Preserving Patient Dignity (Formerly Patient Modesty) Volume 120
Graphic: From SmartSign.com via Google Images
posted by Maurice Bernstein, M.D. @ 7:37:00 PM
176 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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Sunday, November 07, 2021
About Me
- Name: Maurice Bernstein, M.D.
- Location: Los Angeles, California, United States
Previous Posts
- Preserving Patient Dignity (Formerly Patient Modes...
- The Sexually Seductive Patient: How Should Doctors...
- Preserving Patient Dignity (Formerly Patient Modes...
- 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
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176 Comments:
Dr B. I don't believe that it would ever be posted because there's too much hypocrisy coming from the medical world. It would be funny if a PATIENT would post it on the door without the medical staffs knowledge. I also liked the post PT suggested one time. It was " If you have a penis, we want to see it!" Obviously it would be taken down as soon as the staff became aware of it but maybe it could have some impact. SOMETHING needs to happen to get a change started.
According to an OB/GYN on Quora HE will never get Versed again if he needs surgery again. I hope this carries over to his patients. One nurse who was subjected to the exposure patients are was embarrassed by it. She is now teaching students to be careful with exposing patients. Now, what you are drilled with in class, doesn’t necessarily carry over to the real world. Especially, if you have a mentor with a bad attitude and takes the shortcuts. Teachers need to drill these students on what’s right and how NOT to be afraid of calling the other ones out. Just go forward with what you were taught and what you know is right.
My biggest qualm is with the OR/recovery staff. Too much is done when you are unconscious and can’t say cover me up. The prep field for most surgeries is too large. You can drape a patient and lift the gown without exposing them. Same after the surgery. There is no need to take all the drapes off at once again exposing you while they clean you up. If the surgery is on your abdomen, but the sheet over the drape and pull the drape out from under... them clean up the abdomen. You can put the gown on over the sheet then pull the sheet out from under the gown. It takes an extra 3 seconds to do it this way. We only expose what is necessary. Only the surgical site is exposed. That’s a lie. You as the patient expect a few seconds and no genitals being exposed. Meanwhile, after they expose you (after you are unconscious) they hook you up to the monitors, put grounding pads on you, prep your skin THEN it takes 3 minutes to dry before they can drape you. Is that the mere seconds they want you to believe? Stand on the corner in NYC naked for 3 minutes and see how long that is. Why do they bring in paid patients for students to practice on? Why can’t they recruit doctors and nurses to be the naked guinea pigs for the DRE and pelvic exams? It’s all clinical and they need to learn right? They will have seen them all, it’s just like a car. These paid patients don’t have modesty issues so they don’t care. Teach the students on people who do. Tell the paid patients to tell the nurses no. Scream at them, tell them you want to remain covered. You know like it will be in the real world. Then maybe changes will occur.
Maurice,
Providers are now being subject to things that they have forced upon their patients, such as vaccine mandates (peds dropping unvaccinated patients).
Society has begun holding institutions of power accountable. First it was the abuses of religious organizations then it was the 2020 protests holding tho police accountable, now society is going after elected officials, school boards, public health officials, and healthcare providers.
These vaccine mandates are going to push legislators to pass "bodily autonomy" laws that although focussed on vaccined, will also cover other issues of dignity.
-- Banterings
To the extent dignity includes having your privacy respected, the sign is appropriate. As I have said multiple times, much of the disconnect is healthcare staff thinking being polite is synonymous with being respectful. It is an important part of being respectful, but it is not sufficient in and of itself.
Healthcare often requires bodily exposure to strangers that most would never do outside of a healthcare setting. Patients accept that as a necessary part of receiving healthcare. Where it goes awry is when that exposure goes beyond what was necessary in terms of extent, duration, and audience.
It doesn't matter if you immediately place a towel over the patient's genitals after lifting the gown. You still exposed him needlessly if it wasn't the genitals that were being examined or otherwise treated. It is at this very basic level that they just don't get it. It is bringing in the assistant that doesn't assist or the chaperone, scribe, or student without asking first that shouts that they don't see the patient's inherent bodily privacy as mattering.
Being dismissive of the patient's gender concerns is hugely disrespectful. No amount of politeness is going to compensate in such scenarios when acknowledging the patient's concern and showing some degree of empathy could just as easily been done.
No doubt many if not most in healthcare see these seemingly minor things as not mattering, yet it does for many patients.
Going to the other end of the spectrum with the kind of purposeful abuse such as JR's husband suffered, that they got away with it affirms that healthcare systems simply don't care about patient dignity. It is as if it is a voluntary action on the part of staff if they choose to respect a patient's dignity. I say this because there are almost never any repercussions for even egregious dignity violations. The whistleblower is more apt to get in trouble than the perpetrators.
Most patients will never suffer the kind of scenario JR's husband did. Most patients will suffer the routine kinds of things I noted and will do so multiple times. It could be fixed overnight if they simply chose to, but they don't. The sign is appropriate.
Maurice,
Here is a graphic from today (2021, November 9) in "Annals of Internal Medicine" titled Annals Graphic Medicine - The Hospital Makes It Hard to Speak Up for Myself.
While I applaud Annals for addressing the issue, I feel the graphic does not adequately address the issues of why patients find it hard to speak up (power imbalance). I would love to see a frame where the patient says something and one of the providers say "nothing anyone hasn't seen before.
I think that the most disturbing part is that this is how patients are treated REGULARLY. Perhaps it should be titled "How patients are routinely treated and the Profession of Medicine's failure to care about the issue."
Just as parents demand a sayin their children's education, patients will be demanding MORE of a say in their care. Just as Terry McAuliffe and Democrats were blind to what parents wanted and stuck to their ideology, so too the profession of medicine is attempting to do the same.
Just as with the movement holding the police accountable, it is going to take only a single incident to bring on the change. With the police, George Floyd was that catalyst.
-- Banterings
Today on Facebook I saw a post that said Oppression isn't an accident. Change won't be either. It made me think about modesty violations
Good evening:
Just a quick FYI.
There's a company called Clairus that has made a hand-held portable ultrasound device that works with a smartphone or tablet.
Think of the possibilities for guys. If your pcp or urologist has this in his pocket, there'd be no need to go to the hospital & get needlessly exposed anymore.
This could be a game changer for men.
Unfortunately this device will also probably cost some techs their jobs as that bulky ultrasound machine will become obsolete with time.
That's all from me for now.
Regards,
NTT.
"Unknown" from 3:58 pm today, please identify yourself with you pseudonym. Is it JF writing? Thanks. ..Maurice.
Hey Banterings, where are the cartoon graphics of a male patient's genitalia being exposed or potentially to be exposed? What does the gender of the examples tell us something about the exposure issue in males, the gender most of exampled on this blog thread? Maybe graphics such as this only shows the diminished professional concern regarding male modesty. Correct? ..Maurice.
Yes Dr B. It was me. My new phone doesn't cooperate but my old phone wasn't letting me post at all. JF
Biker,
I do agree that what happened to my husband is not as common as the everyday exposure and lack of respect for dignity that most men suffer. He, too, has suffered those lack of respect indignities in the past but just chalked it up as part of inhumane treatment he had to endure in order to get medical care. I believe most men who suffer those types of indignities remain silent like my husband. Others will avoid medical care once they have suffered those indignities or never go at all because they have heard other men talk abt the "strip as you go exam" with the wet behind the ears young female in tow to watch the whole clown show.
While they are more careful with female patients if a male provider is involved, all patients are subject to having their bodily dignity disrespected once sedation is involved. This tells a lot about the moral backbone of the medical community. You would think they would better protect an unconscious patient but rather the reverse is true. They seem to go out of their way to treat the unconscious patient even more worse because they know most will not be able to recall the mistreatment of bodily dignity because of the side effects of the sedation.
I will say that even if you have same gender care, you still should not be exposed unnecessarily. This is something I don't see anyone on this board addressing. Many think of the opposite sex as sexual but in today's society even those same gender care providers can have sexual thoughts towards the patient. All unnecessary exposure must be stopped regardless of the gender of the care provider.
I also agree with Biker in saying the fix is easy and could be done "overnight" so why do they want to continue to willfully harm patients?
Because it’s more convenient for them to totally rip the gown off of you then take the few seconds it would take to drape your genitals first then remove the gown. What gets me is one or two OR nurses have said even if you are getting gallbladder/ingunial hernia/appendix surgery you do not need to be exposed at all yet routinely are. The patient can prep their own groin while in pre op and put the surgical garments on themselves. You shower with antibacterial soap several times prior including the day of if elective surgery. How often do emergencies happen that they need to get to the femoral artery? Besides, they can still get there with the under garments. We the patients need to speak up with our wallets. I know if and when I need surgery I will NOT be getting versed and I will be requesting to stay awake during prepping and draping then again being before the drapes come off. Yes, it’ll take them a few seconds longer too bad.. they say you are awake in the OR before they move you over and ask you questions where are you etc? Being awake/aware will keep them accountable. If they are not willing to abide by my requests, I am not willing to give them a dime. I’m sure someone out there wants my money. It’s all about the bottom line. If we can teach enough patients that we do have a say in our medical care, then they have to start listening. The question is where do we get the word out?
JR....
with all your speaking with Drs how many seem open to make changes?
Catfostermom
None. They have various excuses. The most common excuse is patients don't complain so they don't see the need for change. It is the atmosphere of deflect--it is the fault of the patient for not complaining of mistreatment rather than we should do the right thing in the beginning. It is also telling that in most of my exchanges with harmed patients, very fewer females seem to feel they were unnecessarily exposed especially at the office visit level than males. Males seem to be the loser on in having the ability to have their basic human right of dignity recognized. No wonder so many men avoid medical care.
Getting the word is why CS and I are doing the weekly radio show. This last week we talked abt same gender care and I believe we are continuing it this week. Would anyone like to volunteer to be guest as the more different people we have speaking up and out, the more effective it is. I talk on Twitter abt this too. Most agree they felt they were exposed unnecessarily but didn't know they had rights not to be exposed or for same gender care in intimate situations.
As far as femoral access being needed, if the facility would use the COVR garment, there is no need for genital exposure. Those garments were designed for access without exposure. These garments should be used be all facilities but are not. Yes, I do also believe the patient can do most of the prep and the surgery team can finish once the genitals/breasts have been covered by the patient. If a surgery bra for women is not appropriate, they can use falsies to cover which covers the area needing shielding but would still allow access to leads. I really don't see what the medical community feels the humiliation (via dehumanization=exposure) and ownership of patients is necessary for surgery. Can anyone defend this need?
Has anyone considered the possibility that the basis or mechanism for what the patient and those writing here consider professional misbehavior of both physicians and nursing staff toward the patient and patient's family might be due to physician or nurse "burnout"? Read this article dissecting medical professional
burnout and maybe you will come to a broader conclusion as to the origin of the professional misbehaviors. Yes, problems with the medical system as applied to the duties set for the professionals is a major part of the "burnout" but have you considered the "requirements" that have been written here in the past and currently regarding the patient's or patient's family's points of view regarding each professional's duties, actions and behaviors? Could and should there be changes beyond the medical system itself but also within the "subjects" of the system ("the patient") which could improve how medical care is rendered in the future?
..Maurice.
Dr. B.,
Are you victim blaming/shaming like others in the medical community do? Do believe it is okay to tell a raped woman if you hadn't worn that tight, red dress you wouldn't have been raped? What is the difference? Patients go to medical providers trusting they won't be harmed and part of not harming is to treat all patients with human dignity. It is really very simple. If there needs to be changes in patients, then patients should become very plain spoken: Don't harm me and I won't harm you would probably be the change that might work?
I don't care if they have burnout because that is not a viable excuse to inflict harm/injury on others. We don't accept that poor justification for an excuse in other "professions" so why would it be acceptable in a job that actually holds your quality of life and/or death in their hands? To me, medical people should be the most compassionate, careful, etc. workers ever. There is no reason for all the patient exposure and making the patient feel like an owned object except they can and they do. When when career in education became something I no longer enjoyed, I ended it. I have my principles I have to live by and with and I would assume most people do and if they don't, they should try getting some as not having strong inner strength is a huge issue.
The reason abuse of patients is happening and will continue to thrive is it is an acceptable side effect of medical care for most. The govt., media and legal systems also feed the medical field's need for power, control and greed and most patients do allow it to happen. So I guess the patient does need to become more aggressive. We must have cameras used for the patient's advantage and/or have their designated person in attendance with them at all times including before, during and after surgery as this is when the most unnecessary exposure will happen. We definitely need to teach patients to no longer have the whitecoat/scrub worship syndrome that affects many, many patients.
No... burnout is an excuse. This has been going on much longer then the recent short staffages. Besides, I’m a phlebotomists. If I’m tired and over worked I don’t take it out on the patients by stabbing them harder or missing on purpose. I still do my job the way it should be done. Exposing the patient is more convenient. Day surgery facilities are a meat market and we are the meat. Get them in and out. Don’t you think if we do some of the prep ourselves in prep op that will speed up their process? Someone said you can’t trust the patient to do it.. do you think we want to get post op infections? Of course we will do it right. Just another excuse to expose us in their and be in there control. I trust myself or my husband more then I trust them.. not every patient cares and that’s fine, they can be exposed all they want. But, it MUST be an option for the ones that do.
Has anyone considered that the ethical switch from physician paternalism to patient autonomy in recent generations has been an element in the development of physician and nursing "burnout"? With greater emphasis on the desires and directions given by patients or their families to the profession have just added to the other medical system changes and demands which have been noted as causes. Just a thought to consider. Can we really ignore the pressures brought upon the professionals by their patients now that patients have more "voice" in their attention and care? ..Maurice.
Has any medical staff ever considered that having a family member be with the patient will lessen their loads? I can help my husband to the bathroom. Sponge bath him. Check his incisions. Educate the family on what the different beeps on the machine means. I can get him something to drink. Why do nurses kick the family member out of the room when they come in to do intimate care? I’m pretty sure I’ve seen my husbands genitals before. Who do you think has to do all this once the patient gets home? A co worker broke her hand enough to need screws. One day we were looking at it and told her it’s infected you need to get it checked out. So we asked the nurses in the office. Oh no it looks fine. Ummm no that’s definitely infected. She ended up going back to her doctor and it indeed was infected. Why do medical staff treat everyone like we are 5 yr olds and we couldn’t possibly know something is wrong?
Dr. B.,
So if we follow what you are saying then it would be acceptable that a police officer w/ burnout can abuse a suspect, a teacher w/ burnout can abuse a student, a mechanic w/ burnout can halfway do your car, and so on....Also, with the demands put on each of these professions, they also have the right to be more abusive? Are you acceptable of this or does this only pertain to the medical industry?
