Preserving Patient Dignity (Formerly Patient Modesty) Volume 118
Graphic: https://www.tru-caring.co.uk/ via Google Images
posted by Maurice Bernstein, M.D. @ 2:40:00 PM
178 comments
Bioethics Discussion Blog
What have you been reading, hearing or TV viewing that has provoked some feelings of comfort or concern about what is happening in the world of medicine, medical care, treatment or science? Ethics is all about doing the right thing. Are you aware of any issues in medicine or biologic science which are being done right, could be improved or in fact represent totally unethical behavior? Write about them here.. and I will too! ..Maurice (DoktorMo@aol.com)
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Wednesday, April 21, 2021
About Me
- Name: Maurice Bernstein, M.D.
- Location: Los Angeles, California, United States
Previous Posts
- Preserving Patient Dignity (Formerly Patient Modes...
- Preserving Patient Dignity (Formerly Patient Modes...
- Preserving Patient Dignity (Formerly Patient Modes...
- Preserving Patient Dignity (Formerly Patient Digni...
- Preserving Patient Dignity (Formerly Patient Modes...
- Preserving Patient Dignity (Formerly Patient Modes...
- Ethics of Immortality
- Bioethics and Dealing with the COVID-19 Pandemic
- Preserving Patient Dignity (Formerly Patient Modes...
- NO RESPONSE is "NO DISCUSSION" (2)
Links
- Bioethics Discussion Pages
- Complementary and Alternative Medicine Law Blog
- HealthLaw Blog
- The American Journal of Bioethics Editors Blog
- Shrinkette
- Women's Bioethics Project
- Medical Modesty Blog THOSE INTERESTED IN DEVELOPING ADVOCACY FOR PATIENT MODESTY, GO TO
- THIS ADVOCACY DEVELOPMENT BLOG
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178 Comments:
On my concluding Comment on Volume 117, I started with the following: 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? .
What actions and behaviors demonstrates to the patient and to the healthcare provider a "togetherness" in attempting to reach a goal set by the patient and attempted to be followed by the skills of the provider?
Finally, in terms of "dignity" are there behaviors of not only the healthcare provider but also of the patient or family which can be considered to damage the dignity of either party? If so, how can this personal "hurt" be avoided or subsequently treated? I know this is almost a philosophical question but from what I am understanding from both here and from my clinical ethics knowledge, attempts by both parties in preventing or treating a disease involves such risks to one or both party's personal dignity. ..Maurice.
My primary care physician has suggested that I get an upper endoscopy. While researching the procedure on line I noticed that some hospitals and clinics allow patients to be mostly dressed with a gown over their clothing but others insist that that only a gown and underwear be worn. Could Dr. Bernstein or another reader tell me if there is any legitimate medical reason why I could not wear a cotton tee and cotton sweatpants under a gown for this procedure? Thank you.
MG
MG, as an internal medicine physician but understanding the procedure though never having the experience to have performed it, I see no clinical hazard or performance issue in the description of what you would wear under the gown. It is much more important that you have followed the rules regarding the last ingestion of food, making the physician fully aware of the drugs routinely taken and having someone available to be responsible to drive you home in view of your recent sedation for the procedure. ..Maurice.
What MG has bumped into is the lack of universal "best practices" for how common procedures get done. For most of us, the answer thus is to call ahead of time and ask how things are done. Sadly we can't assume that maintaining our privacy and dignity is a high priority for the staff. It might be, or it might not.
MG,
"...because that is the way that we have always done things..."
There is absolutely no reason. Stand up for yourself and you dictate your terms.
-- Banterings
Some patients arrive in a clinical condition where they "cannot stand up" for themselves. So.. don't forget that all patients should previously assign themselves a surrogate to do the "standing up". I have always assumed our JR was such a surrogate and continues to be one.
We haven't discussed this previously but patient assigned surrogates do become an essential part of maintaining the patient (him or herself's) dignity when the patient is not mentally or physically able to do so. ..Maurice.
Dr. B.,
I am not ignoring putting together some ideas for teaching patient rights which include dignity & autonomy. I have been gathering the info and hopefully will have it done soon.
Yes, I am a surrogate but many facilities severely limit a surrogate's ability to accompany a patient especially when the patient needs the surrogate's presence the most. This of course would be when the patient is sedated. Most abuses will happen when a patient has been sedated. CS and I now call ourselves Patient Partners. We don't like the term advocates because that term has been misused and abused by hospital paid advocates and other patients advocate like the well-known who has the need for patient dignity is some type of mental disorder of the patient. Apparently, she doesn't know all patients are entitled to bodily dignity by right of just being a human. Yes, some do have modesty needs but that is not a mental illness. I may dress modestly by choice but by right I am entitled to bodily dignity.
We need to bust down the doors of the castle so all patients can have a surrogate with them at all times. And yes, we have discussed this before as during procedures, patients are not mentally or physically able to maintain their dignity and this is the main time their dignity will most certainly be violated.
Misty sent me an email about a spouse like me whose husband was violated during a venous ablation below the knee. His vascular surgeon was female and he went to a teaching hospital. His underwear was cut off of him and his groin was shaved. The ablation was done below his knee. He was not told he would be shaved. He didn't realize it until he was showering at home. He felt sexually violated and both he and his wife are now suffering from medical ptsd. Why does this keep happening? Why does the medical community feel they are so entitled to expose genitals of patients when there is no need or explicit permission has not be sought? CS is going to try to get them to participate in our radio spot. I hope they can do it but I know from experience it may take time for them to be able to talk about it especially the male victim. We need to find out why these weasels wait until a patient is sedated and defenseless to launch genital attacks. I know the answer. They said them it was for bandages but the bandages were below the knee so there was no truth in their explanation.
Again, I invite all of you to join Archie, CS, and I on Twitter. I am @Rights4Patients. CS is @TraumaPTSD. Archie is @madmanBantering. Misty is @patientmodesty. My twitter is growing. We don't just talk about dignity but all issues concerning patient rights and the medical community in general. We have been talking a lot about the use of NPs and PAs. Of course, I am against their use as we don't need more not so qualified people in the medical community. We also don't need more females thinking they are gods as we have enough already.
Reminding what I wrote to you on Volume 17:
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?
Remember, the context and direction should be your advice to those instructors who do the teaching of medical and nursing students. It is the TEACHING by the educators which sets the stage for professional behavior in the current student's practices in school and in the future. ..Maurice. p.s.-thanks for your participation.
Maybe Dr. Osler defined and explained the cause of today's discussion of the behavior of the medical system toward their patients.
William Osler 1849–1919
Canadian-born physician
Look wise, say nothing, and grunt. Speech was given to conceal thought.
William Bennett Bean (ed.) Sir William Osler: Aphorisms from his Bedside Teachings and Writings (1950) no. 267
The young physician starts life with twenty drugs for each disease, and the old physician ends life with one drug for twenty diseases.
Aphorisms from His Bedside Teachings and Writings (1950, ed. William Bennett Bean)
One finger in the throat and one in the rectum makes a good diagnostician.
Aphorisms from his Bedside Teachings (1961)
The natural man has only two primal passions, to get and beget.
Science and Immortality (1904)
The desire to take medicine is perhaps the greatest feature which distinguishes man from animals.
H. Cushing Life of Sir William Osler (1925) vol. 1, ch. 14
Reproduced from
oxfordreference.com ..Maurice.
I'm not JR,I'm JF but I think mostly our desire for dignity we have been really clear about. Now that you mention it though there are MULTIPLE ways to belittle a patient or any person. By the way Dr B, Did you see the moon last night? It wasn't pink like it was supposed to be but it was AWESOME!
JF, no I didn't look for the moon last night though it was the first of two nights, the next is next month and is associated with the closer than usual distance between the earth and the moon. From Space.com: "April full moon is also called the Pink Moon, but it has nothing to do with its color. According to NASA, the April moon got its name after the herb pink moss, also known as creeping phlox, moss phlox or mountain phlox, which is one of the earliest spring flowers appearing in the United States."
What this tells us is that sometimes events we may experience may not be what we think they are and may represent something entirely different and unrelated from one thing to another.
That is why it is important that in the discussions about medical care vs medical "mistreatment" we should not make conclusions based on assumptions but not on what is actually observed. You all might disagree but not all "misbehaviors" are what are named as such and assumed to be ("pink moon") but are simply misunderstood by the patient (the moon isn't colored pink but only given a special name for its proximity to earth.) ..Maurice.
p.s.- I expect feedback with regard to my above analogy.
Maurice,
"What is actually observed?"
I see a patient who has not given consent to allow medical students perform intimate exams while the patient is under anesthesia;
Providers would say they see learning and patients obligated to allow it.
The American College of Obstetrics and Gynecology (ACOG) asserted in 1997 that patients have an obligation to participate in the teaching process
Patients would see RAPE.
Even despite someone else claiming to see something different, that does NOT change the patient's perception of the event, the negative effects (PTSD) from what happened, or the fact that these negative effects were preventable.
Because of the power differential, the providers MUST be held to a higher standard.
-- Banterings
Banterings, My best friend didn't even HAVE the cover of being under anesthesia when medical students barged in on her pelvic exam. And she wasn't asked about it in advance either. She was deeply harmed by it also.
Banterings is right. Providers and patients are not operating from the same definitions of what things like consent, privacy, and respect mean.
JF,
The moon was beautiful. As the moon wains, the view is still impressive.
My trans female friend refuses blood work and screenings and the doc that sent her inpatient has to deal with the mess that he created (my advice to her).
She recognizes that he had no control over what happened to her, but all she wanted is an acknowledgement (and an apology) that he did not listen to her and she trusted him. She is doing this to "punish" him.
He is very uncomfortable not having annual bloodwork and he feels he is failing her because she is refusing preventative care (screening, vaccinations, etc.).
She is not going to say anything to him, because if he does not see that he owes her an apology, then he will only be offended if she says something.
Your friend can invoke her rights under the ADA and by federal law the provider must comply. She is under NO obligation to prove (or even disclose by name) her PTSD (or other qualifying disability) either.
She should refuse an couple annual exams/paps and say that she is starting to have a panic attack/anxiety spiking/etc. because she fears that once it begins a bunch of medical students will come in the room (AMBUSH her) WITHOUT her being ask and (how she feels) sexually assault her.
Perhaps her gyn may get the idea...
-- Banterings
I looked at the ACOG article Banterings posted and was glad to see they acknowledged that it is not easy for patients to know which hospitals are "teaching hospitals". This is in reaction to the premise that patients know they will be dealing with students when they choose to go to teaching hospitals. Patients very often don't know.
VT & NH each have only one medical school and one large (400+ beds) hospital. Those large hospitals are the home base so to speak for those medical schools but those large hospitals also own some of the small hospitals and those medical schools are also sending students to some of the small hospitals. While I expect students to be around the large hospital I use for scheduled care, I am not in a position to know if or where students might be in my small local hospital.
The other thing is the premise that patients shouldn't go to teaching hospitals if they don't want students participating in the OR or elsewhere in their care. In rural states such as VT & NH, these two large hospitals are the only places where certain medical services are available. They are the only Level I Trauma Centers in each of these states, and they share a helicopter life flight system operated out of one of them. My point here is these two teaching hospitals are sometimes the only choice that patients have. A facility being a teaching hospital should not be a basis for not obtaining informed consent.
Dr B, The events may not be what we believe them to be? That makes me think about an article I read once that said, the opposite of love is not hate. It's indifference. I agree with what I read. Doctors who supposedly see exposure of most private parts in the same way as elbows, could be extremely harmful to a patient by exposing them to whatever family member who happens to be present. They could also display them by whoever happens to be outside the door when he/she opens that door or if another staff person is allowed to come and go without regard to the patients being undressed.
JF,
You are correct. Love and hate are the same; they are "passions." That is why you see people stay together in toxic relationships. Those knock-down drag-out fights are the same as love, passion. People in those relationships will tell you that the make-up-sex is the most amazing in the world. Unfortunately they destroy everything that they own to get to that point.
As you point out, so providers they may be sensitized and numb to naked bodies. That is why so many patients well if it is no big deal, show me your "elbow... no your other elbow... no, THE OTHER 'elbow...'".
Then it is a big deal.
The following medical humor illustrates this:
Question: What is the definition of a "minor procedure?"
Answer: A procedure performed on SOMEONE else.
-- Banterings
The following opinion piece was published in the NY Times yesterday, highlighting the pros and cons of telemedicine:
https://www.nytimes.com/2021/04/29/opinion/virtual-remote-medicine-covid.html
The author states that while virtual office visits are great for simple matters, there is also value in being in the same room, because studies show that patients are more likely to follow medical advice.
In the case of patients with modesty concerns or medical PTSD, I think that telemedicine is a great first step. After the patient, through virtual contact, has determined that the doctor will respect their privacy concerns, then an in-person visit can be conducted with greater confidence.
KB
KB, thanks for introducing a discussion about the value of telemedicine in the matter of preservation of patient modesty and dignity.
However, I can already see an argument regarding, previously presented by our commenters multiple times here, of video systems or photographs in which the concern is that "others could be watching live or looking later at an image." On the other hand, unlike a in-person office visit, the clinician may also have no indication of who "on the patient's side of the camera" who is watching, information which is obviously available to the doctor on an in-person office visit.
So.. what is your opinion of KB's topic? ..Maurice.
The barging in incident happened approximately 39 years ago when she was pregnant with her first child. Also she died in 2013. So that doctor evidently gets away with it.
Virtual visits are a good addition to the tool kit so to speak for those for whom physically getting to a doctor's office might be difficult. Here I'm thinking shut-ins, people w/o vehicles or friends/family in a position to drive them or readily accessible public transportation, parents in need of healthcare but for whom arranging childcare in order to go to the doctor's office is problematic, and people in rural areas who might live hours away from the doctor's office.
The limitation of course is that this option only makes sense if the "visit" only requires a discussion rather than an exam. Personally I would be suspect of the quality of any virtual visit that also includes a exam, but maybe it can be done in some limited circumstances.
As for patient privacy, I'm just saying no to that one for myself. No way am I taking off my clothes to be examined via an internet connection. Is it being recorded by the doctor? Is anyone else in the room with him? Does their system allow for other remote viewers such as students?
As an option for people living in rural areas it can only work if they have good internet or cell phone connections. Much of rural America is still w/o high speed internet and workable cell phone connections.
Banterings.
I don't think love and hate are the same. I just think indifference is loves opposite. The toxic relationship you described? That couple isn't in love. They are in LUST!
Dr B. Did you possibly have a certain incidence in mind? About a patient BELIEVING they were mistreated, when they actually weren't. Because if you're referring to the accounts we've talked about on this blog, the mistreatment is REAL.
JF, in answer to your question to me, I appear to have been very lucky or "very memory impaired" since I recall in my entire medical career (never sued) only one patient, a male, who was unsatisfied in my response to his chest pain of which I felt I had responded appropriately. It was such a benign background in medical care and my general other professional interactions and experience that led me right off in 2005 on this blog thread subject to suggest that my visitors with their complaints may have been statistical outliers with regard to the subject. I think I have been educated a bit otherwise now in the interim. ..Maurice.
And even 4th year medical students don't know what is going on with their teacher superiors personal behaviors to them and resident as the students go into their clinical rotations. Here is an experience by a 4th year female medical student:
The Implicit Consent of Touch in Medical Education
I may not have described my experience previously regarding "professional(??) behavior or even "misbehavior" as an intern:
My only experience of similar concern was when I was an intern standing at the operating table next to a surgical nurse and during the surgery, in anger with his yelling at that nurse, this orthopedic surgeon, across the table, forcefully threw the scalpel towards her . Fortunately, none of us was injured, I didn't speak up and the surgery proceeded but I have never forgotten this incident. ..Maurice.
Maurice,
One set of rules for providers, one set of rules for patients. That is what I see here. Medical students should be practicing on each other and specifically other medical providers (mandatory participating in their healthcare).
