Preserving Patient Dignity (Formerly Patient Modesty) Volume 117
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.
AS OF APRIL 21 2021, THIS VOLUME WILL BE CLOSED FOR FURTHER
COMMENTS . COMMENTS CAN CONTINUE ON VOLUME 118
bioethicsdiscussion.blogspot.com/2021/04/preserving-patient-dignity-formerly_21.html
posted by Maurice Bernstein, M.D. @ 7:09:00 PM
172 comments
172 Comments:
Doctors are public servants and many work long hours but the medical system in general is corrupt. JR once talked about Hospice being an agency to help patients die quicker. Now it's being crammed down my throat that it's really true and I don't know what I should do about it. There is one certain patient were I work who is always really hungry. And a short while ago she was looking really rough and Hospice told our Director to cut back on the amount of food that she's given. But she's FAMISHED! They should at least give her appetite suppressant but probably wouldn't because then it would acknowledge that she is hungry. When her meal servings were cut back I started feeding her snacks in bed and she put on weight and I was told to stop or she would be taken off of Hospice. I don't believe her family wants her to die because she was given the Covid vaccine. So what am.I supposed to do?
JF,
IMO, hospice is used as a vehicle in which to make patients die quicker once someone somewhere has determined that person needs to die. It is a fact the US generally spends more $$$ at end stages of life than any other time. Most of the time that stage is for elderly people. In order to save money, they need to make sure elderly people do not receive all the medical assistance they used to receive. Britain has been one of our critics of spending too much on elderly care. Talking to people using the NHS, they said end stage care is lacking in Britain.
JF, you are in a moral dilemma. Do you help her or do you not? My dad was hungry but hospice refused to do anything about it except to increase his drugs to keep him more heavily sedated. He was hungry in real time but might not remember it later but was hungry still in real time. It was heartbreaking to hear him but my stepmother did as they ordered. He would cry before he was given more drugs to zombie him out. I still have nightmares. Giving this patient the COVID vax while saying to cut back her food so she will die is a clear demonstration at how evil the system really is. As I have said before, it is all about #ControlPowerGreed. What you have stated clearly fits this. This should be considered a crime against humanity. To profit from the COVID shot while denying a person food because it was making them feel better is evil. It is disgusting. I hope there is karma because it is sorely needed.
If she improves, the nursing home will lose the $$$ they are receiving from hospice. Right now they are making hospice money plus whoever is actually paying for her ordinary nursing home stay. This is greed. They don't mind using this poor woman to enrich their bottom line. Pure evil.
We need nursing home reform as well as medical reform in general. What happened in New York and other states like New Jersey, Michigan to nursing home residents is just the tip of the evil cycle of abuse that is happening to our nursing home residents. Nursing homes like hospitals are just in it for profit at the expense of the patients and even at the expense of the average worker like JF.
Dr. B.,
I don't disagree with your opening paragraph. Patients are a consumer but a very, very special type of consumer. I agree that patients and medical providers should have better relationship but oftentimes this is discouraged by the paternalistic nature of medical providers. For many harmed patients, the relationship has become an adversarial relationship as there is no trust and you are just waiting for the next harm to happen. Many men on this blog go to each appt knowing they must be on the defensive or offensive in order not to suffer sexual abuse at the hands of medical providers. Is there not a problem when the medical relationship is being more defined as being an abusive relationship much like a domestic abusive relationship? Like many women who stay in an abusive relationship, patients are afraid to go or stay so to speak. Much like an abused wife, if a patient speaks up they chance being abused even more like my husband was when he politely spoke up about his right to autonomy. I realize you claim not to have ever seen this or experienced this and for that I have no answer but suspect it is because you are in denial of what you have seen. I cannot believe in all your years you have not witnessed some medical provider knocking and entering before the answer of "Yes, you may enter is given." I cannot believe that in each and every time a patient has not been unnecessarily exposed in your presence if a hospital but maybe you weren't present during the hospital process where exposure is more likely. I cannot believe your male patients have been gowned like your female patients for chest exam as most all are just told to remove their shirts. (And this is not giving male patients the same dignity considerations as done to female patients.)
In the case of Star Boy, how many female patients will be required to stand completely naked in a room with a male doctor and a male chaperone? Before I let any worker into my house, I make them identify who they are. Why aren't people who are messing intimately with our bodies being identified as to who they are and their purpose? Again, the chaperone is there solely for the protection of the doctor. They generally do nothing if there is something inappropriate going on like having a male patient totally exposed. At no time should he have been intimately exposed to this chaperone. She was not there in a medical capacity but rather for the doctor. She was providing no benefit to the patient rather she was causing massive stress for the patient. That in itself should stop the harassing of patients from happening.
JF, what we all must understand is "what comprises hospice care"? For an excellent description here is the link to the "National Comprehensive Cancer Network describing in detail "understanding hospice care". Here is an important paragraph: The purpose of hospice care is to maximize the quality of life for people in the last phases of a disease that cannot be cured. "Hospice is a system of care designed to relieve suffering and promote quality of life for people living with terminal illness," says James A. Tulsky, MD, director of the center for palliative care with Duke University Medical Center in Durham, North Carolina. "Its focus is to address all aspects of suffering, including physical symptoms, psychological and social distress, and spiritual pain." That "all aspect of suffering" does include hunger for food, doesn't it? ..Maurice..
Maurice,
Theoretically, let us say that you witnessed a patient unnecessarily exposed, one of your patients complained they did not want you (a man) intimately examining them (a female), they did not want a voyeur (chaperone) in the room, or a patient yeas later said that they felt that your treatment was abusive (for instance you bringing a student into the room and they felt that they could not refuse).
How would that have changed your view?
I suspect that you would label this as outlier behavior; discount them and forget about them.
How does abusive behavior have to happen for it to be abuse?
We know how ofter people just walk into the patient's room or exam room
without knocking. How is this not abusive behavior? Just because the system is overloaded is no excuse for abhorrent behavior no matter what the intention.
How is this any different with the patient anesthetized and someone "pops" into the operating room to ask the surgeon a question or to say "hi" to his friend the surgeon?
I would ask how it is different if the patient were awake, but it is no different...
Here is a question that I would really like you to answer: You know how most of us here define abusive behavior, so what would have to happen to you before you would consider it abusive treatment by healthcare providers?
-- Banterings
Dr B. I'm ready willing and able to not force the issue with a patient who has lost their hungry feeling. This woman is FAMISHED! That's why I started feeding her snacks. I've been still doing it after I was told to stop but could end up in a lot of trouble if I'm caught. Always before when I witnessed homes trying to speed up someone's death they were at least given meds to make it easier on them. I kinda think Hospice is taking advantage of the extra privacy Covid creates to speed up the death of this woman. She can't speak anymore but she also isn't sickly
( so long as she gets enough to eat )
Banterings, in response to your question to me: "Here is a question that I would really like you to answer: You know how most of us here define abusive behavior, so what would have to happen to you before you would consider it abusive treatment by healthcare providers?"
I have posted this previously on this blog thread. On my second hospital admission in recent couple of years, the hospital had ignored my request on the first admission to NOT treat me as a VIP.
This treatment made it impossible for my family to establish communication with me by hospital phone and provided confusion for them when told by the hospital that I was not admitted and not present even though the hospital operator knew I was admitted and still hospitalized. This behavior I was told on the first admission that this was the process for a VIP which
apparently I was designated being a physician. I spoke up and emphasized I did not want VIP status. However, the same VIP designation and the impact on my family trying to contact me by hospital phone was continued in the second admission. To me, I consider this personally rejected VIP status was "abusive" (psychologically harming me and my family) and was apparently based on a concept that physicians do not want to have hospital phone callers know that the physician has been hospitalized.
Now, Banterings, you and others might not consider my experience as "abusive" but I did. ..Maurice. P.S.: I really discourage all potential patients whether physicians or anyone to set themselves as a "VIP" patient in a hospital environment. There is much more chance for patient self-injury with that designation.
Maurice,
That goes beyond a violation of dignity. Keeping your family away from you while in the hospital is DEFINITELY a form of abuse. The United Nations has defined institutional isolation as a form of torture.
Perhaps I should have phrased it differently asking what "modesty" (dignity of exposure, touching, photographing, etc. of your body) would you consider abuse?
-- Banterings
Banterings, interestingly and truthfully, none of the exposure, touching, photographing, as you suggested examples, have I so far considered as abuse. Why do I not consider "abuse" is simply that I have been in the medical profession for more than 60 years and I understand the clinical or legal basis for all your examples and have found no evidence for "abuse".. well, except as I described in my last posting,
being repeatedly treated as a VIP when I rejected that status and its consequences.
..Maurice.
Dr. B.,
You have a point. For you, all the exposure is acceptable but for others having exposure to a different gender is not acceptable or is not acceptable if first not asked. That’s the big difference. I don't recall if you were specifically given explanation & asked before any exam started but if not, whether you realize it or not, you experienced inappropriate behavior. Again, that might not bother you but it does some. For men like my husband, he had no problem with an intimate exam by the opposite gender if done properly. During his prostate exams, he had a female present with the doctor. At the time, it did not upset him as he shrugged it off. However, now he sees it differently bc he knows they were not respecting his right to bodily privacy by not informing or asking him for permission for her to be present. He also now realizes w/ her present, he should have been shielded from her simply being there to stare at his exposed genitals. He also realizes that he was violated by being told to undress in front of them as it’s not acceptable for any pt to have to undress in front of any medical staff unless it is to evaluate issues w/ daily activities.
https://www.professionalstandards.org.uk/docs/default-source/publications/policy-advice/clear-sexual-boundaries-information-for-patients-and-carers.pdf gives clear definitions of inappropriate behavior by medical staff and undressing is part of that.
Was he unnecessarily exposed for entertainment & just bc those women wanted to dominate a defenseless, sedated male patient during the Kavanaugh hearing. We certainly believe he suffered blowback from the Kavanaugh hysteria along with being labeled gay, married. We know from research that gay males are more likely to suffer sexual abuse which is probably the reason they were laughing so hard while he was laying terrified, exposed while they abused him asking him if his spouse also abused him. Since he was not foley cathed for the procedure, there was absolutely no reason for his penis to be exposed at all. I have talked to women who signed a consent to undergo the same procedure, and none of them were left exposed. So why the difference in how women are treated vs. men. Some went to the hospital from hell. Men I have talked to who have undergone the same procedure said they were exposed briefly when the gown was removed but immediately covered by a blue cloth. Why the difference? But more to the point, why is there any exposure at all when there are medical garments designed for bodily privacy, dignity of patients? Can you answer this? Will you answer this or will you ignore this question?
There is a huge difference in the way the dignity of a female's genitals is conducted vs. a male's genitals when a male exam could also be done while laying on a table with the appropriate drapes the the chaperone at the head. Why is it still done differently? It all comes back to power & control as males are deemed to be more dangerous, uncooperative but why is that? Probably because of the way male exams are done. The whole circus-like atmosphere in which men are expected to perform during genital exams is barbaric and is sexually abusive. As I have said before, this would not be expected to be done to a women unless she is going through processing for jail/prison which is how they treat male patients. It is the very same method & really principle. Male patients have always thought to be less cooperative & more challenging so they devised methods in which to "handle" them. The humiliation routine is great at putting most men into the "deer in the headlights" mode. It allows most female providers the confidence in which to deal with a male patient as they feel male patient having more status than they have. The simple truth is the way the medical community delivers healthcare is about controlling & "owning" the patient. They do not want the patient to be an individual in their presence. They want conformity & obedience.
JR, as long as I understand the rationale of the behavior of the medical staff in terms of the clinical behavior I have known and carried out over the years, I have no complaints of what non-professionals might consider as a "misbehavior". Yet, for the hospital staff to characterize and treat me as a VIP when I had previously rejected the designation and associated altered behavior of members of the staff, I considered was "non-acceptable" and entered my complaint.
Consider the possibility that "some" and I mean only "some" of what you and your husband considered misbehavior or worse may have been, if I as a physician was a patient in place of your husband, might have found the "considered misbehavior" appropriate behavior for the situation at the time. The practice of safe but effective medicine has some behaviors which, if unexplained to the patient or family, may be considered by them as inappropriate or worse. Patients have the right, if not the duty, to "speak up" if aware of what is considered as "unprofessional". ..Maurice.
Dr B.,
If you thought any of the behaviors I have spoke of in regards to my husband were appropriate behavior, then you would have a twisted and sick sense of what is proper behavior. I don't have to be a "professional" to know what was done was wrong both morally and criminally. Also, for your clarification, I don't consider those people who harmed my husband to be "professionals" not least in the delivery of real medical care as real medical care should never be abusive or criminal in nature. Neither my husband or I have made complaints about anything that any "normal" person would not consider to be criminal and/or unethical. Lay people aren't as stupid as the medical world would like to think they are pointing back to the paternalistic attitude of "they just don't understand because they aren't a medical professional." Humane, dignified care is not rocket science. It is common sense and decency which apparently going through any type of medical training, they appear to forget or maybe never had to start with as the medical field does have a higher than average share of serial killers/harmers. When it comes to their own care being delivered to them, many medical "professionals" become upset if their dignity is not respected hence why many of them excluding you go to other provider/facilities where they are not known. Please feel free to enlighten me as which acts I have mentioned in the past happening to my husband were no big or we just misunderstood because we are not "professional" so therefore, we have no hope of understanding the reason?
As I said, I recognize you do not define bodily privacy in the same manner in which many of us do. That is acceptable except when your definition directly affects how healthcare is delivered to me and others like me. I personally would not have been upset abt the VIP status as I would have been over bodily violations because the VIP is a clerical error and not a personal one. I consider having to wait for hours and hours w/o any word knowing your loved just had a procedure that had been refused worse than someone calling the switchboard and not being given your phone connection. But then I am not a "professional" and as not being one, my loved suffered criminal harm not a clerical error.
JR, in no way can I deny your conclusions regarding how your husband was treated. I wasn't present to witness. Yes, there are subtleties between proper and ethical medical practice and unethical practice and part of a decision regarding behavior but one doesn't require bearing an MD degree, such as in your example, to come to a conclusion. That is why I never expressed a conclusion that your direct and the additional responses were inappropriate. Ventilation by speech and writing, here and as you are doing elsewhere is certainly of value to both you and your husband. And, who knows, may lead to behavioral improvements in all of the medical care profession. ..Maurice.
Maurice,
As JR pointed out, what we find violating, you do not. You find those actions acceptable. Many of us do not.
The problem is that providers take the approach dealing with patients where they impose their values on the patient instead of asking. That is the very definition of paternalism.
If providers are so learned, why can't they learn how regular want to be treated?
-- Banterings
I am so glad I am on this Blog! It is abundantly clear to me that you good folks understood the “initiation” I described that happened to me two years ago. Biker, JR and Banterings, I appreciate that understanding and your support for us victims. I also appreciate Dr. B for hosting this blog so these discussions can take place. It is comforting to me to be a part of this important conversation.
As I mentioned earlier, I have been lobbying our state legislators for patient protection during intimate examinations. I shall never forget being exposed, spotlighted in the center-ring for my last full body skin exam. I had no idea I was going to be a “show”. Never again!
Clearly, medical chaperones exist to protect the physician! While patients are sometimes told that the extra set of eyes are there to “support and provide comfort” for the patient, I can assure you there was nothing comforting nor supportive by the presence of the third party during my exam! If a patient wants a chaperone, he/she should have one, so long as the chaperone’s gender is acceptable to the patient. Likewise, if a patient declines a chaperone, that too should be honored and respected. If the healthcare provider feels they need a chaperone for legal protection and the patient declines, could not the patient sign a hold-harmless waiver to eliminate the provider’s concerns?
I have been lobbying members of our state legislature regarding medical chaperones. As of my last check, there is no AMA REQUIREMENT for one to be present, but 7 states required them—fortunately not mine. I am interested in learning what elements you feel would be important considerations in drafting protections against unwanted medical chaperones (for the patient and physician), as well as any other things or personal experiences you might wish to add that might be useful in swaying legislators for support. Thanks, in advance, for your thoughts.
Starboy
Starboy, thanks for your personal appreciation of our hosting this blog thread and I am pleased of all our visitors participation here. However, there is one class of visitors I miss and that class would be direct active or previously active representatives of the medical profession. I would like the read their interpretation of the upsetting experiences which is being described here by patients and whether they have seen or experienced them themselves or their general reaction to what has been presented. Again, thanks. ..Maurice.
Approximately 39 years ago, my best friend was pregnant with her first baby. She was getting her intimate exam when the door opened up and a group of med students came in. Nobody had asked her anything. She said there were about 15 of them. Was she exaggerating? Maybe! She sometimes had a tendency to exaggerate. What percentage of those students were male and what percentage were female I don't know but you can be sure that there were more than two men in the room. Her doctor examined then said "Next?" But then she spoke up and said "No!" After that she NEVER had that type of exam without her husband
being with her.
JF, 39 years ago the majority of the students would surely have been males.