I also don't understand why the medical community has such a difficult time in accepting their services are very personal to the patient and therefore deserve more scrutiny and input by the patient. In addition, I do not understand why the medical community feels that dealing with all patients their basic human rights should not be violated. Are you fine with police officers violating basic human rights bc they too hold life and death in their hands? I am not sure why the feelings/rights of the service provider takes precedence over the patient? Can you explain why? Why should I, as the paying customer and the one who the action is happening upon be considered non-important? Where else would this be considered standard? If what you are saying is valid, then it means that any medical provider is allowed to harm bc of their personal feelings such as bias or burnout. Do you find this as being acceptable? However that is what is happening now. They have even went so far as to say they will not treat sick patients if they have not been vaxxed. To me, this is being put out there to see if the public is accepting of them to be able to harm without consequences. Just saying, the medical establishment of old was in it to treat all sick people not just some who conformed to their personal biases. Scarier times ahead if this is not countered by especially those in the medical community who actually have ethics.
Burnout creates it's own problems. It's not just Medical workers who suffer from it. It's ANYBODY who works too many hour or works understaffed too much of the time and don't have a balanced life. We need to live our lives outside of work also.
I don't think modesty violations are connected generally speaking. Those kinds of abuse and neglect are the fruit of character defects. JF
If medical staff are subject to burnout, I suspect it primarily comes from the managers of these hospital systems running them like factory assembly lines. Pushing staff to see more and more patients in each shift, and keep up with the electronic records systems surely takes a toll.
Catfostermom .
I posted here before of the care I provided to my wife while she was under going chemo . I slept next to her during her entire stay . ( 2 different times ) . I showered her , I dressed her , I walked her 3 times a day . When she wanted to go outside I got the wheel chair and pushed her around the grounds outside for a hour or so . On one occasion I even helped the nurse catheterize her . I admit this isn't normal but good things do happen . Sometimes you have to look for the good places . They are not all the same . AL
Catfostermom .
Not all hospitals and nurses are the same . I think most people here would agree my experience is not the norm . I showered and dressed her every morning . Walked her around the halls . I even helped the nurse catheterize her once . I was right next to her 24 hours a day all with the nurses blessing . Find the good ones . Use the internet to make either good or bad comments . They hate bad comments . AL
Maurice,
Patient autonomy would lessen burnout if anything. Instead of the provider having to convince then coarse the patient to do what they want, the patient makes the decision and the provider simply complies.
I believe that paternalism and the abusive behaviors discussed on this thread is what leads to burnout and suicide. The constant struggle that a human being has with moral, dignified, ethical treatment patients DESERVE compared to what the do or witness others doing puts them is a state of constant turmoil. There is also the aspect of the Golden Rule, thus physicians not wanting to be treated the way they see patients treated.
The Golden Rule aspect can be seen in Physicians Recommend Different Treatments for Patients Than They Would Choose for Themselves and Physicians Choose Less Intensive End-of-Life Care than General Public.
A good correlation is 40% of LGBT you considered suicide due to internal conflict (who they are vs. who they are expected to be).
This is the same internal conflict physicians have with how they SHOULD treat patients and how they ARE treated.
-- Banterings
And how does the medical profession preserve their patient's dignity when the patient demands that, when the staff has decided it was time for the patient to be discharged from the hospital, the patient refuses to leave? Read this 2012 topic on this blog "Patient Refusal to Leave the Hospital: And Now What?"
By the way, PT was one of the respondents on that topic. ..Maurice.
I’m not seeing how that relates to exposing a patient unnecessarily. Can someone explain?
Catfostermom, patient dignity is not set set by only bodily exposure but is also set by acceptance by the medical profession of other factors related to physical and behavioral aspects set in the interaction between patient and profession. Setting of when the patient feels comfortable to leave the "comfort" and the "care" of a hospital can be a factor. Dignity does include
a patient making their own decisions about their health and management.. or does it?
"Time of leave the hospital" is a just as important a decision that a patient may make as it is to "the time to reject a treatment or a physical examination to which a patient may be uncomfortable."
When Google is asked "what represents the dignity of a patient?", Google responds with "In the context of healthcare, dignity often is defined as a multifaceted approach to patient interactions that involves the elements of respect, autonomy, empowerment, safety, communication, privacy, acceptance, acknowledgment, fairness, and more." referenced from https://www.medpro.com/promoting-patient-dignity. It is that patient empowerment and acceptance which provides the challenges to medical decision making by the providers. Challenging "It's time to leave your hospital bed" is just one example. ..Maurice.
There are so many subject topics on this bioethics blog which I have created and have been responded to by readers that are definitely related to the issue of preserving patient dignity.
Take for example, one I published in January 2018 titled "Difficult Patient vs Difficult Doctor" to which our Biker and Banterings along with others kept the topic moving along and constructive. You all may be interested to go back and look at the discussion and, yes, you can write your 2021 views of the subject as directly related to our current topic here "Preserving Patient Dignity".
Again, I want to again thank Banterings for uplifting the scale of this blog subject title to "Preservation of Patient Dignity" which provides much more to think and write about that "Patient Modesty" itself. ..Maurice.
I would have to agree that patient dignity is more than just bodily dignity. It encompasses many areas. However, bodily dignity is the one that is violated consistently along with the patient's right to autonomy. Far too many medical providers only give patients the options they personally have chosen and only are wanting the patient to agree--not to ask questions or do research. Many medical providers do not feel the patient is the captain of the care team.
As far as leaving the hospital when they wanted me out, that was never an issue as I was always several miles ahead of them planning my escape. However, some are booted from the hospital far too soon and yes, there are those who don't want to leave but really they should be asking why because the reason(s) may be they can't care for themselves once released or they are in an abusive relationship. This would be a good use of the social worker instead of while molesting man asking him if his spouse sexually abused him but it would not be as much as fun or entertaining.
Dr. B.,
Who is defining who is difficult? I have been labeled "difficult" because I have the nerve to ask questions. However, from my viewpoint it is the medical provider who is difficult bc they dodge or are obviously angry/annoy that I ask questions and don't fall into the godlike worship they are used to having. When this happens, it is an immediately firing, exit--stage right bc that doctor is the type you do not want if you value your right to any type of dignity and/or autonomy.
And so, JR.. how can a physician and patient and patient's family get together to attack and hopefully cure the illness? Are we missing some important teaching point in medical student education? Are patients and their families getting erroneous and unhelpful information from the media and others which lead to the detachment of the doctor-patient relationship?
In order to cure we need a tool or relationship which cures. What is missing? ..Maurice.
The missing link is the doctors willingness to give the patients the power to choose their course of treatment AFTER given different options. Then being able to go home do their own research on how we the patient wants to proceed. Is it the newer Doctors or the older ones that don’t include us in our treatment? Does it matter what’s taught? Only if you have morals or were an abused patient yourself before do you retain this. A few nurses have admitted being embarrassed during their procedure and changed how they think. That’s great for future patients, but what about the thousand they did exactly that to before they became the patient? Once in the field you get lazy and start following others leads on how to do things for your convenience not the comfort of the patients. Doctors/nurses know the privacy garments are out there. Why aren’t they insisting they be used? If you are the patient asking for them you are difficult and fired.
Dr. B.,
I don't suppose you have seen any of Fauci's interview he did this past weekend? What I saw in his demeanor is what I so intensely dislike in a medical provider--the smugness and the contempt he shows when questioned. "I am science" is what he said. How dare any mere mortal question the authority or to be more accurate IMO the rantings of a narcissistic ----head. To me, he truly represents what is wrong with many in the medical community and that is the contempt they feel for all others outside of their peerage.
First of all, medical providers (meaning doctors, nurses, etc.) are being paid for their services. They are paragons of virtue selfishly giving their time and efforts to us but rather are being paid by us for their services which does make us their temporary bosses. They need to acknowledge the patient is the team leader and as team leader the patient needs all information--not just the information they want to give. They need to acknowledge the patient has the final say in choices/treatments. The medical staff's personal opinions and biases do indeed need to stay outside of the door. I appreciate that medical providers work hard and have spent many years in school (just as many others have) but that does not make them superior to those who they serve.
As for "hopefully cure the illness" it is pretty well recognized the current healthcare system is more a band-aid system that treats symptoms rather than the "root" cause(s). Band-aid systems of healthcare is what brings in the revenue. As for the media giving "erroneous and unhelpful information"--yes they do but not in the way you may think. The media simply glosses over what is really wrong with healthcare. They portray healthcare in a deity-like manner and that is not what we really experience. We need truth--the good, the bad and the ugly. We see the media portraying the ugly(Fauci) as being good when most of us see a little man who shows nothing but contempt for most of us all the while smiling while he spins fictional tales. He reminds my husband and I of the all those involved in his assaults. The female nurses "smiled" while they were abusing him. The behavior represents to me how morally corrupt the medical system has become.
I and I imagine many others do not respond well to those in the medical world who treat us like property--we don't matter, we lose all basic dignity rights such as bodily privacy and autonomy as a few examples. So if you want to teach medical students something of value, teach them to value the basic dignity rights of every patient and you and they will find patients will better respond to them. I know the doctors that I have met and who have shown me they respect my basic dignity rights are the doctors that I respect. The others, I have no respect for them and will not allow to even touch me. BTW, it goes for all in healthcare from administrators, drs, nurses, techs, office worker, etc. If you get a bad feeling at the front desk, your view of them has already been put into place.
So basically, what is missing is the respect of patients and their basic right to dignity. I doubt if any patient wants to not respect their medical provider or dislike them, but many end up in an adversarial relationship with them thus not following treatment recommendations or avoiding healthcare altogether.
Read this short Harvard Medical School article titled
"Setting the Stage: Why Health Care Needs a Culture of Respect".
The article describes, yes, respect by the members of the medical system to their colleagues but it also stresses the importance of the members respect for patients.
With regard to respect for patients the article sets forward the following:
Equally, if not more important, is respect for our patients. All patients deserve to be treated with dignity and an acknowledgment of their value as individuals. One of the most widely cited elements of disrespect mentioned by patients is simply failing to pay attention to their needs, by leaving them unattended or ignored. Think of how this translates to the way patients are greeted by your front staff, treated in the emergency department, or when they appear lost in the halls. As Don Berwick stated, “We are guests in our patients’ lives.” As such, we must act accordingly. This is demonstrated by listening to our patients, asking for their opinion and recognizing the importance of incorporating their personal values and priorities into treatment decisions. We convey respect by being considerate of patients’ time (e.g., striving to provide timely service and apologizing when we fail to do so). The physical environment that we create for patients is a direct reflection of our respect for them. Our ability to ensure privacy, cleanliness and quiet surroundings speaks volumes. When we request permission to enter a patient’s room, ask a patient how they would like to be addressed and explain to patients who we are and what we plan to do, this all communicates respect for them as individuals. Respect is also showing gratitude to our patients who entrust us with their care. A simple thank you can mean so much.
When did you last hear a meaningful "thank you" from your physician, nurse or medical staff? ..Maurice.
It appears that I couldn't get the link written in my last posting to work. But, otherwise, what is your opinion of the excerpt which I published above? ..Maurice.
Try this address for the above article:
https://postgraduateeducation.hms.harvard.edu/trends-medicine/setting-stage-why-health-care-needs-culture-respect
..Maurice.
I wanted to let you all know that we have a new article on Medical Patient Modesty's web site, What You Should Know About Surgery.
Misty
"Bullying". Does anyone here think that some of the misbehavior sensed and, as documented here, received by patients regarding their medical "caregivers" has as its underlying pathology ("cause") the result of bullying within the healthcare system and this is the disorder that must be attended to and prevented?
In the current issue of AMA Journal of Ethics Dec. 2021 is a case and commentary titled "Whose Responsibility Is It to Address Bullying in Health Care?"
https://journalofethics.ama-assn.org/article/whose-responsibility-it-address-bullying-health-care/2021-12
As is necessary in treating any disease, defining the "pathology" involved is necessary to attempt to fully treat. Do you see "bullying" amongst your healthcare providers or directly with you, the patient, is a mechanism of what you have been experiencing? Is there any chance that there might be some "bullying" toward the professional that is also going on? ..Maurice.
Maurice,
Having a chaperone or medical student in the room is "more against one," hence bullying. The patient only wearing a gown with fully dressed providers is bullying (I have previously provided citations to this).
Joan Emerson's Behaviour in Private Places: Sustaining Definitions of Reality in Gynecological Examinations is a how to bully patients instruction manual.
Here is a very good article from Very Well Health: Is Your Healthcare Provider Bullying You During Appointments?
See the section "Signs Your Healthcare Provider Is a Bully."
-- Banterings
Great article as always Misty. Thanks for the work that you do. It surely makes a difference for your readers.
Dr. Bernstein, there are bullies in every profession and based on my experience/observations from my own working career, the result is usually a lessening of the organization's performance. Bully-bosses stifle innovation & either increase costs or decrease revenue. Often the best and brightest leave for healthier environments.
In healthcare my former urologist who was amongst the elite of the profession was a bully. After experiencing it firsthand when I asked whether he'd be telling me my test results and being barked at that he didn't have time to give everyone their results I never asked him another question. Sadly, being afraid to ask him a question subsequently caused me to ask someone else in his office if the test he was ordering was something I was supposed to get scheduled now or it was something that would get done in conjunction with my next visit. She couldn't figure it out herself and asked him when he happened to pass by her desk. He was furious with her for asking him the question. I felt horrible for being the cause of her getting publicly dressed down like that. He actually told her she wasn't to ask him anything. It was no wonder I rarely saw the same office staff or RN's twice. I suspect the practice had high turnover. I left that practice myself.
If you want to know about bullying on the medical communities part, just read the answers from nurses on Quora or allnurses. They are the least compassionate of the bunch. As they are bashing the patients about our modesty and telling us to get over it. Yet, not a single one sees this in themselves and swear up and down they’ve never heard of any medical staff doing such a thing. Or how it’s not possible too many are in the OR and won’t tolerate this kind of behavior. I just said to one if you are one of the good ones, why aren’t you advocating for us to be able to wear the Covr undergarments instead of bashing us. Of course it’s crickets. Her initial comment was about patient safety and how these aren’t possible to be worn. I said a surgeon invented them for surgery, how can you possibly say they aren’t safe? More bashing calling me crazy. So who bully’s who?
In the first article that Archie mentioned, if you read it you will find it says the medical staff has the "right" to view a patient's genitals. Really? A right not a privilege? No one has the right to view my genitals not even my husband so says the law. I must give expressed consent. No wonder patients are exposed unnecessarily and some are even further victimized by being full-blown victims of sexual abuse.
Catsfostermom--I am on Quora and I have basically stopped as most are a bunch of dip sticks. I have had a few heated discussions and some I have won. There is the one younger RN who said she and her fellow females took great pleasure in humiliating male patients in a hernia center by unnecessarily exposing them to other staff and really anyone they could. I have had conversations with others that have changed their tunes and of course, there are those who believe they are superior and clung to their "right" to do harm because it is only a patient. I will find you Quora profile and get in on your discussions.
Dr. B. The last article you posted seemed useless to me bc it talked more about respect among staff rather than the patient. The mentioning of anything pertaining to the patient seemed more of an afterthought rather than what should be the main focus--total respect of the patient.