-- Banterings
Dr B, I predict that that orthopaedic surgeon received no consequences for throwing that scapel at his nurse. If he would have actually hit and injured her? He still wouldn't have received any consequences.
JF, there I was a "new intern" with, as I recall my first attendance at a orthopedic surgical operation and had never attended a prior operation with this surgeon.. should I have spoken up to him? I didn't. ..Maurice.
I don't know but I csn tell you I wouldn't have. If you would have spoken up YOU would have had consequences and he wouldn't. That's why I'm so sold on the idea of hidden cameras.
JR, if you are still with us on this blog thread, I am still looking forward toward your education piece tot the teachers regarding how medical and nursing students should be taught with regard to their relationship and behavior toward patients. I hope to be able to publish it on a medical education listserv to which I subscribe. ..Maurice.
Maurice
PT here. I do hope you are still giving thought to my suggestions regarding this blog and giving yourself a rest. You know, you've carried this torch for soo long, advocating, explaining, listening and yet the fact of the matter is for this subject, there exists no solution. The problem is so engrained in the medical community which really empowers one gender to discriminate against another so much so that most can't see that, even the ones doing the discriminating.
The pandemic has brought hidden blessings. Mainly public health officials, doctors, & providers are not following science and becoming megalomaniacs. They are destroying any "capital" they earned during the pandemic.
Society has had enough from them and is beginning to see them for who they are. They are holding them accountable to society's norms, mores, expectations and laws. Here is a prime example:
Judge Orders Hospital to Give COVID Patient Ivermectin
— Drug to be given to comatose Illinois patient after docs refused
-- Banterings
Banterings, but it was a physician who finally ordered the drug to be administered. I doubt the judge has any medical professional education or licensure to administer the drug him or herself. It was a physician who performed the controversial therapy.
PT, "no solution"? There is always, even in issues in medicine, a way to find and carry out a hoped-for solution. Do you think that JR and Misty, as examples, are wasting their time with their advocating and offering solutions? Is "hope" such an impossible response that it should be ignored? ..Maurice.
Yes, I am still around but sadly I have been more preoccupied lately as one of my cats has been diagnosed with lymphoma. I have been researching natural treatments along with conventional treatments and have been spending a lot of time at the vet's office with him. It is an all day event for chemo and he has had 3 rounds in the past week. Between the chemo, Flor Essence, and other supplements, he is holding his own and his lymph nodes are shrinking but his time is limited.
Yes, I am working on the research from a patient's perspective. I also want to include the information Misty has on Medical Patient Modesty as it is invaluable. I also have been doing a weekly radio spot with CS called Patient Partners along with still building my Twitter following. I have recently been tweeting and agreeing with physicians about restrictions on the scope of practice for NPs and PAs. I believe their increased activity poses a real danger to patients. Their use is more about profit which again gives proof the medical system is not patient friendly but rather profit motivated. The other issue with the use of NPs and PAs is there will be less gender friendly care to male patients.
By the way JR, are we and if not should we including doctors of animals and their relationship to the animal but also to the animal's owner in our discussing preserving patient dignity? When you are in with the vet, how do you evaluate him or her with regard to their behavior toward the animal (your cat, for example) or the animal's owner , you? Or are "vets" in a completely different class and "immune" for the criticism displays on this blog thread for the human health providers? ..Maurice.
Part I. Generally speaking, vets are more apt to provide for patient dignity including how they deal with the animal's guardian. I am not an owner. And no, vets are not "immune" from the criticism displayed on this blog thread.
Over the course of many years, I have fired several vets because I do not like their interactions with my fur child or how they interact with me. I fired one because his answer seemed to be "kill" rather than examining the issues and trying to treat them. Animals are certainly entitled to a life and we as animal guardians have a responsibility to care and provide for them and not "kill" them at the first sign of serious illness. We must investigate and weight the pros & cons and make an informed decision based on what is best for our fur child. Another vet had the same attitude plus he would not make eye contact with humans. Neither of these 2 vets gave true informed consent meaning they did not give the treatment options and risks so a true informed decision could be made. Both were male vets.
A pair of female vets treated one of my pups in an abusive manner as he resisted them so they punched/kicked him in the nose which started a massive nosebleed. I got a call saying come and get him as his nose was bleeding. He was a mini. schnauzer. Needless to say, that was the last of them and I always tell everyone abt them so that has cost them a lot of business.
Vet techs are another area that provides care. I have had good and bad care. I will specifically say I do not want so and so involved in the care if warranted. Recently, I had one say my cat Jimmy fought her so I reminded her he is a cat and that is what a cat will do when scared. I told the vet and I haven't seen her there. Also, at the same office a female vet without any proof told me my main cat, Jack, had cancer. I knew he did not as the lump didn't fit the definition of cancer. I had to fight with her to get the proper med. The med took the lump down within 24 hrs. On return visit, I told them I would accept her as Jack's dr. I had to take my one cat Danny, Jimmy's sister, to the airport ER where Dr. S is bc the vet wouldn't see her for 2 wks. Dr. S said that was unacceptable & he called them to talk with them (Dr. S. is a big deal here in Indy). She is no longer there. Although the current vet got Jimmy's diagnosis wrong, he acted with compassion and I know he did the best he could and that is apparent in the manner in which he acts. He gives the options/risks so we can make an informed decision. With him, I always ask his opinion because I value his opinion bc he is sincere and caring.
The current vet is one of the few if not only oncologist outside of Purdue in Indiana. She is very nice. She takes the time needed to explain and re-explain if needed. She talks abt her personal animals letting us know her experience is just not clinical. She talks abt what is best for Jimmy and asks us if she has any questions abt Jimmy. For example, she thought Jimmy might have had a brain function disorder as he went psycho with them. No, that is just Jimmy when he has had enough. She noted that and said in the future they would be more careful not to stress him out. The techs are wonderful. So much info coming at us, they are more than willing to explain and answer questions. They talk with Jimmy and act as if he is really important. I have even talked with them and showed them pics of Jimmy's housemate cats which is something I don't normally do.
While patient dignity for animals doesn't have so much of the genital dignity involved, it does require them to have an even deeper sense of compassion and sincerity in their interactions with animals. Animals cannot talk but they have mannerisms in which you know how they feel about certain humans.
Part 2 My one dog, Wally, loved Dr. S. He would actually go in for his chemo and hold up his chemo for Dr. S. One time, he growled at a tech (Wally never growled as he had the most gentlest soul of anyone) & Dr. S. just happened to walk by as the tech was getting frustrated w/ Wally. Dr. S. told me he corrected the tech & called me immediately to get Wally out of the holding cage so he wouldn't be stressed. When Wally died from the 2nd round of a stronger chemo (Dr. S. warned that could happen) he was devastated. He quit private for a while even though I made it plain I did not blame him. When I got another schnauzer, he came back to see him and started private practice again as time does heal some wounds. As he is far away, I went locally for care. But when Reilly had a violent reaction to a vaccine and the vet said they had no idea what to do, I called him and he told me to go in and give them my phone so he could talk to them and tell them what to do.
When the pups were being born, he stayed on the phone with me for hours and hours and wouldn't take a dime. I made a donation to the shelter. He then saw them for their first dr. visit. As far as heroes, Dr. S. is what a real hero looks like.
With the new vet, I tell them each and every time how wonderful and caring they are. I don't just tell someone when they are horrible. I believe it is even more important to tell them when they are exceptional because hopefully they will continue that behavior with each and every person and animal they come in contact.
As I have said before, human providers should take compassion lessons from vets. Vet's direct clients cannot put into words what they are feeling. Vets have to be more sensitive to the animal's needs. They have to be sensitive to our needs as we are worried and often have no clue. It is a slippery slope which many vets and staff have learned to scale well. Most vets when informed abt a staff person's actions will take steps to rectify it whereas the human providers do not. So the bigger question is why do human providers seem not to care abt the overall well-being of their clients or in other words how their services are delivered to the client?
On an entirely different note, this week I called my husband's cardiology office to tell them about the MA who provided care to my husband. I wanted them to know how compassionate and polite her behavior was. She explained and asked for permission before touching him. She warmed up the leads. She told him she would do a special thing to make sure that wouldn't hurt taking them off. She didn't order him to strip but rather explained the need for the EKG and asked if he was ready. She didn't try to touch him until it was time. He kept his shirt on and was able to control the opening and closing of it. To some, this seems like a small thing but for him it was a huge victory in retaining control over his body after having been sexually assaulted. For him it is now very traumatic to be in any state of undress in the presence of a female medical worker. He still have a somewhat elevated BP but not nearly through the roof like in the past with them. I gave the doctor more of the brochures from Misty and talked to him about the COVR garment. He is head of cardiology at this hospital system. I told him cardiology is a specialty high on the list to cause unnecessary patient exposure which cause traumatic mental injuries to patients. I reminded him that physical saving a patient isn't enough if they cause such mental damage a patients will not return for more care. He said they do most all cardiac cath through the wrist but I reminded him that patients are still exposed if the policy is still to prep the groin if the wrist(s) does not prove to be viable. I reminded him the importance of not taking away a patient's right to control their body and being more to the point, their personal bodily dignity. He said he would like to discuss it further.
JR, please update us on the cardiac cath prep discussion if you hear anything more on that. The standard protocol of doing groin prep on the off chance using the wrist doesn't work seems needlessly cruel. To knowingly embarrass patients in this manner is just wrong. They might as well post a sign saying staff convenience is the only thing that matters, not patient privacy, respect, or dignity.
October 14 2020, I had 4 coronary vessel stents placement via inserting in my right groin. To me the issue is a satisfactory clinical procedure with results. My view in serious situations such as the prompt need for repair of coronary vessels is efficiency, safety and the modesty issue is trivial contra-issue. What is missing in those patients worried at the time of the procedure about modesty are missing the basis for the clinical decision to accomplish the goal safely and effectively when a patient's life is at stake.
There has to be a "proportionality" when it comes to the introduction of patient modesty in the treatment of life-threatening condition repair. ..Maurice.
Dr. B.,
I disagree. There are garments specially devised to provide for patient modesty/dignity even during ER procedures. The COVR garment or something like it should be standard issue for all hospitals. There is no justifiable reason for it not to be. Yes, saving the patient's life is of upmost importance but I think you and other medical providers are missing the huge point that it can be done while still providing for patient dignity. For patients who's lives may be saved their future health may be in question as they may not seek future care because of the mental trauma incurred because the medical community gave no thought to their mental health ie. respect to their bodily privacy. If you disagree with me about the vital importance of how the actual physical delivery of treatment is provided then you fail to understand the concept of humane delivery of health care services. Patients do not have to give up the right to bodily dignity in order for their life to be saved especially in cardiac cath situations. Maybe if they are a victim of severe physical trauma and there is a need to uncover the entire body but the exposure of the genitals in cardiac cath situation is not necessary even in ER situations. It is done because they can do and get away with doing so. The exception to this would be if the patient is incontinent then they may need to foley cath them or if the patient already has a foley cath. Patient dignity is NEVER a "trivial contra-issue." If you believe that, you as are as Banterings would say "Part of the problem." Always patient dignity must be respected. I saw you used the term "modesty" which infers blame on the patient for needing special accommodations rather than bodily respect most hospital Bill of Rights guarantee. Respect of bodily privacy is not a modesty issue. I don't care if a female nurse is exposing a female patient etc.--if the exposure is not absolutely necessary, it should NOT be done. Don't confuse the 2 situations as they are totally different. Don't "save" a patient's life only to lose them because how you saved so traumatized them they won't ever seek care again. This is a point many medical providers have missed/have no clue about and it seems you may be part of that crowd. It is not a patient's fault if they do not understand they do not have to be exposed unnecessarily for the staff's convenience but rather it is the fault of the staff for not understand patients even ER patients are humans entitled to bodily privacy.
Biker,
I will as now that some COVID restrictions have been relaxed I intend on following through with this. As I said, husband's doctor is the head of cardiology at a very large hospital system and he said exposing the groin isn't done as they do radial procedures. I reminded him it is the protocol of many to prep the groin just in case the wrist was not a viable route but he seemed to think this wasn't done. I will be following up with him about this as I will also be talking to others at the hospital system. The shave for the cardiac cath per groin is overkill at best anyhow. It is something they have been allowed to silently do for years. I have an emergency C-section and no shave was done and I survived--no infection. They just slapped some yellow stuff on me and said "good enough." I remember seeing all the dust flying from the light above worrying more about that than my own germs. Cardiac cath also shaves the thighs too just in case you wanted to know in case they need to use IABP or temp. pacemaker.
Dr. Bernstein, my understanding is that most cardiac caths are scheduled procedures rather than emergency procedures. I also understand that most of those scheduled caths are via the wrist and that going in via the groin only occurs if using the wrist doesn't work. Prepping the groin ahead of time so as to save the doctor a few minutes on the off chance the wrist doesn't work is putting the doctor's convenience ahead of the patient's privacy and dignity. It is a cruel practice and renders all those "we treat the patient with respect" statements meaningless.
Dr B. Most instances of dignity violations are NOT life and death circumstances.
I have in the pat posted about the fact I was sodomized at age 20 by a female aid and nurse. I have made it perfectly clear to my current doctor that I would never have surgery under any circumstance due to 1] a known serious life threatening reaction to any form od anesthesia and 2] any surgery involving females or nudity. At age 75 I will not agree to any contact with female staff. What everyone including Dr. Bernstein is that the trama lasts a life time and as such decisions are made irregardless of others'opinions; doctors included. I have been ridiculed, demeaned, and humiliated by the "humanitarian efforts of correct thinking doctors to known the medical profession is made up of a group of power crazy males. My opinion, and I will stick with it and if any doctor gives a lecture. he has his pedigree read and thrown out. I intend to died without the help of any doctor. I only use a doctor to get information I need to made decisions. I am not interested in what the doctor thinks. Medicine is just a bunch of "good ole boys" club like banking, military,law,religion, politics. A well known doctor in his field, who along with his wife were friends and clients of mine said the medicine is only an educated guess. A number of my closests friends are well known PHDs in medicine and there regard of the profession, institutions, persons, and professionalism at this time is that all is at it's lowest level currently. They are also angered by the stupidity of profession, ancillary staff, and all forms of management which they find poorly educated, money oriented only, rude, and .lacking proper social skills.
Mitripopulus, and yet we teach medical students that the patient and the patient's illness are the SUBJECTS of the professional relationship and NOT the OBJECTS. Being an "object" totally dehumanizes both the patient and the illness. So what happens later in the 3rd and 4th years of medical education and beyond, it is possible the teaching is hidden under the pressures of the medical or surgical "workload". What is missing is adequate supervision and indoctrination during these pressures that the assumed relationship is never to become one of the physician, nurse or attendant looking at the patient, the patient's disease as some "objects" and treated as such. I think this ignorance of this distinction is the basis for most professional-patient errors and damage. ..Maurice.
JR,
I believe vets are generally better healthcare providers (all mine have been excellent). I believe that they generally don't care for humans to begin with and they see injuries to innocent animals at the hands of the worst of humanity.
I posted this on my Twitter; "Grieving Cat Comforted by Doll After Her Kitten Dies". Humanity shown by our animals. This will bring tears yo your eyes.
Mitripopulus,
So eloquent and accurate. Thank you for your participation and presence here.
Maurice,
Yes a judge can order a physician to do something or hold him in contempt of court. The profession of medicine exists WITHIN our society and thus bound by society's norms, mores, expectations, customs, and laws.
Anyone who believes that dignity gets in the way of healing should never be allowed to touch another human being.
The pandemic has shown that the profession of medicine's answer is "because I am a doctor and I say so." The promise of normalcy with the vaccines and yet Fauci and others still pushing masks and distancing.
Power corrupts, absolute power corrupts absolutely...
Even before the pandemic, Americans' trust in science was waining.