In my graduating class 1958 of medical students of, as I recall, 39 students, 2 of which were females. This was the 4th graduating class of the new UCLA School of Medicine. ..Maurice.
On further research and thought, we had 48 graduates and the 2 women in our 4 years did not graduate with us. 1958 is a long time ago. ..Maurice.
On the "other hand" here is my 2007 blog thread with 22 Comments:
The Sexually Seductive Patient: How Should Doctors React?
On my other threads on patient modesty and why doctors are hated, there is much concern and worry about sexually seductive doctors. Such concerns are warrented even though I am sure most doctors will treat patients professionally and keep to the professional and legal boundaries of behavior. However, physicians have their own concerns. One of their concerns is the behavior that the patient will bring into the office. There are the angry, disruptive and frankly belligerant patients. Medical students are taught to expect such patients and to react by trying to understand what is motivating these patients to these behaviors since such understanding may provide a therapeutic approach rather than the physician simply reflecting anger back to the patient. One of the more subtle and difficult patient behaviors for physicians to deal with is the sexually seductive patient. Such a patient, often a female relating to a male physician enters with the expression of obvious greater attention and interest with respect to the physician's personality and appearance than true concern about her own symptoms. Her actions may be sexually provocative. The patient may expose her body to the physician during the interview or exam to an extent which is clinically unnecessary. Female physicians are not free of seductive male patients.
Psychologists explain these patients' behavior as expressions of transference--where psychologic unmet needs are attempted to be met by engaging physicians who seem to resemble and reflect critical persons in the patients' emotional life. Of concern is the issue of counter-transference--where the physician may respond to this situation in a manner to support the physician's unmet needs based on the physician's emotional life. This can lead to physicians responding to the seductive patient in a manner beyond the professional boundaries of sexual attention.
How should physicians react to the seductive patient? Should they consider the patient has a psychologic or psychiatric problem in addition to their other disease and seek out evaluation, patient education and treatment for this disorder? Or should the doctor go ballistic and spell out the established rules of further behavior? Medical schools find that the need to educate students regarding how to deal with the seductive patient an important topic. I would like to read the views of my visitors on the subject of the seductive patient and what they think would be the very best approach to deal with the issue if it arises. One point I don't want to read from my visitors is that there is no such person as a sexually seductive patient or that the way patients behave is simply a reflection of the doctor's unprofessional behavior at the onset of the relationship. You have to be in medical practice yourself to see that this conclusion applied to all is not true! ..Maurice.
It is the actions of those seductive patients that contributes greatly to the rest of us suffering with unwanted chaperones. I think most of us understand why doctors feel the need to protect themselves. The problem is the manner in which they address that risk. The physician may feel that anybody serving as a chaperone solves the problem, but for many patients opposite gender chaperones creates a problem where one did not need to exist. Donning scrubs does not make one a professional nor does it make one asexual, yet that's what they expect patients to accept their chaperones as.
Do physicians not understand this or do they simply not care? I understand they need to protect themselves. I just want them to do it in a respectful manner.
I agree there are patients who exhibit sexually inappropriate behavior towards a medical provider but that is a different topic and not one many of us who have suffered the opposite behavior from a medical provider is interested in discussing. We are discussing the obvious power imbalance between patient and provider which allows the provider to undertake actions that erode or even destroy the trust the patient may have in the provider to protect and respect their personal dignity. Inappropriate sexual abuses of the providers have range in various degrees of inappropriateness to downright criminal actions. The actions of the provider(s) are totally actions where the blame is place squarely upon the provider. It has been the discussion topic of this particular blog thread to tell our stories, to try to figure out why these providers are undergoing the actions they are and how to bring about change. I will say that even though some patients do act sexually inappropriate with medical providers it in no way gives any of the them the right to retaliate against other patients. I do feel the culture within the last years of blaming men for every bad thing that has happened has thrown fuel on the fire of male patient abuse as I believe there are some females in the medical community that believe they have the right to hold judgment and deal out punishment to innocent, unsuspecting, and defenseless male patients. As in Starboy's case, it would clearly would have been perceived as a case of sexual misconduct and probably a criminal investigation would have been launched if a male doctor and a male chaperone had done the same to a female patient. My issue with most all medical providers is they acknowledge this situation is wrong but do not acknowledge in kind the opposite is also wrong. What is wrong with the medical community that they do not have any common sense or even any common decency. A male patient deserves the same respect as a female patient. You do not take away the rights or protections of one group to give it to another group. Purposely creating inequality in care does not solve inequality in care. All I can say is "Duh."
I believe a patient is more likely to be exposed unnecessarily rather than a provider being confronted by a sexually inappropriate patient. A patient's risk for unnecessary exposure grows greatly once they have been sedated and/or if they are male. More and more females are becoming anesthesiologists so most OR teams in the pre-op/post-op are going to be all female which increases the risk for every male patient of being exposed unnecessarily. This is scary for any male considering any type of procedure. More and more females are becoming cardiologist and urologists bc of the working hours so again this become more and more dangerous for male patients. Patients need protection from the predators who by their own personal belief system do not believe male patients are entitled to privacy and respect.
Biker. Maybe they don't understand the concept of win.win. In order for them to get their desired protection ( or whatever else their motive is ) the patient must be embarrassed if they're the kind of patients who will be. It doesn't matter to them if that patient avoids care in the future ( assuming they bother thinking about such things at all ) Female staff wandering in and out while male.or female patients are exposed is not acceptable and who ever invented it isn't a good person with any pure motive.
Demand is greater than supply. So either accept what they offer or go nowhere...
Read:
How Government Helped Create the Coming Doctor Shortage
Thanks to doctors, there aren't enough doctors
The US is on the verge of a devastating, but avoidable doctor shortage
The AMA keeps the supply artificially low, and since healthcare spending accounts for $1 of every $5 of GDP, there is considerable money to lobby the government to GDP what they want.
It also helps ensure the power the profession holds and forces patient compliance.
Power corrupts, absolute power corrupts absolutely.
Society has reacted to the situation without breaking the social contract. Part of the AMA's power was reduced in Wilk vs. AMA.
Society has also granted NPs and MAs much of the authority GP and some speciality physicians have to treat people.
-- Banterings
Banterings, I will add that the male-female mix at the provider level is skewing towards female dominance a bit more each year. As older male doctors retire, half of the newly minted doctors are female. Physician ranks will soon enough be 50/50 M/F. As the doctor shortage grows, NP's and PA's are filling the void. Currently 3/4's of the PA's and 90% of NP's are female. Primary care will soon enough be dominated by NP's & PA's as fewer medical students choose that specialty, but NP's & PA's are making inroads into other specialties as well.
My county of nearly 1,000 sq. miles has 2 dermatologists, a male at retirement age and a young female, plus there is a female NP. We have a male urologist at retirement age, his recently hired female replacement and they have a female NP. When I needed to find a new primary care provider, there weren't any family practice or internal medicine physicians within an hour of here taking new patients.
The looming female dominance of provider ranks (physician/NP/PA) does not bode well for males being treated as the equals of females given the mindset of modern day feminism. Within healthcare there are two rules that I stated recently and will repeat again:
- Female patients are entitled to gender privacy and respect.
- Female staff are entitled to full access to male patients.
Were you all aware of a dynamic which is appearing, based on studies, within the relationship between female physicians and female nursing staff?
As relationships in the medical field are evolving, female physicians have generally noted a more challenging rapport with female nurses compared with their male counterparts.
Read this article in the Mayo Clinic Proceedings.
Do you think that this disturbance in the female physician-female nurse relationship can explain some of the issues described on this blog thread regarding how male patients are treated? Or is this immaterial?
I am just trying to find a valid functional etiology for the upsetting concerns that male patients are writing here. ..Maurice.
Dr. Bernstein, I suspect the female doctor - female nurse dynamic is just part of human nature. In my career I observed that the hard charging female professionals sometimes struggled to get along with other women, be they subordinates or peers. It was as if they needed to make sure everyone knew that they were the alpha female. Not all were like that of course but it was something I observed from time to time.
In my retirement role as a local official working in my little two room town hall, I see what I call Middle School behavior from the women. Who is in, who is out, who they're going to gossip about. Conversely, the other guys and myself just go with a stance akin to "whatever, we'll just stay in our lane and avoid the drama". As a result we get along with all of the women.
I suppose it is possible that rather than compete with each other for the alpha role that female doctors & nurses could find common ground in a dynamic of a collective alpha women. This could be seen in the observed and experienced indifference to the privacy, embarrassment, and dignity of male patients that has been expressed here again and again. Donning a pair of scrubs gives any woman in healthcare a power over the very dignity of men that they might not be able to exert in other aspects of their life.
I suspect this is what happened to JR's husband. Those women were angry at men for reasons we'll never know and their roles empowered them to take it out on him. We also see it in Mr. Kirschner's urology office visit. The sisterhood at that practice saw their entertainment as a superior right vs his right to privacy and basic human dignity. The same goes for Twana Sparks and her all-female OR team. Their sisterhood power to entertain themselves was deemed to be of higher priority than treating male patients with even a shred of respect. With the Denver 5 their perceived right to be voyeurs was deemed superior to treating that patient with dignity even in death. That there was no meaningful punishment in any of these examples attests to the healthcare system itself seeing the collective rights of the sisterhood being superior to the dignity of male patients, perhaps because they see it as preferable to the female staff competing with each other for alpha roles.
I agree with Biker. I have seen that dynamic time and time again in the education atmosphere. My principal once asked me why I would not have lunch with the other teachers or hang out after school with them so I told her outright it was because they were mean and cruel to almost everyone as they were big gossipers. No one was safe was their evil tongues. Students standing right outside the breakroom door could hear them. Since I was an independent classroom, I was able to generally arrange my lunchroom after most of them eating lunch with the 5th grade teachers which one was my friend and the other was a male teacher. Peace reigned.
I believe in healthcare since most staff are female and putting a female doctor in the mix would be of the same atmosphere as Biker and I have described. Also, I have found working with a female boss can sometimes be a lot more difficult than working for a male boss as many females seem to have bigger "chips" on their shoulders. As I have said before and as well as Biker, I do think many women are angry at men. The media feeds into this by constantly playing the blame/shame game on men. Men in medical situations are an easy target as they are out of their field of comfort and very vulnerable, defenseless--unarmed so to speak. Add in sedation and you have the perfect atmosphere to abuse a man and most likely unless a fluke (ie. my husband) they will remember nothing or very little of what happened. The main nurses who abused my husband, I have read their social media posts. They have issues with men along with drinking and illegal drug usage. Apparently the hospital does not monitor their social media pages but I did and even if they would delete them, I have saved them forever. School system told us outright to watch what we say and don't engage with students and parents on social media. We knew they would be watching and for the ones that did, they could end up in deep trouble like the male teacher who was "dating" a 16 yr old girl or the gay student teacher who was putting out a list of attractive male students. Nurse who molested my husband in CCU room talked about taking Mollys which are a dopamine which dopamine is used in CCU. Mollys also make user sexually charged.
I also agree with Biker that the rights of the abuser is more protected by the healthcare industry than the rights of the abuser. Imagine if my husband had been a female patient and the abuser was male. Would have been a different story but there certainly is bias in healthcare against male patients.
I do think the article that Dr. B. found does have significant bearing upon how healthcare is delivered because in a mostly female dominated system, there will be petty cat fights along with retaliation and the sense of entitlement of being able to seek justice for past sins of mankind with emphasis on man.
Biker and JR, WOW! Maybe you have found a major etiology as to why male patients are treated by the medical profession the way they have been described by the participants on this blog thread subject. I have had no professional experiences observing the interactions between female physicians and the female nurses and nursing staff.
I hope everyone reads the study published by the Mayo Clinic on the link I put up yesterday.
Does anyone think that female doctors are "competing" with the female nursing staff for the male patient. And how does the behavior of the male physician fit into this interestingly discovered and published relationship>? Or am I making a big deal (conclusion) out of nothing? ..Maurice.
Dr. Bernstein, to compete one on one with someone takes a lot of mental and emotional energy, regardless of the genders involved. It can also prove to be a lose-lose scenario in workplaces given the potential for disruption. Uniting around a common identity or against a common foe takes far less energy and is usually less disruptive in workplaces. This is why a sisterhood that includes doctors & nurses is generally going to be the preferred path in hospital settings. The collective power is greater than what they could yield individually.
This collective power is how gross violations against male patients can occur by groups of female staff without fear of meaningful repercussions. Every one of the examples in my last post involved groups of female staff, not individuals. Male staff that abuse female patients are almost always individual actions. There is not a brotherhood in healthcare to protect group action and more importantly, it is far more difficult to hide group actions. A group of men abusing a female patient would be seen and called out immediately. In female dominated settings such as hospitals, group actions by female staff can occur in the open while the collective sisterhood looks the other way.
The other aspect of the sisterhood is that it extends into the administrations of hospitals. In a setting where women overwhelmingly dominate the staffing mix, and those women see nothing wrong in their treatment of male patients, taking steps to protect the privacy and dignity of male patients is not a battle most administrators are willing to fight.
I recall at the time of the Denver 5 incident reading comments by female nurses. Most thought they shouldn't have done it but didn't see it as anything rising to the level that warranted punishment. Some nurses didn't even see that there was anything wrong with the voyeurism. If that is how female nurses saw it, it is understandable why such things go unpunished. No administration wants to deal with the collective fury of the female staff in a setting where 90% of the staff is female.
This is how a few years ago when I was having a procedure w/o sedation that is normally done w/sedation one of the nurses in the room said to the other nurse "he's so cute, too bad he's not sedated." The only difference between being sedated and not sedated is that not sedated I wasn't naked under the sheets. A male nurse having a similar thought about a female patient would never be able to openly voice it because he is not surrounded by a protective brotherhood. In my case she knew she was "sisterhood safe" saying it in the open to another female nurse. And if I was sedated, surely she'd of felt safe in lifting the sheet if that's what she wanted to do.
How about this from the North Carolina Medical Board? Would this be effective in protecting the patient and maintaining patient dignity?
https://www.ncmedboard.org/resources-information/professional-resources/laws-rules-position-statements/position-statements/print/guidelines_for_avoiding_misunderstandings_during_physical_examinations
Position Statements
Guidelines for Avoiding Misunderstandings During Patient Encounters and Physical Examinations
Categories: Ethics and Professionalism Adopted May 1991 | Amended Jan 2021
It is the position of the Board that respect, empathy, and sensitivity to the vulnerability of patients are needed at all times during a patient encounter in order to avoid misunderstandings that could lead to charges of boundary violation or sexual misconduct against licensees. The Board offers the following guidelines to assist licensees in reducing the possibility of such misunderstandings.
Licensees should recognize that misunderstandings regarding boundaries may occur at any time during a patient encounter, but particularly during disclosure of private information by the patient about symptoms, prior personal experiences, or during the physical examination. The licensee should maintain a professional demeanor at all times. While some licensees have adopted a more informal approach to patient interactions, such as use of first names for both patients and the licensee, this may blur boundaries and result in later misunderstandings.
Sensitivity to patient modesty and dignity must be maintained at all times. The patient should be assured of adequate privacy and should never be asked to disrobe in the presence of the licensee. Examining rooms should be well maintained and equipped with appropriate furniture and supplies for examination and treatment. Gowns, sheets, and/or other appropriate apparel should be made available to the patient.
Regardless of the patient’s gender, a third-party chaperone, possibly a staff member, should be readily available at all times during a physical examination, and it is strongly advised that a third party be present when the licensee performs an examination of the breasts, genitalia, or rectum. It is the licensee’s responsibility to have a staff member available at any point during the examination. If no chaperone is available, the patient should be clearly advised of what will occur during the examination and provide verbal informed consent for an unchaperoned examination. Continued next post.
The licensee should individualize the approach to physical examinations so that each patient’s sense of vulnerability, apprehension, fear, and embarrassment are diminished to the extent possible. An explanation of the necessity of a complete physical examination, the components of that examination, and the purpose of disrobing may be necessary in order to minimize the patient’s apprehension.
The licensee and staff should exercise the same degree of professionalism and care when performing diagnostic procedures (e.g., electrocardiograms, electromyograms, endoscopic procedures, and radiological studies, etc.), as well as during surgical procedures and postsurgical follow-up examinations when the patient is in varying stages of consciousness.
Sexual impropriety by the licensee may include behavior, gestures, comments, or expressions that are seductive, sexually suggestive, disrespectful of patient privacy, or sexually demeaning to a patient, and may include, but are not limited to:
o Neglecting to employ disrobing or draping practices that respect patient privacy or deliberately watching a patient dress or undress.
o Subjecting a patient to an intimate examination in the presence of students or other persons without the patient’s consent.
o Examination or touching of genitals/genital mucosal areas without the use of gloves.
o Unprofessional comments made at any time during the encounter about or to the patient, including making sexual comments about a patient’s appearance, body, or clothing or offering demeaning observations about the patient or others.
o Using a licensee-patient encounter to solicit a date or romantic relationship.
o Conversations or comments regarding the sexual problems, preferences, or fantasies of the licensee.
o Performing an examination without clinical justification or without explaining to the patient the need for such examination.
o Requesting details of the patient’s sexual history or sexual preferences when not clinically indicated.