Dr. B.--To answer your question of if bullying within the staff lends itself to the patient being bullied, it does. However, having said that, it does not justify the bullying of a patient. I believe my husband was bullied by those RNs that night who both medically and sexually assaulted him. THERE IS NO EXCUSE. I don't care if they were just beaten and slapped by a male doctor, that does not excuse their behavior of transferring their biases to an innocent male patient.
I believe most patients are victims of medical bullying from making them wait without explanation or apology to the way they are talked down to also including the refusal to validate all patients absolutely have the right to dignity which includes autonomy and bodily privacy. The Medical Mafia is just one big bullying machine. Like with the mafia, it eats its own while also causing havoc and terror far and wide (ie.patients).
catfostermom is right. In addition to routine "get over it" type replies, they consistently say they have never observed a patient that was exposed more than necessary, nor a staff member who was ever anything but purely clinical with patients.
A few of the women will admit that they when they themselves are the patient they don't want male staff for intimate procedures or to be exposed to their co-workers, but they dismiss it as "their issue" and not a reflection that they or their co-workers see healthcare as anything but purely clinical.
banterings, I like your thought that bringing scribes or students into the room is a form of bullying, though I would add "without prior consent".
If back in 1993 Brown (?? As in Brown University or a Dr Brown???) said that the removal of underwear during surgery is illogical, outdated and needs to stop, why is it still being done? Shouldn’t it be up to the professors at these esteemed medical schools to be drilling the new nurses and surgeons that this is no longer a standard procedure? I’ve said it before.. if they claim to be our advocate, why are they not advocating for these to be automatically given to patients and not fighting us?
Good afternoon:
Cat, to answer your question Brown 1993 is a case that went on over in England. Over there they take patient dignity much more serious than they do here in the US.
The US healthcare system loves innovation as far something that might make their job easier or a breakthrough treatment.
Where they won't budge is how they handle patients. They want that POWER over the patient. It's there way or don't come for here for care.
They claim to be patient-centered. There is NO SUCH THING currently in the american healthcare system.
They talk the talk but don't walk the walk.
The only way like minded people like those that are here will make the system change is by speaking up for ourselves at the time of an infraction & by electing people to congress that believe people should have the final say as to what can & cannot happen to their bodies.
The system will need to be forced by legislation to make changes in favor of the people.
There is no reason why 100% cotton underwear or a medical garment similar to what Covr makes be worn by a patient to protect their privacy during surgery if that area is not involved.
Voters have the power to force change but they simply refuse to use it.
That's all I have.
Regards,
NTT
Another sad and criminal behavior of the medical profession. In this case a male nurse raping a chronically incapacitated hospitalized female patient:
https://www.medscape.com/viewarticle/964180
Is this and all the other medical professional rapes simply explained by "human nature" and there is no other excuse? ..Maurice.
If you mean by "human nature" there are some sick, twisted people who work within the medical community and it does a horrible job of self-policing, then yes. When will the medical world understand that by allowing and even promoting that nearly every person who ventures in for treatment especially hospital-related are unnecessarily stripped naked and/or sedated, it encourages sick individuals to commit sexual crimes. By acting like unnecessary patient nudity along with audiences is acceptable is setting into motion crimes like this to happen. Also, by the actions of the medical community, it makes sexual crimes against male patients totally acceptable because rarely do crimes by female medical predators make the headlines. No one thought that it was a crime for a female rn to repeatedly sexually abuse a male patient unable to defend himself. Certainly a double standard exists. And yes, there is no excuse for this type of behavior to happen. When should a defenseless patient ever be left alone with a medical provider? Never and let me further clarify--no patient should ever be left alone with any health provider if they do not have a trusted person in attendance. This means that another fox is not reliable to guard against another fox attacking the chicken so there is no safety for the patient even if more than one medical provider is present. Just ask my husband about this.
Good evening:
Dr. Bernstein medical & nursing schools do a woefully inadequate job of psychological testing on possible candidates before accepting them in their schools.
The almighty dollar always wins out.
Regards,
NTT
JR, to comment on one point you made, I would be concerned with what not leaving incapacitated patients alone with healthcare staff entails. In virtually every case it would mean a low level female staff member being an audience for intimately exposed patients. I'd rather take my chances without her presence.
Certainly in the example Dr. Bernstein posted it would have prevented the rape, but short of that what are the odds that medical assistant or clerical worker will stop needless exposure or inappropriate comments? Look at what Dr. Sparks got away with in OR's full of so-called professional staff. Or in Denver when the female nursing staff spread the word to all of the other voyeurs on staff to come get a look at the guy before and after he died. Even in your husband's case there were multiple staff that made no attempts to intercede on his behalf.
I posit that an extra person will more often simply increase the audience and misbehavior than it would stop misbehavior.
NTT, as concerns medical & nursing students (& techs & other staff too), a phrase that comes to mind is "when they tell you who they are, believe them". My guess is that most schools choose to look the other way rather than admit that a student's career interests appear to include intimate access to patients.
Just as many pedophiles sought access to kids by becoming priests or Boy Scout volunteers, some choose healthcare careers for the access it would give them to whatever their proclivity might be. In the most extreme cases it goes as far as rape such as Dr. Nassar with the female gymnists, but the most common proclivity is simple voyeurism. Those nurses in Denver made clear that they saw voyeurism as one of the perks of their job. Same with the staff at Olympia Urology in WA that abused Mr. Kirschner.
I am suggesting that sometimes schools can see the future rapists and voyeurs in their midst, but choose to ignore it because the signs are subtle and easily explained as something innocent, or conversely thinking the student will grow up professionally. The schools as well know that most hospitals and medical practices will choose to look the other way, so why boot out a source of tuition payments?
As Biker pointed out, there has been a reconning of society with institutions that have abused power over people (Boy Scouts, organized religion). We are seeing a reconning with the police and our elected leaders.
The next reconning IS coming, and that is with the profession of medicine. People like Fauci and Rochelle Walensky (the worst offenders) are showing the paternalistic, narcissistic nature of physicians falling back on "because I am a doctor and I say so."
Just look at the latest poll: Republicans' trust in doctors is eroding. It's a symptom of a larger disease.
Our day is coming.
-- Banterings
Biker,
I think you might have misread what I wrote. When I said trusted person, I meant someone the patient trusts such as a spouse or even their patient partner because as my husband and others can attest to, there is no real or absolute safety in other medical members being present. I am talking about patients in pre-op post-op, or ICU, etc. really needing someone with them at all times. Because I do not have confidence or trust in other medical providers to stop the sexual abuse of patient is why I made the fox in the henhouse remark. My husband was sexually abused by a medical provider with other medical personnel in attendance so I absolutely do not feel more of them present offers the patient any protection.
To your point, yes schools can see a certain amount of this behavior. Many of the kids I had in elementary who wanted to become doctors or nurses were kids I wouldn't want to become doctors or nurses because they showed no compassion as children. Some of the ones who did want to become doctors or nurses and show compassion were the ones who wouldn't make the cut due to grades. Many of the females who become nurses are the cheerleader-type and from my experience many of those don't have much if any compassion in them. They would make fun of those different from them or kids who had issues such as their clothes or house weren't as nice.
Thanks for the clarification JR. Now I understand what you were saying. I agree that some people show you who they are at a young age, but people can and do change if they so choose, or if life somehow happens in a way that changes them. That said, if they show you who they are while in medical, nursing, or some healthcare tech field however, and who they are is unsuited to providing respectful care to patients, the schools should believe them.
Here are links to JR's Twitter and my Twitter.
We both regularly mention, promote, and link to Maurice's Bioethics Blog.
This is my latest mention and invite.
I have a paltry 194 followers while JR has an impressive 2788 followers. Both JR and myself use it to expand our reach on social media. I prefer this format because it allows for more academic discussion (discourse).
-- Banterings
Nurses are commenting on a post about wearing a bra during surgery. I explained about the Covr invented by a SURGEON. They are fighting me saying nothing can be worn not even them. Why can’t they educate themselves and stop fighting us..
Cat:
The answer is they don't like change which means they'd have to give up some of their power over the patient.
Many people don't like change but sometimes change is good.
We aren't there yet but, this is just another step towards a patient-centered healthcare system.
Regards,
NTT
Cat,
If bras are so dangerous, then the nurses should not be wearing them either.
-- Banterings
I had a fun visit to my Urology office last Thursday. Normally Urology visits are not fun at all, but this one was.
Most of you recall my Covid vacation last summer. That put off my annual Urology visit for a later date. I needed a visit to draw blood to check my PSA. That occurred last Thursday. Next Friday will be the actual visit with my doctor for my annual follow up.
Most of you may also recall my hiccup with the Green Light Laser surgery last fall and the resulting stay in the hospital. You may recall the experience with the female doctor who had the rounding duty during my stay who brought along the female student to observe.
The Urology group I go to has 3 doctors assigned. My doctor (male) is Dr. S. and another male doctor is Dr. R. The female is Dr. G.
Last Thursday was Dr. G's office day. Since I was in for a blood draw, I would not see any doctor, just give the sample and go. I got there and the place was packed and I waited in line to check in. Some of the patients are female but many are male. Nearly all are retirees from the adjacent Villages Retirement Community. With the snowbirds in town that contributed to the packed house.
Continued...
58flyer
58flyer Continuance;
While I was checking in I noticed a patient watching me and that got my attention. After I got done with the paperwork and yet another presentation of my ID and insurance card, I sat down across from the man who appeared to be watching me. I had on an airplane themed shirt and in typical Villager old fart fashion, he struck up a conversation. After some small talk about flying, he asked If I was to see Dr. G. Since he was somewhat hard of hearing, I dropped my mask down so as to not hinder my conversation.
I didn't hold back. I told of my experience with Dr. G. and of her total disregard for my dignity. I compared her visit with Dr. R's and how he closed the room door upon entering and established a rapport with me before asking if he could take a look under the gown. Dr. R was a man like me and still asked permission to look. Dr. G just came in leaving the room door open with the female student in tow and after introducing herself proceeded to try and pull up my gown. I related how I stopped her and also asked who the second woman was since there had been no introduction of her. I used words like "stupid woman" and "complete idiot" and whatever else came to mind. I told of her coming in later looking for her car keys she had misplaced to further illustrate what a moron she was. I told of the subsequent discussions with management about the student observer and of my suspicions that she may have been related to the doctor. The gentleman I was talking to just shook his head and I asked if he was there to see her. He said he was but may just have to look into the other doctors for future visits. I told him he would be better served if he did.
I took a deep breath to calm myself down a bit and in looking around discovered the place was totally silent, you could have heard a pin drop, and all eyes were on me. The 2 receptionists were staring at me with eyes agape. All the waiting patients were looking my way. I turned to the man I was talking to and said "sorry, but that's just my experience." He said "that's OK, thanks for for your report." The silence was awkward for a minute or so and the gentleman turned the subject back to our mutual love of aviation. We talked some few minutes before he was called out and then I was called back for my blood draw shortly after that.
During the drive home I thought about it and wondered if I should have kept my mouth shut. Those other people were there to see just the doctor I had griped about. I wondered how their visits went, or if any of them brought up the matter to Dr. G. during their visit. I'm sure somebody said something. No doubt Dr. G. has heard feedback from when I was in her presence back last fall. Time will tell I guess.
I will see Dr. S. next Friday. I don't know what to expect. Having had a few days to think about it maybe it was a good thing those patients of Dr. G. got to hear about her.
58flyer
Absolutely, you should tell people. How else are we going to get the word out to protect ourselves. I’m sure others there have had your experience with Dr G. Some may not have been uncomfortable but I’m just as sure many others were. These people now know they can speak up. Maybe if more start seeing the other doctors she will take the hint.
58flyer, Dr. G. had absolutely no concern for your privacy or dignity. She thought nothing of lying to you in hopes of giving a high school girl a good look at your genitals. Why should you worry about merely expressing your opinion that she was unprofessional and totally out of line?
That said, word likely got back to her from the office staff and you may hear of it when you go for your visit with Dr. S. Had Dr. G. apologized to you, it would be different, but she hasn't apologized, so she can't expect you to have forgiven her.
I just had someone on Quora tell me that she requested a friend who is an RN be her advocate during a endoscopic procedure. They refused and assigned her the head nurse of the dept. she told her of her wishes for no men during the procedure. The day of the surgery she did not see this person. But, moments before it was lights out... there were 2 male techs that would be involved. How is this happening? Men can’t get all male teams yet women who don’t want males get them. I’m tired of them lying. Tired of the manipulation. How many people are going to die because they will refuse healthcare? Healthcare corps OWN congress. Not to mention it’s full of wusses. How far do we have to travel to find a doctor who treats us with respect? Why can’t we interview the nurses who will be taking care of us? I’m totally disgusted and fed up with the system.
Catfostermom, don't let your "totally disgusted and fed up with the system" impair your public and personal drive to create a much, much better medical system. Continue to "speak up" to the public and "speak up" (as necessary) to your healthcare providers.
You have as much right to present your direction to the medical system as those who work in the system who have the responsibility to communicate with their patients, listen, consider and make the changes to bring both parties, patients and the system together. So "disgust" should not prevent your or any patient's attempt for acceptable changes. ..Maurice.
Catfostermom, that head nurse probably thought your friend would be out before the presence of the two males would be known to her. I read a similar story about a guy having a cardiac cath who refused the presence of a female student observer. The girl leaves the room and apparently as soon as he was sedated they called her back in. The guy's wife was also outside the room and watched the girl be called back in a few minutes after she had left the room.
Yes they lie; probably because they know they can get away with it and because they simply don't care about patient privacy or dignity.
Since we don’t seem to be getting through to the medical staff... I’m hoping we are at least getting through to people who may require care in the near future. Making them aware that we do not need to bow down to these people and we are taking what happens to our bodies back under our control. If enough speak up then maybe the staff will listen. I think next time someone says it’s policy my response will be EVERY policy has loopholes... find one. The policies are outdated.
I was wondering what my visitors think from personal or family or other knowledge of MDs with the sole specialty of psychiatry regarding their doctor-patient relationship and whether they are contributing to the benefit of their patients' dignity or whether like what has been repeatedly written here about physicians in other specialties potential and examples of active degradation of patient dignity. So what is your experience or knowledge about psychiatrists. Do they get "a clean bill of health"? ..Maurice.
From all the mental health patients I have encountered on Twitter, I would say NO. Most say the mental health treatment hurt them more than helped them along with the nasty side effects of the meds. They also say they are "labeled" once they seek mental health help and forevermore most live with that stigma. Many say it affects how their physical health services are delivered to them. Most will say that being in a facility is the worst and you can expect to be physically, mentally, and sexually abused. I haven't seen any positive posts about mental health except from one a pharmacist here in Indiana who says it helped her.
I remember an incident in approximately 1975 or 76. My sister ( 2 years older than me ) was seeing a phycologist and they had a brief fling. She was much more emotionally involved than he was. One night she swallowed a bunch of pills. Fortunately she went to my oldest sister's room and wanted to talk so she was rushed to the hospital and her life was saved. I don't know if this incident would be what you're talking about though.