So, will public trust in science survive the pandemic?
Public health officials and “academics” continue to promote Covid-19 fearmongering over factual reassurance.
Society is fighting back: The Supreme Court reaffirms that COVID-19 regulations must comply with the First Amendment.
Society is codifying this as the push to limit public health authorities continues.
We see society triumphing over officials who issue edicts that circumvent the legislature.
Even you (Maurice) admit that the 3rd and 4th year of the medical education kills empathy and creates medical monsters.
Medical trauma is finally
-- Banterings
Oh! I just found my bioethics blog thread from 2015 which fits rightly into the issue of preservation of patient dignity:
"Commercial Surrogacy": Women'$ Bodie$ as Container$
Here is my Introduction to the Topic. You can write your response here on Volume 118 but also write to the blog thread itself which is currently being "looked at" by my visitors there. ..Maurice.
The title of this blog thread " 'Commercial Surrogacy': Women's Bodies as Containers" with the plural expressed with dollar signs may be a bit over descriptive but yet it emphasizes a commerce present today which is utilizing local women or bringing foreigners into the United States and elsewhere to directly participate in the pregnancy and delivery another family's genetic child. The question is whether this is a fair utilization and commercialization of a woman and her body and whether, after delivery and she is no longer a container for the pregnancy, she should be allowed to maintain some relationship to the child and the child's family.
This topic is, I think, very nicely described, in a paper by a PhD student Hannah Giunta on the Michigan State University Bioethics website. The ethical and humanistic point which is stressed by Ms Giunta is "Commercial surrogacy arrangements where prospective parents possibly supply the raw ingredients, sign a contract, and return for pick-up with the intention never to see the surrogate again require women to do fundamentally relational work without relational support or respect. Effectively, couples are saying,'You’re good enough to carry our child but not welcome as part of our family.' It’s this attitude that is unacceptable."
What I would like to see discussed here on this blog thread is both the ethical good or bad of this form of commerce but also Ms Giunta's concern that if such use of women and their bodies is socially and legally acceptable whether something more should be offered to these women: acceptance into the newly born child's family as a family member. ..Maurice.
Dr. Bernstein, I realize the extreme personal and emotional aspect of surrogacy, but society has said women have control of their own body, and so a woman is free to choose to use it for surrogacy. I have a cousin whose daughter is an extreme women's rights advocate, and she served as a surrogate for a gay couple. She and her husband are upper middle class professionals, and so this was not an act of desperation for a poor woman. Whether she has any relationship with those guys I don't know.
Even if done for the money, her body, her choice, and that can include whether she wants a relationship afterwards. If she wants a relationship afterwards and the bio-parents don't, they can find a different surrogate.
Biker, it would then appear that the surrogate is setting her own definition of patient dignity for herself. I suppose that this then represents preservation of her own dignity since her role in the exercise is of her own making. ..Maurice.
While women constitutionally and judicially have the right to decide what happens to their reproductive organs, there are still in many instances where this is denied and seems to be acceptable. If a woman who is pregnant is taken to a catholic hospital as an ER case and her intention is to have permanent birth control in place (ie tubes tied) that catholic will mostly likely deny her right. Furthermore it is acceptable under the law the catholic hospital does not have to follow the law. Isn't it very strange that women have the right to abort babies under the law but a patient who has refused a surgery and/or drugs doesn't have that right under the law? What is the difference? Why aren't patients rights as popular for activist groups as the killing of a baby? This should be huge red flags that society should be heeding. The most defenseless part of society (a fetus) has no one protecting their rights such as the right to life. Defenseless (especially elderly and/or sedated) patients also have no one protecting their rights such as bodily dignity and autonomy. Shouldn't this be a severely troubling sign the medical community seems to gravitate towards the harm of the more defenseless? What does this say about catholic hospitals who intentionally ignore a woman's right to choose what happens to her body? Doesn't that point out they are willing to ignore any patients right to choose what happens to their body? Why don't aren't the double standards in medical care and delivery of ever addressed? My core belief is everyone has the final say as to what happens to their body. If a woman is willing to kill a baby because she was irresponsible in preventing the conception in the first place, it is telling of what of person she is. Dr. B., you have often said it is questionable if the good of one should not harm another such as in th delivery of medical care. What is your opinion of medical providers who willingly kill another human being such as baby just because they happened? If you believe this is acceptable then you must also believe COVID shots for everyone should not be. You must also believe no one else is responsible for the welfare of anyone else. Do you also believe medical people have the personal right to decide if they will deliver medical care or not such in the case of a woman wanting her tubes tied but a catholic doctor refusing to do so.
There is a case on Twitter by @medclit abt a doctor refusing to remove an IUD as he felt the woman should have no more children. Is this acceptable? Does this same doctor perform abortions? Would be interesting to know. It is right for this doctor to dictate this woman is sentenced to birth control? Do we or do we not have control over what happens to our bodies? Apparently not but what are the conditions or stipulations? Are they written somewhere? Big question is why is it acceptable that men have lesser control over what happens to their bodies?
Another question is when a female accuses a male provider of inappropriate actions it is taken more seriously but on the flipside when a male patient accuses a female provider of inappropriate actions is viewed being false or even humorous? What the double standard? Can't women even gain equal rights as being viewed as being just as vicious and malicious as men in committing crimes especially those of a sexual nature?
Yes Dr. Bernstein, a surrogate such as my cousin's kid is defining dignity for herself. A poor woman doing it for the money might see it in different terms, but it is still a choice she is making vs other options. I pity any man who would have dared to tell my cousin's kid what was dignified or not as concerns her being a surrogate.
JR, except for certain communicable diseases, patients (or their legal surrogates) have the right to make their own clinical decisions. The medical system has the responsibility to help the patient find a resource (if one is available) to carry out the patient's decision rejected by the current physician. If conflicts persist, it is up to the court system to make a final decision. I am aware that Catholic hospitals who, because of religious doctrine, will not perform a gynecologic-obstetric procedure, still maintain the clinical and even moral responsibility to facilitate the transfer of the patient to a hospital willing to accept and treat. ..Maurice.
Yesterday, I wrote the following to a bioethics listserv to which I subscribe and participate. I titled it: CDC Stepping on a "Hot Potato"?: "Off With the Mask"
Is this a medical-ethical or purely political issue? One example of published concern regarding the CDC's current "off with the mask" decision:
https://www.medpagetoday.com/infectiousdisease/covid19/92596
Should ethicists step in here?
..Maurice.
Dr. Bernstein, that mistakes were made, especially early on when there were many unknowns about the virus, is understandable. What disappoints me is that it doesn't seem that there has been any learning along the way about how to manage the messaging and the actions taken by federal, state, or local authorities.
If ethicists are to get involved I would advocate it be from the perspective of pushing for a science-based handling of public health emergencies in the future rather than politics such as we have seen for over a year now. They endlessly say "following the science" yet the science changes as soon as you cross state borders. We've seen federal science different than state science and even city science different than state science. From where I sit it seems it has all been managed in accordance with the whims of politicians. Whether this latest CDC change concerning masks is science-based or political is anyone's guess.
In less than half an hour I can be in NY. NY science deemed it safe to send infected people into nursing homes. VT science said it wasn't. NY's death rate per capita is 2nd only to NJ's. Only Hawaii has a lower death rate than VT, and we were flooded with people fleeing NYC & NJ last spring. The underlying science is the same of course here as there but it was the politicians calling the shots that were different.
Science would have looked at things like HVAC systems, separation spacing & density requirements, indoors vs outdoors, masks, disinfecting protocols etc when making open vs close mandates, yet that isn't what happened. The mandates were instead based on the products & services being sold or the activity itself. It was if they thought the object or service being bought was the determining factor for viral transmission. Essential vs non-essential choices (which greatly varied state to state) were often nonsensical. Not tying mask guidance with vaccination or local infection rates is just more of the same.
Ethicists should focus on the harm done by allowing politicians and whatever their motivations were to manage the pandemic in lieu of using science. How many people needlessly died? How many kids, especially the poor kids, were needlessly harmed in terms of their education? How many livelihoods were needlessly destroyed? How many cancers and other serious health conditions progressed due to routine care and surgeries being shut down? Many healthcare staff were laid off for lack of work. They weren't all diverted to covid patients. So yes, ethicists should weigh in on what the non-science based handling of the pandemic has done.
But that is just it, if a woman is taken to a catholic hospital in an ER situation and she delivers the baby, they will not perform a tubal. In refusing to do so, they are subjecting her to another total unnecessary and dangerous procedure bc they believe their religion gives them the right to medically control what happens. Catholic hospitals should either be private hospitals (meaning they do not accept true emergencies) or they should suck it up and provide full medical care. This is part of the double standard in healthcare I have been pointing out that personal and religious beliefs do interfere with healthcare. Medical providers do bring their personal biases into healthcare and it does result in patient harm.
One would think a catholic hospital would be more apt to allow patient dignity as they are advertising they are compassionate and operate within christian values. The catholic hospital from hell says: "We respect you privacy and dignity" in multiple place through their patient handouts. They also say they "want to make your stay as pleasant and worry-free as possible" but what is said is not what is done. All of this is false advertising because they do cause real harm. They cause harm by the privacy rape of patients. They can cause harm by causing a patient to have to have another separate procedure when it was not necessary. They generally cause harm by the very fact they lie. The catholic hospital from hell is also involved in a lawsuit for denying treatments to LGBTQ persons which is morally wrong. What type of treatment do these people receive when going to these type of facilities in an ER situation. I can tell you a story about that.
As I have said, if hospitals cannot provide full service to all clients, they should be private hospitals and receive no federal funding.
Many female providers bring their personal bias into how they deliver healthscare to male patients. Many female providers have views of male patients such as 1) male patients do not have bodily privacy concerns 2) male patients are sexists and deserve to be unnecessarily exposed bc for many yrs females have had male providers and/or have been molested by male providers 3) female providers believing they are entitled to be judge and jury to "punish" male patients either for generic sex crimes or because the female provider has suffered sexism/harassment by males within the medical system 4) they believe any patient must suffer through however the medical care is delivered.
I wanted to encourage everyone to check out our new video, Unnecessary Pelvic Exams, Pap smears, and Breast Exams By Male Doctors.
Misty
Great video Misty. Thanks for all the work you do.
\JR, excuse me but I just couldn't wait for your presentation on education of medical students which appear to be missing and need to be developed and carried out. The following is the first of three postings I made to a medical education listserv. All were made under the title of "Blunting Occam's Razor" in Medical Student Education" and was presented as follows:
Is there a tendency in medical education to aim for simplification of the differential diagnostic possibilities of the complex symptoms of an illness but also the social (doctor-patient-other healthcare provider) relationships
(an "Occam's razor" approach)?
On the other hand, Is there a "hard truth" teaching and learning (avoiding primarily stressing some easy "Razor" clinical or social aspects of medical diagnosis and the system's patient care)?
I understand that it is more challenging in teaching to spend time in complex details rather than simplification. What is your view?
This second posting was:
What I am learning from my visitors writing to my Bioethics Discussion Blog blog thread which has been going on since
2005, moving from "patient modesty" to "preserving patient dignity" is that there is a failure in the way both male and
female gender patients are treated by the medical profession. It seems that, by their experiences, told to the thread
year after year after year since 2005 there is a problem in the area of misbehavior or worse by one or more of the professionals
who attend them, from doctors to nursing staff to techs. In my introduction posting here I wrote: "Is there a tendency in medical education to aim for simplification of the differential diagnostic possibilities of the complex symptoms of an illness but also the social (doctor-patient-other healthcare provider) relationships (an "Occam's razor" approach)?"
What I was getting at is that the latter concern is to propagate to medical students that they are entering a fully "professional" profession which pays attention to perform and act the "best" for each patient. But it appears, based on the years of blog visitor comments is that this "Occam's razor" assumption is for the most part totally wrong. Their experiences disclosed on my blog
thread suggests that students should be educated that they are going to witness misbehavior or worse on the part of their superior professionals and assistants toward patients (leading even to patient PTSD). If no professional or student will "speak up" about what is occuring, I suggest this might be motivated by inadequate medical student education in this regard. Yes, "Occam's razor" simplification of the realities of professional behavior (actually "misbehavior":} ..Maurice.
p.s.-more to come
And finally one more posting to the medical education listsev:
I just wanted to add the following to my last posting. Back in the earlier years of the Patient Modesty thread presentation
on my Bioethics Discussion Blog, I thought and expressed the view on my blog, that all those "negative and harmful
experiences" expressed by these writer patients were that the writers simply represented "statistical outliers" to the way patients
are actually treated by the medical profession. In recent years, with more and more personal bad experiences by my blog
thread participants and with attention to the news media repeated documentation of the bad or "worse" behavior of members
of the medical profession toward their patients, I am beginning to wonder if defining my blog readers and their personal experiences
as "statistical outliers" is not realistic. This change in my evaluation of their reported experiences has just increased my
concern that perhaps, as instructors of medical students, that we are not warning our students, in patient clinical settings
to be on the alert and be concerned and to "act" if they witness professional to patient misbehavior.. This is my basis for
finding the need to "blunt" applications of Occam's Razor in student education with regard to the behavior of the professionals they will
be encountering as they fully move into their profession. ..Maurice.
Dr. Bernstein, in your bioethics posts that you copied for us to see, you use the word misbehavior. I suspect most construe that to mean purposeful behavior. Certainly that occurs (Twana Sparks, Denver 5 etc) but misbehavior isn't the right word to describe the needless exposure and lack of respect for patient dignity that patients experience every day in every hospital. This is where the definitions used by healthcare staff of what privacy, respect, and dignity means differs greatly from what patients see those terms as meaning. They don't see what they're doing as falling under the heading of misbehavior, thus my word choice concern.
Specific to intimate exposure, it means minimizing exposure in terms of extent, duration, and audience. Repeating a very simple example I've used before, healthcare staff see covering the patient's genitals after lifting the gown in order to examine the patient's abdomen as minimizing exposure given they promptly cover the genitals with a towel or sheet. Patients don't see it that way given there was no need to ever expose the genitals at all. The genitals could have been covered over and then the gown lifted from underneath in order to examine the abdomen. Somehow the training of doctors, nurses, techs etc. never includes what the words minimize or necessary mean. Somehow they finish their education & training thinking that so long as they are polite they are being respectful of the patient's privacy and dignity.
The other major definitional disconnect concerns gender. Healthcare staff say medicine is gender neutral and purely clinical but then they treat male patients differently than female patients when it comes to intimate matters. Many in healthcare, especially the women,see it differently when they are the patient as well. Yet they expect male patients to simply accept the gender neutral, purely clinical mantra. Again, how do they manage to complete their education and training without ever talking about this rather massive "do as I say, not as I do" disconnect.
Biker,
What is lost here is the patient's perception is not dictated by anyone other than the patient. The argument made on the topic of intimate exams on anesthetized patients without consent in the patients and those of us who have been patients is MEDICAL RAPE to us despite the fact that the profession of medicine says it is not sexual. How dare anyone tell me that my feelings are wrong. It is your fault because you (the provider) are making the procedure feel like rape.
-- Banterings
banterings, healthcare staff can't dictate patient perception, but they can function in accordance with some very simple to understand concepts. Minimize exposure in terms of extent, duration, and audience. Treat anesthetized or otherwise unaware patients with the same degree of respect as would occur were they aware. Obtain informed consent. Recognize gender-based concerns.
How many female doctors would want a group of medical students giving her a non-consented vaginal exam after she is anesthetized? How many male doctors would want that to occur to their wives, daughters, sisters, & mothers?
These are not obscure or difficult concepts. Acting on them would go a long way towards improving patient perception.
Some doctors do want to share their own personal medical stories with their patients and the patient's worries or condition and that is called "empathy". Here is a physician expressing his feelings and experience with his patients:
https://www.medscape.com/viewarticle/948391z"
Do you find something wrong with your doctor expressing their own story and concerns about his or her own medical illness and symptoms in response to your own personal concerns? ..Maurice.
