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Preserving Patient Dignity (Formerly Patient Modesty) Volume 121
Actually APODYOPSIS is not only the "Word of the Day" but is also the expression of the participants of this blog thread over the years as applied to those within the medical profession who attend to patients. And, upsetting the visitors here, professional misbehavior involves more than "mentally
undressing" (though that can happen) but undressing the patient in a physical sense for unneeded inspection or procedures. But either way, the visitors find such motivation and behavior clinically unnecessary but also destructive for maintenance of the patient's dignity.
Graphic: Jason Travis Ott via Google Images
181 Comments:
Good evening.
In reference to Cat's comment. She is correct,they never do go over how you will be prepped.
They act like medicine is a "secret society."
They pray the patient doesn't know anything so they don't have to explain anything & the process can move along.
For many years I've searched Dr. Google about medical procedures.
Only once did I find a hospital's website that thoroughly explained what would happen to the patient from the time they came to get the patient until the patient was in recovery, left the facility, or back in their room.
And the kicker is, it wasn't an American medical institution. It was up in Canada.
Really, for a patient to truly give their informed consent they should be asked up front do you want to know all the steps involved or just about the operation or just told EVERYTHING that will be happening.
They hate it when they get some who knows anything about what will happen because then they have to answer questions that should go "on the record."
I referenced Biker's procedure on Dr. Google & of all the many sites I looked at only 1 made a comment about prep & they made it short & sweet. "The groin area in and around the access site may be shaved".
That all they said.
I recently heard from a friend of mine that a couple of gentlemen in their 50's I met at a men's support group mtg. had died because they stopped going to their prostate cancer treatment simply because of the way the female healthcare workers treated them.
Too many guys are walking away. Something has to give.
Regards to all,
NTT
NTT, I've looked at YouTubes for cath lab prep too and if they show anything it is a couple seconds of a nurse in a private room shaving only one side of the groin and with only the most bare minimum of the patient being exposed. The same minimal exposure is shown when they include a nurse holding the wound site to stop the bleeding after the procedure. The patient is back in a private room with the sheet only slightly pulled back to expose the wound. Those videos are a far cry from the patient lying naked on a table in the OR with 6 people present. Hopefully students or other observers didn't come in to watch the prep after I was unconscious.
That my procedures were more involved than the standard cardiac cath did not necessitate that part of the prep occurring as it did.
I have been hurt too many times. I have now dehumanized providers. I am the consumer, I only care about myself.
-- Banterings
Banterings, when you write "I have now dehumanized providers" are you implying that you yourself has "dehumanized" them in order to "only care" about yourself? I think that you and the others here who have concerns about the behavior of their healthcare providers, should, in the patients' own interest consider them as your colleague as you, together with those providers, work toward a resolution of your personal clinical problem.
What patients should know is that they are not simple consumers but are part of the clinical "manufacturing" team and process. To produce a product acceptable "to the consumer", they or their families must participate with the providers to achieve that product. "Only caring about myself" is a wrong methodology. "Joining the team", if possible, is the way toward a wanted conclusion.
Physicians are taught that their patients are not inert "objects" but are "subjects" and the patient and as necessary their families are to all work together with them to achieve the patient's goal. Physicians know it, must accept it and so should the patient. ..Maurice.
Maurice,
It is like when a couple fall out of love and you no longer love or hate the other person, you just don't care about them. Not that I dehumanize them, I just do not care about them as human beings.
I see them as objects because of their behavior and hubris. Indeed, human beings do not treat other human beings the way that they do. I try to consciously bring myself back to the thinking that they are human, but the hurt that I and others have suffered at their hands continuously makes that impossible.
To say look at all the good they done is a hollow statement. It is like when someone is being sentenced and all the people come out to say look at all the good that he has done.
So, X amount of good works = 1 felony pass? It does not work like that. Yes people make mistakes, but we hear how all these providers are for human dignity but it is still the self interested business as usual.
Then they have done away with intimate peer physical exams yet they believe that patients are obligated to participate in such.
Then you have people like Fauci who have lied and admitted they have (moving herd immunity goal posts) not to mention the whole puppy thing that further erodes trust in the profession. I have seen physicians defending him and his actions.
I want the providers to be loved again, I don't want any human being to suffer. Like with addiction, if one refuses to change, you have to let that person hit their rock bottom. That is what the profession of medicine is doing, ignoring society because they know so much better.
It is the issue of do what I say, not what I do. The vaccine mandates for healthcare workers exemplifies this. It is OK to mandate it for everyone else...
Technically, the vaccines are NOT vaccines in 2020. Very few people realize that the CDC has changed the definition of a vaccine in 2021 (via CBS News).
Another case of because I am a doctor and I say so.
The profession sees nothing wrong with all these behaviors. There is a breaking point and that is coming real soon. The profession is going to be gutted of their power.
-- Banterings
Banterings, I offer a worthy correction to the link you provided in your last posting regarding CDC changing "the definition of a vaccine in 2021 (via CBS News)". Actually, the article was presented on CNS News which is a politically conservative publication. And what was written in the article could be interpreted as politically directed.
Unfortunately, this is an example of the issue of political orientation when dealing with what should be non-political potentially basic science issues. But unfortunately the world has political biases everywhere and it should be the job of everyone, particularly in medical science and science discussions to identify those potential biases as they occur. That was the rationale for my current posting.
In any event, thanks Banterings for your explanation of your views. ..Maurice.
Biker
I, too, have done a lot of research about how cardiac prep should be done. The sources I have found say the genitals should be covered by at least by a blue drape (cloth) as they are not part of the field. However, most do not want to slow down to avoid getting hair and solution on the area so they would rather expose because harming the patient in this manner means nothing to them. There are several articles in Cath Lab Digest and other misc. sites I referenced because we wanted to know why my husband was subjected to such outright cruelty in the lab not to mention the sexual assault he suffered in the CCU room. It all boils down to they don't care either about your right to bodily privacy and they do not care that a naked patient is a cold patient which can adversely affect your general well-being as hyperthermia is a risk of being exposed as the cath lab is kept extremely cold for the equipment and for the staff's comfort along with the drugs and dyes they inject via the IV are cold. Also, because of the procedure itself, there may be a drop in BP which causes even more cold. They didn't record my husband's temperature until hours after the procedure although this a supposed standard and hours after the procedure it was still well below his normal reading and he remembers being so very cold. It is interesting that despite them saying they need a sterile field that they do the hair clipping on the procedure table which is what they also did to my husband. There is no rhyme or reason why they do what they do except they can and they get by with it.
Dr. B.,
Again, this is not about modesty but about a person's right to say what happens to their body and by who. Give me one valid reason for patients to be unnecessarily exposed. Again, what medical students and nursing students are taught is much different than what many are actually practicing in real life medical encounters with patients. If the medical system is truly patient-friendly, wouldn't they be trying to actually become more proactive in delivering better customer services to its patients rather than denying there is a problem? What is the big deal that a medical provider cannot allow a patient to have bodily dignity unless it is all about power and control? And yes, patient dignity means many things and that is why I often use bodily dignity/privacy to highlight what I am describing.
JR, I'll never know how I was prepped or otherwise treated after I was unconscious. All I know is that 100% of the prep occurred after I was out and that there were 6 people in the room at that time, not including the doctors that weren't present yet. I as well know that the groin clipping at least could have been done beforehand in a private and dignified manner.
I think healthcare staff fall into four broad groupings, most in the 1st two groupings:
1) Providers with empathy for their patients but who operate with a set of definitions that run contrary to how patients think. By this I mean to them "necessity" is synonymous with "most convenient" and "polite" is synonymous with "respectful". They are nice and well-meaning, but clueless. This is perhaps the largest group.
2) Ego driven types with little empathy for others and for whom all that matters is the technical success of whatever the procedure is. They can be brilliant and skilled practitioners, but they don't understand people and thus don't ever see things via the patient's perspective.
3) Those for whom it is just a job and even if very good at it, there is no emotional connection to the patients.
4) Those for whom their jobs are a means of wrongful access. These are the sexual predators and voyeurs; predators being but a very tiny minority in the healthcare community vs voyeurs being far more common than most would admit. Most voyeurs likely don't admit it to themselves even but they are the ones for whom healthcare is not purely clinical. People who work in healthcare gravitate to that which they most like, but in any discussion of why some choose pediatrics or L&D for example, why some nurses & medical assistants gravitate to urology is never part of the discussion.
Biker. How can it be said that those certain employees are good at their jobs if they don't care about patient encounters except for the current encounter only? It might appear to them to have been successful but it isn't if and when the patients are run off.
JF, by good, I mean at a technical level. They know how to do the surgery, treat the cancer, make the diagnosis etc. That it may elude them that the patients are real people with hopes,fears, and feelings they are dealing with and who want to be treated with dignity and respect isn't necessarily on their radar.
As a now retired physician and medical student instructor, I can tell you that the patient (as a subject and not some repairable object) is as essential to the rapidity and thoroughness of the finally cured or controlled illness as much as the attending professional healthcare providers. There is no clinical value for doctor-patient separation in the outcome or its route to the outcome. The methodology and goals have to be agreed upon by all parties (including, at times, patient families).
Challenge the physician or nurse to this concept if you find the relationship and goals in some form of unacceptable status.
There is no professional excuse that support this separation.
And, by the way, most hospitals have clinical ethics committees whose working goal is to investigate, communicate with the patient, physicians, nurses and patient's families to provide all parties ethical and legal understanding as well as acting as mediators of conflicts that may arise. I should know the role of hospital ethics committees after more than 30 years of active participation even many years as chairman of the ethics committees of two hospitals. All that experience and "work" has been a major factor which led to the creation of this Bioethics Discussion Blog.