I have been purposefully been trying to avoid the issue of dignity in relation to patient dignity. In a recent development, I must point out the following:
Emails released under Freedom of Information Act show Collins and Fauci sought to subvert (real) science and create propaganda attacks against those they disagreed with.
This is how all of healthcare treats patients. Elitists.
-- Banterings
But Banterings, what exactly is "real science" when immersed in political conflicts? How does one, in political context, separate the "real" from the "unreal or imaginary"? ..Maurice.
Maurice,
There is no real or unreal science, there is only DEBATE. There was a time when science said the earth was the center of the universe and there were only 5 elements. Look at what happened when Nicolaus Copernicus brought up what was considered unreal science.
It is happening again and too many sheep don't see it.
-- Banterings
But Banterings, in essence, science and its changes in concepts should be based on science and should not be based on political views or is such separation unrealistic? ..Maurice.
Maurice,
Modern science is based on alchemy and religion. There is no rule what we base our hypotheses on, but all positions MUST be able to be talked about (discussed) OPENLY and RESPECTFULLY. Then we test the hypotheses.
It is not about what we know, but what we THINK that we know.
I have posted research on my blog about things that are labelled "misinformation which is being proven true.
-- Banterings
On this first day of the year 2022, I want to wish all the participants on this bioethics discussion blog site and specifically all those who have been reading and those who have been contributing to this blog thread topic Volume, irrespective of your views, a healthy, happy and productive year ahead. Things change, views may strengthen or change and there will always be an opinion or differences of opinion that all deserve publication and contemplation by the readers. So go to it. ..Maurice.
Do you feel that "healthcare workers" really care about you?
Here is an interesting topic I put up in 2012 with some interesting responses. ..Maurice.
Healthcare workers care? That would be a case by case thing. One problem is too many rules, or maybe just the wrong rules. In the past we had to have TB tests when hiring in. ( I worked at nursing homes ) It was done in the nursing homes and read in the nursing homes by the LPN's. Where I work now it's done at Care Spot. And lately it's been unexpectedly closed down because of shortage of staff. I recently went to have a TB test for work and returned 48 hours later but they were closed. They couldn't be reached by phone either. I showed up once to be told I had to wait a full week before being tested again. I showed up the following Monday and Tuesday but they were closed again and I couldn't get them on the phone. I got another TB test the following Wednesday, went to get read Friday but they were closed AGAIN. I even went to another Care Spot in another city but they were closed to. I couldn't reach them by phone Saturday ( New Years ) but then just showed up any and was able to be read.
The so called difficult patient on volume 116 had my sympathy because if there wouldn't have been so many rules he could have been in and out Somebody should have been able to ask the questions and given him his prescription. I didn't consider that patient as being unreasonable.
I think they think they care. But between their answers on both Quora and Allnurses they DO NOT care. Getting patients well has a lot to do with mental as well as physical. If I got a nurse and recognized her name from the comments on either site, I would immediately fire that person from my care. Many have proved over and over by their verbal abuse to strangers on the internet who they truly are. Do you think that would change if their patient in person didn’t follow their orders? Their demands of us? When did it start? Many say in my 30+ years... I’ve never.. is itthe new recruits that the caring stopped? When hospitals sold out to the corps?
catfostermom, I suspect that many of the nurses & others who insist how respectful and caring they are of patients truly believe what they are saying. At issue is they use a definition of respectful and caring different than what patients consider respectful and caring. They all insist that they only expose what has to be exposed and only for as long as it has to be exposed, yet all of us here complain of having been needlessly exposed.
Just as they confuse being polite with being respectful, they also confuse convenience with necessity.
They insist patient exposure is always clinical and healthcare staff never judge yet when they are the patient many admit they don't want to be exposed in front of their co-workers, or they (female staff) only want female GYN's for example. And they don't see the disconnect between those two positions.
There is a general lack of self-awareness.
They need to take it from our prospective not theirs. Checking incisions on the abdomen but lifting the gown or moving the gown up is unnecessary exposure. Removing the gown from under the blanket but leaving the blanket on is the correct way. They say it’s not and we don’t know what we are taking about. Umm I think I know when it’s to long or not necessary.
Catfostermom and Biker
What you complain about is a valid complaint but it isn't as bad as my last job. Privacy curtains don't even exist in that facility. Much of the staff are BLATANTLY dismissive of patient modesty. Speaking up to them does no good either. I've tried and accomplished nothing. I blame it on the need to have power over the patients.
JF, the families of the patients where you work may not see the lack of concern for patient modesty,assuming such behavior occurs when family members aren't present, but surely they can see things like lack of privacy curtains. Are the families simply oblivious to how their loved one is being care for or are they powerless to do anything about it?
Are male and female patients treated equally in this regard? Is there any male staff for intimate care should a patient or family member request it?
The patients family members aren't allowed in the main part of the building because of Covid. They have a designated area. They have to schedule the visits. There is a male CNA on first shift and he's assigned to take care of the male patients. The male patients are all on one hall. The offending staff violate male and female's equally.
To Catfostermom: You should know the answer to this issue regarding need for animal genital hiding to prevent embarrassment. Have you ever observed any behavior of cats which might be indicative of such animal concern?
Could you extrapolate and say that such concern is not an animalistic concern but one specifically (except for nudists) a general human behavioral concern. In other words, as humans, either male or female as described on this blog thread, exposure of genitals even as part of a thorough clinical examination is primarily a humanistic creation and fixture?
Others here who have experience observing other animals, do you find this genital exposure concern also primarily humanistic?
I think it is important to compare other animals and mammals with humanistic behaviors. Are we all alone as mammals with this characteristic concern and behavior? It is of interest that not all animal genitalia are fully covered by hair.
..Maurice.
If you ever noticed a dog when scared they tuck their tail if they have one. If they don’t the hunch over to protect their backside. Many animals will only show their tummy to those they trust. The animal instincts is to protect the belly from being ripped open by the predators. Are we the prey protecting ourselves from the predators of the medial staff?
Dr. Bernstein, this is a socialization issue rather than something genetically inherent in people. This is why different societies across the globe and over time have had different social mores as concerns nudity. Even within societies, there are many subsets of what is deemed socially acceptable and what might trigger embarrassment.
One of those subsets is the healthcare system in the US which does not see anything wrong with needless opposite gender exposure whether it is extent, duration, or audience. Of course they don't ever see it as needless. Regretfully, many of their patients live within a subset of society that does differentiate between staff gender in this regard and have a different perspective of necessary vs needless.
The new female urologist in my county who is replacing the male urologist that will be retiring wrote a paper when she was a Resident about patient gender preferences for urologists. She concluded that men need to just get over their reluctance to be treated by female urologists. She is a reflection of the socialization within the healthcare system in which male patient modesty is not anything to be taken seriously.
Biker
That new female doctor is not going to have much of a practice if she keeps that attitude.
I thought dignity/modesty was being taught/drilled into them during schooling? Where have the professors gone wrong that it slips from their mind once out in the field? Should they have checks against their licenses for this behavior? Should she have even gotten a license with this attitude? If she is a newly licensed doctor somewhere patient centered healthcare has failed us. I truly hope that her comments about men needing to get over it results in her having an all female clientele. When she is naked in front of a male patient then maybe she can be such a bitch. And yes bitch is really what I want to say to these people’s faces.
Yes, yes, yes Catfostermom, I know that first and second year medical student instructors teach the need to attend to the personal dignity and personal modesty of all patients of either or all possible genders. But this indoctrination is primarily in years 1 and 2 of medical school education and a lot can change in the later years and internship, residency and specializations. It may be difficult for physicians and nurses to separate diagnosis and therapy of disease from "behaviors" of their patients which they feel may potentially "interfere" with the goal they have set for themselves in the professional attention to their patients.
And that goal?: "get that damn sickness to be gone so I can move on to the next patient". This goal then leads to what has been written here all these years and the modern problem of "professional burnout". I fortunately practiced in a period of medicine when patient daily load was minimal and comfortable. I have a suspicion that this change in patient load plays an important role in the professional behavioral responses.
What would you or the others here suggest to treat this problem? Publicize and actively work to get more medical students and nursing students into schools? Diminish the medical system's itself demands on the providers in the system? Further education programs for potential patients and their families to "self-treat" and not jump up and go to the doctor or ER for "everything"? Could it be that the recent generations ethics movement into patient autonomy is, in part, responsible for this issue of patient dignity and modesty which have been written about in all these Volumes? Should switching a backward toward physician "paternalism" solve the problems discussed here? What do you think? ..Maurice.
Regarding animals and their genital exposure, read this analysis:
https://tvtropes.org/pmwiki/pmwiki.php/Main/AnimalsLackAttributes
..Maurice.
catfostermom, the new urologist I mentioned will be the only urologist in a nearly 1,000 sq. mile county when the male urologist retires. The hospital had spent several years looking before they found her. A piece of modern day healthcare is that newly minted doctors don't want to work in small town/rural areas. Her practice will be full. The closest hospital to the south of here (about 1.5 hours) went a couple years w/o a dermatologist before they found a young female dermatologist to take the job. The people in that county were thrilled to again have a dermatologist and no doubt her practice is full regardless of any guy's modesty concerns.
For a number of reasons I choose to drive 1.5 hours to NH for all of my scheduled healthcare, so the new urologist won't be my doctor. I should note that her credentials are stellar and that by all accounts she is a very nice person. The paper she wrote that I mentioned instead speaks to a mindset that men need to get over having gender preferences for their providers. That doesn't make her a bad doctor or one to be avoided but rather that she is in the mainstream of modern day medicine.
Dr. Bernstein, medical students being taught to tend to the personal privacy and modesty of patients is all good and well but it still comes from the premise that healthcare is gender neutral. Until the system is willing to acknowledge that it isn't gender neutral for many patients, there won't be any outreach to encourage more boys to seek nursing and other non-physician careers, nor attempts by urology & dermatology practices to have something other than 0% male non-physician staffing, nor a re-thinking of bringing in female audiences for intimate exams & procedures for male patients. More is needed than just draping and being polite.
Regarding animals and their genital exposure. A few years back I was walking my little ( male ) dog and a bigger male dog that was not supposed to be there came over and tried to have some gay sex with my little dog. My dog seemed MORTIFIED. I grabbed him up to keep the bigger dog off of him but the dog kept trying to get at him anyway. A neighbor lady witnessed what was happening and chased the big dog away with a ball bat.
I am having a brain freeze, and I have posted links in the past, but I am wondering if anyone has updated research about medical students participating in a patient's care, examining their body, etc. (both the correct way and incorrect way) and/or correct (trauma informed) way to approach patients about student participation?
Thank you in advance.
-- Banterings
Dr B. I'm not very clear about why animals somehow became part of this issue. Unless it's out and out rape, animals don't experience humiliation over modesty.
Sometimes apparently non modest humans do though. My grandson when he was still a young boy would (every single day ) after his shower run through the house completely nude and it didn't matter to him that there were other people in the house. However his biological grandmother once took him to Children's hospital for some reason when he was about 8 or 9. The nurse or maybe doctor who attended him made him get completely undressed in front of her and his grandmother and aunt. He was embarrassed and his aunt teased him about it afterwards. ( his aunt was a kid herself )
Archie,
Cindy and I are going to discuss this maybe today on our weekly radio broadcast. I found this site some time back and it is from the UK. The US doesn't seem to want to openly discuss this. Wonder why? Just something else they work hard at trying to hide.
https://bmcmededuc.biomedcentral.com/articles/10.1186/1472-6920-14-39
We have discussed on Twitter the present govt's/medicine's position on saying for women it is their body their choice when it comes to the killing of a baby but when it comes to vaccines it is they own your body so therefore it is their choice. What a huge double standard that when examines makes no sense. Argument is vaccines will "save" a life but yet supportive of abortion which will end a life. Also, we discuss how very little senior lives matter just as one state has now drafted a resolution to send COVID positive patients back to nursing homes.
Biker, I believe the view of the female urologist more than gives proof why some should be doctors as there is no compassion or true caring. She believes she has supreme rights and the patient must deal with her actions. However, I imagine she supports women having access to female ob-gyns as most like her do not see this as being a double standard. It would be interesting to know how she actually conducts her uro visits with male patients. I would imagine the females are gowned and draped but how is she conducting the male exams. We know the strip and bend over method doesn't have to be done as male exams can be done on the table. Are the males gowned and draped as the females most likely are? Does she make a difference in how she delivers the exams even though she promotes males should not have a preference in the sex of the doctor? Would be interesting to know.
He was comfortable in front of his family. Medical staff do nothing to comfort the patient. It’s not convenient for them to do so. They are/were strangers to us. They did nothing to gain his trust. They didn’t even give him privacy. Is he still like that with medical staff? This is how traumatized patients start out. And the medical community doesn’t see it as an issues.
JR,
Thank you.
What I am looking for is guidelines for how things SHOULD be done in the US.
-- Banterings
I read the study that JR posted and while I don't know how what the norm is in the US, I would say that using standardized patients in medical school before doing intimate exams on real patients is a must and that it shouldn't be a one-off. The 2nd time a medical student is doing an intimate exam shouldn't be with a real patient.
It is also worth mentioning that if it is uncomfortable with sexual overtones for medical students, on what planet are we supposed to believe that patient care is completely clinical for 16 year old CNA's that have completed their couple month licensing program? Or 18 year old CNA's in other States? Or 19 year old LPN's that have completed their 1 year course? Or 20 year old RN's following their Associates Degree course? Or 18 year old medical assistants that have had only on-the-job training?
Of course everyone has to start somewhere and have their 1st patient, yet all we ever read is "seen thousands". I would much prefer some honesty in acknowledging that healthcare staff are human and cannot help but judge good, bad, or indifferent but that they have been trained to keep their judgements to themselves. That and training to minimize patient exposure to that which is necessary in terms of extent, duration, and audience.
JR, I'll never be able to answer your questions about how that urologist functions with her patients being I don't plan on having her as my urologist. I will continue to make the trek over to NH for my scheduled care. Of course it is always possible I'll end up in the local ER someday and she'll be the one treating me, but if I'm sick or injured enough to be in the ER, the protocols will be different than a scheduled office visit.
Biker,
I knew you wouldn't go to her but I thought you might have friends or neighbors who might therefore getting the information. I talk to others about their hospital experiences and not surprisingly, have learned many stories of horror. It seems like most of them once they think about it and once they know the medical community does not have to expose them, they open up about stories of their own harm. Men especially talk about the young girls present who do nothing but stand and stare during the prostate exam. Many doctors still doing the strip as go routine when it is absolutely a sexual show as there is no justifiable reason it should be done this way. I always ask them if they have had a procedure and if they remember anything and most only remember snatches at most. Most have comments about their bodily privacy being violated in some manner. It is amazing how many do not know it didn't have to happen. Try to leave all with some information to help them in the future.