Dr.Bernstein, I like that doctor's approach. He humanized the transaction in a way that the patients felt heard.
Yes, Biker, I am sure virtually every doctor has their own medical story to tell and to integrate it into a sign of empathy relative to the patient's own feelings and concerns. However, there has to be time for this disclosure to be going on without sacrificing needed evaluation and care of the patient. And, also.. the patient has to understand the basis and the patient's personal value to be listening to the doctor's personal story. Will the patient simply think "that doctor is wasting my time and I came here to attend to my problems and not his (or hers)."
In my opinion, as I have indicated in previous titled blog threads, a physician showing true empathy (a real personal experience relative to the patient's own distress) is a therapeutic tool itself.
..Maurice.
Biker,
I am referring to statements made by physicians to patients that it is healthcare education and not rape.
I think that as part of the licensing renewal process that licensed healthcare providers must allow one healthcare trainee a year participate in either their annual exam or an invasive healthcare procedure.
This is inline with bioethics in the concept that the current generation of providers is responsible for training future generations of providers.
State law should have participation of medical students for licensed healthcare providers to be opt out and for non-licensed healthcare providers to be opt in (due to the special training that they receive as part of their medical education).
Read The dehumanization of the patient by Abraar Karan in the BJM. My point made.
Note: Abraar Karan on BJM has some excellent articles that paints a real picture of modern healthcare. Follow the links in his articles.
-- Banterings
Here is a really great example of how providers are squandering any goodwill they have earned during the pandemic.
Not to Message the Public on COVID Vaccines
The paternalistic arrogance is sickening.
In no case should a collective community agreement or the consent of a community leader or other authority substitute for an individual’s informed consent.” - UNESCO documents on Medical Consent in Bioethics and Human Rights, Article 6 (2010)
-- Banterings
Banterings, thank you, thank you, thank you! ..for presenting that link to Dr. Karan's article for us. I read it and then wrote the following to the medical education listserv to which I subscribe.
Is Medical School Education Leading to Dehumanization of the Patient?
Sat, May 22, 2021 9:26 pm
Maurice Bernstein (doktormo@GMAIL.COM)
Moving on from concern that current medical school education may be utilizing an Occam's Razor focus with regard to disease but now to a similar simplification of the patient as a patient with a clinical disorder ("the gallbladder in room 305") and not as a distinct individual who now happens to be ill:
I am pleased to present a link https://blogs.bmj.com/bmj/2019/10/16/abraar-karan-the-dehumanisation-of-the-patient/ to the BMJ Opinion article by an Internal Medicine resident who sees a defect in how physicians look at their patients. The article starts out with:
“It is much more important to know what sort of a patient has a disease than what sort of a disease a patient has.” William Osler, the “Father of Modern Medicine”
On a warm summer morning in the hospital, “Mr P” sat in the recliner chair in his room waiting for his medical team. Today was different, however. He was no longer wearing the usual orange hospital socks, or his teal hospital gown. Today, Mr P had laced up his dusty black sneakers. He had pulled his grey hooded sweatshirt on over a T shirt and regular blue jeans. When we arrived, he looked up at us (we were quite surprised—I personally wondered if he was planning to leave against medical advice) and announced, “I put my own shoes on today, and my jacket. It made me feel just a bit more . . . like me.” Who knew that such a small fix could make such a big difference in the way he felt—and yet, it should have been obvious.
and concludes with:
I fear that we are operating in a healthcare system that primes us to see people as patients, when what we need is one that reminds us that patients are in fact people. As much as we try to make health systems more cost effective, of higher quality, and more accessible, we must do even more to make sure that they are humane, patient centered, and ones in which Mr P can feel a little bit more like himself.
Read the entire brief presentation and let me know if our current view of a patient primarily as a "patient with disease" is another Occam's Razor teaching simplification error that needs attention. ..Maurice.
I think this issue of how students are taught regarding patient vs disease is important in how the students are going to behave when they become physicians and faced with a patient (not only the disease). Again, Banterings..thanks. ..Maurice.
Banterings, I would love to see medical and nursing schools incorporate opposite gender exams of students. So as to keep it anonymous and similar to the real world, the examiners don't have to be their classmates. The examiners can be from other classes or even other schools where that is an option.
I am in favor of this because I don't think most newly minted doctors & nurses understand what it is like to be a patient. Learning some empathy early on will make them better at their trade.
There is 0% chance of this ever happening however because medical & nursing schools and their students know medical care is not gender neutral and they want to avoid embarrassing their students. If they truly thought it was all gender neutral and that medical care was entirely clinical, neither the schools or the students would object.
Our medical students, as I have previously mentioned, do examine each other in mixed genders but as first and second year students they do not perform genital exams on each other nor on patients. If you want to have the students experience a week of their life as patients then it would be more appropriate to delegate a week during their more free fourth year to become a patient in a hospital for a week and be subjected to the routine workup and nursing care all patients experience, attended to by physicians, nurses and techs of both genders. As I have mentioned this before somewhere amongst my blog threads, a residency program at a local hospital for a week was actually in practice. There is no reason such a teaching experience could not be arranged as part of the student's final schooling experience before they enter residency. I think my suggestion is more realistic to what we want to teach them. Having one student do genital exams on each other teaches nothing with regard to professional behavior, both in clinic and in hospital, they will be expected to follow later on in their careers. My suggestion is more realistic for education regarding the students' bodies and emotions. ..Maurice.
Dr. Bernstein, doing it in their 4th year is fine and even perhaps preferred in that the experience will be more recent before they are working on their own. Given most hospitals will automatically defer all of the intimate care for female students to female staff, there would need to be some parameters in place requiring students receive care from both male and female staff. This would be especially the case for lower level activities such as bathing/showering.
I realize most students will find this to be needlessly embarrassing but it would be a valuable lesson towards learning some empathy for their future patients. Simply telling them in class to respect patient privacy is too theoretical. They don't really grasp what that means. We see this in the casual manner in which patient intimate exposure is generally handled.
I am getting a host of responses from medical educators relative to my suggestion of having 4th year medical students being put into a hospital bed as part of their education of "life for a patient in the hospital". One response is from a physician who put first year residents (interns) in his institution immediately into a hospital bed for a overnight experience as a patient.
The practice is detailed in this audio interview
..Maurice.
Dr. Bernstein, I listened to that podcast and I would term that doctor's program of having Residents spend a night in the hospital as patients is a good start, but it does not go far enough. The doctor said they set up the program so that the Residents would not experience anything uncomfortable or embarrassing. That is not going to teach them any empathy for real patients that they themselves are going to make uncomfortable and embarrassed.
At the end he said that in the morning the residents will be discharged as patients, they'll take a shower, get dressed, and then go about the rest of the day. Something as simple as not discharging them as patients until after they've showered (with an opposite gender CNA assisting them) would make a much more realistic experience, one that they won't likely forget.
What those Residents get is a sanitized version of being a patient.
Maurice,
They should get the full treatment like a bed sore check, a nurse watching them shower, an IV by a nurse having their license less than 6 months (if real patients have to endure, so should students), or a catheter by the opposite gender?
This is purely window dressing like saying I took an oath to do no harm...
Read: The Mammogram Assault!
Putting doctors (like Flip-Flop-Fauci) in the spotlight during the pandemic is only helping to accelerate the inevitable: complete loss of trust in the profession of medicine.
Most people who work in hospitals know that the virus was probably "tinkered" with and definitely escaped from the lab. The coincidence that a lab in Wuhan was studying bat corona viruses and one jumps species in a market in that very city is laughable.
The CDC, all those public health doctors, etc. fell back on the paternalistic "I am a doctor and I say so [are you a doctor?]". Even the current administration used this paternalistic approach in the press briefing by Press Secretary Jen Psaki, May 25, 2021:
"Well, I think, Annie, as you’re not a public health expert, I assume — neither am I..."
This has caused the public to lose trust in public health officials
-- Banterings
Maybe we need more "modest" doctors. Go to the Feb. 22 2008 blog presentation titled
Is Being a Modest Doctor a Virtue and a Benefit for Their Patients?" Particularly read thee posting by TS at the end of the presentation. Sounds like what one of our current contributors would write. ..Maurice.
Maurice,
If there is one thing that the pandemic has demonstrated is that there is one set of rules for thee, and one set for me(those in power). Michigan Governor Gretchen Whitmer and California Governor Gavin Newsom (dining), and House Speaker Nancy Pelosi (hair salon) are just a few of the examples.
Despite a physician being modest, that does not mean that the physician will respect the patient's modesty/dignity.
This thinking is no more evident in the profession of medicine that the joke; What is the definition of a minor procedure?
One that is performed on someone else...
-- Banterings
Dr. Bernstein, the comments by TS make abundant sense.
In other news, I have commented before about the hospital I get all of my scheduled care at seemingly being more aware of gender issues than most, except for Dermatology that still struggles with the concept that not every man is OK having a female scribe and a female LPN observe his full skin exam. I went for an annual wellness exam today with my primary care provider and it was a male Medical Asst that roomed me and did the preliminary data updates. Few places would hire men as Medical Assistants. I have had my annual cystoscopies there for 4 years or so I think and there has always been a male RN to do my prep. I talked to a male sonographer there who told me he was specifically hired so that men can have the option of a male doing their testicular ultrasounds. If this hospital can do these things, any hospital can if they so choose.
Thanks to Biker and Banterings who seem to be the only recent contributors to views on this blog thread. It would be of value for all who visit here to submit your own views.
And here is another subject relative to the preservation of patient dignity to talk about which we haven't covered before and is currently being discussed on a ethics listserv.
If the patient is an alcoholic and has entered the hospital for some unrelated medical or surgical problem and the patient requests alcohol so as not to go into a withdrawal episode, should the patient's physician order alcoholic drinks from the hospital's kitchen? Shouldn't the patient have the right to set what condition they want to be treated and what condition they want left alone. Isn't following this request part of maintaining the dignity of the patient? ..Maurice.
Another example of the issue of preserving patient dignity.
A 65 year old white female has entered the doctor's examination room for a blister on her foot which has not healed but has been getting more symptomatic. In the exam room, having taken off her shoes, she appears short of breath and coughing and pulls a cigarette out of her purse and first asks to the doctor (you) who has just entered the room "Do you have a match?" She has not
entered your office for any symptoms or behavior other than the foot blister. If her smoking habit is not her expressed concern or the reason for her presence, should the physician deny a simple request for a "need" which, in no way was the basis for her presence but may meet her immediate need and improve the doctor-patient relationship?
The general question for our visitors is what are the limits for the preservation of patient dignity: responding to a simple request? What criteria would you set, as a physician or nurse, if the request was involving the maintenance of a habit which was not the basis for or related to the current medical issue? Should any patient set the limits (part of patient dignity) regarding what the physician should investigate and treat? ..Maurice.
Dr. Bernstein, respecting the dignity of patients does not mean doing anything the patient wants. In the case of the woman wanting to smoke, being respectful only requires a polite "I'm sorry but this is a non-smoking facility." There are many things a patient might ask for or want to do that are inappropriate in a medical setting. They can be told no in a respectful manner. Telling a person they can't smoke does not diminish them as a person or discriminate against them based on their gender or other protected characteristic. It is simply a universal "you can't do that here" statement. There is a long list of unacceptable behaviors that apply to any public facility.
I kinda think that confusing the issues is how our issue got so out of control in the first place. HIPPA with medical privacy rules. Possibly when it all started started it was about modesty but then a patient didn't want everybody and their brother knowing they had a sexually translated desease either. A new mother maybe wanted to pass off her baby as Bill's child when it was actually Jim's. I know one former poster here always talked in a derogatory way about Type 2 Diabetes. But not everyone who has it is overweight. So the being exposed unnecessarily to unwanted witnesses kinda just got pushed through the cracks. Dr B. You have talked about you can't believe that a person would go to school foe years and years just to get a sexual thrill of seeing people exposed and exposing them to other people. I'm inclined to agree with you. It isn't the ONLY reason. Just a perk that gives them pleasure and amusement. Or they're just too busy and important to care that they are destroying another person.
JF, I don't know much about the origins of HIPAA but it seems primarily concerned with protecting written and electronic medical records and the verbal sharing of those records with people who don't have a need to know. There doesn't seem to be any aspect of it concerned with the bodily privacy of patients. It as well seems very loose in terms of who is included within the "needs to know" sphere.
The nature of electronic records puts a patient's entire record on display for anyone you deal with within any given healthcare system. Why does everyone I interact with in cardiology need to see all of my urology, dermatology, or gastroenterology records for example, yet they do. The answer is hospital systems go through the minimum motions that their lawyers say are required in order to be in compliance with HIPAA. Actual patient privacy isn't the goal.
It is not that most of this information is some deep dark secret but rather for most healthcare staff, it is none of their business as it doesn't apply to anything they are doing, but the system shares it widely nonetheless.
At a practical level in most settings, the concerns I express here are perhaps more theoretical than real given the staff has no personal connection to the patient and there isn't anything of particular interest as concerns the patient's health history. The problem is the system is a one size fits all and shares the health info just as readily with those who do have a personal connection and when there might be something that interests staff who didn't really have a need to know. I have stated before that living where I do it is all but impossible for me to receive healthcare in a truly anonymous manner. HIPAA is a joke. Thus I drive 1.5 hours each way to NH for any scheduled healthcare. I like my privacy and there I can be an anonymous patient.
I will add that the lack of concern for bodily privacy that patients routinely experience is just a different aspect of the this lack of concern when it comes to restricting health records to those who truly have a need to know.
Biker, you write "Why does everyone I interact with in cardiology need to see all of my urology, dermatology, or gastroenterology records for example, yet they do". The explanation to your question is the basis of, for the best and correct diagnosis and subsequent treatment, physician's should not "jump the gun" with a quickly assumed common diagnosis ("Occam's Razor") but consider the full medical history which could well include "urology, dermatology or gastroenterology".
Remember cardiology symptoms are not always strictly related to heart disease but is caused by or associated with diseases and symptoms of other organ systems. "For example, the diagnosis of acute rheumatic fever in patients presenting with acute carditis includes 2 skin signs out of the 5 classic Jones criteria (ie, arthritis, carditis, erythema marginatum, subcutaneous nodules, and chorea)." "
I have always taught my students not to "jump the gun" even though it is easier and takes less time than obtaining a more detailed current and past history. ..Maurice.
Dr. Bernstein, let me rephrase my question then. The point I am trying to make is that modern electronic health records systems provide patient information to far too many people that don't need that information.
As a result of an accident I lost a testicle when I was 11 years old. I am now 68. Why does the NP I see for sleep apnea need that information, let alone her staff, yet it's right there on the front page of every visit summary that the staff prepare. Why did the audiologist I saw for an inner ear problem need that info, let alone the techs administering tests he ordered or the therapists he sent me to, yet there it is in the patient visit summary as part of my history. Why did the neurologist I saw in connection with the same inner ear issue need it? Yet there it was. In trying to rule things in or out with that issue before it was diagnosed they sent me to a hematologist for a lot of blood tests. Why did she and her staff need it, yet they too had it right there in front of them. Not everyone needs every bit of a patient's history. Are they not smart enough to at least categorize different kinds of history? When I go for an annual wellness exam, does the Medical Asst. that rooms me really need it there in front of her, yet there it is. None of the people I have mentioned have ever brought it up in my visits because it isn't pertinent to the visits, yet the system thinks it is important enough to put it right up front for all to see. Before the modern health records systems, the only people that would have had that info was my primary care doctor and my urologist as it wasn't pertinent to anyone else. Now it is available to anyone who works at the hospital, from the Medical Assistants on up.
A piece of respecting a patient's dignity is respecting their privacy, both bodily privacy and their medical records, and the system is failing on both counts. "Need to know" should be an important part of healthcare delivery, yet they err on the side of "everyone is entitled to know".