..Maurice.
Hospital from hell said via their review that "as he is getting and will have more and more medical encounters, he needs to adjust to how he was treated." They also said if he didn't like how he was treated, to go elsewhere which is really bizarre as they sedate to the point the patient can't even more to go elsewhere or he would have. He didn't know what they were doing (as he nor I was ever informed they were doing a procedure on him) but he did know they were being abusive and vicious in the manner in which he was treated. Yes, while some hospitals may have an ethics committee, some are just rubberstamping whatever happened as nothing.
The so-called challenging is probably what set into motion all the harm that was inflicted upon my husband and me. Most medical providers do not being questioned or told NO by patients. Bc my husband refused care at one hospital, refused sedation, refused their gold standard, won't take long-term prescriptions was in all probability why they decided to teach him a lesson or punish him. I know of several other harmed patients who were mostly targeted because they challenged their medical provider. We do know from COVID as many health providers are openly admitting their biases against certain patients they will intentionally harm patients. COVID has pulled the cover off the myth that health providers do not allow personal biases/hatred into how they deliver healthcare. The attitude of the medical providers is the cause of most patient/medical provider separation.
Maurice,
ethics committees ignore one important aspect of the relationship and that is the patient is also a consumer (due customer service). that is a trump card that patients have held and now play in this world of corporate medicine.
everything that the profession of medicine has done is in its own self interest. whether it be establishing a medieval guild through ama accreditation, self regulations (because mere mortals cannot comprehend the alchemy of medicine), doing away with intimate peer physical exams while expecting patients to comply, etc.
"because i am a doctor and i say so" is no longer justification. even if something is contrary to science, society may choose it over the profession's opinion. tobacco is a prime example.
a regime change is coming, then the investigations and the accountability. that will show that the profession is not untouchable.
-- banterings
Banterings, "patients as consumers"..really?
Patients, as consumers, should be more empowered to promote patient-centered care and improve outcomes. However, health care is not like other consumer sectors so reducing costs and improving quality cannot be the responsibility or burden of patients alone. We have to be careful when thinking of patients as consumers because health care is unlike other industries. Medical professionals cannot treat patients like other consumers and give non-indicated care. Additionally, the customer is not always right when requesting certain treatments.
For more on this controversial topic, simply go to the
"Primary Care Cooperative"
Patients are more than consumers, they are their very own participants in the job of providing their own care. Medical care is not something just "taken off the shelf" but the patient is more involved with the physicians and nurses as the creators of the final product. ..Maurice.
Dr. Bernstein, until we get to the point that phrases like "patient-centered care" are defined in actionable terms, it is all just theory for academics to banter about and feel like they've accomplished something.
I don't doubt but that just about every doctor and nurse would say that they practice patient-centered care. The problem is that they get to define what it means, same as occurs with what "respecting patient dignity", "necessity", and "privacy" mean w/o ever getting the patient's input.
There are a million or so cardiac caths done every year yet there are no standard protocols for how something as simple as groin shaving should be done; each hospital and practitioner getting to decide for themselves how they implement the associated patient-centered care, respecting patient dignity, necessity, and privacy aspects of it. The same can be said for just about any procedure.
If the academics are serious, let's see them shift into some of the nitty gritty of how practitioners actually interact with patients. Broad/vague terms like patient-centered care don't mean anything otherwise, no more so than the phrase informed consent carries any meaning when there isn't an actionable universal definition.
Maurice,
I did NOT say patients are just consumers, but they are ALSO consumers. You can NOT argue the fact because healthcare is 20% of GDP. They are consumers too.
What you espouse is what the profession of medicine has written as the narrative.
The provider is not always right either (that is why they have malpractice insurance).
As for unneeded treatments; what about defensive medicine? Talk about unnecessary...
When one points the finger to blame someone, there are three fingers pointing back at that person.
Why do you look at the splinter in your brother’s eye but don’t notice the beam of wood in your own eye? Matthew 7:3
-- Banterings
My younger sister was recently told by her doctor that she has one more year to live. Then her doctor promptly turned and walked out of the room. This is the same sister who had instruments left inside of her from a surgery from 13 years ago She was told she couldn't sue because too much time lapse but she didn't even know about it until much later.
I'm sorry to hear about your sister JF, and saddened by the manner in which she was told. Being intelligent enough and hard working enough to become a doctor does not automatically carry with it human empathy or people skills.
Banterings, "Why do you look at the splinter in your brother’s eye but don’t notice the beam of wood in your own eye? Matthew 7:3"
Couldn't a patient enter a doctor (nurse)-patient relationship with a beam of wood in the patient's own eye? One might call such a relationship "a pre-judgment of the physician or nurse's behaviors or actions". Pre-judgment without adequate time and attention leads to heuristic generated conclusions and behavior and such behavior can occur within both the patient population or the medical professionals. ..Maurice.
I want to explain my comment in the last posting which was written as follows:
"Couldn't a patient enter a doctor (nurse)-patient relationship with a beam of wood in the patient's own eye?"
How could that happen? Well, consider a first-time visitor to this blog thread on "Preserving Patient Dignity" and has read the views of virtually all the current contributors to this thread regarding their experiences and view of how they or their family member was treated by doctors and nurses who attended them. Might that reading have the potential to plant "a beam of wood" into the eye of that first-time reader here? Or is this religious analogy of "splinter and beams of wood" and the affect on an education to some new visitor reading what has been written to this blog thread not a proper or correct analogy? ..Maurice.
DR B..
I started reading this blog after I started researching about what’s exposed during surgery, which was too late, surgery already happened. Those that are stopping by to read have already been mistreated. The medical staff Gloss over what happens to you once you are given that drug “ to relax you”. Most think the the staff will protect you it’s after the fact they learn that they are actually the predators. That’s when they start looking for answers.
On one of Quoras questions someone posted a video of student nurses learning how to prep a patient for abdominal surgery. She very carefully folded the blanket down to keep the dummy covered, then lifted up the sheet to the neck ( if this was a female patient her breasts would have been exposed) while she was starting to apply the solution it looks like her wrist touched the blanket. She stopped and the instructor was saying something then went over to the patient and lowered the blanket exposing the dummy. There were comments from students if it was a male or female dummy. Then the student said oh I should have exposed them more... so they ARE being taught to expose the patients. With more practice that student would learn how to apply the prep without touching the blanket, instead of just exposing us. Whose to blame there, the instructors for just moving the sheet saying it’s ok the patient won’t know?
What we as medical school instructors are teaching our students from the very first days of patient contact is the need to preserve the patient's dignity. What we teach them is, as an example, summarized in this article Promoting Patient Dignity in Healthcare .
Here is the introductory excerpt of the article:
Humans have an intrinsic need for dignity as a basic element of well-being. Yet, the concept of dignity can be somewhat nebulous and its defining features can vary across societies, cultures, and individuals.
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.1
The very nature of healthcare, however, can generate feelings that starkly contrast with the pillars of dignity. During healthcare encounters, patients might feel exposed, vulnerable, judged, anxious, and frightened. Further, in the busy healthcare environment, the principles that promote dignity — such as compassion, empathy, and attentiveness — can suffer because of time limitations and greater focus on goals and improvements that are more easily defined and measured.
Despite these barriers, treating patients with dignity is an essential element of patient-centered care, engagement, and satisfaction. Even small gestures or modest changes can have a meaningful effect on a person's sense of dignity. This article discusses eight areas in which healthcare providers can promote patient dignity and reinforce patient-centered care as part of everyday practice.
We teach and expect nothing less than what is described in the article. ..Maurice.
Then this female instructor has no sense of what might be considered protecting the patients dignity and should be reprimanded herself.
catfostermom, it is all in the definitions used. As I have been saying everyone who works in healthcare maintains that they protect patient privacy and respect patient dignity. Without specific standards in that regard, they are left to apply their own definitions of what that means. Generally speaking at an operational level, necessity is synonymous with convenience and respecting dignity is synonymous with being polite.
I am sure if questioned the staff in that cath lab a couple weeks ago would all say they protected my privacy and respected my dignity and that shaving my groin with me naked on the table in that room with all those people was necessary. The question we're left with is why isn't there an industry standard that says groins will be shaved in private one side at a time with the patient being draped for the process? That would seem to be a very easy thing to agree on if the goal was to protect patient privacy and respect their dignity. But that's not their goal.
Biker,
Do we need to explain to them each time we go in for medical care what OUR definition of protecting MY dignity means to me? And that they need to respect my needs not their own?
Good afternoon:
Dr. Bernstein, you and your colleagues may very well be teaching what's in the Promoting Patient Dignity in Healthcare article however, what's taught in medical school on this subject more often than not is NOT carried over in real world practice. In most facilities personnel are told get it done as quickly & safely as possible. To hell with how you were taught in medical/nursing school.
Many of the resources used in that article are from Canadian healthcare sources. From doing some of my own research, I have found that Canada & Great Britain take patient dignity much more seriously than the American healthcare system ever has. To them patient dignity is integrated into their everyday way of doing things.
Here in America for most institutions, it's just a second thought if that. There's only one facility that I know of that's changed their culture & is making an honest effort at making patient respect & dignity a way of life & that's at Beth Israel Deaconess Medical Center in Boston.
Our healthcare system is currently totally dependent upon the character of the individual(s) at the top calling the shots for each hospital, outpatient center, clinic, and doctors office as to whether the patient who uses their facility will have their dignity respected & privacy protected.
Senior management sets the tone. If they show respect, compassion, empathy, and a little kindness towards colleagues & patients within their facility that culture will then in turn get passed down thru the ranks & the staff will mimic the same values towards their colleagues & the patients they deal with on a daily basis.
That culture is what is missing today in the majority of american medical institutions.