To all--front page of website is up and I am currently working on content to put in it. First up I am dissecting the article on "Behavior in Private Places" as it does a lot to explain the medical behavior in all aspects of medical care.
JR.. I’m glad you are getting more people to realize it’s NOT normal and it DOES NOT need to be done that way. It’s the only way we can get the healthcare system to change. Legislators won’t do it. More people have to take back control. Have you gotten any feed back from these people? Will they speak up next time or just let it be? Will they tell family and friends?
Catfostermom,
Yes, several of the ones CS have had on the radio show now speak up. I don't know about the ones locally but they have the information. I lay Misty's brochures out at various places. There are several religious groups that have taken some along with a senior service administrator who asked for some. It is amazing that most people do not know they do not have to be exposed and when exposure is needed, how it should be done. They didn't know they had choices. Some have commented on the chaperones. They are always shocked when I tell them the chaperone is not there for them but for the medical provider who actually signs their paycheck. I have told them to ask they not be present or have them stand where they are not directly exposed to them. Most of the time, it is not a chaperone's business to see your business. I give them other info like request those MRs from time to time to see what falsifications are in them. Have someone with you. Ask questions. For men, I tell them you should be gowned during a prostate exam. There is no reason to be made the central attraction of a clown show. Ask if there is going to be a chaperone and the purpose of them and especially where they stand. The patient has the right to say who sees their body as just because someone works in the health field does not mean they have automatic rights to your body.
We will be getting this info on the website. I plan very direct language because it is time we don't sugarcoat violation of all patient rights. Standing by and nothing has not done a thing but has allowed the abuses to increase.
Is the entire medical/surgical care system of physicians, nurses, other office or hospital staff practicing the patient dignity suppressing practices and behavior which much of what has been written here are all guilty of this misbehavior (or worse description)?
Or is what is being written here a description which is applied to a small group of such professionals?
Yes, over the years on this blog topic I have changed my mind from what has been written here critical of the medical profession coming and representing not some statistical minority of patients but which may be more generally experienced by the majority of patients. But if that newer evaluation by me of what is being written here is now true to what proportion of the medical system are we accusing? Are the offenders of our intrinsic patient dignity a cult of a minority within the profession or are the vast majority of doctors following the guidelines of maintaining patient dignity and their behavior toward their patients accepted and appreciated?
Yes, we all know about the news published description of terrible and criminal professional behaviors but does their behavior..must their terrible including criminal behavior be painted on all of us medical professions? As one who has always practiced and taught medical students with patient concerned and practiced physical and ethical behavior and frankly have not ever witness all the disgraceful and unprofessional behaviors described here or in the news media, I wonder what percentage of our profession are the rightfully upset patients referring to? Should students be taught that they are about to enter a personally hazardous profession with regard to the way some of their superiors have misbehaved and how suspicious and angry some of their patients will be about their own subsequent behavior.
You know, thinking about all this..perhaps it should be an important addition to the medical school faculty and subjects for discussion for patients such as JR, Jf, Catfostermom, Biker, Banterings and the many other writing here to be such specific faculty members. I think such instructors and those whose experiences can be detailed (such as how a patient would like a rectal exam performed) would be an appropriate addition to the medical school faculty as the student move up to graduate. What do you think? ..Maurice.
Dr. Bernstein, first, I like your thought of having people like those of us who post here speak to medical students, and would extend that to nursing student sonography students etc. Hearing our stories wouldn't be a theoretical lecture but a real life experience.
On the other matter, I would say that the most egregious cases that make the media come from a small minority of those who work in healthcare but that the majority whose profession includes intimate exposure err on the side of what is most convenient for them. It doesn't seem that most go into patient encounters with the thought to minimize exposure in terms of extent, duration, or audience but instead focus on being polite while needlessly exposing or over-exposing the patient. It can be seen in the very simple example of needing to examine a patient's abdomen. The norm is to lift the gown fully exposing the patient and then placing a towel over the genital area whereas they could have instead lifted the gown from underneath a towel or sheet and never exposed the patient at all. Sometimes it really is that simple.
I think the largest problem is that when staff do go beyond the bounds of standard protocols, that their co-workers just look the other way. We almost always see this with the egregious cases that go on for years before anyone says anything. If that is the case, who in healthcare is going to risk reporting a co-worker over a simple needless exposure? The person filing the complaint is likely to end up the one getting in trouble.
Dr Bernstein,
Can we show them the extent of unnecessary exposure on their naked bodies?
Catfostermom, why demonstrate "unnecessary exposure" on "their naked bodies"? Why not perform as professional medical school patient surrogates do with respect to performing a male genital exam or female pelvic exam, have the students observe the issue as demonstrated by you on yourselves, the teacher. When I was teaching first year medical students about lesions, in my case muscular fasciculations, I demonstrated on my own body.
So, demonstrate to the students, the degree of clinically necessary exposure by some means without forcing the student into a degree of their own personal exposure that you yourself would not tolerate. The principle of teaching medical students is to educate but through means that you yourself being a medical student or as a potential patient would in fact tolerate.
Yes, my view as a former teacher, presentation by those who write here to medical students would be "tricky" but should not perform a "punishing act" as education on them that you yourself would not tolerate.
..Maurice.
Dr. B.,
When I talk to average people out here, what strikes me the most is their reaction once I educated them. I always ask them to explain what happens to them during an exam requiring intimate exposure. I try not to lead them but ask them for their truthful memories. When they are finishing telling, then I explain to them how it should have been done. They are totally surprised. The issue why we don't have more patients complaining as this core group does is not because necessary exposure is happening but rather most do not realize it is not necessary. Big difference! Women are less likely to complain about how their gynecological exam was conducted than men with prostate exams including the biopsy exams. I can't say I have met a patient who knew there are privacy garments that could have been used. What I get back is why aren't they being used?
While preservation of patient dignity and the correct way is in medical books and may be taught by some, it is not transferring in the majority real life patient encounters. I believe it is because they are copying what they are seeing while in training at their corresponding facility. Patient dignity takes seconds more to do and many, many in the medical world simply do not believe patient dignity is an issue. (I will address this in a separate post.) While the vicious attacks like has happened to some here are not the majority of dignity infractions, they are happening enough that it needs to be addressed.
Yes, I do think it would be a step in the positive direction for medical students (both doctors and nurses) to have to hear from a few of us. It must be done in a way as to not make them defensive but they know to hear the truth. We are not outliers but we are the small minority who knows unnecessary patient exposure does not have to happen. We also know why chaperones are used and why the chaperone should be more patient-friendly meaning no male should have to have a female chaperone. We also know patients should be given full disclosure if a chaperone is going to be present and why. Patient should have option of chaperone standing where they cannot see the patient's genitals as many chaperones are not there for the benefit of the patient.
Since it is the vast practice of the majority of medical providers to expose patients unnecessarily, we need to find out while they believe they have the right to do so. As the one paper from the SSRN inferred, they do believe they have the right and they are taught to view patients as objects. When viewing patients as objects, we all know objects can be owned, abused, cherished, and/or discarded. Patients are objects remind me of the days of slavery where another human was regarded as being an owned object. Is this how medical care should be delivered? Is this how they or their loved ones should have medical care delivered to them regardless of their motive?
Dr. B.,
View it not as a punishing experience but a chance for them to put themselves in the same situation they place patients in all the time and have the snappy comebacks blaming the patient for having a mental health issue--modesty. I predict many of them would not like to be naked in front of strangers especially those they work with daily. But if they tell a patient that all genitals look alike to them, you see 100s, etc. ask them why they have an issue showing theirs? This needs to be a discussion. I would gladly take part in that discussion.
I need to share a discussion I got involved in with Catfostermon on Quora with a RN who said patients have mental health issues of modesty. She said they don't pay attention to genitals but later said if they see something different, they all like to have a peek. So which way is it? Obviously, they are doing too much looking in order to spot the "different" ones. She also said patients need to be naked in order for everything to remain sterile which is a myth as once the drape is out even it would then no longer be sterile in dismissing the use of surgical garments. But back up, at first she denied there were such things. I then said to her that as a RN she must know more than the Mayo Clincic surgeon who invented the COVR garment. Got quiet there. While I agree in a few surgeries such as open heart there is a need for a patient to be completely exposed, most surgeries it is not necessary and should not be done. Patients should know before they sign papers or book that appt how they will be prepped. There needs to be true informed consent.
I also talked with a standardized male patient who believes all patients should be naked. He just couldn't comprehend that is not necessary as he seems to enjoy standing naked for mass prostate exams. He said I had a mental health issue of modesty if I didn't think doctors and nurses must see your naked body every time. I can send those to you if you would like. Their arguments turn into personal attacks because they cannot defend their lack of valid information. I will probably end up putting their stupidity on my website because that is exactly what it is. There is no valid argument why patients are routinely exposed except the medical community wants it done like that.
When YOU are the one keeping your clothes on, there is no such thing as unnecessary exposure...
We need to return to peer physical exams and mandatory student participation in the healthcare of licensed providers.
The requirement of providers to allow ("teach") medical students should be required as part of licensing as a demonstration of the skill of "teaching" the profession to the next generation. It syncs with the AMA's ethics and even the The Hippocratic Oath.
...To hold him who has taught me this art as equal to my parents and to live my life in partnership with him, and if he is in need of money to give him a share of mine, and to regard his offspring as equal to my brothers in male lineage and to teach them this art—if they desire to learn it—without fee and covenant; to give a share of precepts and oral instruction and all the other learning to my sons and to the sons of him who has instructed me and to pupils who have signed the covenant and have taken an oath according to the medical law, but to no one else...
What is really interesting is what has been left out from the original oath:
...I will try to understand his sorrows but his secrets will never leave my ears. Under no circumstance I will use his body to advance my knowledge or my fame, unless in his last moment, he or his widow give me his corpse, so that his death may help me understand how to soothe another’s pain... source:
Very convenient, but NOT surprising.
-- Banterings
JR, in no way do medical student instructors teach students to look at, communicate with or examine patients as "objects". I know that from 30 years of teaching them and being associated with other teachers doing the same teaching. As I have mentioned on this thread numerous times, we teach and indeed monitor students as they interact with their assigned patient..patients, whom I have noted here in the past, must give their specific approval for a history to be taken and specific approval for each part of a physical exam to be performed by the student. I cannot speak for nursing or other patient-related professions or occupations but that is the dictum of medical student education for the first two years and what is expected of them in the latter 2 years as they interact with more than one patient during the day and in a more clinical diagnostic and treatment form of patient interaction.
I can see how as a very very very busy hospital resident learning and treating many hour and daily activity, time spent with each patient becomes an object of personal managerial concern. But after my own residency I supervised residents and I know I emphasized attempting to treat each patient and disease as sick individuals. But that was then..in the 1960s and obviously exampled by "burnout", work and interaction with patients have suffered a change within the past few decades.
But I know that the current teaching in the students' early years of medical education, attention to the patient as a person and not a disease has not changed. ..Maurice.
JR, one point you made bears repeating. Patients don't know how exams or procedures ideally should be done. That works to the staff's advantage.
In my 30's when I had a vasectomy, following the nurse's instructions all I had on was a polo shirt and socks as I sat spread eagle with my legs in the air. I couldn't have been more exposed but at the time I didn't know she should have at least given me a gown or towel or sheet to give me some semblance of cover. I can't begin to say how embarrassing it was.
At age 51 I had my 1st ever ultrasound; it being of my bladder. The sonographer had me take off pants & underwear (in private) and don a gown. She then proceeded to lift the gown up to my chest briefly fully exposing me and laying a towel over my genitals. I didn't know that a bladder ultrasound doesn't require pants & underwear to come off at all, as I learned some years later when I went for the exact same procedure.
Also in my early 50's I had a testicular ultrasound. Again I didn't know the degree of exposure she gave me was unnecessary. Same with the 1st 8 years of cystoscopies. I only learned after switching to a new urology practice and had male nurses for the 1st time that for 8 years I had been exposed more than was necessary by the 100% female staff at that prior practice.
Now I know the difference between necessary and unneccessary and am not afraid to speak up, but somehow for all those prior experiences, the staff had been trained to do things the way they did them, or if not trained that way, allowed to do things as they did.
Dr. B.,
There are many articles out there talking about doctors viewing patients as objects rather than autonomous human beings. The SSRN article and https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4732308/
are just two that address this. While you may not have taught your med students to view patients as objects, it is clear it is happening. Whether it is taught to them at some med schools (please note I include nurses in this) or it is learned behavior once they start on their career, I do not know. Maybe part of it is the consequence of making the healthcare system a business? Other professions suffer burnout. I suffer burnout from my daily dealings doing what I do but it is not a viable excuse to cause harm to those who interact with. You cannot say "current teaching in students' early years...) because you do not teach every student who goes on to become a medical provider. There is no way for this to be true.
Maurice,
As a physician and a medical educator I can NOT you made such a statement:
JR, in no way do medical student instructors teach students to look at, communicate with or examine patients as "objects"...
So why does objectification (dehumanization happen?
...But being a clinician often requires complicated analytical thinking. And awareness of a patient’s humanity may become a distraction that affects their ability to do their job.
Additionally, some critical care professionals unconsciously “turn off” their empathy and dehumanize patients to protect themselves from sadness associated patients patients’ death, a distressingly common outcome from an intensive care unit stay. This psychological shield may enable some medical providers to continue to care for critically ill and dying patients day after day…
Source: Treating Patients as Human Beings
Here are some more academic and medical references:
Suffering caused by care—Patients’ experiences from hospital settings
What’s wrong with objectifying the patient’s body?
Experiencing objectified health: turning the body into an object of attention
Objectifying Patients, Roboticizing Physicians
The orthopedic objectification of women
From the BJM: The dehumanization of the patient
Dehumanization of Hospitalized Patients and Self-Dehumanization by Health Professionals and the General Population in Greece
Stress and Dehumanizing Behaviors of Medical Staff Toward Patients
Here are 2012 articles just to show this is not a new phenomenon (there are much older ones too): Dehumanization in Medicine: Causes, Solutions, and Functions
A Patient, Not a Person
The patient experience can be dehumanizing
Finally, a 2021 article from The Journal of the Association of American Medical Colleges: Patient Dehumanization in Medical Education
Forgive me…
Some of the statements that you (Maurice) have made make me question if you ever practiced as a physician. I get that you may not have personally experienced such things, but after hearing about such things for over 10 years, is there no academic or human curiosity to seek this out?
Perhaps you have had such good medical training that you can not bring yourself to acknowledge the existence of such things. Even when you experienced unnecessary exposure that are a violation of acceptable medical guidelines you are reluctant to label the experience as such.
I accept that you may make such statements to stimulate discussion. You ignore the obvious:
The PATIENT (emperor) has no clothes!
— Banterings
The next time I am in a hospital will demand toilet assistance be given by a male.