It is no wonder some people choose to not be fully forthcoming with their doctors given the modern era of what used to be private health records now being shared with anyone that dons a pair of scrubs.
Biker, I have never been a "fan" of history taking, physical exam findings, diagnoses
and subsequent documentation in the form of the current computerized system and, in fact, I personally was never a participant in this system since I left clinical-hospital practice in 2000 followed by my last 16 years with patients was as a volunteer physician in a "free clinic" where all documents were hand written by the physician. And my teaching first and second year medical students in the last 30 years was oriented about each physician to take and document a history and physical, workup and follow-ups in a written format even in years of electronic healthcare recordings in clinical practice.
The doctor and the patient havw more control over the history of the specific illnesses when documented in the "old way".
Nevertheless, it can be essential that the physician, communicating with the patient, delve into symptoms and clinical conditions which, at first, to the patient, might seem unrelated to the patient's current clinical concern but turn out to be directions to a correct diagnosis and treatment. ..Maurice.
I hear you Dr. Bernstein, but a trauma-based surgery more than 50 years ago is not going to help inform the diagnosis of any current illness, yet the hospital's electronic patient records system literally and mindlessly gives it to every staff person: doctor, Medical Asst, and everyone in-between. It is as if patient privacy is not even remotely a consideration.
I am OK with discussing anything a doctor feels pertinent and with giving that doctor whatever records they want. For everyone else it is none of their business. My privacy matters. My dignity matters.
Biker, snooping on patient's documentation by medical professionals and workers has not been ignored. Here is a link to an article about
the snooping of a celebrity patient at UCLA Medical Center.
Those who access medical records of a patient and who do not have HIPAA legal permission to do so are committing a crime and can go to jail. And its happened. Perhaps you can find more news stories of the consequences of such legally "bad behavior". ..Maurice.
Dr. Bernstein, I'm not talking about that kind of snooping. I am talking about every single person that is involved with some aspect of my care is given access to the entirety of my medical records and that the surgery I noted is placed prominently up front as if it is somehow relevant to any current care I get anywhere in the system. I understand the current prescription list being given prominence. That makes sense as does any current medical conditions that I am being treated for as they define the background for any doctor I am seeing. Trauma-based surgery 50+ years ago is irrelevant. Also, what information the doctor needs to do their job is not the same information that the nurse, tech, or medical asst. needs to do theirs, yet it is all out there for all of them.
I can appreciate you seeing it differently, both as a physician and the fact that you live in a major urban area. In Metro LA, excluding celebrities, patients are almost always anonymous. In rural settings patients are almost never anonymous. As I said, this is why I drive to NH for my scheduled care. Years ago before the current e-records systems I absentmindedly cut a finger badly and was embarrassed by my carelessness. I didn't see anyone I knew in the ER and I didn't tell anyone outside of the ER what had happened, yet the next day at work a friend came up to me who knew the whole story. Someone in the ER knew who I was and had a connection to my friend, so told him. So yes it does matter if hospitals are now prominently placing irrelevant, yet very personal, information for all to see.
It is not just my sense of personal privacy at issue here. These new health records systems are surely causing some people to shy away from being fully forthcoming with their doctors. What they might be willing to share with their doctor might not be what they are willing to share with the staff in every other dept at the hospital.
HIPAA may stop healthcare staff from publicly divulging patient info, but HIPAA does not stop staff from the e-records systems giving them info that is irrelevant to the roles they play. That may not matter when the patient is anonymous, but it does matter when the patient isn't.
What is the current U.S. Federal definition of rape? See below from the U.S. department of justice. I can see why someone other than a patient's or the physician's selection of a
chaperone.. a lawyer or police officer might be more appropriate. ..Maurice.
January 6, 2012
The following post appears courtesy of Susan B. Carbon, Director of the Office on Violence Against Women. In a victory for survivors of rape and their advocates, the Attorney General announced a newly revised definition of rape for nationwide data collection, ensuring that rape will be more accurately reported nationwide. The change sends an important message to all victims that what happens to them matters, and to perpetrators that they will be held accountable. It was because of the voices of survivors, advocates, law enforcement personnel and many others that FBI Director Robert Mueller was able to make this important change within the FBI’s Uniform Crime Report (UCR) Summary Reporting System (SRS). “Forcible rape” had been defined by the UCR SRS as “the carnal knowledge of a female, forcibly and against her will.” That definition, unchanged since 1927, was outdated and narrow. It only included forcible male penile penetration of a female vagina. The new definition is:
“The penetration, no matter how slight, of the vagina or anus with any body part or object, or oral penetration by a sex organ of another person, without the consent of the victim.”
For the first time ever, the new definition includes any gender of victim and perpetrator, not just women being raped by men. It also recognizes that rape with an object can be as traumatic as penile/vaginal rape. This definition also includes instances in which the victim is unable to give consent because of temporary or permanent mental or physical incapacity. Furthermore, because many rapes are facilitated by drugs or alcohol, the new definition recognizes that a victim can be incapacitated and thus unable to consent because of ingestion of drugs or alcohol. Similarly, a victim may be legally incapable of consent because of age. The ability of the victim to give consent must be determined in accordance with individual state statutes. Physical resistance is not required on the part of the victim to demonstrate lack of consent. The UCR is the national “report card” on serious crime; what gets reported through the UCR is how we, collectively, view crime in this country. Police departments submit data on reported crimes and arrests to the UCR SRS. Even though most states have more expansive definitions of rape in their criminal codes, they had to report the smaller number of crimes falling under the more narrow UCR SRS definition. This meant that the statistics that were reported nationally were both inaccurate and undercounted. Because the new definition is more inclusive, reported crimes of rape are likely to increase. This does not mean that rape has increased, but simply that it is more accurately reported. In addition, the UCR program will also collect data based on the historical definition of rape, enabling law enforcement to track consistent trend data until the statistical differences between the old and new definitions are more fully understood. The new UCR SRS definition of rape does not change Federal or state criminal codes or impact charging and prosecution on the Federal, State or local level, it simply means that rape will be more accurately reported nationwide. The Office of Violence Against Women (OVW) worked closely with White House Advisor on Violence Against Women Lynn Rosenthal and the Office of the Vice President, as well as multiple DOJ divisions, to modernize the definition. The change was supported by external partners such as the National Sheriffs Association, National Association of Police Organizations, International Association of Chiefs of Police, Major City Chiefs, Major County Sheriffs, and the Police Executive Research Forum.
Biker,
What the profession of medicine fails to realize is that because of the very issues that you bring up about privacy, patients lie to their providers. It is absolutely necessary on the part of the patient to protect themselves.
I encourage patients to answer with "NUNYA" (none of ya damn business...) This tells providers that if you push, I am going to lie and this is not important.
My ADHD doc has never taken a sexual history or pushed for an annual exam. He avoids the embarrassing stuff. He is also a very good old-school doctor highly recommended by other docs in my area.
-- Banterings
I agree Banterings about the downside of patients lying in order to protect their privacy. Patients can no longer speak confidentially with their doctors given the manner in which it will be recorded & widely dispersed throughout the hospital system.
58Flyer, were there any further updates from the school or hospital concerning your hospitalization and the female urologist & high school girl?
Wow! I just had a conversation with my doctor about EHR privacy and who has access. I also explained that I no longer feel like I can have an honest conversation with him without having to explain to a young female MA what a hydrocele is Everytime I have a medical encounter. I explained to him that. I will not discuss BPH symptoms with him until this privacy issue is resolved.
For continuity, if the last Anonymous posting was from 58Flyer or not, please identify your own pseudonym. Thanks. ..Maurice.
It appears, as also, I think, implied in the past by PT, this ongoing topic "Preserving Patient Dignity (Formerly Patient Modesty)" is undergoing a general public disinterest when I consider the statistics of the numbers of viewers to this blog in their entirety. Many, many, many folks are inspecting the topics of my blog postings from 10 to 16 years ago but may be discouraged to contribute to them because they see no recent viewer posting and may feel their comment will not be read and reviewed by others. Reactions to what others say about one's original posting is an important factor in participating with publishing a personal comment.
So I think I will be moving on, in consideration of the current statistics regarding the "old" topics and revive them now at the "top" of my blog where the viewers will accept them as "active". And the many, many topics I covered in the past are still worthy of further, but current, discussion.
So, it does appear that "Preserving Patient Dignity", though an important topic is statically not at all the topics to which the statistics show are the most visited but those that are should be revived, posted at the entry site to the blog. Any comments to my suggestion for their revival with 2021 incentive for further discussion?
..Maurice.
Dr. Bernstein, I very much understand where you are coming from and understand if the time has come to focus on other topics. I sincerely thank you for having helped me find my voice in advocating for myself. No doubt others will find the archives and by reading the accounts of others will muster the courage to begin speaking up for themselves.
The one thing I wish I understood but remains elusive is why those who work in healthcare continue to ignore the privacy and dignity of male patients when they know that healthcare is not perceived to be gender neutral by many, if not most, patients. The proof lies in the extent to which women who work in healthcare do not allow male staff to perform or be present for many of their intimate healthcare matters. It is disingenuous for them to then say healthcare is purely clinical when they are the caregiver. Nonetheless I know that I can speak up to protect my privacy and inherent dignity as a human being.
Thank you Dr. Bernstein.
Maurice,
with the world opening up, many are traveling. I have noticed (as have many of my friends) that there are fewer people attending some smaller, private events, fewer people on the roads, and fewer people shopping. I am not sure what is going on, but I can only attribute it to the opening up.
-- Banterings
If you didn't see my leading blog thread on entry here is the direct link to the site and my link in the Comments section to a Medscape study in 2018 disclosing the incidence of patient initiated sexual harassment of healthcare providers.
If you have a comment to the topic, write your comment on that thread site to begin the discussion there. ..Maurice.
A clarification to all about this Patient Dignity topic and Volumes. This topic and postings will continue as they are received and as we hit about 170 Comments, I hope to move on to Volume 119. Those who are returning or arriving here for the first time, we are NOT closing down this important topic for discussion. ..Maurice.
Just another anecdotal data point here but it speaks to the larger issue. A friend's daughter who will be going into her 3rd year of college as a science major and who is interested in possibly pursuing a medical career is currently shadowing a doctor in an ER in another State. A relative of hers is friends with the doctor and made the arrangements. I don't know anything about that hospital or how shadows in that ER interact with patients, but will find out when she is done and is back home again.
Another friend in hearing about this young woman shadowing mentioned it to his sister who is an OR nurse at the local hospital. She said just let her know if this young woman (still a teenager actually) wants to shadow in the local hospital's OR "because they do it all the time". 3 or 4 years ago I had pursued with Patient Relations what the shadowing policies at the local hospital were. They did not require informed consent but rather said patients could refuse students if they want. However doctors were not required to introduce students to patients beforehand nor were they required to clearly identify them as high school vs college vs medical school or nursing school. I was as well told that what students (as young as 9th grade) were allowed to see in the OR was between the doctor and the kid's parents.
The "just let me know, we do it all the time" coming from a nurse tells me they continue to be pretty lax with shadows and unconcerned with the patients that are being put on display for curious kids. That nurse said she could arrange for this girl to shadow in the ER there too if she wanted.
Another reminder of why I drive 1.5 hours each way to NH for all of my scheduled care. High school and college kids should never be allowed anywhere near a patient without clear informed consent from the patient, including their actual educational status (vs something deceptive like "student doctor").
Here is the link to a major article dissecting the "Serious Ethical Violations in Medicine: A Statistical and Ethical Analysis of 280 Cases in the United States from 2008-2016"
From the Abstract beginning the article:
Serious ethical violations in medicine such as sexual abuse, criminal prescribing of opioids, and unnecessary surgeries directly harm patients and undermine trust in the profession of medicine. We review the literature on violations in medicine and present an analysis of 280 cases. Nearly all cases involved repeated instances (97%) of intentional wrongdoing (99%), by males (95%) in non-academic medical settings (95%), with oversight problems (89%) and a selfish motive such as financial gain or sex (90%). Over half of cases involved a wrongdoer with a suspected personality disorder or substance use disorder (51%). Despite clear patterns, no factors provide readily observable red flags making prevention difficult. Early identification and intervention in cases requires significant policy shifts that prioritize the safety of patients over physician interests in privacy, fair processes, and proportionate disciplinary actions. We explore a series of ten questions regarding policy, oversight, discipline, and education options. Satisfactory answers to these questions will require input from diverse stakeholders to help society negotiate effective and ethically balanced solutions.
Some of the cases, well-publicized, have been discussed here. This study is pertinent to both the dignity of the patient and the dignity of the medical profession itself. ..Maurice.
Dr. Bernstein, one item worth noting in that study of serious ethical violations is that staff and/or employers typically knew what was going on and did nothing about it. If they choose to look the other way on serious ethical and/or criminal breaches, what chance do patients have when it comes to being protected from dignity violations?
On the shadowing matter that I had posted about, in talking with the girl's mother I learned that she was shadowing in the ER for a couple days before anyone noticed that she hadn't signed any documents or received HIPAA or any other training. She was wearing scrubs though so perhaps they just thought she was a staff member.
Maurice,
With Dr. Stephen Smith's (et al,) research coming out about the effectiveness of HCQ against COVID and the release of Fauci's emails, public trust in the profession of medicine is all but nonexistent.
Society is limiting the powers of elected officials and public health.
The push for mandating experimental vaccines with no long term safety data and unnecessarily vaccinating children is further ignoring science.
Many people such as myself saw the logic of the lab leak theory early on. The leading lab (of maybe 5 labs in the world) studying bat corona viruses and yet it came from a market that just happened to be in the same city...
The first volley has been fired with the limiting of public health powers, the issue of treatment of transgender children, and mandates related to the vaccine.
-- Banterings
And then comes another issue that may be implied by what has been written here: misogyny in medicine-- gender bias against professional females and their misbehavior in medicine. Or does anyone here want to defend female doctors, nurses and other female medical staff? ..Maurice.
Biker,
The new paradigm in healthcare is Trauma-Informed Care. One of the principles is GENDER CHOICE. This is NOW the STANDARD OF CARE. Failure to recognize this amounts to malpractice.
See the CDC's Infographic: 6 Guiding Principles To A Trauma-Informed Approach
-- Banterings
For another more detailed article on Trauma Informed Care is here. ..Maurice.
Trauma informed care would certainly be a huge improvement for many patients and scenarios but I'm not seeing anything that would have it including male patient gender preferences for intimate exams and procedures. Searches that include anything to do with gender bring you to discussions centered on female patients.
Healthcare's orientation towards women is so pervasive that even the proponents of trauma informed care are blinded by their bias. The other thing of course is that to admit the bias would then entail a responsibility to do something about it. It doesn't seem the system is ready for that yet.
I suppose men that try to justify to trauma informed practitioners their preferences using the language of trauma would get a sympathetic ear, but would that trigger accommodation (or changes in hiring practices) or would it simply mean the female staff are extra polite as they tell him to just get over it.
Time will tell, but regardless, I do applaud any movement towards trauma informed care.
I thought you all would be interested in viewing this video Spectrum 1 News did on me about being a voice for change at https://spectrumlocalnews.com/nc/triangle-sandhills/news/2021/06/16/n-c--medical-professional-inspires-change.
It is very short and unfortunately, they cut out a lot of important information because it could only be a few minutes long.
Misty
Excellent Misty! Good for you and good for that news channel to feature you. No doubt a lot of people that may have felt the same way now know that they are not alone.
"Should NPs and PAs Be Allowed to Do Colonoscopies?" The professional argument against that allowance is their lack of skill but I have a strong feeling that because female is the gender of the majority of nurse practitioners and physician assistants that on this blog thread the visitors will be rejecting them because of their gender. Or am I coming to a erroneous conclusion? Read the article from Medscape and then tell me the validity of my conclusion. ..Maurice.
