Bioethics Discussion Blog: Preserving Patient Dignity (Formerly Patient Modesty) Volume 118

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Wednesday, April 21, 2021

Preserving Patient Dignity (Formerly Patient Modesty) Volume 118



 





If hugging or praying together is unacceptable in bringing the healthcare provider and patient to the necessary "togetherness" of a medical relationship then perhaps the simply holding of hands provides the route.  ..Maurice.


Graphic:  https://www.tru-caring.co.uk/ via Google Images









54 Comments:

At Thursday, April 22, 2021 7:38:00 PM, Blogger Maurice Bernstein, M.D. said...

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.

 
At Friday, April 23, 2021 5:47:00 AM, Anonymous Anonymous said...

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

 
At Friday, April 23, 2021 8:25:00 PM, Blogger Maurice Bernstein, M.D. said...

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.

 
At Saturday, April 24, 2021 4:14:00 PM, Blogger Biker said...

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.

 
At Saturday, April 24, 2021 5:05:00 PM, Blogger A. Banterings said...

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



 
At Saturday, April 24, 2021 7:16:00 PM, Blogger Maurice Bernstein, M.D. said...

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.

 
At Sunday, April 25, 2021 9:14:00 AM, Anonymous JR @rights4patients said...

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.

 
At Sunday, April 25, 2021 3:18:00 PM, Blogger Maurice Bernstein, M.D. said...

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.

 
At Monday, April 26, 2021 12:46:00 PM, Blogger Maurice Bernstein, M.D. said...

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.

 
At Tuesday, April 27, 2021 9:58:00 AM, Anonymous JF said...

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!

 
At Tuesday, April 27, 2021 9:21:00 PM, Blogger Maurice Bernstein, M.D. said...

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.

 
At Wednesday, April 28, 2021 12:20:00 PM, Blogger A. Banterings said...

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







 
At Wednesday, April 28, 2021 1:27:00 PM, Anonymous JF said...

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.

 
At Wednesday, April 28, 2021 1:59:00 PM, Blogger Biker said...

Banterings is right. Providers and patients are not operating from the same definitions of what things like consent, privacy, and respect mean.

 
At Wednesday, April 28, 2021 4:42:00 PM, Blogger A. Banterings said...

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





 
At Thursday, April 29, 2021 10:28:00 AM, Blogger Biker said...

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.

 
At Thursday, April 29, 2021 4:07:00 PM, Anonymous JF said...

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.

 
At Friday, April 30, 2021 10:21:00 AM, Blogger A. Banterings said...

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




 
At Friday, April 30, 2021 11:31:00 AM, Anonymous Anonymous said...

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

 
At Friday, April 30, 2021 12:37:00 PM, Blogger Maurice Bernstein, M.D. said...

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.

 
At Friday, April 30, 2021 6:00:00 PM, Anonymous JF said...

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.

 
At Saturday, May 01, 2021 5:06:00 AM, Blogger Biker said...

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.

 
At Saturday, May 01, 2021 12:31:00 PM, Anonymous JF said...

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.

 
At Saturday, May 01, 2021 2:49:00 PM, Blogger Maurice Bernstein, M.D. said...

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.

 
At Sunday, May 02, 2021 1:02:00 PM, Blogger Maurice Bernstein, M.D. said...

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.

 
At Sunday, May 02, 2021 4:36:00 PM, Blogger A. Banterings said...

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




 
At Tuesday, May 04, 2021 12:33:00 PM, Anonymous JF said...

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.

 
At Tuesday, May 04, 2021 12:52:00 PM, Blogger Maurice Bernstein, M.D. said...

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.

 
At Tuesday, May 04, 2021 5:49:00 PM, Anonymous JF said...

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.

 
At Thursday, May 06, 2021 5:39:00 PM, Blogger Maurice Bernstein, M.D. said...

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.

 
At Friday, May 07, 2021 11:43:00 AM, Anonymous Anonymous said...

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.

 
At Friday, May 07, 2021 11:55:00 AM, Blogger A. Banterings said...

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




 
At Friday, May 07, 2021 3:39:00 PM, Blogger Maurice Bernstein, M.D. said...

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.

 
At Friday, May 07, 2021 4:26:00 PM, Anonymous JR @rights4patients said...

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.

 
At Friday, May 07, 2021 6:02:00 PM, Blogger Maurice Bernstein, M.D. said...

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.

 
At Saturday, May 08, 2021 7:25:00 AM, Anonymous JR @rights4patients said...

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.

 
At Saturday, May 08, 2021 7:26:00 AM, Anonymous JR @rights4patients said...

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?

 
At Saturday, May 08, 2021 7:37:00 AM, Anonymous JR @rights4patients said...

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.

 
At Sunday, May 09, 2021 4:56:00 AM, Blogger Biker said...

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.

 
At Sunday, May 09, 2021 9:20:00 AM, Blogger Maurice Bernstein, M.D. said...

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.

 
At Sunday, May 09, 2021 1:49:00 PM, Anonymous JR @rights4patients said...

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.

 
At Sunday, May 09, 2021 1:55:00 PM, Anonymous JR @rights4patients said...

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.

 
At Sunday, May 09, 2021 2:15:00 PM, Blogger Biker said...

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.

 
At Sunday, May 09, 2021 3:28:00 PM, Anonymous JF said...

Dr B. Most instances of dignity violations are NOT life and death circumstances.

 
At Sunday, May 09, 2021 10:30:00 PM, Blogger mitripopulos said...

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.

 
At Monday, May 10, 2021 8:56:00 AM, Blogger Maurice Bernstein, M.D. said...

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.

 
At Monday, May 10, 2021 2:09:00 PM, Blogger A. Banterings said...

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

 
At Wednesday, May 12, 2021 9:22:00 PM, Blogger Maurice Bernstein, M.D. said...

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.

 
At Thursday, May 13, 2021 5:27:00 AM, Blogger Biker said...

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.

 
At Thursday, May 13, 2021 8:52:00 AM, Blogger Maurice Bernstein, M.D. said...

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.

 
At Thursday, May 13, 2021 9:16:00 AM, Anonymous JR @rights4patients said...

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?

 
At Thursday, May 13, 2021 10:56:00 AM, Blogger Biker said...

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.

 
At Friday, May 14, 2021 3:00:00 PM, Blogger Maurice Bernstein, M.D. said...

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.

 
At Saturday, May 15, 2021 9:50:00 AM, Blogger Maurice Bernstein, M.D. said...

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.

 

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