Banterings, if the "patient has no clothes", the patient still must be covered by their own dignity and accepted as such by their physicians and nursing staff. That means such bodily visibility must be pertinent for the final benefit, not for those attending but for the patient themselves and such an exposure should be made known to the patient or the family, if present. If the benefit is for the medical institution, that should be made with permission of the patient. This latter exposure, previously described on this thread, was made to me, as a patient, on two hospital admissions when the nurse was about to photograph my buttocks before being settled in the hospital bed. I had the right to formally reject the picture-taking. Remember? I posted this here at the times. ..Maurice.
Maurice,
My reference was to the story The emperor has no clothes. Where the people pretended nothing was wrong, so to medical staff pretend that this is normal as if the patient is clothed or covered. Providers act like the people in that story (although I question if unlike the people, they realize this is wrong).
Then there is the issue of medical necessity. Guidelines are ONLY a recommendation, a midpoint. My friend Melissa gets her HRT WITHOU doing bloodwork under the ADA as an accommodation of her PTSD from medical abuse. Her doctor is fine with that. How many would DEMAND bloodwork to prescribe?
Then they use the excuse "I can't diagnose unless..." Look at the old requirement of a pelvic exam for hormonal birth control. When the science was looked at, there was no need. I argue the root cause was greed.
Despite the provider saying (or even believing) I need to, it does NOT mean that they HAVE to. The excuse is liability. That is a BS argument if they practice informed consent and document.
-- Banterings
Maurice,
A patient (by nature of being a human being) will always have their dignity. That does not mean that it will not or can not be assaulted...
"That means such bodily visibility must be pertinent for the final benefit..."
There is never "must" or "need." It is up to the PATIENT to decide if the exposure is NECESSARY. What providers deem necessary is usually just CONVENIENT. The patient also decide how much risk the lack of exposure presents and if they are willing to take that risk. Providers are there for ADVISE and CUSTOMER SERVICE.
-- Banterings
Banterings, I agree it is up to the PATIENT (or, if necessary for a patient who cannot communicate, THE SURROGATE) after being informed, educated regarding what is needed to be accomplished and under what clinically necessary conditions by the physician or nurse to provide the agreement or disagreement with the professional decision. If there is no surrogate present and the patient is in no condition at that moment to make their own judgment (eg intoxicated or comatose or already under full clinical anesthesia, emergent, with no time to await return to full understanding decisional capacity), the responsibility for going ahead with the decision is up to the healthcare provider. The patient or surrogate must be fully informed regarding the necessity for the proposed degree of bodily exposure. If extent of clinically proper observation or management cannot be accomplished by the patient's decision, the patient must then accept responsibility or request another healthcare provider.
And that was my behavior and experience throughout the 62 years of my active responsibility as a licensed physician. ..Maurice.
Maurice,
The dirty trick of the profession is in the phrase "clinically necessary." That is not for the provider to decide, but the patient.
-- Banterings
Yes, Banterings, it IS necessary for the patient to finally decide when told (detailed with regard to patient clinical value as part of the diagnosis and treatment) by the physician. That is the requirements supporting the status of informed consent, if the patient does consent to the clinical procedure. ..Maurice.
Dr. B.,
Even when a patient is unable to communicate, the medical MUST take every measure to protect the bodily dignity of every patient. Just because someone is not conscious or able to respond does not give the medical staff the right to exposure them unnecessarily. This is especially vital in ER and surgical care where patients are more likely to suffer from unnecessary exposure. To have it any other way is to liken their behavior to a "naughty" child who behaves when the adult is looking but is misbehaving when the adult turns their focus elsewhere. I told both my own kids and my students even though no one witnesses their bad behavior, it is still bad.
Biker,
I have concluded why most people don't complain about unnecessary exposure is because they aren't educated enough to know it should not be happening hence is why I do what I do. All those years before he was viciously sexually molested, my husband accepted their disregard of his bodily dignity as part of the price he had to endure/suffer for certain types of medical care. So many are like he was. They believe while they receive medical care, they are allowed to be mistreated and abused. This the sad state of how healthScare is delivered to many.
Maurice,
Beyond that, the provider cannot simply stand behind clinical necessity. For instance, if I ever decided to get a colonoscopy, I would refuse the digital exam and insert (and advance) the scope myself, so there is no need for me to be exposed. The provider can not fall back upon "I have to insert the scope."
-- Banterings
Hello Banterings! It is impossible for a patient to safely and effectively insert and operate a colonoscopy instrument and obtain information and tissue themselves. Here is the details for those who don't know what this diagnostic and procedural tool is all about: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4258567/ and here is the abstract from the presentation:
Abstract
The incidence of colorectal cancer has been increasing in the developed world including South Korea and China. Colonoscopy allows for greater diagnostic specificity and sensitivity compared with other types of examinations, such as the stool occult blood test, barium enema, and computed tomography colonography. Therefore, in recent years, the demand for colonoscopies has grown rapidly. New beginners including primary care physicians may help meet the increasing demand by performing colonoscopies. However, it is a challenge to learn the procedure due to the long learning-curve and the high rate of complications, such as perforation and bleeding, as compared to gastroscopy. Thus, considerable training and experience are required for optimal performance of colonoscopies. In order to perform a complete colonoscopic examination, there were a few important things to learn and remember, such as the position of examinee (e.g., left and right decubitus, supine, and prone) and examiner (two-man method vs one-man standing method vs one-man sitting method), basic skills (e.g., tip deflection , push forward and pull back, torque, air suction and insufflation), advanced skills (e.g., jiggling and shaking, right and left turn shortening, hooking, and slide-by technique), assisting skills (e.g., position change of examinee, abdominal compression, breathing-holding, and liquid-infusion technique), and intubation techniques along the lower gastrointestinal tract. In this article, we attempt to describe the methods of insertion and advancement of the colonoscope to the new beginners including primary care physician. We believe that this article may be helpful to the new beginners who wish to learn the procedure.
..Maurice.
Maurice,
This is exactly the thinking that I fight against. You are stuck in the paternalistic thinking that the provider is some sort of magician that has secret, forbidden knowledge. I teach people how to care for themselves. You, like the profession of medicine needs to think outside the radical medical doctrine box.
If this person can perform a SELF COLONOSCOPY, I am sure that the patient can insert and advance the scope.
Doctor performs colonoscopy on himself to understand patients' pain
This is NOT just some publicity stunt, here is the accompanying paper in the academic journal Gastrointestinal Endoscopy:
Colonoscopy in the sitting position: lessons learned from self-colonoscopy by using a small-caliber, variable-stiffness colonoscope
So if one can perform a colonoscopy on themselves...
-- Banterings
On the topic of how nurses say if they see something amiss they WILL report it.
I have a true crime daily calendar.
Kristen Gilbert started working in a VA hospital in Massachusetts in1990. There was an unusual amount of cardiac arrest deaths during her shifts. Enough so that her coworkers “jokingly” called her the “Angel of Death”. It wasn’t until 6 YEARS later in 1996, that 3 other nurses spoke up and reported their thoughts. She is estimated to have killed over 350 people by putting drugs in their IVs. If we are to believe nurses will speak up if they see any misconduct why did it take 6 years? This is causing death and nobody spoke up. They want us to believe they will call out a nurse for unnecessarily exposing a patient?
We the patients must be the ones to determine how exposed we are going to be. They need to tell us about the prep and come to an agreement if that is OK with us. One nurse on Quora said she doesn’t care if you wear a tux into the OR, go for it. I said sure, so you can wait until the patient is unconscious to do what you want anyway. They don’t want underwear on because THEY might hurt themselves removing them once you are asleep.
Good Afternoon:
Cat, if they don’t want underwear on because THEY might hurt themselves removing them once you are asleep then it's time they make arrangements to have same gender teams available for ANY patient that requests one.
I for one am tired of hearing it's our way or the highway.
I've held off on surgery for 9 yrs. now because the system lies thru their teeth to patients. I was promised an all male team & the day of surgery a female shows up in prep.
I cancelled everything immediately & never went back to or gave a good reference to that hospital.
The system MUST be changed.
Regards to all.
NTT
NTT. The sad thing is they probably didn't even think it was about modesty. They more likely thought it was because you thought women are incompetent. Then they promptly didn't think about it or you AT ALL. They just moved on to their next assignment and didn't concern themselves about their responsibility to anybody.
JF... they were thinking if this guy cancels his surgery we can move onto the next one sooner and get out of here quicker.
I do believe that healthcare workers are taught about dignity in school. However, I also believe that unnecessary exposure is not taught. Meaning, they do not teach the students how to keep the patient covered. Ie: keeping the sheet at waist level and pulling the gown out from underneath. Or, place a towel over the genitals first then pull the gown up from underneath the towel. On the very rare instance that they might be taught that, once they get in the field the mentor says no no no that takes to long save time in your busy schedule and just lift it at once. Instead of saying no I’m going to do it the way I was taught, it only takes seconds my way. Then the ones who throw out what was taught become the teachers of the new recruits. Hence the cycle continues. It’s the rare nurse who kept with her lessons should be the ones to teach the others, not the bad apples . A favorite comment from the nurses is TRUST US, we don’t want to see your genitals. Then WHY do they routinely expose us if they don’t want to SEE? Wouldn’t you do everything in your power NOT to have to look if there was a simple way to keep us covered? So the simple fact that they do routinely expose us unnecessarily that means they DO want to see us and more lies through their mouths. And that’s how we should trust you? Sorry liars aren’t in my trust network.
Catfostermom,
I have read some of the textbooks for nursing and they do teach them how to properly expose areas to examine them. There are ways to change a gown that doesn't expose patients but yet they strip one off leaving the patient naked while they put the other one on. It is simply they have somewhere picked up the attitude that patients are objects and they have the right to treat an object however they please. I think that comes either by how the instructor teaches it (ie. do they make more like a joke) or it comes once they start working in the medical world. The nurse you referenced also said she was a patient advocate but since she blamed patients as having mental disorders for wanting what she called "modesty" rather than personal dignity, I doubt she truly advocates for any patient.
Men are more likely to be victims when they are conscious but both women and men will be victimized when sedated. Medical providers know they are more likely to face consequences if they sexually abuse a female patient than a male patient. The routine exposure of male patients is a learned abuse as it is falsely believed men to do care about being exposed or sexually abused if it is a nurse doing it. This attitude is completely sexist. No patient should be exposed for any reason unnecessarily even if it is caregivers of the same sex as in today's society, you have no clue to what sex your medical provider is attracted to so I would think the medical world would follow the science and reduce instances of unnecessary patient exposure.
I don't intend to diminish the value of the arguments presented on this blog thread but read this presentation of what is happening to the lives of your healthcare providers:
https://www.ama-assn.org/practice-management/physician-health/medicine-s-great-resignation-1-5-doctors-plan-exit-2-years
Truly, the stress, upset and attack on dignity is not one sided (that is--applying only to the patient). It is happening to the physicians and nurses and the cause is not just COVID. It could be, in addition to other factors, due to you, the patient. What, as a patient, can you do to improve the life of the healthcare provider?
..Maurice.
Speaking of Covid, places of employment are GIVIN Covid money because of working short. As a natural reaction not every business advertising pretending to be hiring actually is. I lost my job on November 4th. Four days later my co-worker RD contacted me through Facebook messenger that she had been terminated also We we're the only two full time workers on third shift and had been working overtime hours for several months and suffering because of it.
Since that time I relocated in Orlando for a month but returned when I was contacted for a job offer.
The lady that wanted to hire me really wanted to hire me and as quickly as possible. She talked about how she didn't understand how so many people weren't working and how were they paying their bills. I was having difficulties getting into Care Spot because of not being able to reach them by phone. I'd show up and they'd be closed because of shortage of staff. I jumped through hoops to get that job and finally I got what I needed from Care Spot The Assisted living home had to pay for my TV shot and to have it read.
Then I handed the results in to find out the lady who hired me had quit The woman who I talked to acted like I was the one who wasn't cooperating. But I had a job interview with them cancel because the lady who was supposed to interview me called off and nobody bothered to call me to cancel. ( this was earlier before I had even moved to Orlando )! Yesterday RD my former coworker contacted me saying she hasn't been able to find work. But I bet you anything all or most of the homes are working SHORT.
I’m sorry if this sounds harsh... but my responsibility is NOT to the healthcare workers, but to myself and my loved ones. Besides, not long ago my very first post on here was rebuttals to their why family can’t stay with patients pre/peri/post. Any and all of those would help them out. It is not the patients fault healthcare has turned into a Corp type business and the corps are to greedy to hire more staff.
Dr. Bernstein, I don't doubt but that corporate medicine has made life tough for many who work in healthcare, but they need to fight their own battles. It is hard enough being a lowly patient.
I am always polite and do my best to be cooperative. This past week I was an inpatient for a cardiac matter. I routinely thanked anybody and everybody for anything they did for me. Rather than use the call button I always waited until an RN or LNA came to my room for something they needed to do to ask for so much as some water or to say I needed to use the bathroom.
I also kept all conversations with the doctors on that which was their purview so as not to waste their time. That meant resisting the urge to delve into the intimate privacy matter as I thought I could take that up with the nursing staff that would be involved. That tactic didn't work out so well on account I was entirely wrong as to how I thought the prep process would unfold and by time I realized my error, it was too late. It occurred after I was unconscious in an OR with a minimum of 6 people there, and most likely I was naked on the table as my groin was shaved and prepped. I found it a bit ironic after the discussion with JR earlier this week about patients not knowing, and me thinking I was ahead of the curve in that regard.
So yes, I feel bad for the staff and what corporate medicine has done to them, but they don't seem to feel bad about violating my privacy.
Dr B. Sorry. I kinda went away from what you asked. One problem that creates turnover ( besides what I just talked about ) is bullying. Often nurses will harass a CNA. I have heard that at hospitals Doctors will bully nurses. I've never been employed by a hospital so I couldn't say first hand but the nurse bullying CNA's absolutely happens.
In my opinion, anytime there's a circumstance where a supervisor is riding somebody under her ( or him ) an investigation should be done to find out where the problem lies. If the greater part of the problem is the CNA, fire her. If the nurse or supervisor is the greater part of the problem that supervisor. I've worked under nurses where everybody was afraid to tell her a patient was having extreme pain.
And yet they didn’t give you informed consent. I really want to know what those other people are doing while the patient is getting prepped. For some prep one persons job is to hold the leg up, that’s it. They are looking at you while someone is scrubbing you, shaving you. You better bet their heads aren’t turned. They have the perfect spot to see everything. The solution takes 3 minutes to dry and draping that area can’t be done until it is. So what exactly are they doing while you are all hung out drying? Surely not everyone is busy getting other things ready. That should be done prior to your arrival into the OR. Some Drs want to help drape you, yet they aren’t in the OR while you are getting prepped. How long until they get in there? During the 3 minutes of drying time? 10 minutes later? All they ever say is the OR is cold we need to cover you ASAP. 3 minutes for drying time is ASAP? Some surgeries you need to be naked the whole procedure, how does that work if the OR is so cold and we need to be covered?