No. I don't care about the gender aspect of this. I'm not about to let an NP or PA of any gender do my next colonoscopy. I refuse to accept the contention on the part of NP's that a 2 year NP program is in any way comparable to all those years of medical school and Residency, and possibly Fellowship. Why go through all those extra years of training if 2 years of NP school would give you the same skill level?
NP's are pushing the envelope into many specialties. The local urology practice hired a female NP who had no experience in or certification in urology, yet she started seeing patients right off with her newly minted online NP. She did have a few years experience working as an RN at the hospital but on what planet could she possibly have been qualified as a urology specialist?
In part I don't trust the healthcare industry to ensure that NP's will be qualified to do colonoscopies. I suspect the main qualification hospital systems will look for is their willingness to work for less than MD's. I'm thinking of my colonoscopy a few years ago where multiple polyps were found and had to be removed. Sending a scope up and looking is one thing, dealing with what you find is another. Or will they make those patients come back for a 2nd pass for an MD to do what would have been handled the 1st time if only an MD had done it?
Biker,
What I really took away from the article is how the profession of medicine continues to use patients as warm cadavers for training purposes. Johns Hopkins has a long history of patient abuses:
Johns Hopkins wrote the rules on patient safety. But its hospitals don’t always follow them.
The Scary Science at Johns Hopkins University
Hopkins Hospital: a history of sex reassignment
Johns Hopkins settles case for $190M over gynecologist who took secret photos
Johns Hopkins Hospital inspires mistrust and fear in parts of East Baltimore
Suspicion still simmers just under the surface
...and finally this one which i could not read. No animal deserves to be maltreated, they are truly innocent unlike mankind. There is more, but it turns my stomach.
Hopkins barn owl lab faces scrutiny from PETA
It is not just Johns Hopkins or black patients. ALL institutions will take advantage and abuse ALL patients given the chance. It is NOT what is best for the patient, but what is best for the provider.
-- Banterings
Banterings, very sobering articles. I recall two years ago I was thinking how fortunate my brother was to be having his colon cancer treated at Johns Hopkins, their being amongst the best of the best. That might be true, but maybe we give too much credit in how good we think the best really are.
Whenever articles of this nature come out it there seems to be a common theme of arrogance blinding institutions to the reality of what they are doing.
From a female family physician writing to Kevin MD Medpage
Too often, medical front desk staff are being abused by patients who have not gotten their expectations met 100 percent. Whether it be having to reschedule because they were more than 15 minutes late for their appointment (mind you, 15 minutes is often the allotted time for said visit), they didn’t get prescribed the (inappropriate) medication that they wanted, or some other beef they have with the visit. Some patients are even more rude on the phone, having no face-to-face buffer to provide social etiquette reminders. Racist remarks by elderly patients to black and brown providers are often endured because “they aren’t going to change now.” The number of times that individuals are inappropriate with female providers, calling them sweety or sugar, is countless. I can go on, but I shouldn’t have to.
So, you see from reading the entire article and from above excerpt, there are two sides to whose the "troublemaker" in the function of the interaction between professional and patient. Do you agree? ..Maurice.
Maurice,
I saw this and it wreaks of paternalism where it does not take into account the power differential where the provider is a gatekeeper. That is why society is pushing healthcare to a client-advisor relationship.
True to style with KMD, when comments begin to go against healthcare, they shut down comments.
Just look at the comments of Carol Levy, abused and denied needed meds. Yet, medicontheedge, who "stopped taking s**t from patients long ago (in the ED)" ignores the horrific treatment of the patient.
An interesting analysis of the BLM riots and the destruction of property and life attributes the frustration of this group and the only option being to lash out.
More so in the ED, but for all patients, they are hurting, afraid, disempowered, and in need of care and COMPASSION, yet medicontheedge is not taking their s**t???
When we begin having the same response to providers that BLM had to the police, the profession will only have itself to blame.
The medical rape of Brian Persaud (I have referenced this case previously) showed when a patient is put in a fight or flight situation, they will fight if they cannot flee.
New York Presbyterian Hospital justified overriding his consent/refusal by saying he could not consent. Wen they tried to press charges, they were dismissed because by NYP, he was deficient at the time. NYP CONTRADICTED itself.
You can't have it both ways. It is paramount that the patient ALWAYS has ABSOLUTE control in healthcare encounters. That is what society is moving towards. Just look at the pushback against public health officials, lockdowns, and mandates.
Providers are crying about PTSD and mental trauma from the pandemic. Guess why the public is not showing any sympathy?
Just look at the latest: Dr. Robert Malone, who invented the mRNA technology used in some coronavirus vaccines says he was censored by YouTube for sharing his concerns on the vaccines
He also talks about how the vaccine causes lipid nanoparticles to accumulate in high concentrations in the ovaries, bone marrow, and other organs.
This info came from a Japanese biodistribution study which had been kept from the public and obtained by a freedom of information request for the Pfizer data.
The chances of something going wrong with the large numbers of vaccinations with no long term data is very likely.
How do you think that society is going to react to healthcare providers and the profession of medicine pushing these as SAFE? (Please note that I am NOT commenting on the safety of the vaccines, I am simply discussing the suppression of data related to the vaccine and the ignoring of potential risks.)
Couple this with all the other abuses of providers that we discuss here, and a revolution is coming. I hope that it will be a BLM style revolution against medicine.
-- Banterings
I have done my share of complaints here about past experiences, but I have also noted the very professional manner in which I have been treated at the hospital I had switched all of my scheduled care to a few years ago (with the notable exception of Dermatology that just doesn't get it). In urology I was always able to get a male nurse for my cystoscopy prep and I never got anything but professional responses from the scheduling staff when I asked. Elsewhere in the hospital the staff was always professional (except Dermatology as noted), including a bladder scan done by a female sonographer w/o any exposure vs the full exposure I experienced for the same scan at a prior hospital.
I finally had an intimate exposure experience there with a female nurse and the manner in which she handled it was perfect. When she brought me back to the procedure room I said I was scheduled with a male nurse. She said he wasn't working that day and apologized. I told her there was nothing for her to apologize for, that she wasn't responsible for the hiring & scheduling of the staff and that I knew she was only there to do the job she was hired and trained for. I then told her I was very modest and asked that she try to minimize my exposure to that which was necessary. I could tell that she understood and was empathetic.
Having had a couple dozen cystoscopies at this point I can say that nobody ever minimized my exposure to the extent she did. When the doctor was done she even pulled my gown out from under the drapes so as to cover me before removing the drapes. Nobody ever did that before. She fully understood what minimize meant. It came as a surprise to me that I was not embarrassed given the manner in which she handled the prep and the cleanup.
I plan to send a note to the urology dept. to thank her for her professionalism and empathy.
Maurice,
I believe that the pandemic has reduced elective and non-emergent medical procedures to almost nothing. The number of patients being abused has also reached zero. As things open up and more procedures are done, you will see people who have been abused searching the internet to make sense of what happened, they will find your blog. That is how most of us got here.
-- Banterings
Banterings, I was wondering why currently not only has been a drop in the number of visits to this Volume but also visitors providing input has settled down essentially to you and Biker. Yet, to all of the many, many blog thread titles including Patient Modesty I continue daily to get plenty of visitors (based on blogger statistics). It does seem that people are satisfied currently with the way they are being treated in the medical system, at least with regard to our current topic of the preservation of patient dignity. Or are they?? ..Maurice.
Dr. Bernstein, it could be that the others who posted with some regularity here thought you were shutting this down, and they stopped coming by. That's what I thought was happening until you clarified that you weren't.
Banterings may be right that resumption of business as usual post-covid may send more folks here.
I never intended to close the "Preserving Patient Dignity" down. The topic header is one of the most important topics certainly in bioethics. Preservation of patient dignity means that the medical system is not treating the patient as an object from which to remove income or to stack up as some other source of personal value but as a human creature no different, in that respect, than oneself. And this is the definition we should all preserve. ..Maurice.
Do you think that if all the elements serving patients in the medical profession showed the property of compassion, most of all the stories and concerns expressed on this blog thread by my visitors would be extinguished?
I wrote the following, this afternoon, to a medical education listserv:
Compassion: Something That Really Can Be Taught in Medical School?
I read what I thought was a current worthy article regarding the matter of teaching compassion with the patient in medical school:
https://journals.lww.com/academicmedicine/Fulltext/2021/07000/Advancing_Understanding_of_Compassion_and.1.aspx
What is compassion by the healthcare provider? Should it be taught to the medical student? How can it be taught and be effective for the future behavior of the student as a physician? Is a one hour lecture all that is needed? If observation of the student-patient interaction is possible for the instructor, what would be the criteria establishing the developing true compassion be used in the evaluation? Does the grading come from a teacher or from the patient? And what, if any, are the difficulties or even impossibilities in the attempt to teach this particular professional behavior? ..Maurice.
Dr B. I can't answer for anybody else but I'm still here everyday. I've tried to chime in different times but my phone(s) won't let me.
JF, glad to see your posting today. So.. what do you think about the role and degree of compassion being expressed to patients in our current medical system. Do you see compassion being expressed directly to the patient (and even the family) in your current work experience? ..Maurice.
Dr B. It just depends on the personality of the workers. Our boss is a sweet lady but she doesn't know how to confront bullying behavior from the staff. I have a coworker who always does showers with the door standing open. Our assisted director of nursing ( when we had one ) did the exact same thing.
None of the patients rooms have privacy curtains even though a lot of our patients have roommates. A couple of days ago a female patient started to walk into a male patients room while we were transporting him into bed. I told her to leave and shut the door. My coworker said "We're not stopping what we're doing. She's just gonna have to see his @$$!"
The reason you never witness the blatant disregard is you are in a position of authority and are able to set the stage. YOU respect your patients so your staff does also ( in front of you )
As JF has repeatedly documented, there is an underlying need to emphasize to the staff of nursing homes the need to obey the legal and ethical rules in order to preserve the dignity of each and every patient. Here is a listing of "Things Nursing Homes are Not Allowed to Do" ..Maurice.
A question for JF concerning the staff members who leave the door open when showering patients or that don't minimize exposure in other ways such as the man with his backside exposed to the female patient. Do they do things differently when there are family members or other people from the public present? If so, then it is not a function of staff not being properly trained but rather that they simply don't care, but put on a show of caring when family or others are present.
I also wonder whether facilities with primarily Medicare/Medicaid patients treat the patients differently in this regard than facilities that primarily have private-pay patients.
Good Afternoon:
JF's Saturday, July 03, 2021 12:19:00 AM, comment says it all.
The way patients are treated in any facility in this country depends on the culture within the facility & that culture is put forth from the top on down so if management really cares about patient dignity & privacy it will show itself in the manner the healthcare workers within each facility treat the patients.
regards to all,
NTT
PS. I am always checking this board so I'm never far away.
A couple of days after I hired in our home got quarantined. Eventually our patients were allowed visitors but in a designated area. Not were the general population was. Now I'm on third shift. But from past experience there is seldom a lot of visitors in the buildings.
Do you all think that a physician or nurse should be objective rather than subjective when interacting with their patient? In other words, should they be more interested and attentive to the disease than "this or that" regarding the patient or the professional's own personal interests or desires. I seem to understand that much of what has been written here takes the view that there has been too much subjective interaction, much of which deals with what the patient poster considers professional misbehavior. Is that a reasonable conclusion of the views presented here? ..Maurice.
I know that a certain number aren't especially embarrassed by being exposed in a medical encounter. A certain number are euphoric and the more ( staff present ) the merrier. Other patients are harmed by it. Some to the extent that they can't seek care in the future..And it should automatically be assumed that every patient is modest. Staff coming and going from the room needs to stop. If and when a patient is displayed to a person walking past the room or a child opening the door before anyone can stop them huge fines need to happen so medical staff get the message that it needs to be prevented. The doors should actually be LOCKED. If a Medical providers has been found guilty of sexually abusing a patient a chaperone isn't the solution. Job termination is. Plus some time in jail. Family members shouldn't be watching intimate exams either unless the PATIENT requests them to be there and most of the intimate care and examinations shouldn't be happening AT ALL. Not by an apposite sex provider OR same sex provider. Anyway that's MY honest opinion. Medicine shouldn't be about giving ANYBODY sexual thrills. It should be about prevention and healing.
Dr. Bernstein, it doesn't have to be an either subjective or objective choice. Of course the overarching goal should be treatment of the disease, but that doesn't preclude recognizing the humanity of the patient and their feelings and wants.
In regards to what is discussed here, we see the dangers of pure objectivity in healthcare in their foundational principle that for male patients, healthcare is gender-neutral and that it is always purely clinical. It is an objective truth not to be questioned.
Being purely objective precludes the need to concern themselves with what all those silly patients think about those things. Patients are just too ignorant to understand that on her 1st day of work, as soon as that 18 year old Medical Asst dons her scrubs, she is an asexual medical professional. Just accept that you don't have anything she hasn't seen; that she's seen it all 1,000 times, that it is all purely clinical to her. She's a medical professional after all and is only watching your exam so as to protect you.
Doctor/Nurse-Patient relationship would be so much better if the professionals found and expressed true compassion toward each and every patient. They should be able to put themselves in the position of their patient (since it is inevitable a time will come when such a position will be experienced). True compassion should be a goal which should guide every medical professional in their relationship to their patient. ..Maurice.
I should be but it isn't. We need them more than they need us. So they act accordingly.
JF, when you wrote "them" did you mean "the professionals" and "us" you mean the patient?
So by "acting accordingly" you mean that the professionals care nothing about being "compassionate" to their patients. I do think that being compassionate to the patient may be more difficult for the professional than making a diagnosis by the doctor or carrying out a smooth comforting response by the nurse.
..Maurice.
It's case by case of course. But there is widespread lack of respect or compassion coming from the medical world. Yes. I was talking about patients need medical staff more than they need us. There's way more of us and they have more than they want or need.
Maurice,
It is the "patient-doctor relationship" (patient mentioned first as they are the most important aspect of the relationship.
-- Banterings
Banterings, yes.. I agree "patient-doctor" relationship is the description which is most appropriate and probably the one less used by physicians to describe their relationship to the patient. If all here want to read an excellent current study on this very "patient-doctor" relationship the link is right here and the title is "The patient–physician relationship: an account of the physician’s perspective"
In contrast to patients who traditionally stress the importance of interpersonal skills, physicians stress the significance of the technical expertise and knowledge of health providers, emphasizing the role of competence and performance. Physicians evaluate the relationship on the basis of their ability to solve problems through devotion, serviceability, reliability, and trustworthiness and disregard the “softer” interpersonal aspects such as caring, appreciation, and empathy that have been found to be important to their patients. This illustrates a mismatch in the important components of relationship building that can lead to a loss of trust, satisfaction, and repeat purchase.
I have a feeling that most of those reading and writing to this thread would agree with that analysis. True? ..Maurice.
The hospitalized patient is elderly and is in the process of dying from an incurable illness. The patient is now comatose, unresponsive and clearly in no distress. An order has been written by the physician for an intravenous morphine drip administered on a regular basis to keep the patient comfortable. The family, sitting at the bedside, observes a respiratory irregularity that concerns them that the patient is uncomfortable. They request that the nurse provide the patient with additional morphine to what has already been administered. The nurse who has been following and observing the patient finds nothing in the patient’s respiration or responses to warrant additional morphine. She tries to explain to the family the basis of her conclusion. The family disagrees.
The nurse is concerned that to administer the morphine now would not be appropriate care for the patient but would risk that the patient would die prematurely from the morphine dose. The nurse is concerned that she might be causing the patient’s death not for the comfort benefit of the patient but simply for the comfort of the family sitting at the bedside.
The nurse refuses to administer additional morphine and the family calls the doctor.
If you were the doctor receiving the call how would you respond? Again the question “Is it ethical for a physician to treat a patient simply for the benefit of the family?” ..Maurice.