The licensee should also be alert for suggestive or flirtatious behavior or mannerisms on the part of the patient and should not permit a compromising situation to develop.
Are you all happy with this Board's Position Statement? ..Maurice
Hello Dr. Bernstein,
"Regardless of the patient’s gender, a third-party chaperone, possibly a staff member, should be readily available at all times during a physical examination." Nowhere in this statement is there an indication that there should be a same-gender chaperone. Perhaps, an amendation might be, "It is highly recommended that a chaperone of the same sex be used."
Reginald
Dr. B.,
I had copied this on Twitter some time back saying it was the one that came closest to actually protecting a patient. That is if they actually abide by what they have written. In Indiana, we have informed consent laws. However, they do not follow them and the govt./legal does nothing to make them. All major hospitals have patient bill of rights that list the ways they are responsible for in protecting a patient. Again, they are just words written on a piece of paper that mean nothing. Medical boards also do not serve their purposes. In fact, the Indiana Medical Board was investigated by Jim Axelrod on the CBS Morning Show for its corruption. Indiana Medical Board is also the one who licensed a convicted, violent felon as a MD when even Arkansas turned him down. Again, Medical Boards spout goodwill but don't really mean it. Legislators here in Indiana have told me getting real patient reform passed is next to impossible bc so many have been bought and paid for by the medical lobbying groups and if you check on their campaign donations, that can pretty much be verified. I put out several really good tweets about how much lobbying the the combined medical community does and it is astonishing. No wonder politicians are soul-less because if they ever had one, they have long sold it to the highest bidder.
Yes, I believe in what Biker said because I have been saying the same thing for a long time. The women stick together to protect one another. This is true in just about any workplace environment. Male nurses are viewed as either being rapists or gay and there is no brotherhood. Doctors, of course, protect one another. Now that many women are becoming doctors, the protection racket will only grow stronger and since many are becoming anesthesiologists pre-op/post-op for male patients will become even more abusive in nature.
Dr. Bernstein, no I am not happy with the NC Board's statement. There are some good points such as needing patient consent for students to be present for intimate exams but it ignores altogether staff gender, especially that of chaperones that we have discussed at length here. It is also disingenuous in making chaperone presence out to be something that benefits the patient.
Healthcare staff are fully capable at a technical level of treating both males and females and that does not make healthcare gender-neutral. They know this but they are afraid of angering the sisterhood.
I like the statement:
Sensitivity to patient modesty and dignity must be maintained at all times.
For those of you that remember, it took me 3 volumes to finally make the point that it is dignity that we are talking about here.
The board's statement is saying that it is not only the patient's intrinsic value as a sentient being and human being (dignity), but also their WANTS and NEEDS (modesty).
Too bad providers don't care about this and the board does not enforce this. Very much like "first do no harm..."
-- Banterings
And thank you Banterings for encouraging the change in our blog thread title and thus the thread's content and goal. By the way, though the blogger.com statistics show, for example, 31,077 visits to the entire blog in February 2021 and 7592 visits so far in March, since Volume 117 was started February 27, we have had only 78 visitors and 37 posted Comments to Volume 117 itself.
What I am getting at, looking at the published statistics, we really need to have encouragement of more visitors to come specifically to Volume 117 and hopefully contribute their opinions. I think our fine "regulars" could help by "spreading the word" of our Volume and its topic and goal of "change within the medical system behavior to promote rather than destroy patient dignity". I think your access to the internet resources, as upset potential patients, to encourage more visitors to come come here and hopefully participate with their experiences and views. While, your input has been worthy of the topic, we could benefit with a goal for system change if we could invite more visitors. Yes, 31,000 visitors to the entire blog in a month is wonderful but we need more active participation by more visitors to our current topic and I hope you all can help make this possible. ..Maurice.
Banterings, I agree "Sensitivity to patient modesty and dignity must be maintained at all times." is one of the good aspects of the policy but I have a hard time reconciling it with "...and it is strongly advised that a third party be present when the licensee performs an examination of the breasts, genitalia, or rectum.".
How can bringing in an opposite gender audience be construed as being sensitive to patient modesty and dignity? It is sort of saying the doctor must be in two places at the same time. You can't respect a patient's modesty by turning it into a spectator sport. How can they not see this? For male patients, it is always an opposite gender chaperone.
Just to be clear, I am fine with providing chaperones for those patients that might prefer one. I totally understand why some women want another woman present when they are with a male doctor for an intimate exam.
Banterings, from a legal or ethical point of view, which chaperone would have the greatest honest respectability and worthiness to both the patient and the examining physician?
A chaperone present selected by the patient, either a family member or a clinic employee, the latter's gender selected by the patient.
A chaperone present selected by the physician, a clinic employee of a gender selected by the physician and approved by the patient.
In summary, my question: would most physicians accept a family member selected by the patient? Would most patients accept a physician selected employee, even of the patient's desired gender.
Too complicated? Or is the answer: "it all depends". ..Maurice.
Dr. B.,
Something you may not realize is that many providers feel the chaperone is there for their safety against the patient. They feel the chaperone is undeniable proof that something sexual didn't happen. However, there are several flaws in this argument.
The first being the obvious is the chaperone is on their payroll so therefore the chaperone's loyalty is to the doctor. The second being there are plenty of cases where sexual misconduct has occurred and the chaperone did nothing or not at least until the doctor pissed them off too.
Because the doctor feels they must pay for this service probably irritates them so many do not care about the patient's dignity with the chaperone being involved. While a male doctor would rarely ever have a male chaperone present with a female patient, they don't care about a male patient's dignity. Even 2 females being a doctor and a chaperone will gang up on a male patient which is not done w/ the opposite gender.
I as a patient do not feel my genitals need to be put on display. I in the past objected to the chaperone being where they can view. They can be there but they do not deserve to see body parts unless they are willing to pay me for that privilege. I have noticed most male doctors will not have a nurse in tow if I am present with my husband but a female dr. will try it only to be told the voyeur must not be able to view his unclothed body. Again, the chaperone is there for the MD's protection not the protection of the patient. I doubt a doctor would find it acceptable if they insisted on a chaperone to use the chaperone of the patient's choice as they want to be able to control the chaperone and being their employer providers that extra benefit of loyalty.
I think more male doctors would are accepting of a patient's spouse being the chaperone of the male patient but female doctors are not. I think that again goes out to what I have discussed that some women in the workplace are just plain tyrants and/or control freaks.
IMO the doctor and patient do not have the same goal for the use of a chaperone. However, the patient is one in charge and should have final say in who sees and/or touches their body. That should be the end of that discussion but it will not be as many in the healthScare community feel entitlement or ownership rights over patients.
Maurice,
It depends.
The first step is the physician ASKING (not imposing or ambushing).
Step 2 is respecting the patient's decision REGARDLESS.
-- Banterings
Take a few minutes and review the policy regarding chaperones in medical examinations at the Michigan Medicine of the University of Michigan. Would you have hesitancy to be a patient for an examination based on what is the institution's policy? ..Maurice.
Dr. Bernstein, the Michigan policy is generally well written though without any verbiage on one critical aspect. This concerns the opt-out. Their failure to say that the patient will be advised that they can opt out likely means the patient is ambushed with a chaperone that will stay in the room unless the patient exercises his or her right to opt out. Having a right that you don't know exists doesn't rise to the level of an actual right in practice. Burying a reference to the policy in some generic consent form, which is what I suspect is the case, does not constitute informed consent.
I do like them saying that the chaperone should be of the gender the patient prefers, but again, does anyone ask the patient? Their policy doesn't say the patient should be asked but rather leaves it as a another right that the patients likely have no idea that they have.
I also like the statement that all clinical areas should staff appropriately to administer this policy. They do not go as far as stating that each clinical area should be able to provide both male and female chaperones, likely because they aren't making any attempt to provide male chaperones for male patients.
So, a generally well written policy but given the level of detail they have gone into, that they don't speak to the issues I mentioned likely means the actual practice is ambushing male patients with female chaperones being standard operating practice.
I was truly surprised about the need for a chaperone for female breast examination which would also involve beyond the breast tissue itself but also palpation (hand on breast) to palpate for masses but also as part of the cardiac exam to palpate and percuss for heart size and murmurs and rubs. Auscultation for pulmonary and heart sounds can be impaired by overlying clothing. The breast should be exposed, not only for above, but for inspection of the overlying skin for pathology which could explain chest pain.
The role of the chaperone for the patient's comfort is for procedures for which the patient cannot visualize the actions of the physician. The examination of the bare anterior chest of a female is certainly easily monitored by the patient herself. ..Maurice.
Maurice,
I advise patients t tell the provider (when discussing chaperones) to say "I don't like being the only one naked in the room."
When they push the issue, you then say "I many be comfortable having another naked person in the room."
They usually question why one would think the chaperone would be naked. The response is "As a doctor you are an intelligent person, and when I said I didn't like being tho only one naked in the room, you surely would not want to make me even more uncomfortable, feel bullied, threatened, or vulnerable by bringing more clothed people in the room."
So far they all answered "never mind" and drop the conversation.
-- Banterings
Reading the AMA's https://www.ama-assn.org/delivering-care/ethics/use-chaperones policy on chaperones is very interesting. The most interesting part of is them saying even if the patient has their own person present, the medical provider should also have their own person present. This is a clear signal of the systemic problem within the medical community of not believing a patient's or a patient's witness is a credible, truthful witness of wrongdoing. It signals that the doctor & the dr's witness whom is on the dr's payroll will be believed over the harmed party.
The very comical part of this AMA policy is where it discusses the dr. should make sure the dr and pt can have private conversation w/o the chaperone being present. So the pt may have a need for private conversation but does not have a need for bodily privacy? Shows how sometimes the more educated a person becomes the more stupid they actually get. However, other sites say a chaperone must always be present as clearly the use of chaperones is for the safety of the medical provider and not at all for the safety of the patient even though they are using misleading propaganda to say otherwise.
https://pbieducation.com/courses/ctp-2/ says: "family members will always side with the patient, and are therefore not reliable witnesses" as if paid staff are reliable witnesses because they won't be worried about losing their income? The use of chaperones is a violation of a patient's right to bodily privacy as a dr's chaperones is there for the benefit of the dr and their presence does not benefit the patient. Others sites also have the audacity to say that a naked patient will feel more comfortable having more clothed people in the room to see them naked. This would only work for most if you were a stripper being paid for everyone to view your naked body. This is the type of propaganda that is put out there to try to make patients believe exploited is in their best interests.
Banterings, I would merely add to your speech that normally I receive payment for others to view my naked body and I can either take cash or credit card.
We may have covered, in some previous Volume, this alternative to human chaperones set by the physician or by the patient. How about a video system focused on the patient's anatomic area of physician activity from which a complete copy of the recording is presented to the patient and a copy retained by the physician. Any misuse of the copy by either the patient or the physician would be subject to legal litigation. Such a recording would provide both physician and patient documentation of the behavior and actions of both parties.
Should I give up considering this alternative as a better approach for documentation and protection of all parties involved? ..Maurice.
Anything and everything gets hacked sooner or later if anyone wants to hack it bad enough. Even w/o that potential, anything that is entered into the medical record is there for every other person you interact with in that healthcare system to see. As someone who lives in a low population rural area, that includes nosy neighbors and acquaintances. I've said it before that I can't walk into my local hospital w/o bumping into several people I know.
Being assaulted in some manner by my doctors or their staff is not anything I am even remotely concerned with. My concern is simply having my exposure minimized in terms of extent, duration, and audience. The problem is most protocols are instead based on staff convenience. Videos aren't going to resolve that discrepancy. At the moment the best option most of us have is speaking up before, during, and after as appropriate.
There is no way to keep the camera footage private. The problem with doctors having a copy is everyone and anyone could view them and the patient would have no idea as many in the medical community are not above lying about who has actually seen them. Also, your medical information is sold to different entities per HIPAA as cost of doing business so some company could have your nude pics and yes, hackers would no longer have to bluff saying pay or they will show your nudes on the Internet. Many medical practices are still not even HIPAA compliant because they don't like the cost of keeping patient info safe so they would rather chance your info being stolen than given up a few thousands dollars in order to keep it safe. It is this mentality that makes them morally corrupt in not being able to safeguard your nude pics. They already do not respect your nakedness in person so why we would think they would safeguard pics?
In conclusion, there is very little a patient can do in a hospital situation where they want to unnecessarily expose you when you have been rendered incapable. We know they don't care and will do it because they feel entitled to use and abuse because even when caught, nothing happens. As the current political climate is making white men into objects of loathing and hatred towards, we will see more and more men being medically abused because the system knows they can get by with abuse. The way the medical system exists encourages crime against patients to happen because there is a long, solid record of no consequences. There is rampant whitecoat/scrub worship that makes calling attention to medical harm almost impossible. However, I will not stop trying because it is the right thing to do.
Facing the issue of sexual misconduct and the value of chaperones in medical practice with specific reference to the OB-GYN specialty is a January 2020 detailed article "Sexual Misconduct" in the presentation of the American College of Obstetricians and Gynecology. A worthy read regarding the current view of the professional organization to protect the patient. ..Maurice.
As Biker has pointed out, the Michigan policy’s blatant omission of an opt-out policy for medical chaperones is a glaring one. I can’t help but believe it was intentional. I suppose their policy makes them feel good, but not so much for those of us who are not willing to have an extra set of eyes on them during intimate exams.
I liked Banterings’ script for dialogue with the doctor regarding chaperones. I hope I don’t need to use it, but more importantly, I hope I can keep it in mind if I do.
Finally, I concur with the other writers in recognizing the pitfalls of videoing an intimate medical encounter. Certainly such recordings will be hacked at some point in time, and when that does happen, it will occur by the hundreds/thousands. I feel a waiver is perhaps the answer when the patient chooses NO CHAPERONE.
Starboy
Anything that the ACOG says about protecting patients is hypocritical, a blatant lie, and just marketing fluff.
If they really wanted to protect patients, they would have done away with medical rape (unconsented intimate exams on anesthetized patients).
One of the positive outcomes of this pandemic is society seeing the hypocrisy that comes from the profession of medicine. Just look at Fauci:
In the beginning:no mask, always mask.
Now: 2 masks.
In the beginning: Wait for the vaccine then we can open up.
Now: We still need to lockdown after vaccination.
In the beginning: Herd immunity 65-70%
Now: Herd immunity 85-90% (to scare people into gettin vaccinated).
We are told to follow the science, but when the science says schools are safe to open up, teachers' unions an elected officials say it is not safe (despite science).
While I do not condone the threats of violence, there comes a time when the citizens must stand up for what is the right thing to do.
Dr. Tedros Adhanom of the WHO downplayed the pandemic for months, wasting valuable time and allowing it to spread when it could have been contained.
Physician heal thy self.
-- Banterings
And now lets get down to the reported statistics and views of the public regarding the medical professionals. A trusted resource center for such descriptions should be the Pew Research Center and their results as published Aug 2 2019 (a year and a half or so ago) titled "Americans generally view medical professionals favorably, but about half consider misconduct a big problem".
So, is this the statistics we need to establish my long running concern regarding that the popular view on this blog thread may not be fully representative of a national statistics? ..Maurice.
No, it doesn't as the average American does not really know what goes on in the medical world. Those who do know prefer to bury their head in the sand leaving their naked butt exposed. Medical community does a better job at keeping its dirty secrets hidden than in delivering compassionate, humane, respectful and non-harmful healthcare. Most people have complaints but many of them are fearful to complain/talk because they fear they could receive future harmful healthcare. That alone speaks volumes. Also, the media for the most remains silent about medical harm as they have been bought and paid for---heartless and soul-less. Govt and legal system mostly remain silent only so often taking on cases of harm as they cannot stand by silently when it becomes obvious so they must appear they are in charge when they are not. Little Fauci is perfect example of what is wrong with the medical system. He lies. He clearly doesn't know what he talking about. He has questionable ties to the country where the virus originated. He tries to rule the lives of ordinary citizens even though he clearly doesn't know much and should not be given the right to make such subjective decisions. And he smirks constantly. Nothing is worse than a smirking slug especially because you know they are smirking because they are aware of the power and control they have to harm you. I see these same characteristics in far too many in the medical community who think the heinous acts they force upon patients is funny as they are the ones with the power and control and are afraid to use it. The first time I saw Fauci he reminded me of what is wrong in the medical community. In him I see the ones who think they are entitled to harm because they are superior to us mere mortals. Sadly, more don't complain or talk about medical harm because they are scared and they know it is pointless.
JR, remember that Fauci is as mortal as Biden, Trump and everyone of us. It is what all of us mortals (including all the medical professionals and their bosses) do to keep us all happy and healthy as we move on through our individual and hopefully useful and productive lives. ..Maurice.