Biker,
Sorry to learn what happened. But yes, you probably were naked the entire time while being shaved and prepped. They will move the penis around as they are shaving and prepping with the Chloraprep. They will also place the electrode pads and most likely the grounding pad(s).
Although the directions state it takes a minimum of 3 minutes to dry, it does usually take longer. Some cath labs have a prep area while others like the hospital from hell will prep on the cath table itself. Afterwards you were probably again naked once they drapes were removed and the team minus the doctor did any after procedure duties. They generally gown you only once this is done and you are ready to be moved to the recovery area. The strange thing about is in the UK, the clipping/shaving is to be done at home but for some reason the US likes to demean its patients as much as they can. I would imagine even though you knew from my very descriptive story of what happened to my husband, they probably pretty much caught you off guard. They are experts at that. I don't if you had been given anything prior to that but you really should check your MRs to see if that happened. I would guess they ignored your notes in your MRs about female care. It would be also be interesting to see if you were given versed or midazolam and how much as that would explain you knowing but not getting your wishes expressed. The thing abt midazolam is that most patients are "conscious" but are really not capable of free expression without prompting from the medical staff so I imagine this is what happened to you. Most will be unable to remember but many will have nagging sub-conscious thoughts of the missing time.
Catfostermom,
I am with you as I really don't care about their problems as their problems must not interfere with my care. If it does, they need another job. And yes, the OR is very cold as well the cath lab is very cold. My husband remembers being so cold that he shook violently. When you strip patients naked in a cold room for prep and just because you can leave them naked, coat them with cold alcoholic substances, shot cold drugs into their veins, loss of blood, etc. the chance of making that patient become hypothermic is greatly increased. Their definition of covering a patient is with drapes. You are still naked (no gown) but have the thin drapes which did not keep my husband's temperature from dropping. They are supposed to record temperatures but they did not start recording his until hours after the procedure was finished. They have little safeguards in place like omissions of harm to help protect them but nothing is in place to protect the patient. It is also known that patients who are cold before and during the surgery are ones who do not recover as well as those who are kept warmed. Setting the bodily dignity issue aside, it is a matter of patient safety that a patient is kept covered and warmed but yet they fail to understand this too. That is also true some doctors want to help in the draping and some will make them re-drape. My husband's cath lab doctor was not even present during the first time out which according to various medical authorities he should have been. There was no second time out according to the MRs but then it was these same MRs that said he had a baby, he was gay, married, and he had a six hour TAVR done in the space of just little over an hour's time. Makes you have trust in the "science" as they don't appear to know what science is. My husband remembers them moving his penis around while they were shaving and prepping him. They didn't do it like is instructed in the textbooks but instead did it full hand. Textbooks say to move the penis with the back of a gloved hand if it needs to be moved but then many, many more say the genitals are not part of the prep area for a cath and should be covered to preserve the bodily dignity of a patient. Again, they know how the procedure should be done but they purposely (maliciously if you want my opinion) do it in the manner which most harms the patient.
Cindy and I have talked about this on our weekly radio show. We have articles on how the patient must be kept warm. We had a lady on that was naked for ankle surgery. We had a husband and wife on that he was exposed for a lower leg procedure. Not only did this traumatize him but she was a survivor of childhood sexual assault (medical provider if I remember correctly) and it retraumatized her. We had another gentleman on that was also unnecessarily exposed. It goes on and on and it does not stop. They simply don't care and with the medical freedoms they have stolen from us during this COVID fiasco, I think it will only become worse. We know they have no idea what science is so when is the public going to put a stop to their tyranny?
My friend Melissa's best friend (Erica) was abused by a NJ hospital. Melissa even asked the surgeon's PA to protect her friend as she was a survivor of medical abuse. Melissa learned a lot from me (and I still guide her).
Now they are both going after everyone. Erica is suffering from Stockholm Syndrome and afraid to attack her surgeons. Melissa is going after everyone. Erica has set up a web site about her journey. I link it in a Twitter post (below). PLEASE SHARE THIS. GET THE WORD OUT>
I will be posting Melissa's open letter to the surgeon next week after she launches a volley of letters. These women are out for blood
trans-gressions web site tweet
I will update when the letter is posted. This is how you make change.
-- Banterings
Part 1: I had attempted a couple posts adding some detail about my recent hospital stay, but they got lost in cyberspace. Don't waste any time looking for them Dr. Bernstein, as I can recap the pertinent aspects here. I think the posts were too long so I will split this into two.
This was a 4 day non-scheduled event that started with a routine non-cardiac office visit where the routine taking of vitals surfaced my heart rate was twice what it should be and that I was in atrial flutter. I was rushed to the ER, admitted, and had a atrial ablation via my neck and groin under general anesthesia, immediately preceded by a transesophageal echocardiogram.
I was seen by many people doing many tests and being carefully monitored. The 1st 2 days and morning of the 3rd every single person I dealt with was a total professional. Everything was explained in advance, permissions sought and granted, and my privacy protected.
I knew my groin area would be shaved but I mistakenly assumed it would be in a staging area and done by one person one side at a time w/o exposure and that I'd have an opportunity to express modesty concerns for the OR. Instead I was taken directly into the OR where 6 people awaited me, not including the doctors that weren't there yet.
Knowing I had no control of the situation, all I could muster was saying "before you start, please know I am very modest and I ask that you not expose me any more than is necessary". My underwear was still on and a male RN covered me with a sheet so that I could remove them from underneath with a tad of privacy. I appreciated that gesture. I moved onto the OR table and that group of 6 went to work immediately w/o explanations, permissions, or consents. In a span of a minute, two at most, there were patches added to my back & chest, including some chest shaving, another IV added to a wrist, and a statement "you'll feel something going in and will be immediately unconscious". About 6 hours later I came to in post-op.
No doubt as soon as I was out, the sheet & gown were off and I was naked on the table for the rest of the prep. I can tell that my groin was shaved fast as the side they didn't use had been nicked by the razor. No doubt when the procedure was over I was again naked on the table. I have no idea whether or not they were discreet in checking the groin wound in post-op. I don't react well to anesthesia or sedation and have a hard time coming to.
Part 2: It was night by time I was back in my room and I had two 20 something female RN's assigned to me. One was being oriented to the role under the guidance of the other. Amongst other things they had to check the groin wound for bleeding and my bladder for retention. The 1st time they came in, the trainee started to just lift my sheet & gown to see the groin area. I immediately grabbed the sheet stopping her and exposed the area myself. I had been allowed privacy to attempt urination. The other RN then grabbed sheet & gown to push them away so as to scan my abdomen for urine retention. I stopped her as well and exposed the area myself. Going forward each time they came in I would expose the groin area myself and when it was time I would pull my gown up from underneath the sheet and the lower the sheet to expose the abdomen.
The senior RN said she needed to straight cath me. I said it isn't full and I don't need to go. She repeated her statement each time she came in and I ignored her, though the last time she said it more as a command than statement, but I again ignored her. Their shift ended and by then I was able to urinate enough to not need catheterization.
I don't agree but I do understand the OR team moving as fast as they can as a group to keep things moving given their time constraints. It not occurring to those two night RN's to use basic request/permission protocols is the more problematic piece for me. That 1st time they should have stated what they needed to do and been clear that they'd only expose the groin and abdomen. they should have explained urine retention and acted in a more consultative manner on that issue.
There may be some follow-up in the next few months and I will be better prepared.
I truly hope you plan on escalating the attitudes of the 3 nurses. It does not sound like they got the messages. ESP since you had to move the gown yourself.
Hello,
The following is from an incontinence blog.
"Hello all. I know this fear all too well. I was ordered
to have a uroscan not long ago. I was so afraid of having an accident during the procedure or when I went to stand up at the end. I had myself so worked up I said to my hubby, "I'm beginning to understand why women don't seek treatment!" My greatest fear was having a male tech. I felt like if I was going to lose my urine in front of a stranger I at least wanted it to be a female. Best case scenario would have been a female over forty. So... I called the imaging department prior to my appointment and requested a female tech. The lovely lady I spoke to said she would note my request on my file. I did end up getting a female tech. After the scan was completed she left the room so I could dress. And of course when I stood up out it all started to flow. I used the disposal cover to soak it up then dumped it in the garbage. Almost identical story with my most recent cystoscope. But again my Dr. is female. I think my mind was my worst enemy sometimes. But the imaging tech did ask me what I would have done if I got a male tech. Easy answer- I planned on refusing. Best wishes to you."
It seems that gender-concurrent care is a concern for many. How long will it take for medical personnel to realize AND ACCOMMODATE this NEED?
Reginald
Biker,
Most only clip the hair as using a razor and having nicks can cause infections. Isn't that the very thing they say they have to do this to prevent? My husband had both sides clipped as well as both thighs. They also used a vac afterwards to clean up the hair as he was directly on the procedure table. He remembers them spreading and lifting his legs to do this. Then they do the chloraprep and its drying time can vary depending upon circumstances.
It is my opinion that when you tell them you are "modest" you are conveying to them it is a mental issue you have rather than if you say they need to respect your bodily dignity thus making it their responsibility to do so. I would educate them the genitals do not have to be exposed for cath lab procedure. I would also buy and keep in the factory package several of the COVR garments or at least have them place a blue towel over your genitals before you are stripped. Because you told them you are modest and not to expose you any more than necessary, in their minds the total exposure of you genitals were necessary as they do not respect the right of patients to have bodily dignity/privacy. You can still be polite but be firm. On your form, you can write your instructions as well as having them in your Advanced Directive. Also, I assume this is the hospital where there seems to be flag about your "modesty" requests?
The thing about the cath labs is they want to get people in and out at a fast pace. Once they are done with the last patient, they are done for the day so this is an incentive not to take the small amount of extra time needed to safeguard the bodily dignity of patients. I am so sorry to hear that you were treated like an object. I can't understand why they continued to treat patients like that because especially in a heart unit, patients are told to avoid stress but how is that possible when they the medical provider is the cause of the stress. My husband had to take natural supplements during his stay to keep his blood pressure down so he could escape them. It should be the goal of any hospital not to add more stress to the stressful situation of being hospitalized. Please feel free to tell your story on the PatientsRightsInfo.com website as it is up and we are adding content as I have time.
Hello,
$ 1.1 Billion, USC, George Tyndall MD. $ 460 Million, U of Michigan, Robert Anderson MD. $ 500 Million, Mich State U, Larry Nassar MD. (Source WSJ 20 Jan 22). $ 123 Million, Pediatrician, Dr. Earl Bradley (Source USA Today 20 Nov 21). Six-Figure settlement, Federal Gov. - Indian Health Service, Dr. Stanley Patrick Weber (Assoc. Press 25 Feb 21). This is over $2.2 Billion - Yes, Billion - paid for physician abuse. Have any steps been taken by the medical profession or insurance carriers to PREVENT similar abuse and payments in the future? Would a concern for patient privacy and dignity be a first step towards abating this abuse?
Reginald
JR, you may be right that they view expressions of modesty as signs of mental illness, but at the same time their interpretation of privacy and dignity isn't likely anything more than being polite and maintaining a proper gameface. In their world being it was just the 6 of them prepping me as I lay naked on the table, my privacy was protected, and because they didn't mind seeing me naked on the table, they saw my dignity as being preserved too. It is the concept of minimizing exposure that many in healthcare simply don't grasp.
I did receive a Press Ganey survey for my Day 1 experience in the ER. As I had said, the 1st 2 1/2 days of my 4 day adventure were textbook perfect as concerns respectful and dignified care, so I will give them kudos in this review.
Biker,
You really don't know if your privacy was protected. It does not take 6 of them to prep you. That night my husband had 4. I would say part of your team were being trained. They also learn in schooling that a patient's genitals should not be exposed to maintain patient privacy. You also do not know who else came and went as my husband remembers seeing others coming and going during that time that as once we got the names/faces of cath lab he was able to see there were others present. Because if they did not cover your genitals, they did not protect your privacy. They do know the difference and if pinned down, they would eventually admit they knew they were not doing best practices to protect your dignity. Those who have been harmed should not feel like they have to make excuses for the ones who harm. Victims should never make excuses for the harm they had to suffer. It is really not about even minimizing exposure because your genitals never required being exposed in the first place.
As for the Press Ganey survey, in case you don't receive a survey about the last days, I would hand write in about what happened the remainder of time.
And yes, in talking with those medical "professionals" about bodily privacy issues, they do view modesty as being something wrong with the patient. So many of them believe you must comply with all the conditions of care they impose. They do not believe you as a patient have rights that do not have to be forfeited when becoming a patient. Even that patient advocate, Trish something, blames patients needing "modesty" as something wrong with the patient. You can have the basic human right of bodily privacy/dignity and not be modest. There is a big difference. I don't believe my body should be unnecessarily exposed to any healthScare worker be they male or female. That is my right and they do not have the right to take away my rights for whatever reason they consciously select.
Genitals, genitals, genitals..modesty, modesty, modesty.. There is another issue when considering concerns of the public regarding patient dignity with regard to the medical profession using the anatomic names for the anatomy of the genitals. I published this topic on my blog June 26, 2012 "Failure to Use the Anatomic Names for Female Genitals: Ethical Illegitimacy?"
https://bioethicsdiscussion.blogspot.com/2012/06/failure-to-use-anatomic-names-for.html
PT and Doug Capra contributed to the discussion. Do we really all want even anatomic names of human genitals "hidden" as is their representing anatomy which should also be "hidden"? ..Maurice.
Genitalia is SACRED whether or not medical staff wants to acknowledge it or not. Love making is one of God's greatest and most sacred gifts to humans ( other than Himself and people ) Sexual abuse is a harm that destroys deeper than just about anything else. Oppression isn't accidental. Arrogant bully's put the wheels in motion for all this patient abuse and financial rape.
Dr. B.
It is not that I cannot bring myself to say penis, vagina, etc. or that I do not know the correct anatomical name, it is your blog has severe character limitations and it is easier to blanket all of the terms under one--genitals. There is nothing wrong with using the correct wordage but yes, some people are shocked if you utter the word penis, etc. out loud.
Also, I wonder if you yourself know the difference between the medical need to see someone's penis, etc. for only a medical action reason and the common state of exposing a patient's penis, vagina, etc. just because you are a medical provider since you seem to think there is hidden reason (ie. mental health issue) in not using the anatomical terms in our blogging. I also wonder if you think medical people have been given the supreme right to unnecessarily expose patients at will as your last post infers? I don't think any of us here have an issue with the absolute need of our vaginas, penises, etc. being examined as long as we have given explicit permission and know who will be doing the exam and who will be present and why. My vagina is not a hidden treasure but it is mine to hide from whoever I choose and to show it to when appropriate just as other things in my life. Yes, I have a house but it my decision who I let come into my space and who I don't. I don't suppose you have ever been taught "good touch, bad touch" as it certainly applies to the medical field in the area of patient exposure--"necessary exposure (which is permittable), unnecessary exposure (which means bad, shouldn't be happening). Does that clear it up for you?