The above is the introduction to a TREATING THE PATIENT SIMPLY FOR THE BENEFIT OF THE FAMILY blog thread from 2009 which has 13 responses currently. What is the role of family dignity vs patient dignity? ..Maurice.
Hello Dr. Bernstein,
The following is excerpted from the article you recently presented:
"The quality of communication between doctor and patient involves assessment of the doctor’s WILLINGNESS [my caps] to include a patient in the decision-making process and to provide a patient with information. As there is a growing attention and changing policy with respect to informed consent, the quality of doctor-patient communication must be better understood.
As a result a more active role must be GIVEN [my caps] to the patient, who being well informed by the doctor, can HELP [my caps] in the decision making process. Policy schemes need to be implemented as a way of changing physicians’ behavior, FORCING [my caps] them to better build and utilize this dyadic relationship."[P12]
Although couched in benign terms, the author(s) obviously realize that the physician-patient relationship is still PATERNALISTIC (as noted by the capped terms). Why else must doctors be FORCED ...? NO CHANGES WILL OCCUR UNTIL THIS RELATIONSHIP IS VIEWED BY EVERYONE INVOLVED AS A MUTUAL COLLABORATION OF EQUALLY VESTED PARTIES. In my experience relationships don't change w/o incentives. What incentives exist to "encourage" medical practitioners to change? Since surveys are not pinned to a particular individual, personal accountability for change is non-existent. And the impasse goes on.
Reginald
Maurice,
In regards to the article, The patient–physician relationship: an account of the physician’s perspective:
In many service contexts and especially in the medical industry, customers do not know the appropriate level of service required for their specific needs [42]. They rely on the advice of an “expert” who typically also provides the subsequent service. For example, the Hippocratic Oath of a physician controls for the problem of under-treatment in the medical services.
This article makes two traditionally false assumptions. The first false assumption is that the provider ALWAYS knows more than the patient. This is FALSE. There are instances where the patient knows as much if not more than the provider.
Many chronic patients have dug so deeply into their personal health data and all the research on their specific disease that they literally know more about their disease than their doctor. That is not a knock on doctors, but the reality of chronic diseases. A chronic patient has time to obsess over their disease and specific health data while a doctor has to worry about thousands of diseases and patients.
Patients who have in-depth knowledge of their condition encounter problems because of the power imbalance.
The second false assumption is that the Hippocratic Oath is a legal requirement. It sounds good to say "I took an oath," but in reality it is ignored in practice. Just look at the practice of defensive medicine (which is the standard of care today).
Society will bend the practice of medicine to meet its expectations.
-- Banterings
Reginald, great evaluation of the point the authors are making. You ask "what incentives exist to ENCOURAGE medical practitioners to change?" The state medical boards can require such education. For example, the state medical board of California requires 12 hours of pain management education before medical license renewal is permitted. In the U.S., state medical boards can set standards for promoting and "encouraging medical practitioners to change". ..Maurice.
Banterings, regarding the Hippocratic Oath https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6482690/ :
The oath has not taken into consideration the vegetative states, unnecessary suffering, ... The recent increase in government regulation, the proliferation of the ... In 1973, the US Supreme Court rejected the oath as a guide to medical ethics and ... the latest developments and methods of medical practice and research.
More is needed beyond some "oath".. just like the misbehavior of politicians in government. ..Maurice.
Maurice,
The profession of medicine finds ways to circumvent the law or lobby to have exceptions put in the law. For example, the Nuremberg code does not cover consent for students learning. Since this has not been properly addressed, states are just beginning to address it when the loophole has been abused.
The oath would be relevant and not paternalistic if looked at properly. "First do no harm" would cover issues beyond beneficence, such as patient autonomy. The question becomes what is defined as harm?
Since the patient comes to the healthcare system seeking help (which is a service), then what is considered harm must be defined by the patient. For some, dying without dignity is more harm than 6 additional months of a reduced quality of life.
-- Banterings
I will differ somewhat on the doctor-patient relationship in that I don't expect it to be a meeting of equals. The doctor has vastly more knowledge than I do on medical matters and I have to respect that. It is me going to him for help, not him imposing himself on me. This is no different than the plumber knows vastly more about plumbing than I do, and I have to respect his expertise too.
I instead think the issue is more that the relationship requires that the doctor treat me with respect and while not his equal on medical knowledge, his equal as a person. Respect includes listening to what I have to say and helping me make an informed choice as to course of action. It is his job to educate me as to choices and consequences. It also includes respecting my bodily privacy by not exposing me more in terms of extend, duration, or audience than is necessary.
For the most part I do think my doctors work with me in a collaborative manner and treat me in a respectful manner. What I more see as a failing of the system is for complex situations is each specialist looking only at their area of expertise while nobody is looking at the whole person. I learned this the hard way when my brother was diagnosed with what proved to be an inoperable brain tumor. At the very beginning a family friend that was a nurse told me we needed a medical advocate but I didn't understand what that was and why we needed it. By the end I knew she was right and why. The brain surgeon took no interest once it was deemed inoperable. The radiologist's interest ended when the radiation treatment failed. I was at that doctor's appt and there was no referral to anyone else for what was to come. Whatever the doctor was that dealt with its spread to his bones never looked further than the bones, and it was my brother who had to seek that doctor out because even his primary care wasn't looking at the big picture of the cancer's spread. When it got to his liver that doctor only focused on the liver. The hospice nurse was the only person in the entire 7 month saga that looked at him as a person. He was just a series of narrowly focused symptoms and a disease to all of the doctors that treated him.
What your brother should have had, if somehow he didn't have, was an internal medicine or generalist, who was in charge of following through with the patient's symptoms and course, throughout the various specialists and changes of the disease and final management in the later stages of the disease. Without the presence of such an ongoing physician's management and care, the patient is asking for chaos. Every person should have their selected physician who will be with them throughout their illness. ..Maurice.
I agree Dr. Bernstein, but the primary care doctor didn't take on that role. Being this started with really bad headaches he started the process with primary care. This was in a large urban area in Florida in the mid-90's. Maybe they do things different now.
Biker, everyone and I mean every potential patient (which amounts to everybody) should have a general physician or internist who knows the patient from before the acute illness onset and is involved, in some degree, with every illness which is being managed by a specialist or specialists. This is essential. Every patient needs a "moderator" and "follow-up" physician who will be available to "control" the patient's management especially when multiple specialists begin to get involved in a case.
What you and others might not realize is that it is not unusual for conflicting views definitely do occur between the specialists with regard to patient management. It does require someone (the patient's generalist or internal medicine doctor) to become the mediator of the views of the patient's specialists. This is true.
Every patient must have that professional who knows the patient from "head to toe" in personality and yes physically and full medical history. And that professional should be around as the various specialists "take over". Patients should understand the responsibilities of that important professional primary care doctor and keep that professional informed and available to provide necessary support for the patient.
If that generalist is unsatisfactory..change doctors! ..Maurice.
I totally agree Dr. Bernstein. That's how it was when I grew up. Our family doctor was the center of all our healthcare. Everything started with him and he directed what happened from there.
The frequency with which some people relocate these days certainly interferes with establishing those kinds of relationships. What for many are unaffordably high costs of co-pays and deductibles affects whether some even seek non-emergency care. That too interferes with establishing those relationships.
There have been many miracle drugs and amazing treatment advances in my lifetime, but it feels like the underlying delivery system itself has deteriorated. The assembly line nature of hospital-owned practices discourages the kind of relationships that used to exist. Each doctor is charged with doing their piece and passing the patient along to the next provider, including the hospitalists that manage the case for hospitalized patients. Patients seeking care are often scheduled with whoever is available rather than seeking continuity of care in that regard. It is a model of efficiency for the practice perhaps, but not necessarily for the patient.
Biker, as you can imagine, the hospitalist will never be equivalent to the patient's primary care physician. Why? Because the hospitalist is primarily the employee of the hospital and the primary care physician is primarily the employee of the patient, you. ..Maurice.
The longer the assembly line the more expensive the care. Could there be a way of cutting out some of the assembly line? What do other countries do where health care isn't as expensive? Who is being overpaid and how did it come about?
Biker,
Going back to your question on June 3rd, no, there has not been any further activity from the hospital concerning the high school student. I let it drop after the response from the chief nursing officer.
All,
However, there has been much that has happened to me since my last posting. I did take a CNA course and passed with a high grade. I then contracted Covid 19 in mid May and was hospitalized for 32 days. It was close. There were issues.
I am sorry to have been quiet on this blog for so long but a lot has happened. I have kept up but not posted.
We have a lot to talk about.
To be continued...
58flyer
58flyer, I am sure we are all sorry to read that you were attacked by COVID and fell for 32 days. We all hope that from the COVID infection you have become free of symptoms or residuals. I think we all would be interested in reading how you were treated in the hospital and whether family members were able to visit.
It would be of interest to see whether you have experienced less professional "misconduct" as a COVID patient as compared to your prior non-COVID illnesses. ..Maurice.
58flyer, I am so sorry you had such a scary covid-19 experienced. Glad you are better. I look forward to hearing sbout it all.
58flyer,
my prayers are with you.
-- Banterings
Thanks for the kind words guys.
Going back to the CNA course, it was constantly stressed about the importance of introducing oneself to the patient, explaining fully what was about to occur, and obtaining her permission to begin. I say her because the training aides were always female. I made the politically incorrect mistake of referring to the training aid as a dummy. I was quickly corrected but still the small class got a laugh.
Also beginning this year I got a job working for my neighbor in his aircraft engine overhaul shop. I'm not exactly using my new CNA skills but it is a lot more interesting. About the first week of May my boss got sick with flu like symptoms and coughing constantly. He insisted it was just a cold. On Mother's Day I had taken my wife to Olive Garden and I noticed that I had no appetite and just didn't feel right. On Monday I had a Covid test and on the 12th got the notice of being positive for the virus. I remained sick and queasy through the 18th of May. I was hoping I would get through this like most healthy people do. I told my boss to get tested and he did and came back positive for Covid. He has some very serious health issues. He went to the hospital and stayed overnight, got some meds and went home. Not me. Per the advice of my doctor, I went to the ER on the 19th and got admitted. I recall arriving at the ER but nothing after that. I made 2 irrational texts to my wife and my boss that night that I have no memory of.
I spent the next 18 days in ICU on the ventilator. No memory of it! My wife then tested positive for Covid but with mild symptoms. She guaranteed at home for 10 days. She could not see me in the hospital during those 10 days. So, I was on my own. When I could breathe on my own, I was sent to a regular room on the Covid floor for the next 6 days. I have very little memory of that.
On the 12th of June I was sent to the rehab hospital. That's where the adventure began!
To be continued tomorrow since I might be short on space.
58flyer
58flyer, I am looking forward to your continuing description of your experience and I am sure the others here have the same interest. ..Maurice.
I received the following today from an unidentified visitor to Patient Modesty Volume 13. I get many, many visitors to virtually all of the modesty blog threads but today this is the one of the first to write beyond reading. ..Maurice.
here is my story and i have many my fist was i went to er with sever pain was given morfine then had x ray to be told that i had a kidney stone and it had to come out i was told by the doctor that it could be taken out by going through the penis so to stop the pain i agreid to the prosedure next morning i was taken to he operation room here was 3 nurses and a male doctor that knoks you out well he stuck a needle in my arm 3 times and i did not go outhe said to me your a good man for not cmplaing so i told him yes and i have not hit you yet next a dctor comes in and pulles my gown up exposeing me i sat up and yelled at him plese wait until i am out and told him there are weman in here the nurses laughfed the doctor left the room i was kncked out and woek up with a cathitor and no kidney stone since then i have had 4 more stones removed thats another story.
58flyer,
Please be aware of potential retraumatization and PTSD, as PTSD common in ICU survivors.
Feel free to reach out to me, as I have been helping my one friend with her therapy and she has made great strides until she was
-- Banterings
Concerning the guy who wrote to Volume 13, it is that kind of unprofessional treatment that will cause him to be leery in healthcare settings forever more. Clearly the nurses who laughed have no concern whatsoever for the dignity of their patients. Odds are they had fun mocking him after he was unconscious.
Banterings,
That's an interesting article you linked in your last post. I've been in contact with some supervisory personnel at the rehab hospital. I will direct them to that article if they will bother to read it.
I had a lot of crazy dreams while on the Covid unit. Most of those occurred after I was transferred to a regular room. My wife says I appeared awake and was watching TV, changing channels, and conversing. I have very little recall of it. She took a picture of me at some point and I really look to be out of it. Kind of a blank stare at the camera. I fell out of bed at some point and hit my head on the floor and caused some open wounds. I remember the fall and just laying there and looking up at the ceiling. I went back and forth from the dream state to partial reality, but no point in going into all that here.
I finally regained some degree of awareness during the van ride from the hospital to the rehab facility. I remember the whole ride but thought I was in Pensacola and not Ocala. Once at rehab I was taken to my room in a hospital bed. There I was interviewed by a male nurse. That was on 6-12-21. My first contacts with the therapists happened on Sunday the 13th. My first encounter was with a male physical therapist (PT) and that was uneventful. Then 2 females came in and announced their intention of assessing my ability to shower and tend to personal hygiene and toileting. One was an occupational therapist (OT) and the other I don't know. Neither introduced themselves but had name tags that I couldn't read because of their hair. Both were wearing blue scrubs. The OT did all of the talking. I was alert enough to question the OT knowing that a shower involved undressing and I would not be OK with that. So I said to her "that we are not of the same sex concerns me greatly." I would have thought that that alone would have prompted her to put the brakes on the whole thing. Instead, without hesitation, she said "don't worry, your dignity will be well respected and protected." I took that as meaning that they would not actually watch me undress and shower.
Using the walker, I went into the bathroom and shut the door. I don't recall undressing but my next memory was testing the warmth of the water and then I became aware that both females had entered the bathroom and were standing behind me. My heart skipped some beats but I was caught. I recall shampooing my hair and then pumping cold body wash onto the wash cloth and trying to wash while holding onto the rail. I kept my back to them and when I washed my legs I lifted them rather than bend over, which hard to do while holding onto the rail.
Continued,
58flyer
58flyer, thanks for the ongoing detailing of your experiences as a patient unintentionally stuck within the healthcare environment. It is my opinion that if JR was still around to read your story, it would raise her blood pressure and heart rate and readily equate your experience and emotional turmoil to the unfortunate experiences of her husband and JR. ..Maurice.
Thanks for sharing your story 58flyer. It is hard to conceive how those two women watching you take a shower qualifies under "don't worry, your dignity will be well respected and protected." I suspect it falls under the mindset that the staff being polite is synonymous with respecting patient privacy and dignity.
Your experience does raise an interesting point. Most of our discussions have centered on us as patients being of sound mind in asserting our concerns and preferences. Despite you being conscious, you weren't fully of sound mind at that time. Surely the staff understood that, and despite your having expressed yourself, they totally ignored your concerns.
Sorry to end my discussion so abruptly, I haven't slept well for a long time and the melatonin kicked in during my posting and I needed to get to sleep.
So, there I was in the shower, totally naked in front of 2 females. As Biker observed, I was not of sound mind at that point. I had been sedated with all kinds of drugs which included fentanyl and propofol. I was not all there. Even though I thought I was back in control, I was at best only about 50%. I had not mentioned the past sex abuse and neither had my wife. Remember she had to quarantine for the first 10 days of my hospitalization and wasn't able to advocate for me. By the time she was able to visit me I was sedated and intubated and she didn't think to bring up the abuse history. When I was in the ICU and the Covid floor, no doubt I was tended to by many female staffers. My wife said I had a catheter in and was wearing adult diapers. I have no memory of that so I am not bothered by it. But by the time I was in rehab I was somewhat coherent and concerned about my modesty. I am not studied up about physical therapy and just thought it was about regaining strength and range of motion. I didn't think that physical therapists were concerned with intimate exposure. I was about to learn a valuable lesson that I can pass along here.