The almighty dollar is currently driving most institutions at patient expense. Keep the patient minimally safe and cut corners where ever & whenever you can.
Unlike other country's healthcare systems, the medical community here in America is set in its ways & resists change of ANY kind when it comes to the way they do things.
Here it's their way or the highway. Change here has to be forced upon them.
Here as far as respecting a patient's dignity & protecting their privacy, Biker said it best. The medical community has their own definitions as to what patient dignity & privacy means & the patient has theirs.
He is correct in that there should have been industry standards long ago on the way things are handled with patients & those standards cannot & should not be dictated strictly by the medical community. There has to be input from normal everyday americans.
But being that they refuse to budge of their position of it's "Our way or the highway" nothing will change & men like myself & women will continue to walk away from needed care.
Every so often you'll hear a story on the news or read it in the paper that the healthcare system can't understand why people (especially men), don't get their regular checkups & tests they should.
They never stop to think that maybe the reason is because of something they are or are not doing to make them want to come in. It can never be their fault ya know.
The only way I see any change is to get like-minded people in congress and/or state legislatures then legislate changes.
That's all I have for now.
Respect to all,
NTT
catfostermom, that would seem to be the case.
NTT, beyond "moaning and groaning while spreading the word", isn't there something positive, constructive that can be done to bring this observed "unprofessional" behavior to an end even if all that is described here is some statistical minority? Is the solution only "moaning and groaning" on public media of one sort or another, the latter which has certainly been described as being carried out by our visitors here? Short of legal responses to gross and accepted as unprofessional behavioral or decisional acts which have been filed over the years, there is apparently no general public action to rid the medical profession of those who commit those patient disturbing behaviors described in detail here.
Here is a suggestion that comes to mind. How about electing those to perform as physician, nurses or techs like electing members within the country's governing system. It shouldn't be the medical school or clinic or hospital to do the voting but the general patient public. Once defeated, the physician, nurse or techs are out until they restore confidence in them by the public and are "voted back into office".
Silly? What solutions do you all have regarding how the public can together pick the professionals whose total behavior is acceptable? Silly? But what else is left? ..Maurice.
Maurice,
Yes, and I do. I have PTSD from medical abuse. By your own admission, what med students learn in the hidden curriculum is contrary to what they are taught the first 2 years.
Providers are expected to be professionals, trained in their art. There are no professional patients in the ED.
Patients really don't have a choice when they need medical care, providers have a choice to treat patients with dignity or not.
Just look at what the profession advertises: Hippocratic oath
-- Banterings
Banterings, what 3rd and 4th year students experience in their years as they clinically interact with assigned patients (of course, generally under orders of their superiors--the patient's attending physicians including residents but also patients themselves). Yes, even the patients become the student's superiors to whom they must find time to properly attend and respond. This is unlike the systematic, uniform education which they have experienced in the first two years. What the students learn and experience in the "hidden curriculum" they will carry on into their residency and beyond.
I disagree that there is no such mature aged patient who could be considered "professional". You and the others writing here, as examples, are as medically professional as most of the adult patients who treat themselves from home TV ads, internet activities, repeated medical office visits and occasional hospitalizations. Patient professionalism is set by their knowledge and their personal or family experiences which trains them in the art. And I would consider all these patients as medical professionals and should be treated by physicians and nurses and techs as such and that is why these licensed practitioners should be attentive to their patients' views and integrate what they hear into their own decisions to be expressed to their patients. That has always been my view and perhaps reflected and explaining why I never have been sued.
..Maurice.
Maurice,
The profession of medicine is radically changing. Trust is nonexistent. The pandemic and LACK of science is the final nail in the coffin.
Just look at the latest abuse by a physician: Dr. James Heaps at UCLA. $243.6 million settlement.
My point is that providers are expected by society to be professionals, not to mention how the profession markets itself as professional. Patients are NOT required to have any professionalism or experience to be at patient. To your point, Melissa, now her friend, JR, Biker, myself, etc. have become professional patients.
As a professional, we all hold that any other person who is NOT part of our profession has no ability to understand our profession, therefore we are the absolute authority over healthcare.
This is the same argument that the profession of medicine used to justify paternalism. We are justified in saying: ...because I am the patient and I say so. Are YOU the patient?
There are more patients than providers in society. Patients' expectations are more in line with society's expectations.
George J Annas rang the bell in 1974. Hubris caused the profession to ignore the warning.
Physician, heal thyself...
-- Banterings
NTT is right. The people at the top of any organization set the tone of the culture. Every hospital says that they respect patient privacy and dignity but if those are only hollow marketing slogans to the executives, the staff will generally follow their lead. Employees react to how they are measured and judged, and if respecting patient privacy and dignity is not key to success, then that's not what the employees will focus on. Certainly there can be exceptions in a given dept. if there is a strong manager there willing to set an example different than what comes out of the executive suite.
Hello Dr. Bernstein,
Today's (9 Feb 22) WSJ has an article titled "The Doctor Will See You Now - Wait, Not You". Dr. L.S. Dugdale (Ctr for Clinical Med Ethics @ Columbia U) considers treating vs not treating unvaxed patients. His closing paragraph follows: "The earliest hospitals were sites of hospitality. These days medical professionals are required to be neither saints nor martyrs. But they are obligated to care. The greatest hazard we face - vaccinated or not - is to have a generation of health-care professionals who lose sight of that purpose [i.e. caring]."
Isn't that what the posters here have been "screaming"? - Care for me as an individual and not as a procedure.
Reginald
Hello All,
A thousand pardons for the gross error on my previous post re Dr. L.S. Dugdale. I cited, "His closing paragraph ...." Dr. Dugdale's first name is Lydia. I apologize to you and to her for not researching her first name and addressing her accordingly.
Reginald
What is the role of "the family" in the preservation of their family-member's "patient dignity"? Interesting topic on my blog and responded to by a number of ethicists.
The topic is titled: "Treating the Patient Simply for the Benefit of the Family: Is that Ethical?"
Is anything like this going on? ..Maurice.
Because with a family member around especially while the patient is unconscious they will be more likely to control their own behavior. You won’t hear any remarks about the patients weight, genitals, tattoos.. they will need to actually BE professional. They don’t want to be monitored because that’s not convenient. Many employees are monitored. My husband works at a casino. He is under surveillance 24/7/365. He can’t even pick a penny up off the floor. He can’t step one toe across a door frame with his casino keys. We are talking about vulnerable human beings, not pieces of meat. They show us no respect. Why should we care that they aren’t comfortable being monitored if they don’t care about protecting us? IF they do no wrong they should be saying bring it on, I have nothing to hide. Why is the OR such a don’t say anything keep it hush hush type of place? Don’t you think if it was more transparent then we wouldn’t be having these discussions?
As an add on. I know I’ve said this before.. I would be much more relaxed if my husband was around taking care of/watching over me.. then the non professionals.
Catfostermom, you write "Why is the OR such a don’t say anything keep it hush hush type of place?" Not being a surgeon, I can only make assumptions. An operating room is what one might call a "closed environment" led by a
"captain" surgeon for a certain number of cases and generally with a "team" for those cases including assistant surgeons, anesthesiologist and various assistants (techs and nurses). They are all working together with the "captain". And, yes, there are occasional students or occasional surgery equipment product representatives.
What happens (including at times a musical recording background) is set by the leader "captain". This structured operating room environment makes for the "hush".
I hope we have a surgeon reading this blog thread who can contribute further to your question. ..Maurice.
That’s not what I meant by hush hush. You have to KNOW to ask about how you will be prepped. What drugs you will be given. Versed is ALWAYS said to relax you. No, it’s to make you loose your memory. You are awake and aware but won’t remember. My husband thought he was out when they started to move him to the OR. No... he most likely got himself onto the table but he doesn’t remember that. They also say they introduce themselves and tell you what they will be doing once you get into the OR. Isn’t that kinda late since you got the versed in pre op? Why don’t they want you remembering this? Why is it automatically given without our knowledge or consent? Don’t use the BS line of something to relax you. That’s the last memory my husband has. Also, they wake you up on the OR, but because of versed you don’t remember that either. Then some of even get an extra dose of versed as they are waking up so you don’t remember the first part of recovery. WHY? What is being hushed and hidden from us? It’s our right to decide what’s given and what we remember. NOT them to decide for us.
Catfostermom. I don't remember where I heard about this. Whether it was on this blog or somewhere else, but one male patient wanted to make sure he got full instructions so he recorded with his cellphone but forgot to turn it off. He was in surgery and his surgeon talked about wanting to shoot a gun up his rectum. She said other derogatory things also. I like to imagine her surprise when she was confronted with it. She was sued for a lot of money.
I’ve read that on Quora.
As if the profession of medicine did not have enough problems with the trust of patients they are now making the whole situation worst by proposing medical reparations based on critical race theory.
This article was linked from MedPage Today. The comments provide the real insight:
...what is racist is to grant special rights to individuals based on their membership in some arbitarily selected subset of the population. In a truly just and democratic society all individuals have equal rights. That's what it means to have "equality before the law." Policies that seek to establish 'equity' by means that violate the principle of equality before the law are the ultimate threat to our democratic republic...
If one accepts this whacked out notion, then one believes that Maurice by the nature of being a white (male) physician is a racist individual. I would argue this point to the contrary, that he most certainly is NOT.
To believe the articles would only enhance the position of many on this thread of a corruption that infects the profession of medicine that calls NOT for a preference to provide care to patients of certain races, but a subjugation of the profession, a subservience of providers, and the paternalism of the patients.
Even if one does not subscribe to this notion, there is still a corruption that calls for this remedy. The fact that such articles are written is the greatest justification of the remedies that I propose.
