be treated in a certain, humane manner.
The dignity of the providers is an issue when dealing with the facility or the system. That is because of the power differential between the provider and the facility or the system.
-- Banterings
A primary care physician writing an article in 2010 on the
"Health Care Blog" wrote the following and much more. Read it and read the interesting back and forth discussion by the responders to the article.
Here is one paragraph from the writing. JR and others: will this view be acceptable to you coming from a physician?
I am not sure why people bristle at calling patients consumers; that’s what they are. They are also customers, participants, autonomous, and humans in need. This is not an “or” proposition. If we forget the humanity of patients and just treat them as customers, they lose. But they also lose if we forget that they are paying us and demand our respect and our attention to their needs. We are as much servants as we are professionals. Signing up to be a doctor means you agree to give yourself to your patients. All of them. It’s hard, and it’s complicated. It’s a human-human relationship.
..Maurice.
WE ARE NOW AT 171 COMMENTS AND I THINK IT IS TIME TO MOVE ON TO VOLUME 117 https://bioethicsdiscussion.blogspot.com/2021/02/preserving-patient-dignity-formerly.html
I HAVE COPIED MY LAST POSTING REGARDING "HEALTH CARE BLOG" ARTICLE TO START THE NEW VOLUME AND WE CAN CONTINUE THE DISCUSSION THERE. ..Maurice.
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