ACOG cannot be trusted at all. They are basically an organization to protect gynecologists. It is interesting that they mention sexual misconduct is uncommon. This is not true. It is far more common.
A chaperone is there to protect the doctor. The chaperone often argues that a male gynecologist is thorough when he actually sexually abuses under the guise of medical care.
Misty
What is needed here is a worthy "dissection" of who and what is Anthony Fauci. I think it is best described in a December 23 2020 presentation in the Philadelphia Inquirer newspaper just prior to his December 24th 80th birthday. Fauci and his life is meaningfully dissected by Joel Achenbach of the Washington Post. Nothing mysterious or sinister but the history of a medical professional who has contributed repeatedly in the past and currently to the public's health. Read the article. As I said, it is a worthy read. ..Maurice.
Dr. B.,
I never said Anthony Fauci was not a mortal/human as it is his mortal qualities that I find so disturbing. He tells everyone to wear masks but yet he is caught many, many times not doing so. He wants ppl to wear masks at home but yet he is sitting in a ballpark unmasked. Most of them including Fauci speak at mic unmasked. Newspapers tell stories. How they decide to tell stories is how they personally perceive the subject. Most hated Trump so most they could find nothing good to say about Trump even though any reasonable person knows he did more good than bad. (And yes, I used the word "reasonable" that the medical community loves to use to convey if you do not agree you are mentally ill.) It is Fauci's arrogance and human mannerisms that make people like me give his motives a second and third look and quite frankly, I don't like what I see. I stand behind my opinion of Fauci represents what is wrong with today's medical community. Snap judgments not based on ANY science, an arrogance of infinite proportion, and just reeks of an absolute corruption completes my picture of Fauci. He does remind me of all those medical providers of the past who thought they were entitled to imposed their form of harm upon any patient at any time. Having seen what patient harm looks like, I am constantly on the lookout for others who fit the profile of a medical provider likely to commit patient harm. Fluff pieces in a newspaper and or on CNN/MSNBC do nothing to sway me from the truths I believe. It is no different than you saying what I saw or what my husband experienced may or may not be considered harmful depending on the point of view. I had no reason to believe differently of Fauci when I first saw him because I had no idea of who or what he was but the more I saw and heard from him, the clearer my opinion became. So yes, again Fauci does represent what is wrong with the medical community.
Dr. Bernstein, I think Dr. Fauci is more a symbol of the dysfunctional federal & state response to the pandemic than anything else. I haven't particularly paid him much mind given he comes across to me as more a political creature than a man of medicine. That's not an indictment of him but rather just an expected outcome of anyone achieving high status in a highly political environment. In such settings, science rules unless it conflicts with politics. It makes for what can be an impossible situation for people like Dr. Fauci.
I think what continues to frustrate the general public is that a year into this the response still seems governed more by politics than science. For a full year now they have told us that the restrictions, what's open, what's closed etc is governed by science. What the public has seen however is that the science somehow led to 50 often significantly different sets of restrictions and actions. Even now the science has somehow led to 50 different prioritization schemes for vaccine distribution and school re-openings. Nobody has ever explained how the underlying science changes when you cross State borders. Within States, the politicians and their public health officials never addressed the seeming inconsistencies of what was open vs what was closed. They just said "science". This is why the public has become so sceptical. My State has a death rate of 34 per 100,000 population whereas NY that borders us has a death rate of 248 per 100,000. Yet the media fawned over Cuomo's leadership while completely ignoring our Governor who was also giving news conferences & taking any & all questions from the media. By the beginning of March last year the science in my State said to tightly lock down the nursing homes whereas the science across the border said it was safe to send infected patients into nursing homes. I will add that last spring my State was flooded with people from NYC fleeing the pandemic, sometimes bringing the virus with them.
Yes, Biker, I admit that Dr. Fauci has been an "object" of either "misuse" in the last Administration where the dangers of the pandemic were seemingly minimized by the government or now an "object" of "supportive use" in the communication of what is validly known and what is unknown about the pandemic by our current government administration. This public ambiguity of the political use of his past experience and knowledge has contributed to how and what the public thinks about him now. ..Maurice.
Dr. B.,
Your observation of the Trump's administration "misuse" "where the dangers of the pandemic were seemingly minimized" is totally untrue. Your state of California and the state of New York had HARD lockdowns and severe restrictions. How are those numbers? Not good so your fallacy of blaming Trump just doesn't hold water. It was Fauci who was spouting the science that was misleading in the masks. States makes the rules. The federal govt can only do so much in the running of state's affairs. Your governor is facing a recall over his mishandling of the pandemic and Cuomo well he killed around 15,000 seniors while he was busy writing a book on the great job he was doing along with sexually harassing any female within his reach. Let's see Trump was busy fighting a bogus impeachment from Crazy Nancy from your State of California along with Chuck Schumer from New York. Perhaps they should have not been so corrupt and paid more attention and allowed Trump to focus on the job of the President rather than their games of stupidity. I wish Biden/Harris would receive the same treatment from all that Trump did. I would have no problem in that. It is Fauci himself who has contributed to how people view him. His "Do It" because I decree it attitude stinks! If he was not such an arrogant and really not well-informed clown the public's opinion might not be in the toilet. Fauci himself is responsible for his mistakes. You can blame Trump but it wasn't on Trump's watch to wear 3 masks and this will be here into 2022. That's all on Fauci. But don't worry, as of January 20th there has been a magically downturn in the virus. It is indeed a miracle. PS You made the public's perception about Fauci political.
Dr B. You were so good for such a long time about not letting politics into this blog. Now we have to listen to Trump worshipers breath out their love and adoration for him?
JF,
Are you kidding? Is it acceptable to bash Trump but unacceptable to defend him and then to be label as Trump worshipping? You hit the nail on the head of what is basically wrong in this and in the medical community: only one opinion counts and those of dissenting opinions have something wrong with them. All this one-sided thinking leads back to what is being done to patients and that is whatever the medical provider says and does is acceptable. If we follow your line of thinking you said from above then all of us are wrong for disagreeing with the prevailing opinion.
JF, I agree fully with your concern about the consideration of the preservation of patient dignity, such as in this blog thread, when discussion becomes national political. There will always be conflicts in political behavior in a country which is not autocratic and dominated throughout by one in universal power.
But, here, we are considering the preservation of patient dignity in a country where the citizens rule the leadership.
In my opinion, preservation of patient dignity is not set purely by the government but is directly set finally by the individuals or institutions as those who directly influence the actions toward patients and the patients' inherent dignity. Those individuals or institutions may not be fully set by the government but by their individual behaviors toward the patient. They would include the physicians, nursing staff, medical institutional policies and approaches to the benefit of the patient and even the patient's friends and family. Even the personal behavior of the patient can enhance or impair the basic demonstration of dignity. So political parties will come and go and each make some impact on patient dignity, constructive or destructive but as I wrote, political parties in a non-autocratic government such as the United States, will never set the final behavior of those responsible for the preservation of the dignity of the patient.
It should be therefore the basis for discussion here about the roles of the individuals and institutions directly affecting the intrinsic dignity of each patient.
It would be wise to consider what I wrote above as the basis for further discussion on Banterings worthy change of the title of this blog thread. ..Maurice.
I think that one approach to improve patient dignity is to get rid of these seemingly professionally used but improper slang terms documenting the patient's behavior and condition. What do you think? ..Maurice.
I think politics has nothing to do with the dignity matters we discuss here, though govt. has the power to effect change if it so chooses. It hasn't chosen to do so and isn't likely to do so for two key reasons.
One is men are not a priority. It is that simple. Women's groups are organized and vocal. Neither party is willing to risk their wrath over something society deems unimportant. No way will women's groups tolerate any limitations of female healthcare staff for the sake of modest males.
The second is that healthcare is operating within societal norms that have existed for centuries. The privacy of females is to be protected. Males are deemed to not be in need of privacy. Males are instead expected to keep themselves covered so as not to offend females. Key here is that society says women are the ones to decide what offends them. In the modern era this has come to mean there are not any occupations in which male exposure is deemed offensive, hence female reporters in locker rooms, female prison guards doing strip searches & shower duty, female NP's doing middle & high school male sports physicals, and female healthcare staff for every possible intimate procedure.
It is a societal cultural issue.
I fully agree with the analysis just written by Biker. The issue of how patient dignity is looked upon (considered) between males and females has always been generational over hundreds of years and throughout the world and has been clearly independent and differs in the way that males have looked upon females in the political world until recent generations and though female leadership in national politics has developed more rapidly in other countries, we still do not have a female as presidential leader in the United States.
With regard to patient physical modesty issues in the United States I have not heard of any political decisions to apply to males what is attempting to be applied to women or has long been applied to women.
So, in conclusion, we should not be discussing Biden vs Trump in the area of patient dignity, the main topic here, but of the other factors in our lives and specifically the medical profession which is one factor which directly affects how this dignity is applied or ignored. ..Maurice.
And if you don't believe that physicians are being subjected to patient misbehavior or worse on social media, well, read this current review article: Calls for More Support as Physicians Face Online Harassment. Fortunately, I am not allowing named physicians to be criticized on this social media except for physicians already named by the news media. I have confidence that JR doesn't name names on her trips to the social media just as, while telling the experiences she has encountered, she avoids those names here. Or..what do you all think about those individuals who will "name names" when presenting "online harassment" or is "harassment" not the proper word for what is being presented elsewhere in the social media? ..Maurice.
Maurice,
As to social media...
Just like intimate exams on anesthetized patients, social media attacks happen. Get over it. Until the profession cleans itself up AND makes amends, I have no sympathy. If you are not part of the solution, then you are part of the problem.
I get it that not all treat patients inhumanely, but many look the other way. Part of the problem.
Now, for the public health issue: First off, the Covid vaccines are NOT safe, we THINK that they are reasonably safe. There is NO long term data, and they are still under EMERGENCY USE. Yet, public heath officials tout them as safe as the MMR vaccines.
People are not ALL stupid. When the officials state that they ERE SAFE, intelligent people know this is factually untrue. Shaming and bullying those who are hesitant does not help either. All these do is erode what little trust might be left.
Let me use Fauci as an example: First Fauci is responsible for the death of 30,000+ Americans for his role in the use of Bactrim as prophylaxis during the AIDS epidemic.
During COVID, Fauci dismissed HCQ which has been beneficial (as shown by Harvey Risch, M.D., Ph.D. of Yale). There is a recent study (that escapes me right now) that shows it is effective against COVID. Let us not forget that the WHO was forced to admit that a study they relied on, which removed hydroxychloroquine from a list of COVID-19 therapies for further study, was entirely fictional.
Fauci was flip flopping: no mask, always wear a mask, then 2 masks. Fauci admitted to the New York Times that he lied to the American public about the herd immunity threshold because he didn't think we could handle the truth.
Fauci backed the 6 foot rule when the latest CDC data (when it examines the science) says that it should be 3 feet.
Then we have people like Gov. Cuomo who are touted as the gold standard with lockdowns and social distancing only to find that he lied about the numbers.
I am not even going into the fact that our society is ruled by the US Constitution and NOT science.
So why has society lost trust in its public health officials?
-- Banterings
While on the subject of misbehavior...
Thousands of Latinos were sterilized in the 20th century. Amid COVID-19 vaccine hesitancy, they remember
A whistleblower – a resident physician later let go by the hospital – leaked that the practice occurred on many women. Hermosillo became one of 10 Mexican and Chicana plaintiffs in the hallmark Madrigal v. Quilligan federal class-action case, which grabbed headlines in the mid-1970s. The judge sided with Dr. Edward James Quilligan, and the women lost, but the case inspired legislation passed in 1979 to abolish the practice in California.
The Los Angeles County Board of Supervisors issued an apology in 2018 for the coerced sterilizations, but the women did not receive reparation money as victims did in other states, such as Virginia and North Carolina...
Throughout the 20th century, about 20,000 women and men were sterilized in California alone under state eugenics policies, according to researchers...
When is the profession of medicine going to answer for this and other crimes against humanity that it has committed and begin making amends?
Why do providers deserve to be treated as human beings?
-- Banterings
Banterings, you ask "Why do providers deserve to be treated as human beings?" Because they are not machines but humans.
Let's move away from politics and Dr. Fauci and focus our discussion to the methodology of encouraging and preservation of patient dignity by the patients themselves and those attending their medical or surgical care. While politics play some role in how people are treated (such as abortion), it really comes down to the behavior of each individual healthcare worker and each of their patients. ..Maurice.
I firmly believe each physician/nurse etc and each patient deserve to be judged on their own merits. The larger problem is the system itself which as I have noted operates within cultural norms that dismiss the notion of modesty and privacy for males as mattering.
Healthcare staff that violate the modesty and privacy of male patients don't see themselves as having done anything wrong if those violations (as perceived by the patient) occurred within standard protocols. The problem is those protocols are not based on minimizing patient exposure in terms of extent, duration, and audience but rather are based on staff convenience and the premise that the staff is polite throughout the encounter.
The overarching systemic premise is that female patients are entitled to same-gender privacy by active (only hiring or assigning female staff) or reactive (immediate acquiescence to same gender requests)means. At the same time the overarching systemic premise is that healthcare is gender-neutral for male patients (meaning all-female staff as the norm for intimate procedures) is the ultimate root of the problem. Simply put, they don't think they are doing anything wrong as concerns male patients.
It is more the societal cultural system we are fighting than the individual players.
Banterings, those eugenics programs played out using the localized prejudices of the day in many places I suspect. Here in Vermont the victims were primarily Abenaki and French Canadians. Our legislature is currently discussing a public apology. It would be good for the Medical Boards and Societies to also issue an apology being it was the medical community that carried out these crimes against humanity.
Maurice,
I am not being political. A physician who caused the death of 30,000+ Americans was allowed to practice for 40 more years. The same physician lies and admits lying to the people he is supposed to take care of, and the rest of the profession pushes him as trustworthy. What does this say about the profession?
As to humans, the treatment that patients are subjected to is inhumane. This practice was universal until just over a year ago, meaning that 90% of the practicing physicians today had given nonconsensual exams to anesthetized patients. Has the profession ever acknowledged this, asked society for forgiveness, and made amends?
And the practice still continues.
Treat others as you wish to be treated. That is all that I am saying.
Biker,
Eugenics actually started in the state of Missouri and spread throughout the world eventually leading to the Holocaust. In the US it was mainly against wards of the state, the most vulnerable of people.
As per the last part of my comment to Maurice, don't hold your breath on medicine's apology.
-- Banterings
Speaking about the effect of politics regarding patient dignity, how about throwing in a religious dictum. U.S. Catholic bishops issued a statement claiming that Catholics should avoid the Johnson & Johnson vaccine because it was developed, produced, and tested using a line of cells taken from a fetus that was aborted in 1985. If given a choice, the bishops said, Catholics should choose the Pfizer or Moderna vaccine.
Should not Catholics be given the potential patient dignity to choose their own scientifically advised vaccine and not be locked in by their religion? ..Maurice.
So, Banterings, it appears that all patients should depend on their own knowledge and decision-making capacity rather than any input from the physicians, medical profession, politicians or religion or religious leaders. Agree? ..Maurice.
Maurice,
Thankfully the US Constitution gives us the freedom to choose if they follow their beliefs, public health officials, a combination, or something else along whether to get vaccinated or not. Furthermore, they owe NOBODY an explanation for our choices.
Our clergy, stock brokers, and our healthcare providers (among others) have been relegated to being advisors without presumed trust (they now must earn and keep that trust). This is because of abuses of their power. In Great Britain, physicians no longer self regulate because they they lost the trust of the people.
The concept of informed consent demands that the provider give the patients options (including refusing) and the patient makes the decision which best aligns with their values and goals.
Again, US Constitution gives us the freedom to choose who we follow or not follow and what we choose to do with our bodies. It is well established (I don't feel necessary to reference this fact because I have previously) that paternalism is alive and well.
Patients are bullied and the profession of medicine tries to justify paternalism as beneficence. This is the same way that physicians and med students justify intimate exams on anesthetized patients without consent (I have also documented this as well).
-- Banterings
Preserving a patient's dignity or an individual who has not yet to become a patient may be tempered by how others look at that individual. One interesting issue is presented by Arthur L. Caplan, PhD is written and presented also as a video in a Medscape presentation "Should a PhD Be Called 'Doctor'?
Caplan concludes with a political twist:
In general, if someone wants to be called "doctor" and they have a PhD, for most settings, I think I'm fine with it. They earned that title. It's part of what goes along with having a PhD and an MD. Unless you're trying to pretend that you're a physician by doing a diagnosis, recommending a treatment, or claiming to understand some medical detail that you didn't train in, where that would be inappropriate, I'm fine with it.
I also thought The Wall Street Journal attack on Jill Biden was a little bit of a cheap shot. There are plenty of people running around publicly calling themselves doctor who have PhDs. Dr Phil, Dr Ruth, Dr Laura, and many of the people who talk about mental health or other issues on TV or radio are using the title "doctor." The Wall Street Journal didn't see fit to go after them.