Even though both articles advocate for more minority providers (provider race matching patient race), what is blatantly ignored is the issue of gender.
For a profession that touts the education and intelligence of its members, they are pretty damn dumb.
-- Banterings
Banterings, is what you are looking for is the medical professional system should have sufficient male and female physicians and nurses so that at the specific gender of the healthcare provider can regularly and fully provided to the request of each and every patient, whether in an office, clinic or hospital exam table or hospital bed ? Should the patient's request for a specific gender be part of the patient's pre-written advance directive so that if the patient enters unconscious, professional gender selection by the patient can still be known?
And to have sufficient male and female physicians and nurses to accomplish this patient decision would require more male nurses and more female physicians to be trained in all areas of their upcoming work.
Beyond gender should the professional's sexual orientation, race or religion play a role which is followed in patient's selections? ..Maurice.
I tried to wait for Banterings to answer. I think what you said is about enough male staff ( and female) staff is what we want ( plus a lot of the intimate care and examination shouldn't be happening in the first place ) Effort should be made to not display patients to family members or other people or people passing by outside the room or staff who happens to be in the room. Maybe they shouldn't be in the room. You make it sound like it would be incredibly difficult to accomplish but it wouldn't be if medicine hadn't made it into a non-issue. People avoid care because of this issue. Some get care but are emotionally harmed. Family relationships are destroyed. Sometimes permanently.
Dr. Bernstein,
It has been a while since I’ve posted anything on this blog. Since you are a professor in medical school, I wanted to run this question by you. I know you do not conduct surgeries in an operating room, but you probably interact with some surgery professors who supervise residents.
If a teaching physician is not present to supervise the resident at every point of a surgical procedure, does this also violate federal law?
Misty
Misty, "at every point in a surgical procedure", the answer is NO.
Here is the link to for your details from the AMA Journal of Ethics:
https://journalofethics.ama-assn.org/article/how-should-trainee-autonomy-and-oversight-be-managed-setting-overlapping-surgery/2018-04
..Maurice.
Maurice,
Melissa informed me today, the hospital where her friend was abused is being investigated for human rights abuses. You do not get that if you are compassionate. There is a reason that they are being investigated; the complaint was credible. First JCAHO, now this. This is how one makes change.
Give me a lever long enough and a fulcrum on which to place it, and I shall move the world. Archimedes of Syracuse, 250 B.C.
-- Banterings
Why is it that “lay people” have to educate the “professionals” about patient rights? I’m in a semi argument with someone who seems to think they know all... It’s on Quora. A guys wife got kicked out of the room in a urologist office. There were 2 nurses there to “comfort him” he’s wife had to leave. I told him it was his right to have his wife there. Some know it all came and said would be nice yes. A patient right NO. Then I said something eles and she replied. I then went and got 2 screenshots of yes that is a patient right.
I have to take retraining courses every 6 mths just for being a phlebotomists. Privacy, patient rights, harassment, OSHA, needlestick, etc etc. I don’t understand WHY nurses don’t. Hands on tests, where the nursing boards watch every single nurse preform their hands on patient interactions. How they expose them with intimate care. Etc etc. weed out the ones who do not know the patients rights. Isn’t it their jobs to keep up with the latest studies and research? Why don’t the majority of them even KNOW about the surgical undergarments? WE educate them on what they are and that they are beneficial for the patient and ALL we ever get is crap from them. Oh no.. not gonna happen, get counseling. Blah blah blah. Bet many of them would turn around and insist on wearing them for their own surgeries. If JACHO is investing one hospital I truly wish they themselves would take the initiative to drop in on others. Surely they can’t think this is the ONLY hospital in violation. Are they the organization we need to petition to get results? Are new nurses so bullied by the older nurses that they can’t speak up and say ya know what... I learned how to do my job with keeping the patient covered at all costs. If you don’t mind I’ll do it that way. OR I see how you exposed that patient unnecessarily I learned it this way and it’s much easier for me to continue if you don’t mind. I go into work to do my job, not make friends. If I’m talked about behind my back, so be it. That’s on them being bitches and won’t effect my life in any way.
Good afternoon:
Cat, I'll answer some of your statements.
A guy's wife got kicked out of the room in a urologist office. There were 2 nurses there to “comfort him” he’s wife had to leave.
You're right it is his right to stay especially if his wife wanted him there for support. The 2 nurses weren't there to comfort him. They were there in support of the urologist.
As far as the patient was concerned, their presence just makes the patient feel more uncomfortable. That would be the last time I went to that urologist. My mate is there for ME. If they can't be with me, I'm not there either.
Hands on tests, where the nursing boards watch every single nurse preform their hands on patient interactions. How they expose them with intimate care. Etc etc. weed out the ones who do not know the patient's rights.
Nurses don't because a supervisor or manager might find out they are cutting corners to get things done. It wouldn't make a difference though because the medical community first & foremost protects their own. They'd just be told to not make it so obvious.
Nursing & Medical boards in this country are a JOKE.
They do NOTHING to protect the general public they serve.
My state has a watchdog group that puts out a monthly report of what the Nursing & Medical boards have done with problem doctors & nurses.
Many nurses get hooked on the drugs they steal that are for their patient. Nursing board just suspends their license for 30 days, attend classes then come back to work & pick up where they left off.
They should have been fired. I wouldn't want a nurse who's high on drugs anywhere near me or a loved one.
Then there's the doctors. Doctor doesn't attend the mandatory stop before surgery to be sure everything is right going into surgery. Comes in after & operates on the wrong knee.
He gets away with a $5,000.00 fine & 30-day license suspension. License should have been revoked.
Why don’t the majority of them even KNOW about the surgical undergarments?
If they knew about the garments, they might have to use them whereby taking away their power to humiliate their patient any time they want. Simple as that.
Bet many of them would turn around and insist on wearing them for their own surgeries.
In a heartbeat!
Regards to all,
NTT
Banterings, you reminded us: Give me a lever long enough and a fulcrum on which to place it, and I shall move the world. Archimedes of Syracuse, 250 B.C.
Having the tools..yes. But having the intent is another matter. And there may be rational excuses for not to apply the pressure on the lever. ..Maurice.
Maurice,
Peter Ubel first wrote about the issues in 1999. 23 years is long enough to get your house in order.
I am going to jump on the lever!
Melissa is having the facility investigated for human rights abuses now. (Not JCAHO, another organization.) She has not tipped her hand on the next complaint that she will file.
Here is her friend's account of the abuse. One can not read this and not be heart broken. Her friend used to trust healthcare providers. Now she is broken and one of us.
I justify using the lever the same way the profession justifies the abuse: medical education. We are educating providers how to treat patients and the consequences of not doing so.
-- Banterings
Hello,
I can't believe what is in the article referenced below. Alfred C. Croftan, M.D., Chicago wrote an article titled A Court of Decency for Physicians. In the article he mentions a need for physicians hearing patient concerns - something many of us have advocated for some time. Please note the date of his original article - Amazing!!!
Reginald
https://jamanetwork.com/journals/jama/fullarticle/2789330?guestAccessKey=74e58fcd-3f7e-4323-a413-b6877c3c05ce&utm_source=silverchair&utm_medium=email&utm_campaign=article_alert-jama&utm_content=etoc&utm_term=022222
Reginald,
That is too little too late. The profession has shown its true colors. Fauci is their poster boy. They have turned their back on science, now the CDC is hiding data because people might actually see the lies we were told the last 2 years. When the red wave rolls in, bodily autonomy laws will be enacted and that will apply to more than vaccines.
-- Banterings
Here is an example of how society is going after the profession of medicine:
California Doctors Warn Against COVID-19 Censorship Bill
Granted, this is the tyrannical authoritarians (like Trudeau) using an emergency to try to seize power. They are going after the profession of medicine to "protect the people." Unfortunately this is the view that has not followed science, ignored therapeutics, lied (even admitted to it like Fauci and herd immunity), hides data and research (New York Times: The CDC is hiding COVID data), etc.
This is a double edged sword; go along with the narrative and perpetuate the lies and further erode any trust left in the profession, or (have the courage to) speak the truth and face discipline. Very few have the courage, but some do.
The larger point is that society is willing to take action against medical professionals to protect citizens.
-- Banterings
I had my 6th annual skin exam and for the 1st time ever I received a thorough exam in a manner totally respectful of my privacy w/o me saying or asking for anything. So it is possible after all.
After thinking I just wouldn't go back to that practice and not being able to find an acceptable alternative anywhere near where I live I decided to instead ask to be assigned to a different doctor and give them one last chance. I was assigned to a male Resident in his last year of Residency, so unless they hire him to stay on, yesterday's exam with him will be a one time event. It did set a new expectation standard on my part however.
After being roomed, I was apprehensive waiting for him as the small size of the room and physical positioning of the chair/table I was on precluded any possibility whatsoever of anyone he arrived with being anything but up close and personal. I prepared myself to insist people leave or face the wall.
He arrives with just a female scribe which was a good start as the standard there is to also have an LPN. She sits at her station facing away from me and stayed facing away from me the entire time. Every other scribe I had had sat facing me the entire time. So another good step. He then proceeds to do a thorough exam in a manner I hadn't experienced before.
While I was sitting he examined my head and arms and had me lower the gown to examine the front of my chest. He then had the chair convert to a table so that I was now lying down and he examined the front of my lower half, being careful to keep my genital area covered after doing a quick exam there. Next he asks me to turn over and he said he'd hold the gown as I did so to protect my privacy. He then examines my back half while making sure my butt was covered by the gown except when he took a quick look.
That I never had to ask for anything privacy-wise and still received a thorough exam begs the question as to why his approach is not standard practice. Is this how he was taught or is he applying his own personal standard being respectful of patient privacy while still being thorough?