There are laws that supposedly protect our medical information although at the present they are not working as the current US government believes it can mandate you disclosing your health information to the store greeter in Walmart. There are laws saying no one may force you to have sexual relations without consent but yet there are no laws covering medical personnel exposing and subjecting patients to encounters that are sexual in nature as unnecessary exposure can be defined as that. We are told to have blind trust in these medical providers that they don't have sexual thoughts in their minds but try telling victims of Nassar, Bradley, more than several universities, and many, many more that. It is dangerous to allow medical providers free, unneeded and basically unregulated access like they currently have. We know the medical system doesn't operate with "science" as we have more than seen this during the COVID fiasco. We can no longer believe we are safe when we are required to give them access to parts of our bodies they do not need access to. So yes, penises, vaginas, etc should be hidden from their view when they are not the direct subject of the medical work they are performing. It is a matter of patient safety. It is is not a matter of modesty and it is a matter even larger than patient dignity.
Dr. Bernstein, perhaps I am a stodgy New Englander, but I think in healthcare settings that correct terminology must always be used. To me it is a part of the formality that is required if patients are to accept the presumed professionalism of the staff. It is also required if patients are to accept the "healthcare is purely clinical" mantra.
JR, I think you misunderstood me. I know that my privacy and dignity was not protected. What I was trying to say is that if asked, those 6 people would have said that it was protected because in their mind it was only the 6 of them that I was laid out naked for and that they were all comfortable with my nakedness. What privacy and dignity mean to us is not what it means to most who work in healthcare, and for certain there is a very different standard for conscious vs unconscious patients.
And of course I don't know if anyone came into the room, nor can I know if anyone, that male RN who covered me with a sheet when I had to remove my underwear perhaps, made any attempt to minimize my exposure.
JR. I remember that article by Trisha Tory. The only difference between her and the other problem health professionals is that she acknowledges that patients are upset about being exposed. And then she immediately sides with the health workers doing the exposing. I seriously doubt I will ever read anything she writes afterwards although that wouldn't upset her any because she isn't any kind of patient advocate.
Biker,
Thanks for clearing that up. That's why you are given sedation so you won't remember. However, most likely at the time you were aware but versed or whatever sedation did its job and erased from your memory any horror you experienced at the time. This is one thing people don't realize is that in real time you do experience the horror but are unable to stop it and most likely unable to remember it afterwards. This is the way it works for most but not all like for Cindy and my husband. It is very much like the forest that a tree falls in when no one is there. The medical community says what you actually suffered doesn't matter since they gave you something to erase the memory but is that really true? Does the erasing of a horrible event you have suffered make the event acceptable? Apparently for the medical community it does.
JF Yes, she did acknowledge but for me that she acknowledged it while at the same time laying the blame for the need of "modesty" on a patient's mentally challenged shoulders while saying she advocates for patients is disgusting. I have been attacked by some of her followers because I have said this. If your paid advocate doesn't protect your rights then why have one at all? Protection of bodily dignity isn't rocket "science" but it does require all to recognize the patient as being more than an object and that they do have some say how the medical treatment will be handled. This brings me back to the medical community cannot concede any amount of power and control. This idea is certainly growing in a time where a woman can choose to kill another human being but is being targeted for hate and maybe more if the same woman refuses an experimental vaccine. Strange reasoning and really a horrible time in our history.
That’s what’s pisses me off the most. How many people are aware that the sedative that “ helps you relax” has a memory blocker in it? They don’t tell you or even ask if you want it. . All you ever hear is I went to sleep and next thing you know I woke up in the recovery room. I don’t remember a thing. Hubby thought he was out before he even got to the OR. Unfortunately, all the research came after his surgery, when I wanted to know why his balls and thighs were tinted from the antiseptic, when he was having a laparoscopic ingunial hernia repair. I then told him that he was conscious and probably even moved himself to the table. But, thanks to their wonder drug he doesn’t remember. Like wise when you are in recovery and they need to check your incision. Of course you are still out of it while that checking takes place so you have no memory of if the sheet was totally lifted or pulled up from under the blanket. The nurse would have had no reason to look lower then the belly button.
Update on Melissa and her best friend:
The first volley has been fired. The Joint Commission came in, heads rolled. The facility is on a schedule to do an investigation, propose changes, and implement changes.
The entire department is to undergo training.
The students (residents) were reprimanded and a permanent write up is now part of their permanent personnel file. Students (residents) are limited to only viewing suture lines on patients.
Her letters showing the behavior as "cruel, inhumane, and degrading" (according to the UN has not hit yet. Outside organizations and legislators have not started making inquiries yet. Her complaints to the licensing board has not hit yet.
She is on safari and going for trophies.
I will update as official notices are released.
This is the change that Maurice and myself advocate for.
This healthcare system needs an example to deter future abuses. They have found the sacrificial lambs.
-- Banterings
I’m hoping this doesn’t read badly. But, I hope this is an all around change and not just a transgender change. Though maybe needing to be more thoughtful towards one group will make them think twice before doing something to another. I’m sure having a mark on your record will not look good to employers. Unless of course those employers don’t see it as unethical.
Has there been a discussion about dignity, privacy and psychiatry?
Common practices today might be unquestioned holdovers from 19-hundreds methods. Requests to share detailed information can be undignified to some, even if not to all, patients. This would include required sharing of memories of childhood, sharing other people's diagnoses, or having to pretend to agree with a psychiatrist's philosophy, in order to get treatment.
Much like other discussions here, medical professionals can react badly to the idea that current practices are unneedfully invasive. Or that just because some patients can easily share, all patients should easily share deeply personal information.
As an analogy, think about ulcers. Ulcers were once treated as psychological and caused by too much stress. If a patient in 1986 knew them to be a physical disease and wanted to get an antibiotic, they might still have to accept badgering lectures and invasive questions about their history and lifestyle to get seen. A patient today who sees depression as a physical disease might be told they'll have to go through invasive talk therapy and take SSRIs for months or years before being allowed much faster and more effective treatments.
Not everyone feels the same about privacy of the mind, just as with bodily privacy. In psychiatry, people can be asked for detailed histories of themselves and their relatives.
I know of a 50-something person switching psychiatrists for ongoing (20+ years) treatment of ADHD. The doctor gave this person a form to be filled out by their parent(s)! It is as if the doctor is saying that a person's own statements aren't trustworthy. Not to mention the parent might not know about the ADHD.
Even if one thinks that illnesses like depression are physical illness, one must pretend to "buy in" to psychiatric theories- detailing their own or their parents' or other relatives' childhood or adult experiences-- to be believed. If a patient states that "I think my parent had high blood pressure" or "I'm afraid I don't know the details of what cardiac issues my parent might have had" this is likely to be accepted. If a patient says "my parent might have had problems with stress, but I don't know the details" they'll be pressed for details. Saying "I can't diagnose my deceased parent" gets treated as being stubborn.
KFamilyQuestion has added an entirely different but pertinent element to consider as part of the practice of medicine with regard to patient dignity.
Could personally sharing detailed information about one's self or family member be potentially just as upsetting to some patients as sharing inspection of one's physical body parts? So when we are all talking about physical undress can this be just as valid to enter complaints about
"undressing" the patient's mind, memory and personal including family experiences.
Can't and shouldn't such inspection be as unnerving for some as physical inspection?
Thanks K for introducing what, to me, is a pertinent issue as we discuss the need to preserve patient modesty.
K, please end your future comments (hopefully returning) with your pseudonym which you want to be addressed in future communication with the participants on this blog tread topic. ..Maurice.
I have never interacted with the mental health system but I can easily imagine it being more painful for some to divulge the personal details of their lives than it is to expose their physical bodies for conventional healthcare reasons.
There is a big difference which complicates things though. With physical exams and procedures patients who are protective of their physical privacy and dignity can easily determine necessary vs needless exposure. It would seem that with mental health matters it would be much more difficult to know in advance what information the provider needed in order to do their job.
As with physical exams & procedures, the onus is on the mental health provider to explain why they need to know certain information. In the past we've discussed medical doctors sometimes asking intrusive questions that don't seem pertinent to us as patients, and that such questions will either go unanswered or simply feeding back to them what we think they want to hear.
Where is the preservation of patient dignity by the medical system's common behavior to interfere with the attempted suicide by the very elderly who have not found any "good" from further living? You know, patient found and taken to an Emergency Room for the clinical attempt at reversal of the patient's intent. ..Maurice.
For more on examples of suicide attempts and completions in nursing homes, read this descriptive article by the Kaiser Health Network:
https://khn.org/news/suicide-seniors-long-term-care-nursing-homes/
Should interference of this human behavior of the elderly within nursing homes be also considered an invasion of the "private parts" of the homes' patients? Remember, patient dignity is not all anatomical. ..Maurice.
Update:
JCAHO came in and lit the place up. The hospital has to respond with an action plan in a given amount time. The students/interns have permanent reprimands in their files. Students are limited to the stitch line for exams. The whole department has to do retraining.
Those two girls are not done yet. I am loving it.
-- Banterings
I’m very interested to know how they will change things country wide or are they just limiting this to this facility.
Let's hope the JCAHO actions triggered by Banterings transgender friend cause a more wholistic rethinking of patient dignity rather than being restricted to transgender patients. Odds are it won't but one can always hope.
Will this be our cue to write to them saying this is a country wide problem and not just for transgenders?
Catfostermom,
Just this facility.
Perhaps this is because of the current political climate: it's all the white males' fault. LGBTIA is a "protected" class especially now with the wokeness of the current administration.
I will take wins where ever I can.
Melissa said that her ADHD doc is unaware of her transition; she never told him. I don't know how he doesn't know or he avoids the topic because she does or does not have time in the visit to get into it. On her forms she checked "other" for gender and wrote in "alpha male." This is her way of letting staff know that she is in charge.
-- Banterings
I would like it if somebody sued over false documentation. It happens all the time but Courts take that false documentation as Gospel. Actually a LOT of patients should sue over false documentation so that courts stop using it as evidence.
There are exceptions such as within the narrative provided by Banterings, but shouldn't we all look at the simple issue of patient modesty during a clinical physical examination or treatment of the genitalia as being simply an example of the ethical principle of "Double Effect" where the goal of the procedure is one of diagnosis and/or treatment, betterment for the patient and not one of sexual pleasure for the male or female physician or nurse? Truly, when such a procedure is clinically undertaken are not all the conditions of the rules of Double Effect undertaken? That is: The action itself is good or at least neutral;
The good effect, not the bad effect, is what is intended;
The good effect is not produced by the bad effect;
There is a proportionately grave reason for permitting the bad effect.
Here is the link to the article from the Harvard Center for Bioethics which clarifies the term "Double Effect":
https://bioethics.hms.harvard.edu/journal/rule-double-effect
Shouldn't all patients who are to undergo a genital exam and treatment consider the Double Effect aspect of what is about to happen. I am sure the physician or nurse has that in their mind too and most will do their best to keep the procedure and their behavior solely to the "good effect" for the patient. ..Maurice.
I disagree Dr. Bernstein on the Double Effect suggestion you made. What we discuss here is not the provider's good intention to address our health issues but rather their intention to do it in whatever way is most convenient for them no matter the impact on the patient's privacy or dignity.
Using my example of last week,while the OR staff had the good intention of getting me safely through a cardiac ablation, they simultaneously had the intention of doing it as expeditiously as they could with me laid out naked for 6 people rather than allowing one person to shave my groin one side at a time in private. Their good intentions didn't include maintaining my privacy and dignity.
The problem is most in healthcare don't see their convenience intention as sometimes having negative consequences.
Biker, before you were transferred to the "operating table" did your cardiac surgeon talk to you for a minute or so to describe what the urgent studies found and what the anticipated procedure might include and if you had any questions or comments? That is the necessary act of "informed consent" even when quick decisions must be made.
Were you able to "speak up" at that time? ..Maurice.
I received a 2nd Press Ganey questionnaire for the inpatient experience, so I filled out both (ER & Inpatient) and wrote out comments on the inpatient one concerning the groin shaving and the post-ablation night nurses. I gave my name & # so we'll see if I get a call.
Dr B. That’s the problem. They tell you what the procedure is and the hopeful outcome. NEVER do they go over how you will be prepped... your exposure or anything that has to do with how they will protect your bodily dignity. They wait until you are unconscious to do all of that as they LOVE to say what you don’t know won’t hurt you. If they do care about our bodily dignity why do they do this when we are “out”. Because, we can’t speak up and they can do what they want and forget everything they promised us.
Dr. Bernstein, the two physicians that did my procedures came to the ER after the staff there had done all of their tests, and attempts at slowing my heart rate. They gave me their diagnosis and explained the necessary actions (TEE & ablation) and decision tree based on what the TEE showed, and explained the timing options and what would be done prior to getting a time slot in the OR. They were very good. I explained I don't react well to anesthesia & sedation and asked if I had any options there. The answer was general anesthesia would be used as they couldn't risk any movement on my part, and that I would likely have a sore throat from the TEE and the subsequent intubation. I didn't ask about groin shaving or similar matters as I assumed those were things I could take up with a cath lab nurse.
The morning of the procedures, one of the doctors came to my room and went over everything again and got the signoffs on the consent forms. The anesthesiologist came by as well and thoroughly went over things, including noting that she had an anesthesiology Fellow that would be with her in the OR.
The missing element was I never went to a cath lab staging area as I assumed would occur but instead was brought right into the OR with 6 people there ready to prep me ASAP. Neither doctor was present yet. All I could muster was "I'm very modest and ask that you not expose me more than is necessary". I had no illusions that would do anything given "necessary" is synonymous with "convenient" for most healthcare staff, but it didn't hurt to remind them that some of us care. The male RN did then put a sheet over me to give me some privacy to remove my underwear. As noted previously, I was rendered unconscious within maybe 2 minutes of moving onto the OR table. One person immediately put in another IV while one shaved part of my chest and started putting stickers on and another held an anesthesia mask over my mouth & nose. The one that did the IV injected something and I was out. I assume at that point the gown and sheet were taken and a couple of them went to town shaving & prepping my groin & neck, with me spread eagle.
I am a bit embarrassed that an old pro like myself made the assumption that I'd have an opportunity to express myself in a cath lab staging area. Had I inquired of the doctors or even asked one of the nurses in the cardiac ward that I was in, I might have at least gotten a more dignified groin shaving before going to the OR.
The other opportunity I missed was my roommate was an interventional radiologist. We never engaged in personal talk and I only know what he did because one of the nurses asked him, but knowing that I could have asked him questions.
As of NOW we are moving on to VOLUME 121. NO FURTHER POSTINGS WILL BE ACCEPTED ON VOLUME 120.
So let's move on to the new volume, Volume 121.
..Maurice.
We know they lie. Heck... many have admitted to lying. They literally call it “comfort lies”. They say they are the ones to decide what their patients need to know and what they don’t. I call BS and that’s not for them to decide. It’s another one of their power trips over the patients. The more they speak the more I hate them and would never trust them.
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