What comes to mind is the fact that the OT fired back at me so quickly when I told her of my concern. She didn't pause for a second when she made that comment about my dignity which leads me to believe she has used that well rehearsed line many times in the past to gain compliance from male patients. No doubt many men have told her of their concern and she has developed her comeback as a way of coaxing or reassuring her patients that all will be fine. In my case, I took it as meaning that I would not be exposed to the degree that I thought I would. We are not talking about a peek under the gown for a few seconds, but total head to toe stark nakedness for a sustained period of time while performing a task. I thought I would take a shower and dress myself and come out of the bathroom and that would be it, unless I fell or needed some assistance.
Back to the shower. I was trying my best not to bend over while holding onto the bar knowing that if I did bend over the boy parts would be very visible to those women. It was very difficult since my legs were very weak and frail. Once I was done I recall trying to dry myself with the towel and not show my front to them. Soon enough, both women were standing beside me, one on each side while I tried to dry myself and hold onto the bar and not fall. So much for keeping them from seeing the front of me. I don't recall redressing myself. I don't recall any conversation nor do I recall them touching me. My memory jumped to watching them both leaving my room. I was sitting on my bed and feeling beyond embarrassed, more like humiliated.
Over the subsequent days, I was taken to the exercise room by various therapists. I observed that there were many male physical therapists. I estimate that about 40% of the therapy staff was male. That made me more angry knowing the male staff was available. I saw both of the female therapists in the exercise room every day for the rest of the time I was there. They never again were a part of my care and both avoided eye contact with me, even though I tried several times to get close enough to them to read their name tags, without success.
I became very angry at what had happened and wanted out. On Monday the 14th I texted my wife that I wanted to end this therapy and go home. My clinical coordinator kept trying to talk me out of it without even asking why I wanted out.
Continued...
57flyer
58flyer, that the two women avoided eye contact with you says there is more to the shower episode than you recall. Your condition at the time precludes you fully remembering it, but they did remember. Most likely you objected to their presence and the manner in which they assisted you. Hopefully they at least felt guilty for not having switched places with male staff when you expressed your concern.
What is necessary to preserve patient and the patient's family dignity is for the healthcare provider to be able to apologize to them.
Here is the current "A Piece of My Mind" opinion writing in the July 20, 2021 issue of the Journal of the American Medical Association titled:
"To Err is Human, To Apologize is Hard" which fits with the views expressed on our blog thread.
"We don't blame you or anyone,” my husband said over Zoom to our son’s doctor.
We waited expectantly, as the stammering and uncomfortable shifting revealed a new side of this physician, someone we knew as a brilliant, thoughtful, and compassionate clinician, never lost between words.
“We do need all our son’s doctors to look his suffering in the eye and acknowledge the role you played. To repair, we need everyone to apologize and learn from this horrible experience.”
What followed was a long conversation—without an apology.
Click and read a family's experience with members of the medical profession.
..Maurice.
Throughout the rest of the week I was angry and wanted to go home. My texts to my wife proved that. By then she was back to work and came to visit me after work. She got off at 5 PM and visiting hours ended at 6 PM. After the drive from work she was able to stay about a half hour. We finally learned that the nurses did not enforce the 6 PM rule, since it just wasn't enough time. We found some amount of humanity in them. Despite my experience, I concealed my anger as best I could. No point in making my situation any worse. Most of the nursing staff were very helpful and understanding. Because of the fall in the Covid unit, I was considered a fall risk. They activated the bed alarm late at night. When I got up to go pee the alarm went off. They asked me to use the call button to ask for help, but they always responded over the intercom. My vocal cords were stressed from the intubation and I could only talk in a whisper which didn't carry so well over the intercom. It was aggravating at first but once they understood my situation it got better. They finally quit using the bed alarm with a couple of days to go.
The second shower assessment occurred on Wednesday the 16th. A female therapist came to my room to inform me of this. I immediately told her that any observer had to be male. She agreed without hesitation. A male therapist showed up and I showered and he didn't even come into the bathroom. He sat in a chair and watched TV and told me to call out if I needed any help. Unbelievable!
Once out of the rehab hospital, I was still upset about the shower. I finally called my case manager and explained the situation. She referred me to the nurse in charge of quality control. The quality nurse was very interested with my concerns. I was impressed with her focus on my situation and she was always most professional when she spoke to me. 2 of my calls to her lasted well over an hour and she never seemed rushed nor did she make excuses for the therapist's conduct. I knew she was the real deal or a great actress. She put me in contact with the nurse supervising the physical therapists. That nurse assured me that the assignments are rotational and who I got was the luck of the draw. She also said that the male therapists were routinely assigned female patients for the shower assessment. I was less impressed with her since she mostly said she understood what I went through since she has been a patient in the past. However, I wasn't looking for sympathy, I was looking for correction of the problem. For me, the problem was ignoring my concern about the gender assignment. I had clearly indicated my concern that gender was cause for alarm and that concern was disregarded. How can they respect my dignity by disregarding my concerns?
I had stated my past abuse history with the quality control nurse and she said that would have definitely triggered a notice had it been known. I explained how the abuse history was not brought up. In my initial interview when I arrived at the hospital I should have been asked about "comfort" concerns and I don't recall that. It may have been asked but I wasn't all there. They even had me labelled as a type 2 diabetic, which I am not. No wonder I got my finger stuck every day for a blood/sugar test! What I learned from all this is to let any medical encounter know that there has been a past history of sex abuse even if it seems it shouldn't be an issue. My wife and I have discussed this for any future medical encounters.
I requested a copy of my medical records from the rehab hospital. They came to 854 pages! That's eight hundred fifty four pages! I then got read what the girls said about my shower assessment.
Continued,
58flyer
Dr. Bernstein, the difficulty in getting doctors to apologize may in part be from a liability perspective. To apologize is to admit they missed something or did something wrong. Another piece is ego. Medicine does seem to attract big ego types. Big egos usually find it difficult to apologize.
The liability aspect is probably what drives hospitals themselves to offer non-apology apologies in response to patient complaints. "We're sorry your experience did not live up to your expectations" kind of stuff.
58flyer, in addition to the rest of your rehab story, I am interested in hearing about your CNA training as concerns patient privacy/dignity, and especially how they taught you to respond to patient objections.
Maurice,
The failure to apologize degrades a person's humanity. It also creates a level of care beyond human capabilities. When this happens, patients expect a cure (not just treatment).
Ego leads to hubris. This creates a situation where satisfaction is less likely. Things beyond their control (EMR, 3rd parties, etc.) no longer are acceptable excuses.
Physician, heal thy self.
-- Banterings
Banterings, I fully agree. You know, I have a feeling that in teaching first and second year medical students, as I have, establishing the concept of professional apology, developing it further than those two years and establishing that upon graduation, apology to the patient is a absolute essential toward the best practice of medicine .. I have that feeling that as teachers of medical practice we could be doing a lot better in this regard than what we are currently doing. But it is hard over the students 4 years of education to stress apology when they are learning about so many, so many clinical issues and how to react and resolve them. It is essential that consideration of apology and its presentation to the patient and family be part of the professional but humanistic toolbox. ..Maurice.
Maurice,
You have consistently pointed to the 3rd and 4th year as sabotaging the profession. The profession does it to itself and deserve what ever it gets (burnout, suicide, etc.).
Society will impose fixes as long as this self-destructing curriculum continues.
Again I say: Physician, heal thy self (or society will).
Time for a new volume. May I suggest the title "Physician, heal thy self?"
-- Banterings
Biker,
The 3 things that were stressed the most were, 1. introduce yourself to the patient, 2. fully explain the procedure/treatment you intend to perform, 3. ask permission. Permission is the most important, since failing to gain permission is basically battery. Oh, I forgot to mention, knocking before entering the patients room.
Today, I got a letter from the CEO of the hospital. I was expecting that since the quality officer said I would hear from him. I won't go into it here now, since I am still trying to process it. I will post it here when I am ready.
After reading the letter I realized that I was complaining about 2 of the staff when in reality most of the staff was very kind and professional. One therapist went out of her way to treat me well. She was very energetic, focused all her talent on me, went above and beyond what was expected of her. For now, I will call her Angel (not her real name). Angel brought with her a barber kit. She purchased it on her own. She gave me a haircut which I really needed. She came to my room at the end of her shift to see how I was doing before she left for the day. I have written out a thank you card that I plan to take to the hospital in the next day or so. I wanted to have flowers delivered with some candies for Angel but the local florists said the hospitals won't take deliveries due to Covid. I am just going to take a gift of candies and the card and just walk in and see if that will be delivered to Angel.
Many of the staff have Facebook accounts, including the 2 who offended me most as well as Angel. So far, I haven't found any references to patients. That's good, I don't want to be in anyones pictures file. Having just turned 65, with age spots, gray hair, and saggy skin, I am quite sure I am not spectacular enough to end up on a Facebook photo page.
I am still going through the medical records from the rehab hospital. I haven't yet requested the records from the main hospital. I would like to know when I went down enough to be intubated and put under. I did call the Covid unit at the main hospital and spoke to a gentleman who was a nurse. He didn't remember me but was excited that I called him. They rarely get a call from former patients. I will be visiting them if they let me go up to the Covid floor in the next few days to thank them for saving my life.
The real thanks go to my church members and neighbors who prayed for my recovery. So many of them brought food to my wife and son during that time. With it being a Florida summer the lawn is growing at a huge rate with the daily rain, the neighbors stepped up and mowed my lawn and my wife doesn't even know who did it! I live in a great neighborhood and attend a great church! Much to be thankful for.
Continued.....
58flyer
Thanks 58flyer, one specific question I have about your CNA training is how did they teach you to handle patient objections, verbal or body language, to opposite gender intimate care.
I had a disturbing story relayed to me by my transgender friend. She has a friend who is helping her with her medical phobia by encouraging and supporting her to take better care of herself. Her friend has gone to appointments with her as support.
She (my friend's friend) has numerous surgeries around the world and here in the US. She has never had a problem with healthcare and she trusts providers. She recently had surgery with a leading plastic surgeon in NJ who specializes in the care of transgender individuals. (She is transgender too.)
Her experiences were enough to send her into a full blown panic attack. It is a good thing that my friend was there to calm her down and take her to her therapist.
Some of the issues were multiple people unrelated to her care wanting to view her genitals. At first she thought she was helping with education but felt like "a side show freak" and "dehumanized" (her words). Even in the surgeon's office for follow up, the chaperone was staring at her genitals.
My friend asked me to help them. So like 58flyer, there will be letters sent.
More to come...
-- Banterings
Biker,
To answer your question about how to handle objection to opposite gender intimate care, I have to say is not much. The main focus was gaining permission. A CNA will work under the direct supervision of a licensed nurse. So if a patient were to object to my care I would pass the matter along to the nurse. In effect, a CNA is the eyes and ears of the nurse. It is the obligation of the CNA to notify the nurse of anything out of the ordinary.
The course was 3 hours per day for 2 days a week for a total of 5 weeks. 30 hours. Not much...
The book was very large along with a workbook. We had to study and do the workbook outside of class time. I estimate I spent about 60 hours on the 2 books. My final score was 99. I wanted to do well so I took it all seriously. There were 3 of us in the class, 2 females and me. One had been a CNA for years and was coming back fo a refresher before going back to work as a CNA and had a job in hand. The other female was a late in life interest in things medical. They both did well on the testing. The teacher was happy with our little group.
I discussed the letter from the CEO with my wife. She is a paralegal having worked for many years in both defense and plaintiff law firms. She specializes in medical malpractice though she now works for the state prosecutors office. My wife said the letter is a standard "feel good" letter, admitting nothing and thanking me for bringing the matter to their attention. I am still trying to process it all so I will comment on it later. I'm trying to decide if I should let it drop at this point or push further. I am thinking about filing a complaint with the state department of professional regulation against the 2 therapists since they basically acted without my permission. I have considered the law enforcement angle but it would be tough since my memory of the incident is spotty at best.
Still working through those 854 pages!
58flyer
Part 1 As some of you might have noticed, I took some time off bc my one cat, Jimmy, was very ill and I wanted to devote as much of my time possible to him. He didn't make it so I needed more time but now I am ready to start working again.
I wrote to Dr. B. and he suggested I might share my experience w/ Jimmy's care as I am the wife of a medically/sexually abused patient. Jimmy's experience was totally different. Even though the family vet left Jimmy's illness go on for way too long without knowing what he had, I know he was doing his best. He and his staff were nothing but kind, compassionate, and caring towards Jimmy. Everything done to Jimmy was explained and permission asked. Completely different from my husband's experience.
The specialty vet center where Jimmy went for chemo was wonderful beyond words. Chemo and specialty treatments for animals is very, very expensive. They made sure before they did anything to check with us listing alternatives, risks, expectations, etc. before doing anything. We rec'd detailed summaries of every aspect of the medical encounter along with detailed billing even receiving a refund on an overcharge which truthfully we wouldn't have recognized if they had decided not to be honest.
During the visits, they would talk to us. They would talk and interact with Jimmy in our presence before taking him for testing to make sure he was comfortable with them. I remember once while we were waiting the tv was playing a show that was on tv the night I had to wait for hours & hours at the hosp from hell having no word for hours abt my husband (this happened while he was being sexually abused by Leather Hench & co.). I was distressed & so was my husband. I asked them to pls turn off the tv asap bc of the traumatic events associated with it. They did it asap and from then on there never was a tv on in our patient room. This clinic is actually just a few miles from the hosp from hell but to this day, we have never seen it again bc it represents hell.
Part 2
On Jimmy's last day, I knew he wasn't doing well. He was supposed to get his 2nd dose of chemo as they gave it to him over 2 days each treatment time. His lymph nodes had swollen bigger than ever just basically overnight. He wasn't moving around much as it was getting difficult for him to breathe. I could tell Izzy the nurse knew he had issues as she took him back. Dr. W. came in a short time later to say he was in distress and needed to put a catheter in his arm while she still could. We agreed. She left and came back and we had the talk abt what was best for Jimmy for the final time as from the beginning Dr. W. had laid out all the scenarios and it was clear the chemo had failed and had in fact, caused the cancer to become more aggressive. Our son didn't like hearing that it was time for Jimmy to die before he suffocated to death. He said he needed to see the proof--the science. W/o any hesitation, she provided the medical evidence. She knew I didn't believe in killing them bc the shot can have bad consequences but she explained she doesn't merely give a shot but goes in through the catheter with a pre-med. Once it works, she goes in again through the catheter & administers the drug that actually kills so there are no horrific side effects of being killed. She said she would arrange for it to be as peaceful as possible. She did.
She had us taken to another room that is not an exam room but rather a private family space. She came back with Jimmy all wrapped up in these think furry blankets. She told us to spend time with him as he was stable for the moment. We all held Jimmy. He got up and moved around. She and Izzy came back and arranged us on the floor around Jimmy including her and Izzy. We sat there and held Jimmy's hands while she administered the drugs. All of us were crying including her and Izzy. She said would continue to cry later at home (she had told us one of her cats had brain cancer so she knew what we were going through). Jimmy left us very peacefully. Dr. W. had asked us what we wanted done w/ Jimmy & we wanted to take him home so she said she would take him back when we were ready & clean him up, clip some of his hair for me, and make prints of his paws. She also said she would take off his bell for his sister Danny to wear. I gave them Jimmy's blankets and later they came back with a packet of Jimmy's things and Jimmy in a little cardboard casket. She said we could leave by the side door and we could settle the billing later.
NOTICE: THERE WILL BE NO FURTHER POSTING OF COMMENTS ON "Preserving Patient Dignity (Formerly Patient Modesty) Volume 18". My visitors are encouraged to write on the newly established VOLUME 119
https://bioethicsdiscussion.blogspot.com/2021/07/preserving-patient-dignity-formerly.html ..Maurice.
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