Did you make any complaints to the office prior? Is it in your records? More importantly did you Thank him and the scribe for their professionalism and hope he continues this type of respect throughout his career. We are quick to blame them when they treat us like meat. It’s just as important for our future respect of bodily dignity to thank them when they act on patient centered healthcare. You never know when he will become a mentor to another. He will be the future to drill into the others how it can be done without exposing us unnecessarily and that an extra second to keep us covered isn’t a big deal.
Biker, as I had mentioned here previously, medical students are taught that patients skin need not be inspected with the patient naked but can and should be performed fully covered except for the serial exposure of segments of the patient's skin. And that is how I taught them. Yes, it may take the examination a bit longer but the technique is as valuable as full nudity and is the way the majority of patients would want to be examined. ..Maurice.
catfostermon, in abbreviated form here is my dermatology experience:
1st exam w/Resident - Upon check-in and upon being roomed I had asked for only male staff and when the Resident I was scheduled with entered the room, literally the 1st thing he did was shake his hand in front of my genitals while saying "Do you have a problem with women?" I filed a complaint with the practice and a month later after no response, I went to Patient Relations with my complaint. The result was a policy change whereas male patients could state "male staff only" upon check-in and only the male doctor would come into the room. However, this was an unadvertised policy so male patients would not generally know they could make such a request. My complaint also included the scheduling staff reacting in a hostile manner to my initially requesting male only staff.
2nd exam - Was reassigned to the head of dermatology. I make the request upon check-in as previously instructed. Only the doctor enters the room. An awkward exam ensues as he was like a lost soul w/o his female entourage. It was a reasonably thorough exam.
3rd exam - Same doctor & upon check-in, I asked to speak to someone in charge given the awkwardness of the prior exam. I acknowledged the doctor was lost w/o his scribe and said she could come in so long as she stepped out or turned around for the intimate parts of the exam. The woman I spoke with said she'd take care of it. The doctor was again awkward & was walking on eggshells so to speak but took pains to give me privacy for a reasonably through exam.
4th exam - Same doctor & I figured I would just speak up as the exam proceeded rather than beforehand as that wasn't working so well. The doctor skipped the genital/rectal part of the exam despite my establishing that I was there for a full exam. I was fully prepared to speak up as necessary but the exam never got that far.
5th exam - Same doctor, same approach on my part & again the doctor skipped the genital/rectal part of the exam. He was running late and in a hurry and was out before I had a chance to ask the one question I did have.
6th exam - last week - new doctor at my request (a Resident) who gave me a thorough exam while protecting my privacy and with a scribe that never looked in my direction. If this doctor stays at this hospital or otherwise in this region I will seek him out as my permanent dermatologist.
Dr. Bernstein, the Resident I had last week apparently was taught in the manner you noted and took it even a step further by shielding me from the scribe. He clearly understood necessary vs unnecessary exposure. Proof that dermatology exams can be done in a respectful manner.
This doesn't have a lot to do with modesty but it does have to do with patient dignity. My sister was recently told she has a year to live. Her doctor didn't say anything about options, he just walked out of the room. Her most recent Chemo nearly killed her. So she cancelled the Chemo that was scheduled after that. When she cancelled the Office kinda fired her as a patient but she doesn't want that doctor anymore anyway. She wants to move to Florida where she can be given more aggressive care. Our youngest brother who lives in Florida was recently discovered to have Cancer also. He has it in 4 locations but it's being treated aggressively.
I believe modesty and dignity run together. A healthcare worker who disregards one will also disregard the other.
was asked by a coworker from another department, who I saw every day, to be his surgical nurse, he put the request in through the Surgical services director after asking me if I would, please be in the OR. I was quite honored that he trusted me to that degree. It was inguinal hernia surgery, so if I wanted I could have looked, but I did as I always did, when prepping for this surgery and tucked “things” that were not involved with the surgery out of the way, clipped any hair that needed and scrubbed, with out seeing the important parts. I maintained this gentleman’s privacy and trust the best I could. If I did have to see his private parts I would have done the prep safely and completely for his safety and never mentioned what I had seen, there would be no need to. I understand that your mind will not be changed on these matters, so you need to go somewhere that can give you what you need.
Nurses comments on Quora Continued from last post.
If this nurse can prep a co worker for surgery without seeing his “important” parts why are we routinely exposed? She then goes onto say in another answer that they really don’t want to see naked bodies, they’ve seen enough. Another nurse says gowns aren’t removed just pushed up. Do they truly not get that whether the gown is pushed up or removed it’s the same damn thing. Exposing us unnecessarily...
catfostermom, for people who say they don't need or want to see it, they sure do seem to go to a lot of effort to make sure that they do see it.
"need to" is the biggest lie told by providers. It is like they are being forced to do it and they have no choice. (Ref: Emerson, Joan P., Behaviour in Private Places)
I tell them that as an abuse survivor this feels like bullying and a threat, please say that "I want to..." (I also teach others to do this.
Providers realize that they sound like sexual predators when they say "I want to" and those conversations don't come up unless there is a pretty compelling reason and even then they are very adamant about the patient's right to refuse.
-- Banterings
In all communication with patients, the medical professional's entry into a discussion using the actions of "wants" and "needs" should always be directed for the patient to decide after given the facts. It should be the patient's own decision or that of a surrogate legally speaking for the patient. What is necessary is that the patient or surrogate understands the patient's self-value of that decision but also the current status of the medical system to follow that decision. This is what the medical ethical principle of "patient autonomy" is all about. The final decision of "needs" and "wants" was the mechanisms of the physician "paternalism" of years ago and which is now a "has been" and, if somehow, somewhere still present today, should be eliminated. ..Maurice.
Maurice,
The only needs are the patients needs. (After all, the patient is the customer.) Unless the profession learns this, society will impose it upon the profession.
-- Banterings
My friend Melissa had an appointment with a urologist today for UTI. She allowed a quick exam down there (lasting less than a minute and no other voyeurs). She told me that the doc made her comfortable (declined a rectal). The doc was very interested in her piercings, more so the nipple piercings (probably does not see too many nipples).
I asked her about this because she told me she would not allow it. She said that the doc was young, male, and made her feel comfortable. She also said that taking down the hospital that abused her friend, permanent reprimand in the residents' records, the investigation into human rights abuses, and other investigations to come, Melissa felt like she had a WIN.
She describes it as getting justice and feeling not only safe but powerful. The JCAHO investigation is still underway. She is not done; there is the sexual assault investigation, the investigation by the foundation donating $100 million.
These exams may be a little uncomfortable but not traumatic, after all, these people are professionals and have seen this before.
-- Banterings
Once again a staff member commented how patients are only briefly exposed. I asked how long is briefly. As a patient laying there naked briefly is a few seconds. Their reply was a few minutes. Once I said that’s not exactly briefly now is it and why Covr undergarments aren’t mandatory. They get totally defensive and bash those trying to protect themselves. All I can keep doing is commenting/educating those who really don’t know what goes on.
Funny ( not funny) is there is a thread about shady things nurses have done in the surgery room. Some guy actually said. A nurse ran to her locker to get her phone to take a pic of a guys penis she was about to cath because it was so huge. He described it as porn star huge. I said I hope he stopped/reported that behavior. Crickets in response. So the lying nurses who say this doesn’t happen we must keep calling them out. I truly hope the people of Quora take notes and put a stop to this when they themselves need procedures done.
I don’t know that I’d call it “shady” or not, but a couple come to mind that were definitely unprofessional. We had to implant a defibrillator in a guy the day before Christmas. The guy was really obese and had a white hair and a beard. One of the nurses said “Holy crap, we’re operating on Santa. He better pull through!” Every OR comes with a supply of red plastic bags. She took a red bag (a clean one) and fashioned it into a red cap. She added some sterile 4x4 gauzes around the edges to give it a white trim and then put the bag on his head. She then whispered into his ear “Say Ho Ho Ho!” which, in his state of conscious sedation, he was able to do.
Another time a patient came in and needed to have a Foley catheter placed. A Foley is placed in the urethra and advanced to the bladder. That way the guy can pee when the procedure goes long. Now nurses have seen just about everything, but this guy had an enormous penis. It looked like the trunk of a baby elephant, you wouldn’t even see something like this in a porn movie. The nurse assigned to Foley duty just said “Oh my God!” then ran to her locker and returned with a camera. She had her picture taken shoving the catheter up this guy’s junk.
I need to put these here to be able to go back and post again once this guy deletes his comment after I called him out.
catfostermon, your comment about the nurse getting her camera gets to the primary problem. There are always going to be bad apples. The larger problem we face is that their co-workers almost always choose to just look the other way rather than report it. They are afraid to make waves and will say things like "the patient wasn't harmed" or "the patient never knew". A piece of it however that some have spoken to is that they say that they are the ones that will get in trouble if they do report it.
"Preservation of Patient Dignity" may include much more than the aspects which have been fervently detailed here. It is also should include how elderly patients are diagnosed and treated. Take a few minutes and review the brief but worthy article on this subject from the current
Journal of the American Medical Association .
And we are all growing older and older and even much older. ..Maurice.
An update to my cath lab experience earlier this year. I had gotten two Press Ganeys, one each for the ER and inpatient experiences. I answered honestly and only nicked them on the privacy/dignity matter. I wrote out the specifics of my complaint in spots that allowed for comments.
Having no idea whether those comments are passed along or not and if so, how quickly I might be contacted, I gave them a lot of time to respond. Hearing none, I called the cath lab and asked to speak to someone about their protocols. An RN called me back. She said the protocol for outpatients is to shave groins in a staging area before going into the lab, one side at a time while keeping the patient covered. She emphasized that this is how she was taught to do it.