I think they went after the president's wife as a political attack, so I'm not buying that. I do buy the idea that it's important to be clear to different audiences when you're a physician and when you're not a physician. I also think that after writing a PhD and having completed your degree in a specialty area, there are many contexts in which it is appropriate to use that title.
Should we take away the dignity of completion of education and contributing to society as a PhD (doctor of philosophy) by taking away the title of "Doctor"? ..Maurice.
Dr B It's about time somebody said something. I was beginning to think that you all had died suddenly. I believe the guy in your video explained it well. Only difference is his kind of doctor wouldn't likely have anything to do with our issue we keep talking about..
I would recommend that you all read some of the hundreds of Comments to the presentation. I particularly liked this short comment by a "Doctor". He wrote: "I learned at my mother's knee that blowing out someone else's candle does not make your light shine brighter."
Do you all think that much of the varied discussion and "bad talk" about the behavior of the medical profession is reflective of significance of how we are behaving in our comments here? Just a thought. After all these Volumes, does our "light shine brighter?" Periodic reflection of value this blog thread I think is a worthy exercise. ..Maurice.
Maurice,
Doctors such as yourself are designated as "medical doctors" (MDs). Legally, you are a physician (a special distinction). The blame lies within the profession of medicine. It has special designations already.
On the profession's side, it is both an attempt to maintain a monopoly as well as trying to restore the practice of paternalism. Here is proof of the AMA's monopoly: Chester C. A. Wilk et al. v. AMA et al.
...records exposed during the discovery phase of the Chester C. A. Wilk et al. v. AMA et al. case showed that medical doctors were encouraged by the AMA to accuse chiropractors of ethical violations...
As to the Dr. Phil's; Physicians have traditionally ignored mental health and even reinforce mental health stigmas when they instead focus on physical health. This is why so many abuse survivors are retraumatized by physicians in routine medical encounters.
Mental health is healthcare!
-- Banterings
Maurice,
The comments on this thread are by people harmed by the profession of medicine who have been retraumatized by being gaslighted, denied justice, being told that we have taken what happened out of context, had our concerns ignored ("you don't have anything I haven't seen before"), and flat out lied to by a profession that continues to justify and perform intimate exams by med students on anesthetized patients without consent.
How long until the Woke movement comes after the profession of medicine?
-- Banterings
Dr. Bernstein, in a healthcare setting I object to Phd nurses (or any other Phd non-physician) referring to themselves as Doctor when with patients because it is confusing and comes across as inferring they are physicians. Amongst their peers, certainly call themselves doctor if that's what they prefer, but never with a patient.
Outside of healthcare settings, I find people with Phd's who refer to themselves as Doctor to usually be pretentious and somewhat insecure in their need to impress. It is OK for someone to introduce a person as Dr. so and so in a formal setting so as to establish the person's credentials with the audience, but not one on one in a more casual setting. One of my brothers is a Phd scientist moving in very high circles in DC. Certainly he is introduced as Dr. in official settings but in his personal life he never uses it. One of my best friends has a Phd in Education and he also never uses it outside of official settings where credentials matter.
Another brother was an attorney but he never put JD after his name or referred to himself as Attorney so and so outside of his taking actions under his license. The JD and attorney status was strictly for work purposes, not personal.
I have an MBA and when I've spoken to groups or had to provide a bio for something or other I did, I have never included that as part of defining who I am because to me it's irrelevant. Another brother that had an MBA was the same way.
So with Dr. Jill Biden, to me her routine use of Dr. in all settings is just an insecure ego at work. In a school setting where credentials matter, then yes call her Dr. In the White House she is not a professional educator and presenting herself as Doctor has the effect of creating a barrier between her and others that doesn't need to exist.
Biker, you wrote: So with Dr. Jill Biden, to me her routine use of Dr. in all settings is just an insecure ego at work. In a school setting where credentials matter, then yes call her Dr. In the White House she is not a professional educator and presenting herself as Doctor has the effect of creating a barrier between her and others that doesn't need to exist.
I fully agree. ..Maurice.
JR, if you posted here today, your post was accidently removed. Please write your thoughts again. Thanks. ..Maurice.
Dr. Bernstein,
In the specific case of our current First Lady, there is very good reason for Dr. Biden to insist on the honorific. She grew up during a time when women were still primarily homemakers, but also were beginning to assert their right to agency. However, for the majority of her adult life, she was viewed as "the Senator's wife". In January, 2007, just as President Biden joined the 2008 presidential race, Dr. Biden earned her doctorate in Education. Now, rather than just being a senator's wife, or a presidential candidate's wife, Dr. Biden could assert that she had value in her own right. She had reached the pinnacle of education in a specific topic, and could be considered an expert in that field.
As a member of the gender who generally still needs to prove that they "belong in the room", I see it as perfectly natural that she would insist on the honorific. However, do we actually know that she insists on being referred to as Dr.? Perhaps it's the mainstream media, in its never-ending quest to be politically correct, that appended the title to her name, and that is how it became the standard way to reference her.
Regardless, people have a right to be called what they choose, and she certainly has earned the title, so let us move on to more important issues.
KB
KB, interesting argument regarding the President's wife as being described in the media as "doctor". ..Maurice.
KB, titles representing the profession are usually, commonly expressed to others during the context in which the title will be of immediate significance. When identified as the wife of the United States President, the title of Doctor is unnecessary and confusing.
..Maurice.
On the other hand Biker and KB, I put the "Doctor" issue on a bioethics listserv and a medical education listserv. On the bioethics listserv, a member wrote "I also took the use of "Dr". at the inaugural as a signal that, in the Biden administration, education and teachers will be valued" ..Maurice.
Yes, I did post as it was identified.
JR, then you may want to post again the context of what you had written.
Additionally, JR, you and the others here might find the "Health Equity and Ethics Series" sponsored by the University of Illinois Hospital and Health Sciences System a worthy upcoming series of public conversations with the goal of "transforming community conversations about COVID-19 to action". ..Maurice.
Biker (and KB) on a medical school education listserv, I had reproduced Biker's comment and a MD Vice President of a medical school wrote the following: "In Dr. Biden's case, I imagine all her interactions are formal. I'm sure there are plenty of great histories of First Ladies but most of them seem to take their position, even though unelected, very seriously. How could it not be formal? We capitalize their description! So my response to "Biker" would be that as much as she may wish there to be minimal barriers between her and the public, there is a huge one she can't do anything about."
..Maurice.
Maurice,
Here is validation of an assertion that I made when I first started posting on this thread: medical encounters, even routine encounters, and when conducted according to the guidelines, can be traumatic. (You pushed back against this assertion.)
Read: Medical Trauma (Social Work Today).
Note that it states:
The idea that medical treatment can be traumatic may seem counterintuitive. We tend to associate medical care with expertise, skill, and advanced technology in service of healing, not harming. Maybe that’s why it has only been in recent years that social workers, researchers, and other health care professionals have begun understanding the ways that medical interventions and interactions with medical staff during times of crisis can result in severe and persistent traumatic stress...
Many of these individuals reported events associated with their current illness as a trauma, and nearly all of these reported it as their worst trauma—even among those who had experienced combat traumas, serious accidents, assaults, and other types of extreme events...
Michelle Flaum Hall, EdD, LPCC-S, an assistant professor in the department of counseling at Xavier University and coauthor of the forthcoming book Managing the Psychological Impact of Medical Trauma: A Guide for Mental Health and Health Care Professionals, agrees that the attention given to ICUs is important but is quick to point out that “Medical trauma can take many forms and can occur in any level of care; it is not a phenomenon that is limited to emergency departments and ICUs.” These other levels of care include experiences with first responders and in multiple hospital settings, physicians’ offices, clinics, and residential settings, such as nursing homes, where medical care is routinely given...
Thank God that there are researchers that have the insight to recognize medical trauma. It is no surprise that social workers are leading the charge. After all, they are the ones dealing with the mess that patients are left in after healthcare encounters.
Too bad the profession of medicine is either too stupid, don't care about patients, or both, to change guidelines and practices to practice trauma informed care.
-- Banterings
Banterings, if all of this is statistically valid and can be generalized to all who participate with one title or another in the "care" of patients, what should be done NOW to change the system. Is "moaning and groaning" on our blog thread, at any volume, the methodology to correct the medical system? You have outlined the problem and provided a "statistic" so... now what?? Just leave the problem to the social workers?
If medical science has found the way to suppress the clinical symptoms and bodily damage of HIV without a "cure" of the disease, what can be done to do the same with regard to misbehavior symptoms and the mental and physical damage attributed to the multiple aspects of "patient care"? ..Maurice.
Maurice,
What is going to happen is lawsuits for malpractice, lack of informed consent, etc. because trauma and PTSD are now recognized side effects of healthcare encounters.
There also will be a push to have providers lead by example as with the COVID vaccine.
-- Banterings
Not to change the subject but I made my appt. for my annual cystoscopy in June (yes they book that far ahead)and in doing so I again said to please put me down for a male nurse to do the prep. As in previous years there was no push back or attitude but rather a polite statement that yes of course they'll put me down for a male nurse. This is how it should be. Why can't every urology practice be like this?
Biker,
I will keep you in my prayers.
Why can't they all be this way? Why do you, the patient, have to make the changes?
All this does is erode the trust society has in the profession of medicine and their credibility (why don't they know better). Every time I hear a provider talk about ALL the training that they have to go through or how much they know (are you a doctor or nurse), I laugh to myself because I know the truth.
-- Banterings
Banterings, Biker, et al, do you think that the pathogenesis of the bad medical professional behavior is simply and I mean simply the lack of professional time available for the physician or nurse to spend attending to the one patient, the patient being interviewed, examined, treated or otherwise cared for. Time. Time. Think back.. I do.. to the time when we had smaller numbers of patients to attend to.. like doctors..an hour for an office visit.. I do. Maybe, the lack of time to attend to the patient is a major part of the pathophysiology of the distrust by the patient and the seeming, if not actual, mistreatment or undertreatment by the medical provider.
Does anyone want to go back to the old days when the professional and personal interaction of healthcare provider and patient was not under the pressure of keeping the interaction short because another patient was around about to be attended to?
All of this argument to this matter is wonderfully dissected and analyzed in an analysis written in the Journal of General Internal Medicine 1999 "Time and the Patient-Physician Relationship".
Time counts. Doesn't it? ..Maurice.
Dr. Bernstein, urology practices choosing to only hire female staff has nothing to do with the time allotted to each visit.
Banterings, my experience to date at the hospital where I get all of my scheduled healthcare has been great, except for Dermatology that is still struggling with the concept of male patient privacy. This hospital, in addition to having a male RN in urology, also specifically hired a male sonographer for things like testicular ultrasounds. I spoke with him and he told me that. If this hospital understood the issue and took action to address it, why haven't other hospitals figured it out? I say every hospital knows it, but most simply don't care.
Banterings, you are right but advocating for myself is the only option available to me in real time when making appts or being treated. I thank Dr. Bernstein and this forum for helping me find my voice in that regard. It was hard at first, but the more you speak up, the easier it gets.
Maurice,
How much time does it take for doctors to do PSAs and post on the internet saying COVID vaccines are safe when they are under emergency use and there is no long term data?
Was it a time pressure that made Fauci openly lie about herd immunity by moving the goal then openly admit that he lied?
He had time to pose for all those magazine covers and have his own children's book.
Is it time constraints that made the social distance an arbitrary 6 feet instead of the scientific proven 3?
Is it time constraints that keep providers from asking patients to consent to intimate exams under anesthesia rather than just letting med students rape them?
Here is another ethical problem: to tell a patient that it is not rape (there is no sexual intent) is the same as saying "you don't have anything I haven't seen before." I don't care how you (the provider) feels. You are simply nullifying my feelings and dehumanizing me, the patient.
Are you telling me that I do not have the feelings that I have? Again, it is NOT about you (the provider).
-- Banterings
Dr B. Why was there more time in the past but not now? My thought is that the small minority who makes the laws are creating laws that cripples the profession.
Also, I have to admit that I wasn't smart enough to understand your comments about my post about the patient where I work being made to be hungry. I couldn't tell if you were agreeing with me ( and JR ) or if you were sympathetic to the Hospice person who said to cut back her portions.
I AM smart enough to know that abuse is abuse regardless of whether it's a CNA doing it or an educated highly paid Hospice Supervisor. I'm also smart enough to think that them getting paid more ( for harming and depriving patients ) is NOT a coincidence!
Hello Dr. Bernstein,
Today's (26 Mar 21) Wall Street Journal has an article titled, "USC Pays To Settle Sex-Abuse Lawsuits". "... a total of more than $1.1 billion, the school said. In all, around 16,780 women will benefit from a series of settlements, the school said."(WSJ page A3) Noting this, I think you'll agree that we can assert with confidence at least two things: 1. This blog discussing patient dignity is not an outlier and 2. Some members of the medical profession actually DO HARM. Although you have adamantly averred that you have not witnessed this harm, I hope you are now convinced that medical harm DOES HAPPEN. It's sad that the profession cannot police itself and, that $1.1 billion is paid for the offences of one or two miscreants.
Reginald
Reginald, I have been aware of the clinical misbehavior or "worse" attributed to the gynecologist assigned to the University of Southern California campus student health department and noted it here from the earlier descriptions in the Los Angeles Times. And, obviously, as in this case and the others, by other physicians elsewhere as published in the news media, this blog and blog thread CANNOT deny the fact that there are those in the medical profession, including physicians and nursing staff who do harm for their own self-interest. So, I agree. ..Maurice.
On my March 1 2021 commentary I wrote the definition of hospice care: "Hospice is a system of care designed to relieve suffering and promote quality of life for people living with terminal illness," says James A. Tulsky, MD, director of the center for palliative care with Duke University Medical Center in Durham, North Carolina. " I agree with the hospice role.
Therefore, JF I agree with your decision regarding your patient to relieve the patient's hunger. ..Maurice.
Maurice,
I have had clients that are healthcare facilities of all sizes. One thing that I like to do with my clients is a hands on assessment by myself across all shifts. (One really learns the culture from the 3rd shift.)
One thing that ALL my clients (industrial, medical, nuclear, etc.) is that the rank-and-file employees (employees in the process as Deming describes them) all know the dirt on their direct supervisors and midlevel managers. When upper management has a member of upper management is guilty of very egregious infractions, they are commonly known.
That being said, I find it hard to believe that you have never heard the "whispers" about certain individuals either in the days of your education or during your time as an instructor.
There are people that the other employees do not want to be teamed up with because of the way they treat other people. Either their colleagues feel at risk personally or fear being dragged in to a "situation" due to their behaviors.
Reginald,
Very well said!
-- Banterings
Banterings, "in the days of my education" was as a student in the 4th class of new medical school, graduating 1958 and I heard nothing, nothing bad about any of my physician teachers. In fact, I was associated with the medical school for 2 years before acceptance to the school as a student doing medical research there using the medical students of the earlier classes as volunteer subject and heard nothing. In my many years as first and second year medical student instructor, I did not hear "upsetting stories" from students or within our faculty meetings about "bad behavior" of teaching staffs or hospital staff. Except, of course, in very recent years, the bad behavior (sexual) of our medical school dean and the dean that followed and this insight was in the news and not whispers. ..Maurice.
Maurice,
I find that so har to believe, because even as an outsider (consultant), I overhear the staff gossiping of snide comments when talking about individuals. I can only attribute this to you do not focus on the little things going on around you where you would have been patient focussed.
When I am at a client's, I pay attention to the little things. Many times the reality is not what my clients think that it is. I take Deming's approach to quality improvement that it is improved by the workers (in the process) and not top down from management.
-- Banterings
Dr B. I don't know if you can do anything about this or not. I'm having a lot of difficulties getting on this blog. In the past if a volume had ended and not accepting new comments it would say "We are no longer accepting comments on Volume 91 please post to Volume 92. We could then touch where it said Volume 92 and instantly be there.
Now its next to impossible to get on this site.
JF, I don't always create an address link that you can click on and be immediately transferred to the newer Volume. But, I always have the full and complete program address and all you have to do is copy it on your computer and fully paste it in the address section of your display screen and click to move on to the new Volume.
Banterings, if one is displaying Comments on a hand held phone how is this explanation for laptop use different?
I hope this helps and I will always try to create an active link (not just an address) in the future. ..Maurice.
Maurice,
There is software that checks the device that is accessing the web site and displays the web site in the most efficient manner. Generally the choices are desktop, laptop, tablet, and cell phone.
Depending on the software and how it is set up, the tablet is treated as a cellphone or its own device and a laptop can be treated as a desktop, tablet, or its own device.
The most popular software for this is Bootstrap (which was developed by Twitter). Being Blogger is older than Twitter, it probably does not use Bootstrap.
So what is happening is that the code displays links differently on different devices.
It can also be the operating system (OS). The laptop being larger and having more computing power and more memory may be more intuitive. So if it sees something that looks like a web address or email address (both are HTML links), the OS may try to translate them into web addresses.
You may have noticed this when working with a string of numbers in documents; the document tries to read them as a phone number.