She said that she was not in the cath lab for my procedure but that for inpatients brought directly into the room that the same one side at a time while keeping the patient covered protocol is the way it would have been done. She was very empathetic in her demeanor.
Knowing before I called that there is no way for me to ever know how things were actually done, my real goal was to simply let them know that some of us do care about our privacy/dignity.
In a couple weeks I will have a follow-up visit with the cardiac electrophysiologist that did the procedure, and though I know patient prep protocols are not his responsibility, I plan to ask him about how my prep was done so as to see if his answer is consistent with what the RN said.
I wanted to let you all know that we have two new articles on Medical Patient Modesty's web site:
1) Choosing a Doctor and a Medical Facility
2) Importance of Filing Complaints Against Medical Professionals / Facilities
Misty
I want to tell my participants on this blog thread that my recent absence here from earlier in the week was due to my hospitalization lasting several days related to my underlying chronic urologic disorder and chronic catheter use. Many here will remember my prior descriptions of hospitalizations. I was seriously ill with infection but fortunately an effective antibiotic was found and administered and I am clinically better. But this was another of my multiple hospitalizations and where I can look at professional behavior from a very personal point of view. I will most like write a bit more about my experience in relation to this blog thread topic. ..Maurice.
Dr B. How was your hospital stay? Did they resolve the problem well?
JF, thanks for your questions. I was toxic from the infection and yes the medical care I received was effective in its initial control and was able to be discharged from ICU to the medical ward and finally discharged home. But, as a 91 year old patient, I was pleased to be discharged home and so far the infection is under medical control. Yes, in my hospitalization recovery phase, I did find my final nighttime "nursing" behavior a bit upsetting. Unfortunately, patient comfort by some non-clinical staff is seemingly ignored in order to finish and go on to the next patient as the night progresses.
But this interpretation was made because I was clinically improving otherwise if I had been toxic as on admission I wouldn't have been intellectually or emotionally concerned. ..Maurice.
Sorry to hear that you were sick enough to make it into the ICU, but glad to hear you are better. You are correct that sometimes patients are too sick or in pain to care about how they are being treated. I know that is how it has been for me. That said, healthcare staff should always act as if the patient does care, especially when they are least able to advocate for themselves, or even unaware.
Though I am not wishing the following on doctors or nursing staff, I do feel that being hospitalized themselves and critically ill and then finally recover does provide potential insights into patient attention and care which cannot be taught to healthy medical students, residents and medical staff. One has to experience patient-hood themselves for real understanding. Unfortunately this may be the only way for some medical professional to understand what has been written on this blog thread ..Maurice.
You are totally correct about patient-hood for true understanding. Echoing Biker's comment about not caring about how you are treated in the moment, there were times when I didn't care about much either. Later on though, when my wits came back to me and I remembered how I was treated, I REALLY cared then. And was shocked.
I hope you are getting better.
58flyer
Dr B,
Did you report to the nurse manager on the way you were treated? If you did I hope it was taken seriously.
Some people are just born with empathy for others. Most learn it instead from life experiences. Some never learn it at all. It seems that most who work in healthcare just don’t understand the patient’s perspective due to never having lived it themselves. This is why I still think it would be good for medical and nursing students, as part of their training, to experience opposite gender intimate exams, including the observers that accompany clinicians.
Catfostermom, a few hours before I was discharged from the hospital. yes, a nurse-manager did come in for my feedback and, yes, I was fully descriptive of how the final day night time "nursing staff" mistreated me. I am not sure how concerned she was about my narration.
Feedback, feedback, feedback: that is a necessity for all patients whether non-MDs or MDs or nurses who have been "treated" and are unsettled about how the "treatment" or "management" was carried out. These issues are important to present by professionals as well as non-professional patients... and even by family members if the patient is unable to communicate. ..Maurice.
Biker. I think I have to disagree. My opinion is much of the intimate examination shouldn't be happening at all. Or should be optional. Not all modesty violations are done out of absent mindedness. A certain amount is a desire to embarrass. Some get a thrill from exposing patient, and displaying them to other staff or family who happens to be present. I kinda think there should be a woman's floor and a men's floor. And the intimate care and examination greatly reduced. On the rare occasions when it has to happen, male staff should attend to male patients and female staff attends to female patient.And chaperoning is often the staff proving they're not abusing their patients by abusing their patients.
How exactly are students taught to protect dignity? Is it spoken or visual? Some say it’s drilled into them, How is it drilled? Limited exposure is a different time frame for everyone.
I saw a YouTube video of a student learning surgical skin prep. She folded down the blanket to the pubis and pulled the gown out from under the blanket. Nothing below the belt exposed at all and breasts exposed for male or female patient. She began to clean/prep the abdomen. Unfortunately, she touched the blanket. The instructor said a few things then went over and completely pushed the blanket down to the knees. WHY? Obviously if that much truly needed to be prepped for abdominal surgery the instructor would have said something from the beginning and not let the student start the painting. The student was TRYING not to expose the dummy. So, instead of teaching the student how to be more careful this instructor taught the student how to just expose us. With practice the student would be a master at prepping without exposing. I am a hands on learner. Meaning, I learn by you telling me what to do, but I have to do the steps. So you could drill into me dignity, by words alone, but it wouldn’t stick.
JF, my thinking is that many who work in healthcare, especially the young healthy ones, simply do not understand the patient perspective because they have never been the patient. Intimate exposure is often a necessity as part of receiving healthcare, and a way needs to be found to teach students at every level of the system the importance of minimizing it in terms of extent, duration, and audience. They need to be taught the difference between necessity and convenience.
People who work in healthcare truly are a reflection of the general culture. This is why change comes so slowly, if at all.
I have followed a discussion on Quora with a question from a Mom about her 13 year old son not wanting his doctor to do a genital check. Of the dozens of responses, most have focused on either explaining to the boy the importance of thorough exams or the Mom letting the boy know that she'll step out of the room. Sending the boy to a male doctor and addressing the matter of female staff observers has been very much the minority view that has gone without discussion or acknowledgement. Were the question about a 13 year old girl not wanting a genital exam, I have no doubt but the common theme would be sending her to a female doctor rather than essentially telling her to get over it.
If Mom's of 13 year old boys and women who work in healthcare can't grasp the embarrassment factor inherent in the kid's reluctance to be examined and then focus on how to mitigate that embarrassment, we as a society will continue to medically traumatize our kids which in turn will carry through to how they interact with or avoid healthcare as adults.
Biker. Did you chime in about the embarrassment factor? I seriously don't know how a 13 year old boys mother couldn't wrap her little head around the notion that her boy might be embarrassed unless she just thinks there's nothing she can do about it. At my past jobs too much of the staff was dismissive about patient modesty. Sometimes it was just a result of the staff being tired. Tired people are OFTEN not very nice people. And it isn't just the younger workers either. Much of it is done unconsciously. I have spoken up sometimes to staff blatantly discounting. Occasionally being listened to. Otherwise it being treated as a bother and not important enough to consider.
I have a feeling of how the medical professional was treated by doctors and nurses and parents as a child with regard to their own privacy concerns that sets their behavior and responses to their patients when they enter the profession of medicine. Emotional trauma as a child may be predictor of their later professional decision making toward their patients with regard to modesty . ..Maurice.
JF, yes I chimed in but not to much effect. The moms and healthcare workers just don't seem to get it.
Do you think that a big mechanism leading to medical profession misbehavior to their patients is that the general medical system demands of their employees to be "more resilient" in their interaction with patients? Read the following, written by a female physician to the medical system:
"Stop Telling Physicians to be more Resilient"
https://www.kevinmd.com/2022/04/stop-telling-physicians-to-be-more-resilient.html
Does what this physician's request to the medical system makes sense and, if followed, might reduce the patient discomfort in their relationship with their medical practice attendees? ..Maurice.
Dr. Bernstein, certainly stressed out and harried doctors are less capable of respecting the humanity of their patients. Just as the system is broken for patients, it is broken for the staff too.
Another follow-up to my cardiac ablation earlier this year. I did talk to the doctor and having thought about what he said vs what the cath lab RN that I spoke with on the phone said, my conclusion is that he was speaking truthfully vs she was mostly telling me what I wanted to hear.
She had me believe that my genitals would have been kept covered while one side was shaved at a time and that they do protect my privacy in the cath lab. Conversely, when I said to the doctor "naked on the table w/o draping as soon as I was unconscious and in a room with the 6 staff I saw plus likely medical students that entered as soon as I was out", he didn't dispute that description at all nor did he get defensive. Essentially he acknowledged my description. He did tell me that during the prep the patient is shielded from view of the people in the control room that looks into the cath lab. In reaction to my expressing my shock at not having my groin shaved in private so as to afford me some degree of dignity and my embarrassment knowing how it was done, he said I made good points that he would discuss with the cath lab staff. He came across as sincere in that statement and repeated it a couple times.
Though it has been a couple months I am going to write a letter to Patient Relations, not complaining about any specific person or accusing the staff of any improprieties, but rather speaking to a dehumanizing and demeaning process that can be easily remedied if respecting patient privacy and dignity is indeed a core value.
The mom's probably get it but don't think they can do anything about it.
Hopefully he follows through. This is the kind of doctor we all need for the changes we need/want. The nurses at this place could easily move on to another and implement changes there. He could talk with colleagues about this and they too could change. Doubtful, but even if something comes out of it, maybe.
Catfostermom, Advocacy of the patients' needs and requests. Here is what I read and support: Advocacy, the method by which doctors can achieve effective change in the healthcare system, is a powerful and underutilized process. Advocacy involves promoting your goals through a systematic plan of action. For physicians, advocacy begins with a plan.
Does anyone here have a history of asking the nurse or physician what they are personally doing to change the healthcare system based on their patients' input of concerns and complaints? ..Maurice.
I can only tell you what I’ve read on Quora. Get over it is the main response to any of our comments/complaints. That has never happened where I work comes in second. They have to be willing to change and not a single one has shown any interest. Unfortunately, there have been a couple of students who have noticed such abuses but were to afraid to say anything and dropped out of school instead of starting the change with themselves.
Round 2...
So my friend Melissa has scored one victory with the Joint Commission. Now she has the Human Rights Campaign investigating the facility for human rights violations which triggered more reprimands and training.
The urology department is where the facility is laying the blame. I hope they are beginning to understand...
On top of that, she has shared with a number of LGBTIA+ groups in the state what transpired so that future patients lay down the ground rules from the get go.
As I have said in the past: you take a shovel, write on it (Abe Lincoln) what the providers need to know, and hit them in the head with the shovel. That is how you get change.
-- Banterings
Banterings, "hit them on the head" with a descriptive shovel will only produce a cerebral concussion and/or intracerebral bleed and not much chance for change.
Now ..open this link:
https://cdn.drawception.com/images/panels/2017/3-3/QTPcDnZq5P-4.png
What has been written here on this blog thread all these years must be brought up to institutions like the Joint Commission and "spreading the word" to others to help make change. ..Maurice.
Good Morning:
You're right Dr. B. "What has been written here on this blog thread all these years must be brought up to institutions like the Joint Commission and "spreading the word" to others to help make change."
Problem is, we're being ignored.
Currently, I've been emailing Health & Human Svcs. Secretary Xavier Becerra since HHS is over the medical community. I'm asking that a panel made up of half medical personnel & have civilian men that have nothing to do with the healthcare system come up with a set of protocols be put in place for all female healthcare workers that must be followed when dealing with male patients that present with intimate medical issues.
Whenever a protocol is violated & the male patient speaks up, the incident must be investigated & consequences must have teeth so as to stop the abuse in its tracks.
They need to do more to bring men into the system.
The protocol would stay in place until the female to male personnel ratio is more towards the middle.
I will continue to email his office once a week until someone replies.
We must get this issue out of the cyber world into real life.
I don't know if anything will come of it but maybe with the conviction of RaDonda Vaught in TN, maybe their ears will open up. Nurses who have been around for awhile now are scared & are quitting. That could be a problem.
They have a petition with over 200K signatures demanding clemency from the governor. He's already said there will be no clemency coming.
So our work continues. I will see about finding a contact at The Joint Commission I can start writing to as congress is worthless as they won't even approve an Office of Men's Health in the federal government when women have 5, one since 1991.
Thanks for listening.
Best regards to all,
NTT
banterings, congratulations to you and Melissa for the success to date. She will surely see more.
NTT, thank you for your perseverance, frustrating as the experience may be. The headwinds so to speak, or perhaps that is too mild a word choice vs say hurricane force winds that males face, come from the reality that no regulatory agency, major institution, or major media is going to be supportive of male patients in the face of the sure wrath of women's groups that would ensue. Even the men who work in healthcare aren't supportive of male patients in this regard. Their livelihoods would at risk were they to challenge the healthcare sisterhood.
Self policing just doesn't work. Otherwise my sister who was told she has a year to live ( 6 months ago ) has tried 6 times to get her pain meds filled and hasn't been able to get them filled. The local Walgreens have shut down after her 4th attempt. She then attempted to get them from a pharmacy 22 miles away but was not successful. The last time the pharmacist said that her insurance won't cover the cost anymore. Rumor has it that some pharmacists in Florida was selling the meds illegally. How does that affect Walgreens in Arkansas? Maybe some of you all might know what the deal is?
JF, disrespectful professional behavior toward patients by pharmacies and their pharmacist and staff is another area of medical care which can impair the dignity of a patient or even worse and we really haven't detailed this area on this blog thread topic.
Here is a link to a very interesting published article defining of such misbehavior of pharmacy practice.
Errors and misbehaviors within the field of pharmacy should not be ignored as we point our fingers at physicians, nurses and other clinic or hospital staff. ..Maurice.
OOPS!..The above link doesn't seem to take you to the article. So here is the
written address:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6751975/
This should work. ..Maurice.
Thanks for the article Dr B. Bullying has a PROFOUND influence and often it's has a sabatoging effect. I sure don't know what the solution is though SOME of the solution could be hidden tape recorders , where ever the bullying is most likely to take place. Also secretly record in the staff break room or wherever staff congregates to have private conversations. Obviously a lot of little problems and wrongs couldn't be confronted when learned about that way. It would blow the cover.
This blog thread is about patient dignity and the need and methods to preserve it. Much has been written by visitors here about the need for patients to voice their approval and disapproval regarding the way those attending them and involved, even briefly, regarding their attention and care within the medical system.
One such area, which needs to be discussed, in a broader sense, is the behavior of the medical profession, legal profession and news reporting about those individuals who have been sexually attacked and raped.
Here is a link to a detailed dissection of the topic "Sexual Dignity in Rape Law" by a female Senior Lecturer at a university in New Zealand :
https://ourarchive.otago.ac.nz/bitstream/handle/10523/12056/SSRN_Copy_June%202021.pdf
Whether in New Zealand or New York or here in California, this matter needed for the preservation of patient dignity cannot be ignored. And is open here for discussion. ..Maurice.
Did I frighten our regular thought contributors away by moving on to other mechanisms which can destroy patient dignity beyond exposing patient genitals without attention to patient's concerns and desires.
Patient dignity preservation is far more extensive then patients protecting their genitals.
I thought Bantering's extension of our blog thread title beyond "Patient Modesty" to the "Preserving Patient Dignity" was an important and valid change. Didn't our other contributors agree? The medical professionals behavior toward their assigned patient is much more complex than simply patient modesty issues. Don't you all agree? ..Maurice.
I don't think anybody is scared off. It's just the feast or famine kind of thing. One of our biggest posters no longer posts anymore. Some of the other posters were people he introduced to the blog.
I am pleased to say that everyone doesn't take the view of most writing to this blog thread. If you have the time, go to my blog thread with many cheerful responses extending from 2007 to the final posting in 2017 to the title "I Love My Doctor and Here is the Reason Why"
https://bioethicsdiscussion.blogspot.com/2007/11/i-love-my-doctor-and-here-is-reason-why.html
Why are the participants who wrote there different than those who tend to write here? ..Maurice.
I’m not sure of the ages of people who post here.. but it’s vacation week. I’m actually on a cruise as I type this. Lol. So some might just be away. Alas.... the nurses on Quora are just as dismissive as always.
Dr. Bernstein, first on your "Sexual Dignity in Rape Law" article, all I can say is that people should be treated with dignity in every aspect of their lives. What we discuss here is just one narrowly defined aspect of it.
On the "I Love My Doctor" thread, for me personally I have liked most of the doctors I've had. Most of my healthcare complaints have been at the nursing or tech level. To answer your question about the people who made posts in that thread, I would say that they've been fortunate to never have had a bad experience.
The question I have for those who work in healthcare is why they don't see respecting patient bodily privacy as an inseparable component of respecting the inherent dignity of the patient. It seems most can't get themselves beyond thinking that because they have seen it all 1,000 times that the patient should be OK with being needlessly exposed if it is more convenient for the staff.
Biker et al, does this detailed Guideline by the American College Health Association (2019) is satisfactory for the those concerns about "sensitive examinations" as expressed by those here over the years?
https://www.acha.org/documents/resources/guidelines/ACHA_Best_Practices_for_Sensitive_Exams_October2019.pdf
We all must decide on some standards of professional behavior in response to their patients concerns and desires. Does this format as described in the article meet what we all are looking for? If not, what is missing and what would you add.
To me, it seems appropriate and fair to all. ..Maurice.
p.s.- Just moaning and groaning in general about the issue on this blog thread or on other sites on the internet is non-productive. We must look for prophylaxis and proper therapy (as one might express this issue in medical terms.)
Dr. Bernstein, the ACHA guidelines article had one very good departure from current standard practice. This is the organizational separation of the chaperone from the provider. Complete independence from the provider and the provider's reporting structure is the only way we'll ever see chaperones advocating for the patient.
Otherwise this is yet another female-only focused article, though it doesn't come out directly saying it. It says the gender of the chaperone should be of the patient's choice "if possible" w/o ever acknowledging that almost universally only women are hired for chaperone positions. That they avoid the elephant in the room so to speak suggests they're not really looking to protect males from needless exposure.
They also avoid addressing the gender of the provider, despite the growing army of female NP's filling that role in schools. The article as well doesn't touch upon establishing protocols for when and how patients are exposed, the apparent underlying assumption being that no healthcare provider ever exposes patients more than was necessary in terms of extent, duration, or audience.
I stopped posting because there is no real conversation. No use posting ideas to talk about if no one is listening or having a discussion.
Dr. B., as for your PS, you are totally wrong. It is the "moaning and groaning" on other sites that bring attention to the issue otherwise people will be like many of of us on here were initially and that is to believe we were alone in how we feel. The "moaning and groaning" is PR work. My Twitter is growing as is the website. I have been busy getting material and contributors. The contributors are people who have been medically harmed in many different ways. They have stories to tell. It will be their stories and their work in "moaning and groaning" that will help bring about change. I understand that as a medical "professional" you may not like the "moaning and groaning" we are doing about the medical community but it is necessary to enlighten and education the public. People need to realize that although they have been conditioned/programmed to endure medical abuse/harm it is not acceptable and change needs to be made. The constant "moaning and groaning" is a method to help bring this about as the medical mafia owns the media and wants to keep our voices silent.