Creating a link at the end of each volume is the easiest way to ensure that people can get to the new volume.
-- Banterings
I think it is time to finally switch our attention to the area of work and concern set by the communications here by JF: the nursing homes. This is the environment where patient dignity can be allowed to be understood and flourished. But it also the place where patient dignity can be potentially denigrated. Here is an excellent summary of what we all should know about nursing homes and "Things Nursing Homes Are Not Allowed to Do" Here is a "Bottom Line" from this Dec. 22 2020 update:
The Bottom Line
Essentially, a person’s rights as a nursing home resident mirror the rights they had outside the facility. Patients might have less control over their lives because of their physical or mental condition, but that doesn’t make it acceptable for anyone else to dominate, intimidate, or exert authority beyond the bounds of what’s necessary to help them manage day-to-day life and get better. Neglect, discrimination, abuse, and theft are unacceptable in any setting, and that includes nursing homes.
Thanks JF for your contribution of your personal experience as an employee in this area where patient dignity should always be preserved. ..Maurice.
Nursing homes offer special challenges as concerns patient dignity, especially for those with dementia who may not be fully aware of how they are being treated. As such the professionalism of the staff matters more than in other settings. If I had my way the CNA's in particular, but also other direct care staff, would be paid better than they are.
One of my wife's relatives went into a VA nursing home out west 2 years ago, his dementia having reached the point that it was too difficult for his wife to go on safely caring for him at home. He still knew who he was and where he was and thus likely was aware of how he was being treated. As part of his admission process a nurse had him strip naked for her to do a full skin exam. I mean naked. No gown or other covering. His wife was present and was startled by the exam as she wasn't expecting it but she wasn't bothered by it on account she said he isn't modest. This being the first time that nurse would have ever met him, she'd of had no knowledge as to his degree of modesty. What the nurse did must have instead been standard protocol at that facility. After spending part of his youth fighting in Vietnam, I'd think respecting his dignity would be of paramount importance at a VA facility. Hopefully other staff there see it that way.
Just days before nursing homes & rehab facilities were tightly secured here last year as the pandemic unfolded, I toured all 3 facilities in my county trying to choose one for my wife who was hospitalized with sepsis. The plan was to send her to rehab for a month when she was well enough to leave the hospital. I still recall at one of them there was a shower room with I think 4 walk-in showers. While I imagine they shower male and female patients at different times, I also imagine the male patients not only having their female attendant observing them but also being exposed to the female attendants for the other men being showered. Whoever designed the facility did not have patient privacy in mind.
Here from the Stanford Encyclopedia of Philosophy is a presentation first published in May 2009 but "substantive revision" in January 2021 dealing with "Privacy and Medicine"
There are two sections which I would like to reproduce here to give my readers a feeling of the value of the documentary. The section starts out with 2. Physical Privacy
There has been relatively little attention paid by philosophers to physical privacy concerns in medicine compared to informational concerns. Yet typical patients bring a bevy of strong expectations of modesty, solitude and bodily integrity to doctors’ offices, hospitals, telemedicine visits and other health care encounters. These expectations that they will not be needlessly touched, crowded, gawked at or secretly filmed, recorded or imaged relate to the need for psychological comfort, dignity and security. The internet has made delivering health care possible across vast distances. (Chepesiuk 1999). Telemedicine, which grew exponentially during the first year if the COVID-19 crisis, allowed doctors and nurses to evaluate common medical complaints remotely without touching the patient. In the meantime, health care typically involves physical contact with others.. The sub-section is reproduced in the next posting. ..Maurice.
2.2 Bodily Modesty
Philosophers in the virtue ethics and Christian ethics traditions have identified modesty as a moral virtue (Schueler 1999). Modesty is a form of physical privacy of special interest to medical ethics. If patients are to receive the best care, they must be willing to expose their bodies to medical personnel and technicians. Removing one’s clothing for purposes of examination and testing is routine for most health care consumers. Busy emergency rooms and neighborhood clinics may be unable to cloak or seclude patients at all. Harried physicians may forget “bedside manners” and fail sufficiently to honor patients’ modesty expectations. In-patients in teaching hospitals are expected to adapt to diminished physical privacy, since medical students and researchers accompany attending physicians on rounds and participate in care.
Yet feelings of modesty and felt obligations of bodily modesty are commonplace. Many individuals understand bodily modesty as a moral virtue, and act accordingly. Under some religious traditions, such as those of Muslims, Orthodox Jews and the Amish, bodily modesty is a requirement of faith. Being asked to disrobe, even for a good reason, may impose the cost of going against principle or desire (Kato and Mann 1996).
Health care providers respond to the modesty values of their patients in a number of ways. They provide special modesty garments and sheeting to minimize nudity. They ask patients to uncover only those portions of the body which must be exposed, and then only for the period of time necessary. While hospitals cannot offer every in-patient a private room, shared rooms are generally dividable by curtains that grant patients some degree of physical seclusion (and associational intimacy with visiting family and friends). Male gynecologists and obstetricians help patients cope with sex-specific modesty norms and sexual abuse concerns by working with female assistants. Some health care providers maintain medical procedures staffing policies sensitive to modesty and harassment concerns. Indeed, mammograms on women are generally performed by female technicians. On the other hand, the radiologists and radiology technicians who deliver prolonged, intimate radiation services to breast cancer patients are likely to be male. Patients may encounter health institutions and providers who are unwilling to honor what they may regard as impractical or discriminatory preferences for same-sex or same race caregivers, preferences sometimes motivated rightly or wrongly by modesty concerns. ..Maurice.
Isn't this what we have been experienced and concerned about leading to discussions here?
Read the entire presentation since the topic of Privacy and Medicine is far more. And the topic has been substantially revised from 2009 when first published to Thursday Jan 28 2021.
Let's hear if this Stanford publication definitions and detailing fits with your views. ..Maurice.
Maurice,
This is outdated thinking. They are talking about modesty as patients' expectations, yet they ignore patient dignity which is what healthcare providers are obligated to respect as a human right. (We have had that very conversation on this thread.)
There is no mentioned to the providers' obligation and failure to respect the patient's dignity. The implication is that patients' expectations are too high and shouldn't expect them to be honored when IN REALITY healthcare's respect of the patient's human dignity is too low.
Biker,
America loves our veterans. A post on social media about his treatment will have changes made. If his wife or you are willing to write the story, I know that I will and am sure that JR will also spread it on Twitter. No human being should have to endure that.
-- Banterings
The following was posted erroneously on Volume 11 of Patient Modesty (March 2009) after the Volume was closed yesterday by an unidentified writer but I will reproduce it here. ..Maurice.
At Monday, March 29, 2021 11:53:00 PM, Blogger Unknown said...
your opinion mine differs I.pay the obscenely exorbitant medical costs and I will NOT submit to something I am extremely uncomfortable with, especially when, with a ittle effort,my request for a same gender provider can be honored if woman do not get looked down on for their preferences, then why should I?
Nothing has changed. You might want to go back to Volume 11 and take a look at what was going on back in 2009. ..Maurice.
Banterings, the VA event was 2 years ago and my wife's cousin wasn't upset or offended by it so I'm not going to be able to get much of a story from her.
Yesterday, UNKNOWN (either the same or a different) contributor wrote the following on Volume 11 and I have encouraged an apparent "him" to continue conversation here on Volume 117. Here is the text from UNKNOWN:
Wednesday, March 31, 2021 5:03:00 PM, Blogger Unknown said...
females are NEVER advised to seek counseling, if modes, and the medical community will acquiesce if they have to bend over backward, but mine is treated like a "silly little non issue" and that I need counciling to get over "my silly little non issue" a fine example of the double standard perpetuated, all to often, by the medical community male mamagram technicians are non existant because it is a "sensitive" issue, but my private parts are casually put on display because my modesty is a "silly litte non issue" the minnespolis VA, where I get my care, hasn't got even one male RN in their urology department this in an institution that has a 90% plus aging male patient population prone to urology problems I'm constantly being told that male RNs constute only 10% of the nursing population that begs the question "why doesnt their nursing staff have 10% males instead of zero"? is it because male modesty is a "silly non issue" not worth considering and I need to get over it, and accept what is rammed down my throat or forego needed medical care?
..Maurice.
Hooray! In 3 days, April 5th 2021, patients will be able to read physician's notes--by law. This should raise a patient's dignity though this law from some physician's vocal expressions to the patient to what was actually written, at the time, in a professional document. It will also raise the incidence of legal actions taken by the patient or family upon the patient's doctor.
Or will it? Read all about this new legal challenge to the medical profession and also the comments by physicians regarding the article written in Medscape.
What would you, as a patient, suggest to all physicians who are documenting you history, physical, labs, clinical conclusions and advised treatment along with any or all the discussions with patient and family? Would you advise the physicians should start looking for a personal lawyer? Or is this MUCH ABOUT NOTHING? ..Maurice.
It'll be interesting to see what this new "open notes" system will do. The notes I see now tend to be a lot of stock language that lawyers have scripted to document everything that was supposed to have been done and me informed of occurred, and with a lot of cut and paste. I almost always see errors, though rarely anything worth my effort to get corrected. Sometimes the cut and paste forgets to update my age even. Usually the errors involve "patient was advised" type things but sometimes it has stuff was done that never was done, such as I received a full skin exam when it never occurred.
I suspect the new system will also use stock language written by the lawyers and will contain the same kinds of overstatements and errors. It'll be very interesting to see if modesty concerns are documented and what language is used.
OK, I want all my contributors here to be explicit in describing, as a patient, what you want and expect and reject to be written by your physician in your office or hospital notes. Please be explicit in "want, expect and reject" within the document.
For examples, do you think it is appropriate for the physician to include the patient's mental state, verbal or physical behavior or misbehavior during the period of a single or repeated communication or examination of the patient? If the behavior of the patient causes the physician to "feel angry or upset' should that be an essential part of the documentation? Should anatomic findings, bodily reactions or behavioral observations through actions or even the patient's specific words by the physician be compared to the physician's experiences with other patients under similar clinical circumstances?
In responding to my questions, be as specific as possible as to what you as a patient would expect as "professional" vs "unprofessional" written narration.
Shouldn't all these expressions of your expectations be made available to the medical profession if not previously adequately publicized to the profession?
Shouldn't the medical writeup be a "team" production in real time or this would simply hinder, timewise or in content, any essential diagnosis or treatment which is necessary for the patient?
Just some thoughts and questions. ..Maurice.
I hope we haven't lost JR as a contributor on this blog since she as well as Banterings are resources to "spread it" on Twitter et al. ..Maurice.
Dr. Bernstein, what I want is an accurate account of my visit and the doctor's findings. If per chance they have anything negative to say about me, I will be very upset if it is something they never said during the visit.
What I expect will occur is more of the same cut and paste and lawyer language. Here is the Examination Notes segment of the record from my last dermatology visit:
"Patient was alert, well-appearing and in no noticeable distress.
Patient asked to undress to their comfort level. Provider preference is to take everything off. If clothing is left on we will not look there. Patient chose to leave on underwear."
Here is the Treatment/Plan Discussion segment of the notes from that exam:
"Spent over half of this visit discussing pathophysiology and the diagnosis, and counselling this patient on treatment options, expectations and follow-up plan.
- Specifically discussed:
1. Sun avoidance re-emphasized, sunscreen, hats, clothing as always.
2. Discussion of venous stasis dermatitis; recommended compression stockings."
First off, I had removed my underwear for a full exam but he didn't do it, instead he just asked if I have any issues down there. The reality is he barely looked at any of me in what at most was a 1 minute exam. That's partly why I'm thinking of not going back to him again. On the treatment plan, none of what was written was discussed. He did suggest I talk to my primary care about some minor lower leg swelling he detected.
This kind of nonsense report will likely be the norm for places that hadn't been providing patient portals to their visit notes. We'll see if anything changes where I go.
Maurice,
Perhaps you may have this answer in regards to open notes (which appears vague on it):
Does open notes require only notes after April 5th be accessible moving forward from April 5th, or does it apply to previous notes?
If so, is it only notes in EMR systems?
-- Banterings
Banterings, I got a notice yesterday from the hospital I get my scheduled care at saying it only applies going forward. As I have said, I am expecting more or less the same cut & paste lawyer language. Maybe they'll have a separate system not available to the patient that they disguise as something else.
Banterings et al, here is the link for an extensive presentation of the rules associated with the U.S. governmental order to go into effect in 2 days:
"Open Notes" is presented documentation and links, a description project of Harvard Medical School and Beth Israel Hospital. ..Maurice.
Here is the link to the U.S. Government full details of the governmental order. Banterings, perhaps you can find the answer to your question and present other governmental directives of patient (or professional party) concern. ..Maurice.
It appears from the viewing statistics I have available for this Volume about its designated and discussed topic that there has been a relatively steady "disinterest" and as you can also see documented very limited participation in actual written discussion
My question now is whether to move on to lead the list of threads to other topics that deal with other topics related to the subject of bioethics. The blog started back in 2004 with many aspects of bioethics which can be updated now in 2021 or topics which has not been written about here previously.
I have a feeling that the absence of new comments on the topic presentation and discussion published in the early 2000s is because the visitor wonders if anyone is still reading these old presentations and get involved in a written discussion. But my statistics show many visitors to those old topics, including suspected college teacher-student readings.
Bioethics has much more to discuss than the preservation of the dignity of a patient, despite that important bioethical good.
Any thoughts on my observations and suggestions to start a fresh bunch of ethical issues which might provoke more participation? ..Maurice.
Hello,
JAMA has an interesting article today titled, "How Sharing Clinical Notes Affects the Patient-Physician Relationship." The URL is https://jamanetwork.com/journals/jama/fullarticle/2778527?guestAccessKey=9c7e0030-5f99-452e-bf04-a17a03d8757e&utm_source=silverchair&utm_medium=email&utm_campaign=article_alert-jama&utm_content=olf&utm_term=040721
Dr. Bernstein, maybe non-posters are Covid-weary. Any thoughts on the ethics of vaccination passports?
Reginald
Patient rights in general is a topic worth pursuing. After a recent argument with a medical provider who claims patients of harm are merely those who do not understand how the health care system work, I see the whitecoat/scrub attitude is very alive and well.
Most states have laws concerning Informed Consent. However, most states will allow health providers to decide what information they deem important to share. This is wrong on all and any scenario. Patients have the right to full disclosure. Questions like why is there no real policing on medical providers committing crimes? Why must 100s and 100s of patients be harmed before an investigation is even started?
Also, when a patient says NO why doesn't it really mean NO? Why do medical providers not realize they are working for the patient and not in charge of the patient? Many times patients feel the medical provider is working against them. This is not how the medical system should be setup.
Why do many within the medical system believe it is okay not to recognize patient dignity? Dignity is demanded and expected in every other of life's situation but why has it been allowed to be dismissed in medical care? Why is it acceptable to basically have all your human rights be literally and figuratively stripped away? Why does much of the public have a bad case of whitecoat/scrub worship?
Right now we have the vaccine card issue going on. The govt is implying you must comply with being vaccinated and having a card w/ snippets of your health history to show strangers including your birthdate. However, they say HIPAA is supposed to protect our health information. No one has to show their measles, TB, etc. vaccines so why this one? Why else is coming? Do we have health information privacy or not? Not is what I think if I have to show some kid at the door of a business my PHI to gain entry. Really we know HIPAA does not protect our PHI as they are allowed to use it for whatever purpose they want as labeled in "doing business". When will this stop or will it stop? Give an inch, will they literally take a foot like in real medical harm stories?
JR, I agree that patient's rights continues to be worthy of ongoing consideration. There is an excellent summary of this very matter, recently updated, which can be reach by clicking on this link . The title is "Patient Rights and Ethics". I found the following example of a "current' patient "Bill of Rights" set by Indiana University as outlined in this summary worthy of reproducing here.
As an example of a current patient bill of rights, Indiana University Health's patient bill of rights includes the following patient rights:
To be treated justly.
To receive information about care.
To refuse treatment
To have confidential medical care.
To have continuity of care.
To have pain treated to a level of toleration.
To be free from physical restraints (unless the patient is thought to be likely to hurt himself or others)
To view medical records.
To have explanations about bills.
To provide advanced directives.
But read the entire presentation. JR do you feel that the entire issue of patient rights is fairly well covered with the article?
Reginald, thanks for your suggestion regarding "vaccination passports". Maybe you can research that issue from a citizen's point of view and post your understanding on our May 2020 blog thread titled "Bioethics and Dealing with the COVID-19 Pandemic" https://bioethicsdiscussion.blogspot.com/2020/05/bioethics-and-dealing-with-covid-19.html
The topic you suggested would certainly fit the thread title. ..Maurice.
Dr. B.,
It is not whether on paper they have reasonably covered the rights but rather if in practice they are being followed. Therein lies the issue.
Unfortunately, I have experienced IU's Bill of Rights. IMO, they aren't just scam candy written on paper. Yes, a patient can refuse treatment but will IU allow the patient's lawful right to refuse IU's chosen treatment for a less invasive means. In my experience, the answer is no. To receive info about care is again not worth even the paper it is written on. Yes, maybe free from physical restraints but nowadays the restraints most often used are chemical restraints which IU has no issue in using. FYI, IU locally is also using an electronic form of Informed Consent which severely discourages patients making changes to the form.
It is not only IU that has an issue with actually practicing the Patient Bill of Rights they print to give copies to most patients but most hospitals breach this "contract". It is a contract as it is an implied contract. Banterings can speak more to this than me. We actually need to find a law firm to start a class action lawsuit against a good number of hospitals for breaching their own Patient Bill of Rights. These Bill of Rights lure patients into a false sense of security. The hospital from hell's Patient Bill of Rights is even more comprehensive than IUs. I have a copy of IU Blackford's Hospital Rules and Regulations of the Medical Staff and again found many areas of concern. (IU has many, many locations around the state of Indiana as does the hospital from hell which is why we are seeking to relocate from Indiana.)
The hospital from hell specifically addresses that all patients have the right to personal privacy. Okay, so what is their definition of personal privacy? Is the sexual molesting of a patient acceptable in their definition? Is it acceptable for a patient to be unnecessarily exposed because their staff member is in charge of the action? Exactly what is the definition? They won't say. So again, words mean nothing except they are false words.
Since hospital systems seem to know the correct words or phrases to print concerning patient rights, this begs the question of why most fail to follow their own acknowledged Patient Bill of Rights?
We also have a federal Patient Bill of Rights which again mean nothing because the federal govt either doesn't have enough brains to enforce them or have been so bought and paid for they won't enforce them. Either way, the patient is the loser.
IMO, all the Patient Bill of Rights do more harm to the patient than protect them. It lures many into thinking the hospital cares about them when that is the farthest from the truth.
The AMA list of Patient Rights, like those at many hospitals and medical practices,includes the following:
-The right to be treated with courtesy,respect,and dignity
-The right to have physicians and other staff respect the patient's privacy
What really matters, of course,is who gets to define what these "rights" really mean. Unfortunately, in most situations, it is the medical providers who have the final say over what terms like "respect" and "dignity" mean. Therefore, I would argue that they are not really patient rights at all.
I do not believe that intimate exposure in the presence of female providers is treating me with respect or maintaining my dignity but when I insist that women not be present, I am generally met with crude attempts to gain my compliance or when that does not work I am told that there are no male providers available, leaving me with the choice of of accepting the violation of my privacy or refusing treatment. Thus far, I have always chosen the latter.
MG
Thanks MG for your contribution to our subject. Does anyone here feel that if there are no male assistants available and the examination or treatment is clinically important at the time, that a male patient should accept a female professional? When should gender selection NOT trump need for clinical attention. Would the patient's presence in the Emergency Room after acute pelvic trauma present such an exception? Shouldn't there be personal limits to the denial of medical or surgical assistance based on the gender issue? ..Maurice.
JR,
A friend of mine wants to travel to Mexico for plastic surgery. It is not clear if the vax passport is required or not. Like me, she doesn't want to get it. She had to cancel her trip last March and does not want any other delays.
She paid someone who looks like her a few hundred dollars to get a vaccine and use her name (ID not required). Now she has a vax pass.
As in the movie Jurassic Park, "Nature will find a way...", so will patients.
I am not speaking to the legality, morality, or ethics of what happened, but there are arguments to be made on both sides.
Furthermore, in the words of President Biden (paraphrased): Asking for a voter [VACCINE] ID is racist and Jim Crow 2.0...
-- Bnterings
Hello,
ProPublica has an interesting article ( 8 Apr 21), "When Births Go Horribly Wrong, Florida Protects Doctors and Forces Families to Pay the Price". It's an "interesting" read. A sample follows:
"NICA [Florida’s Birth-Related Neurological Injury Compensation Association] paid $138,000 in legal fees and costs fighting a mother’s request for $11,058 in reimbursement for a treatment that could help her daughter swallow."
The URL is https://www.propublica.org/article/when-births-go-horribly-wrong-florida-protects-doctors-and-forces-families-to-pay-the-price?utm_source=sailthru&utm_medium=email&utm_campaign=dailynewsletter&utm_content=feature
Happy reading.
Reginald
Dr. Bernstein, whether a male patient accepts a female provider when there is not any male staff is entirely up to the man, same as the opposite scenario is entirely up to the female patient.
Some men will accept the situation and proceed, others won't. Either choice is OK. What is not OK is mocking or bullying the patient into compliance.
My guess is that how men make their choices in large part depends upon what the medical situation is.
Biker et al, preserving patient dignity requires ethics decision making and that is why it is a topic in an ethics blog. OK?
Now comes the question: "Smelling the Unethical: Can You? Should You" and this is the title of my blog thread topic published by me in May of 2013. Below is a copy of my introduction to the blog topic. I thought I would reproduce it here..now.. with regard to the ethical conclusions which have been repeatedly written here about dignity and modesty.
The question arises as to how the average person can "smell" (suspect without documentation) that some act or behavior of an individual or individuals is unethical. An often used expression is: "It smells fishy to me." Is everything which determines what we suspect really set down in the past by our "ethics education" through reading or listening to the views of philosophers, ethicists, our religious or grade-school teachers or parents or the outcomes of our own experiences? On the other hand, is what "smells" unethical simply based on individual personal preferences and not some theory or rule developed by others. Then again, perhaps there is some genetically constructed mechanism or instinct which provides every individual with the capacity to establish that suspicion about what might be an ethical "bad" and not an ethical "good". An important point to consider is whether you can fully explain the reason that the action "smells unethical". If you can't, then maybe this would point to the decision as an instinct mechanism.
Beyond considering the mechanism of the this use of smell, is the question as to whether use of this "olfactory" function is of personal or social value. Will it prevent the individual to enter into unethical actions which might be harmful toward ones self or harmful toward others?
Whether you can or cannot "smell the unethical", I would like to express my personal view. I want to emphasize that all ethical decision making (what is a "good" vs what is a "bad") should be made on carefully obtaining and evaluating the facts of the action or behavior and weighing them on the ethical principles and ethical consensus and law with the understanding sufficient to explain the decision, if necessary, to others. I think that whatever the mechanism is for "smelling the ethics" and whatever its "odor" ,ad hoc or premature decision making about an ethical matter, which. by the way is not uncommon, is itself unethical.
Any comments? ..Maurice.
Dr. Bernstein, some people are better at reading people than others and so some people are better at "smelling" unethical behavior. Of course having all the facts and understanding those facts better enable people to conclude as to unethical or not, though a piece of it is going to be the person's own ethical base when deciding whether someone else is ethical or not.
When a doctor or someone else in healthcare is saying what needs to be done, most patients simply don't have the facts to know whether that recommendation is in the interest of the patient (ethical) or in the interests of the doctor/hospital(unethical). Their intuition or belly twitch might come into play in accepting the recommended course of action or not, but the power differential also comes into play potentially overriding what it "smelled" like to the patient.
This is why patients need the healthcare system to better self-police itself. Regretfully it seems Medical and Nursing Boards don't appear to be good patient advocates, nor does the executive suite at healthcare systems. Throw in the co-workers of healthcare staff looking the other way at bad behavior, and patients are left to rely upon their own sense of ethical/unethical w/o having all of the facts or knowledge needed for a fully informed decision.
This may not be a good example but I am in the midst of trying to get a new Epipen. My old one expired, my doctor wrote a new prescription, and apparently that prescription was sent back to the doctor to reconsider whether I really need one or not. I have no idea whether that was at the direction of Medicare, BCBS (my supplemental), or CVS (the pharmacy). Is that an ethical or unethical action on whichever party's part to question such a prescription when they know I went into anaphylactic shock 2 years ago from bee stings?
Here is another example via 2015 Pharmacy Times of refusal to dispense an emergency-use Epipen:
https://www.pharmacytimes.com/view/case-dropped-against-pharmacist-refusing-to-dispense-epipen
Charges of exercising poor professional judgment have been dropped against a pharmacist who refused to dispense an EpiPen to a family without a prescription.
Charges of exercising poor professional judgment have been dropped against a pharmacist who refused to dispense an EpiPen to a family without a prescription.
The Pharmaceutical Society of Ireland recently held an inquiry involving the pharmacist and a teenager who later died from anaphylactic shock, The Irish Times reported.
Fourteen-year-old Emma Sloan died on the street in Dublin in 2013 after eating a peanut-based sauce at a restaurant, according to the paper.
Pharmacist David Murphy was investigated for his decision not to provide the EpiPen because of the lack of prescription, but the pharmaceutical society has determined that there is no longer a case against him.
A shop assistant at the pharmacy said that Emma’s mother Caroline Sloan had come into the pharmacy saying that “someone she was with” had eaten satay sauce and needed an EpiPen, and the pharmacist told her to call an ambulance, The Irish Times reported.
Caroline disputed that the pharmacist ever told her to call an ambulance.
Meanwhile, the mother was questioned about the discrepancies between her statements in 2013 and now.
When the society’s verdict was announced, she told the pharmacist that she held him responsible for her daughter’s death, according to The Irish Times.
During the inquiry, Stephen Byrne, head of a school of pharmacy in Ireland, said Murphy showed poor professional judgment and should have made an effort to understand the situation before refusing to provide an EpiPen.
Murphy’s lawyer called to have this information ruled inadmissible, but the inquiry did not submit to his request at the time.
The society noted that one of the pieces of evidence that led to its decision was hearing that the pharmacist instructed the Sloan family to go to the hospital.
Since the incident in 2013, the Irish pharmacy has received death threats, The Irish Times reported.
Biker, I see no reason for withholding your resource for emergency use of epinephrine as directed by a physician's prescription.
But the matter of pharmacists dispensing certain usual prescription medications without a physician's prescription is discussed in this article "PHARMACISTS WITH PRESCRIBING PRIVILEGES: A NEW CLASS OF MEDICAL PRACTITIONER"
from the Journal of Urgent Care Medicine
Interesting and important topic in medical care. ..Maurice.
In the past, my husband never had issues with female staff who participated in his care. While it was now something he enjoyed, there was nothing "unprofessional" about they conducted themselves. He had prostate surgery with a female anesthesiologist and female staff. They used a male orderly for the the shave. The doctor was an arrogant ass seeming to feel he didn't need permission to touch him but he was out of the hospital in 24 hrs and never saw him again. He has had ultrasounds done by female techs and had no issue with them. However, the taste, smell, and the sight of what happened at the hospital from hell was different from beginning to end. You didn't have to have much intelligence to see and "smell" the difference. There was no mistaking what they did and there is no excuse for what they did. From beginning to end, the sole purpose was medical and sexual assault of which they accomplished.
When you have been a victim of crime, you look at everything differently. All the doctors involved in his medical assault were not US born or schooled. They are from countries not friendly to the US so they most likely have some bias towards blonde hair, blue eyes older American males. Certainly the doctor who actually committed the assault demonstrated total lack of respect for women. I tasted this during my short time with him and certainly his cultural and religious beliefs point to this.
The nurses who took part in his assaults were all female. Their social profiles points to aspects of being men-haters. Personal bias does play a part in how patients are treated by medical staff. Many cannot make a clear division between what should be a professional and personal demeanor. Furthermore, many know they will be protected in doing whatever they do.
In seeking further healthcare, my husband will be looking for what I have read some black and hispanic say, "I want someone who looks like me" because apparently it does make a difference. We didn't think so up to this time but all involved were different from him so if it looks and smells different it must be different? The myth has been busted for us that medical providers do not let their personal biases interfere with how they deliver health services.
Although my husband was a victim of gross intentional harm, you can also apply this to those like Biker who has been a victim of female staff simply not respecting his right as a fellow human to be treated with dignity that would be accorded to a female patient. Having said this, not all female patients are accorded dignity by female providers as there are some who have no respect for any human they happen to come in contact with while providing health services. But this is much more rare happening for female patients than for male patients.
As I see it, the sight, the smell, the taste, etc of health services is bad. There is no way to gage which providers will respect you as a human until you have experience their actual care. Patient Bill of Rights and other materials do not convey into real time care standards. Male patients can usually expect most health providers not to provide for their personal privacy and/or dignity.
Oh! With all the presentation and discussion of our visitors experiences as patients or family members of patients in our medical system, one etiology (cause) for these experiences and behaviors has not really been considered or discussed and that is "healthcare bullying" (words and actions between members of the healthcare team attending to their patients). Here is a current discussion on the subject titled "Why Bullying Happens in Health Care and How to Stop it." from American Medical Association News bulletin I received today.
This is not about "bullying" by or to the patient or family member but this behavior between members of the medical team having potential to attend to the patient or family member.
Can our visitors here find experiences which might support this action between medical providers that could have led to the personal consequences described here?
How might a medical employee react when confronted with a patient after having been "attacked" for one reason or another by a medical superior?
A principle of making a valid medical diagnosis is understanding all the symptoms and etiologies (diseases and mechanisms of pathology and symptoms) in order to make the best diagnosis. Perhaps, all patients and their families should also consider "medical bullying" between those who are attending the patient or family member.
What do you think? After all.. those participants in your diagnosis and treatment are humans who are know to have the potential to "bully" each other. ..Maurice.
JR, maybe the medical participant (doctor, nurse, et al) are simply responding to the patient or family member in some sort of emotional or behavioral response to the way the individual was treated by their superior. Do you find that as a reasonable explanation of their misbehavior or worse to patient or family member which you have well described? ..Maurice.
No, there is never any excuse acceptable/reasonable in intentionally harming a patient. Just because you may feel bullied by a superior does not give you the right to harm someone who deem to be defenseless. Medical providers literally hold our lives in their hands. Their actions decide if our outcomes are good or bad. Because of their actions, the outcome for my husband was not good as he will no longer seek care beyond just knowing what is going on. He will not again allow those who are supposed to "do no harm" to do great harm.
We have been told over and over again, so many times that medical providers leave their personal feelings at the door. Clearly, they do not and clearly those personal feelings are interfering with how they perform their job. An oops is understandable but to intentionally and knowingly harm someone will never be reasonable. Even if all that is done is if a man says he wants no female chaperone and he is then bullied and/or coerced into having one present, that is intentional harm as that man's right to personal dignity has been discounted or dismissed. Some men who have had this happened never return for medical care again until they are dying and some may die because of the action of some medical provider who by their actions intentionally harmed by asserting power and control over a patient so they could get on with the appointment and make money.
In your way of thinking if someone cuts me off on the road and speeds away do I have the right to take out my rage on some other unsuspecting motorist? No, I don't but that is the "ethical" of thinking you are using to justify criminal harm that was done to my husband.
All these years we have been told naked patients bodies mean nothing but clearly continuing with your line of justifying intentional harm, medical providers are not leaving their personal opinions and such at the door. Maybe they are sexually stimulated by genitals. Maybe some female providers are becoming sexually stimulated over the power and control they have over unnecessarily exposed male patients especially those whom have made a point of saying they don't want to be undressed in front of them? That smells like some good solid odors to me of how far the medical community has decayed and is no longer the ethical institution we thought it was.
JR, you write "there is never any excuse acceptable/reasonable in intentionally harming a patient. Just because you may feel bullied by a superior does not give you the right to harm someone who deem to be defenseless. Medical providers literally hold our lives in their hands."
Fortunately, I still hold the ethical principle of the potential of patient autonomy and unless the patient is unconscious or mentally otherwise incapable of unknowing of what is happening to ones-self through the actions of another individual or prevented by law, every patient has and must maintain the ethical principle of autonomy. And that means, make their own personal inferences, understanding and decisions.
I, personally, have never looked upon or decided about my patients without their understanding and agreement.
I started diagnosing and treating patients when I started internship and beginning residency in 1958-59 with that viewpoint in mind and that is why, when modern clinical medical ethics was beginning to more formally develop from the previous century, by the 1970s and early 1980s, hospital committees formed and the principle of patient autonomy was understandable and accepted by me and hopefully others in the medical profession. And it is the preservation of patient autonomy which is necessary for the preservation of patient dignity despite the uncomfortable and upsetting interactions between members of the medical profession themselves. ..Maurice.
Dr. B.,
I hear what you are saying but I know what I have seen in dealings with other medical providers. Even if you don't want to admit to the fact, many of them do not believe patients have the right to have choose what medically happens to their body. This deep-rooted within the medical community. You hear it. You see it. You may not because you are part of the system. However, the ones of us who are not part of the system probably have experienced it most of the time in dealing with the medical world. We are told.....We are ordered...Why? Because the doctor said and that is if you are not of the few brave individuals who have enough courage to question them.
Rather you admit it or not, many medical providers give off the aura of "I do not tolerate anything but compliance/submission." Most of the public have been trained to believe this is true. Most consent forms are really not representative of a true consent process which risks, alternatives, etc. are openly discussed and the patient is actually the one weighing the information and making their own decision based upon accurate information provider by a non-biased medical provider. Informed consent are sham/cons. They merely protect the medical provider because a coerced patient signed a form excusing a medical provider from harm. Patient autonomy is something most medical providers do not feel comfortable with a patient exercising. Why? That is the question to which I have my theories.
We do agree that patient autonomy is necessary for patient dignity but for many medical providers out there, neither is necessary for the patient to have in their opinion. Patients are more like things they possess. They use and discard when finished just like most inanimate objects. Thus making patients less human is where the high use of sedation finds its place ie. in interventional cardiology in Europe sedation and usually not both versed and fentanyl are used only in 20% of the cases whereas in US both are used routinely in most cases.
By dehumanizing patients, it has allowed the medical community to forget patients are entitled to bodily autonomy and bodily privacy. Dehumanizing patients also allows them to have an assembly line process when interacting with patients in order to show greater financial profit. While the medical community is supposedly in business to provider compassionate care (I have read that in many medically facility's propaganda) it seems they purposely fail to deliver compassionate care. You cannot deliver compassionate care when you do not respect the patient as an individual entitled to both autonomy and bodily dignity along with other human/patient rights. There is no middle ground on this.
I also realize the criminal assaults my husband suffered is probably rare, the instances of male patients being unnecessarily "just" exposed are not rare. It is an issue. And yes, unnecessary female exposure still happens but from what I have seen, it happens generally when there are other female medical providers involved. I believe female medical providers need special educational courses to learn to respect all patients. This would be a start.
JR and others here, have you noticed any similarity regarding the behavior (or better "misbehavior") of "professionals" within the medical profession and those misbehaviors within the police officer community within the United States? I do.
Could one summarize the similarities by discussing either profession's understanding or misunderstanding regarding their professional goals and their techniques to reach those goals when subjected to reach that goal while attending to each "patient" or "suspect"? I can.
The "cure" is not simply to accomplish that result by attending simply to the disease or "legal disorder" but to recognize the absolute individuality of each subject with apparent disease or apparent criminality and the individuality of the appropriate professional response and behavior.
If any of these professionals only categorize (perhaps considering the available "time") rather than attend to each subject as a distinct individual who may or may not fit into some "generalized response" to "cure" the situation, something "wrong" may be about to happen.
I would be interested in reading what my visitors here think about this analogy regarding the goals and final results of these two professions. ..Maurice.
Doctors and police both exercise a power differential over the audience they interact with. However, it seems that police better understand how to interact with the public in a respectful and dignified manner.
I have never experienced a police officer be anything but respectful and helpful in an interaction, including when giving me a speeding ticket. Of course I am always polite and respectful to them. I am similarly always polite and respectful with healthcare staff but I have had my share of being responded to or otherwise treated in a disrespectful and undignified manner. In fairness, I have had many more healthcare interactions than I have interacted with police.
There is a fundamental difference in that the healthcare system operates with a greater degree of autonomy than do police depts. Healthcare is seemingly not accountable to anyone and can decide for themselves what privacy, respect, and dignity means, and if the patient disagrees, too bad. Local and State governance authorities don't have public discussions as to how healthcare staff need to interact with patients, nor does the media get involved. How police interact with the public is routinely subject to public discussion as to how it needs to be done, and the media pays close attention.
Big difference between police and medical interactions is that police primarily are dealing with those who have mostly likely have committed a crime. Police generally see people behaving at their worse. Yes, some police officers have bad attitudes. Yes, some let the power and control they possess go their head. Personally, I have not interacted with police for an issue where I have been committing a crime so I have not experienced what we see on tv. But unlike you, Dr. B., even though I have not personally experienced it or even seen it firsthand, I know from others accounts it exist. Like medical providers, police officers are humans first. All human have character traits of being able to do good, bad, or a mixture of both. Best way to avoid a negative interaction with police is not to commit a crime and if you commit a crime, police do have the right to super impose the consequences of the law upon you. Best way to avoid police harm is not to put yourself in the position of them having to deal with you other than saying "Hi! Have a nice day!"
Medical providers on the other hand are not generally dealing with guilty criminal people. Medical providers have no right to super impose their "laws" upon innocent patients as patients have full human and citizen rights. As far as I know, no one here on this board was a criminal and thus put themselves in the position of possibly being harmed while seeking medical care. If you call asking questions or saying I refuse treatment of your choice a reason to be harmed as it would be similar to saying I will not be arrested for a crime I committed, then we have big problems.
As far as I know, there is no law or anywhere at this date in the constitution where it says I must blindly obey the medical community although ....There are also avenues in which a bad cop can be dealt with but in practice there is no avenues available to deal with harmful medical providers as the medical community is self-policing. Again, see the segment the very liberal CBS Jim Axelrod did for CBS This Morning on how corrupt the Indiana Medical Board is. PS My husband was harmed in Indiana.
Police, by law, have power over us. Medical providers have over the years made themselves to be have power and control over us. The type of power and control medical providers have over us seem to be harder to break as there is no law to rewrite as it is an invisible hold that seems to be stronger than a law defines for police power. That is why it is up to people like Banterings, me, and others to spread the word the medical community has silently made themselves our "bosses" and we must break that cycle of abuse.
see another similarity; there is a reckoning for abuses to society coming for both. Just as the police are being defunded and power that they abused taken away from them, so too will this social momentum come for healthcare.
Personally, I do not believe in defunding the police. Is there a need for greater accountability? Yes.
The root cause of the problems is the same in both: too much power, little accountability, and members not reporting bad actors in their ranks.
-- Banterings
And here is the solution to everything which has been discussed on this blog thread. What is needed is Relationship-centered Care . Here is the Abstract of the article:
All illness, care, and healing processes occur in relationship—relationships of an individual with self and with others. Relationship-centered care (RCC) is an important framework for conceptualizing health care, recognizing that the nature and the quality of relationships are central to health care and the broader health care delivery system. RCC can be defined as care in which all participants appreciate the importance of their relationships with one another. RCC is founded upon 4 principles: (1) that relationships in health care ought to include the personhood of the participants, (2) that affect and emotion are important components of these relationships, (3) that all health care relationships occur in the context of reciprocal influence, and (4) that the formation and maintenance of genuine relationships in health care is morally valuable. In RCC, relationships between patients and clinicians remain central, although the relationships of clinicians with themselves, with each other and with community are also emphasized.
But you should access the entire article by clicking HERE . The article is from the Journal of General Internal Medicine and though was published in 2006 may be even a more valuable concept to be followed in 2021. Let us know what you think ..or is this article and RCC just wishful thinking? ..Maurice.
Maurice,
Anything short of making healthcare providers retail employees subject to customer service to the consumer (patients) is now unacceptable. We have been hearing this BS while they are publishing articles justifying paternalism and students and physicians believing that it is acceptable for them to do exams on anesthetized patients without consent.
The fact that these exams still occur is proof enough that the profession of medicine is morally bankrupt, lacks common sense, and feel that they can behave with impunity (as we are seeing in society today).
Just as a reckoning has come to some and will come to others holding them accountable, so will it come to the profession of medicine. I put my efforts in being a social influencer (think the Kardashians).
JR and myself (and some others that are/have been on your blog) use the truth to paint all healthcare providers as sexual predators, sociopaths, and megalomaniacs.
We are taking cues from the BLM movement from their creating a certain view of law enforcement.
-- Banterings
To my way of thinking if healthcare staff and patients are to operate with a "relationship centered care" approach, the two sides need to have a similar set of definitions of what things like privacy, respect, and dignity mean at an operational level. Currently it seems most who work in healthcare aren't interested in what patients think those things entail, and most patients are too intimidated to speak up given the power imbalance.
In having that conversation there is no avoiding the gender aspect of it which poses the question, are they serious in advocating for relationship center care or is that just a new buzzword that makes it sound like they care.
Until health care providers understand they are no in "charge" of us, there will be no fair relationship. Why does the govt support a woman's right to "My Body, My Choice" in killing a life of a baby but does not support a patient's right to bodily autonomy? There are so many issues that need to be fixed. In a conversation I had this morning with another who agreed with me is: "Civility starts with recognizing all patients have the right to dignity. Most importantly that dignity includes bodily dignity of bodily privacy and bodily autonomy. It is amazing how many medical providers simply do not acknowledge this fact." He replied: "Well said. As a medical director I have to dismiss a few bad doctors to protect patients and the NHS."
This is interesting because this man is a British doctor. Most articles I have found relating to patient dignity has be authored by British researchers. There are very, very few articles about patient dignity especially about bodily dignity authored by US researchers. Why is that? Why has the US remained silent on the need for patient dignity except to print it will be protected on useless pieces of paper--Patient Bill of Rights? An overwhelming number of medical providers fail to provide for patient dignity. Surprisingly most of the ones failing to provide for patient dignity are female providers. Women fought long and hard for bodily autonomy and privacy so is what is happening retribution? On the other hand, almost everyone who undergoes any type of procedure can be expected to their right to bodily privacy as OR teams do not view those patients as being human and worthy of having their right to bodily privacy protected. We know there is protocol on exposure and we know there are reasons not to expose a patient unnecessarily and prolonged so why are they still doing it? It is because people who have a deep need to harm others tend to gravitate to careers where they are in the position of being able to abuse/harm others. Certainly, the medical field fits this need. The medical field has a high number of people who have went on to become serial killers and serial harmers compared to other job areas. There are nurses who are serial killers as well as doctors like Harold Shipman who kept trophies from his murder patient victims.
We certainly know the medical field uses restraints to control patients. In the days of old, they used physical restraints but now they have graduated to chemical restraints. What better way to silence a victim? As long as there is no transparency into all the protocols the medical field uses in retaining their power and control over patients, there will never be true patient safety or a true equal relationship between patient and medical provider. Earlier today, a nurse said to me she didn't know about her rights as a patient until she went to nursing school which is really twisted as many nurses do everything they can to take away your patient rights. But then as far as I am concerned, the relationship is not equal as I am the boss in my healthscare choices.
JR, can you provide those who teach medical and nursing students the expected categories of patient or patient's family interaction, a teaching protocol or directive which defines for student education the expected professional behavior related to their upcoming clinical experiences? This teaching, I think, should be emphasized to the students as they begin their career. Be as specific as you can in the various formats or categories of interactions. I may present your protocol to a medical education listserv to which I am a subscriber for the teachers' evaluation and expression and may write here some of the professional reactions. What do you think about this request? ..Maurice.
Yes.
I thought you all would be interested in viewing this discussion on Quora, How will my dignity be preserved during a testicular ultrasound?.
Misty
JR,
Fauci's exchange with Congressman Jim Jordan was indicative of this attitude.
He had NO regard for the freedom, liberty, or the rule of law for the American people who are his boss. He made personal attacks against the congressman and laughed at his questions.
Fauci has repeated lied to the American people, changed targets, mislead, all to keep his power and relevance.
I didn't even touch on the 30,000 deaths he is responsible for in the 1980's...
They think they are exempt from society's rules. Judgement day is close.
How long until BLM calls out the profession medicine for Tuskegee, the work of J Marion Simms, and so much more?
I am already pushing the narrative that people of color are disproportionally affected by intimate exams on anesthetized patients without consent because of their proximity to teaching hospitals in urban areas.
Look at how the protesters treat our police, what do you think they will do with the profession of medicine?
-- Banterings
Yes, I can.
JR, thanks for your response. I look forward to your teaching protocol for the topic. ..Maurice. p.s.-sorry for the delay in my response to your initial comment today. I had other activities and I don't do any of the work on my blog by cellphone. ..Maurice.
Misty,
I joined in on that conversation on Quora. I hadn't seen it so thanks for pointing it out. It is apparent there are many men out here who feel violated during medical encounters and we need more of them speaking up and out. Some will avoid medical care because they have suffered such horrific lack of personal dignity yet very little is being done to prevent this from happening. All of the studies they do for some reason skips this subject. Bringing dignity into the medical encounter is really easy, doesn't cost, and would actually increase their revenue but it would mean losing some of their power, control, and intimidating they practice. So much for doing no harm as they know the mental harm they do can and does interfere with the physical healing.
I also want to say "thank you" for contributing articles for me to put out on Twitter. Bringing about change in how healthcare is delivered is a numbers game. It won't be done unless we force the issue.
I don't think that I have publicized this blog topic I put up years ago and for which there was 50 responses (me, included). But I thin the topic is very pertinent to the issue of preserving patient dignity. Right?
FRIDAY, NOVEMBER 09, 2007
Being Hugged By Your Doctor: Invasion of Privacy vs Sign of Compassion?
According to the article in Fox News "Affectionate students are feeling the squeeze around the country as their displays of affection land them in trouble with school administrators." Even if the intent is to express, though the act of a hug, a social connection with their peers on the school grounds, this behavior may be considered sexual harassment. I find this news story has directed me to consider something some of us doctors do as part of being a humanistic human being beyond simply a doctor of medicine. Some of us actually hug our patients or patients' family members. We hug, not out of sexual excitement or anticipation, but out of a sense of the need to express directly compassion and support at the time of a patient crisis. Is hugging a patient professional? Does it exceed boundaries of professional behavior? Does it invade the patient's privacy? Should doctors first ask the patient "may I hug you?" and wait for permission? When you are upset and in distress and need the attention and compassion of someone who shows that he or she cares about your feeling, should you or would you accept a hug from your doctor even without them asking? ..Maurice.
Ever been hugged by your physician or other medical care provider? And how did you respond? ..Maurice.
I have never been hugged in a healthcare setting nor do I ever want to be hugged. I'd as well be OK if they didn't shake my hand either. Please just greet me verbally in a genuine manner and make eye contact.
Maurice,
I talked this over with my friend. She said that after her experience inpatient, even though the doc that sent her inpatient was not responsible for her abuse, a hug would have made a world of difference.
Recently in the course of her therapy, she said even though she was healing, there were a couple times that she really needed a hug and had to ask someone.
I too have had a couple times where a hug may have changed my view of medicine and what I am attempting to change in it.
I might cut the profession a break and say it is not all providers. Instead I say all are guilty and the system needs change. Providers need to be subjugated by patients.
-- Banterings
Hello Everyone .
Yes I have been hugged by several doctors and nurses . They were all female and taking care of my wife . The most memorable was my wife's oncologist . She always seemed to be distant . After the first 8 rounds of chemo failed she was handed off for a stem cell transplant which also failed . She passed shortly after . A few weeks after she passed I returned to her office to return some unused hats they had given her . The doctor and staff would all tell her that she would lose her nice long hair during chemo . That didn't happen to their surprise . Anyway when I returned the hats the doctor spotted me and came right over and hugged me for quite some time . She talked for a bit and asked me to come into her office . That's when she opened up . You could see the tears in her eyes as we talked . She explain how she must keep patients at a distance . She treats hundreds of people a year and many of those patients will die . They come to her in pain and in a fight for their life . A lot won't make it . For her emotional health she needs to keep work at work . Not to bring it home . I could hear the compassion in her voice as we talked . Her hug and conversation brought comfort to someone who was hurting over their loss . So I guess I would say under certain circumstances it is ok to hug your patients and their family . Not everyone will agree but that's ok . Doctors are only human . AL
Here is the direct link to my "Hugging" blog thread. There are so many responses by a host of visitors, I think it is worthy for those here to take a look and think about the views expressed.
I want to be personally honest reporting here about my long professional life as a physician: I have never initiated a hug on any patient BUT I have been hugged by a few of my female patients. I acknowledged their hug with an appreciative comment or action.
Fortunately or unfortunately (based on your opinion on hugging) in these COVID-19 days the issue of hugging in either direction is something moot. Isn't it? Go take a look at all the varied responses, it is very informing regarding the doctor-patient interaction. ..Maurice.
I read that other thread and clearly many people like hugs. I imagine this is difficult terrain for a doctor to navigate. Were a doctor to hug me, they'd probably figure out the body language real fast when I don't hug them back. Earlier I had said all I want is a genuine greeting and eye contact. A light touch on my shoulder or arm at the end of an appt. would be OK too, but no more than that.
In reviewing "Preserving Patient Dignity" one volume after another, one wonders what patients and their healthcare providers really want and expect from each other. Actions which suggest, demonstrates or defines "interest" or "necessity" in the behavior of the other? Or if it something less physical as "hugging" what do you think about something less physical but instead emotionally intimate such as praying with the patient ?
In July 2005, I presented on this blog a topic followed by reader responses titled "Should Physicians Pray with Their Patients?"
Could hugging or praying together bring all the parties together involved in "healing" and, in fact, improve medical system-patient relationships and, in fact, end up being therapeutic to the disease? ..Maurice.
No, just no on doctors trying to pray with me. I don't care what anyone's religion is or how they practice it so long as they don't try to foist their religion on me. Culturally it is impolite up here to even ask someone what church or religion they belong to as religion is deemed to be a private matter.
THERE WILL BE NO FURTHER POSTING OF COMMENTS ON VOLUME 117. GO DIRECTLY TO VOLUME 118 TO CONTINUE THE POSTING. I put a welcoming graphic on the new Volume. ..Maurice.
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