The interesting thing I have not read yet on this blog is reaction to Radonda Vaught's verdict. You, Dr. B., as being one I suspect as being very progressive and supporting of the Kim Potter verdict (the cop who the jury said they realized she accidently killed a man but decided she needed to be held responsible) makes me wonder if you are just as supporting of the Vaught verdict. While Vaught's motive might not have been to intentionally kill the patient, Vaught did blow past at least 10 to 17 protocols put into place to avoid such a mistake. Not only did Vaught willfully ignore the warnings/protocol but another very interesting fact that hasn't made headlines is during this particular case, Vaught was training others during this incident. So to all who wonder how patient unnecessary patient exposure keeps happening because the textbooks teach them to keep patients covered and allow dignity, I think the Vaught case clearly shows that probably most of the bad behavior comes during on the job training. Another interesting fact is the first time around the nursing board did what most nursing boards do and that is nothing but protect the nurse. It was only after the headlines read something to this: Nurse Executes Patient" and charges were brought did the nursing board do a second review and took her license. The drug Vaught gave the patient rather than the other overused drug, Versed, is a drug often used for prisoner executions as it paralyzes them. Of course, Versed is often used too. The nursing unions are all upset about this verdict because they don't believe they should be accountable for patient deaths but yet many of them believe cops should be held accountable for deaths of accused criminals. The Vaught case has brought into the open how the double standards of the medical world works. And of course, there is Fauci saying the court system should have no say other public health policy. Again, the medical world believes there should be no oversight of them. Excuse all my "moaning and groaning" but it needed to be done because silence doesn't solve issues.
JR, in place of "moaning and groaning" and pulling out and discussing those nationally or internationally described physician and nurses who behaved criminally, why not discuss all the worthy nurses and physicians who are admired or loved by their patients for the expected and full attention and care provided by them? The medical profession would be helped in understanding the desires of a patient by discussing the humanitarian constructive rather than spending time on the publicized or even the unpublicized destructive-inhumane "professionals". JR, in your publications and elsewhere commentaries, do you publicize in detail (including names) of professionals who you admire their doctor-patient behavior? ..Maurice.
Funny you mention that and I will give you the consideration of answering it. Yes, it our plan to give names of doctors and practices that has been patient verified for good care with a disclaimer that what works for one may not work for all. We also want to give ratings of doctors/hospitals which is protected as long as they are opinions and/or facts. Did a radio segment on this very thing. And yes, we (those I work with) do give credit due to the ones seemingly doing positive things. You might be surprised to learn of all the medical followers I have and have communicated with that agree with me of there being a huge issue. I don't deal in just unnecessary exposure but in a host of other things but again yes, most agree there is too much unnecessary exposure and these are the ones who say they do what they can to prevent it from happening to those patients they have taken the responsibility for in giving compassionate, dignified care.
As much as I would like only to have good things to say, at the present it just cannot be. We cannot be silent about the abuses/harms occurring within the healthScare system. How can we educated people if we give them disinformation that everything is very rosy while seeking medical treatment. I am sure this is the propaganda the medical community would like to have but it simply isn't the truth and I will have no part of leading any patient into a false sense of security.
The big part of you "worthy" nurses, doctors is that many people while they detest the bodily exposure that happens when seeking medical treatment do not know it usually is not necessary. Once they know it is not necessary, their feelings about the medical provider change because at that time they realize their medical provider was not doing what was best for them the patient but rather what was best for the provider.
Again, you ignored the issue with Radonda and that is being she was a trainer of nurses. She was actually training nurses the day she blew past 10-17 protocols and committed homicide. You say you teach students one way but we are saying they give service another way. If you have trainers like Radonda who teach them the wrong way once they have a job, this is probably the answer to the question of what goes wrong when. This was very significant information coming from this court case along with the other issues I mention. This is worthy of discussion. It is also worthy why the medical community believes they should not suffer the same punishment for the homicide of a patient that a cop suffers. It is very telling of the overall attitude of the medical community. This is a dialogue that needs to be had sooner than later. It is not as much about Radonda than it is about the medical community as a whole. Radonda is just the face of it that was caught.
Dr B. The newest threads I have been reading nurses claim that the patient has no business to know the nurses who will be in the OR, much less their names. Moaning and groaning seems to be working getting more people to admit something had happened to them. They are now seeing the lies these nurses are telling. My feelings are, the more people who know this isn’t normal and it can be done differently will request it done how they feel comfortable and not the nurses. JR made the great point of these new recruits and being taught in the field how to make it more convenient and don’t worry about how the patient feels. Unfortunately, while the new nurses know it is wrong they don’t want to be ostracized. At least one quit being a nurse. She sounded like one of the ones we needed the most. Also, no disrespect by any means but this blog has been around for a very very long time. How many new people do you get? Twitter and Quora have thousands of people reading the posts. I’m not on Twitter, but if JRs feed is growing that’s how word gets out. Change won’t happen through our political leaders. Change will happen through word of mouth. If we keep changing drs until we find one who is more accommodating then maybe the ones who are loosing patients will wonder why and change themselves. Better yet if our doctors actually listen to us and change themselves
For those visitors here who is unaware of the Radonda story here is a link
to a description of the case at the verdict conclusion of her criminal trial:
https://www.npr.org/sections/health-shots/2022/04/05/1090915329/why-nurses-are-raging-and-quitting-after-the-radonda-vaught-verdict
..Maurice.
Here are some more articles on the Vaught story:
https://vanderbilthustler.com/47301/featured/former-vumc-nurse-radonda-vaught-found-guilty-for-death-of-patient-by-accidental-injection/
https://www.npr.org/sections/health-shots/2022/04/05/1090915329/why-nurses-are-raging-and-quitting-after-the-radonda-vaught-verdict
Notice the word "socialist" coming to Vaught's defense as well as the nursing organizations.
Also, earlier this month a 4th year med student wrote on Twitter she intentionally had to jab a man twice because he made fun of her use of pronouns. Since that time, the school has walked it back which is pretty standard in the world of patient harm. As I have said before, patient harm does not matter but protecting medical providers from consequences of patient harm is vital. We see this time and time again. Nurses are standing up for Vaught but I imagine many of these same nurses thought Kim Potter, the cop, should be in jail. Funny how the double standards work. The interesting thing about the second story of the med student is what she said she did was intentional harm and shows they do allow their personal feelings of hate, bias creep into how they deliver medical care.
https://katv.com/news/nation-world/med-student-who-claimed-she-harmed-patient-for-laughing-at-pronoun-pin-placed-on-leave
https://www.dailymail.co.uk/news/article-10727523/Woke-student-bragged-injuring-patient-mocked-pronoun-pin-extended-leave.html
https://nypost.com/2022/03/31/med-student-stuck-patient-twice-with-needle-after-he-mocked-pronoun-pin/
https://journalnow.com/news/local/wake-forest-medical-students-tweet-makes-waves-he-had-to-get-stuck-twice-after-gender/article_e32c4aa2-b104-11ec-b8df-c787f3c2f892.html
We really don't have to wonder why medical harm is happening and that includes unnecessary exposure. The reason I am not saying that same gender care will fix the issue is in today's world that doesn't mean anything because you cannot possibly know the sexual leanings of your medical providers so therefore unnecessary exposure needs to be stopped. Here are a couple of questions: Since your provider's sexual orientation or sexual partner preference may not be so easily identifiable is getting same gender care enough or do we need to concentrate more on how intimate is delivered? Do you as a patient need to know the sexual leanings of your medical provider who will be delivering intimate care to you? Really interesting given that we now have more and more people who have more than one sexual identity. Which brings me to the next point is how do we protect patients like Archie's friend Melissa from being abused in a system that is clearly intent on not recognizing a patient's right to bodily privacy?
As a person who worked in Healthcare I can tell you there is a surprising number of questionable deaths and I'm just a CNA.Where I came from there were 5 nursing homes in our city. There were assisted living homes also. One lady fell off of a balcony and there was no alarm on the door to the balcony. The administrator immediately put one one afterwards and told the CNA's to say it had been there all along. One of my coworkers said I'm not gonna lie for you.
One nursing home had three questionable deaths in one year that got a huge amount of attention. An activity director gave a woman a hotdog and she chocked to death on it. She was on a pureed diet but that information wasn't communicated to the director. Then another patient was up and walking around on a broken hip and I guess it caused internal bleeding and she died. Then a woman got her head stuck under a bedrail. There was an attempt to cover it up but that made the scandal even worse.
Dr B. Of course there are many wonderful doctors and they have worked miracles. And of course some aren't so good. My prediction is the ratio of good, bad and somewhere in-between is roughly like the ratio for the general population.
There are only 2 ways to protect ourselves. Our own videos and personal private advocates. Both of which they fight us non stop about. However, I do think it’s ironic that they also are the first to say cops need to wear body cameras. It’s sickening how they are behind Vaught. Many are now saying they will never speak up again as they are afraid of the consequences. Great... just great. They barely spoke up before. This instant just shows how many protocols they actually DO NOT follow. Yet, that’s the BS line we are always given.
A general question on this subject: Is the preservation of patient's dignity aborted when the medical system takes clinical steps to preserve, and indeed does preserve the life of a patient who has attempted suicide?
I wonder what those writing here think about the medical system's response to attempted suicide. ..Maurice.
Here is an old blog topic which goes along with my last posting.
Ethical Dilemma: Attempt Suicide Refuses Rescue
http://bioethicsdiscussion.blogspot.com/2006/03/ethical-dilemma-attempt-suicide.html
Read, read the numerous visitor responses. What would be your response?
..Maurice.
On the suicide question, the doctors have no choice but to try and save the person because they are not in a position to know the patient's state of mind, regardless of any note left behind. The doctor isn't a position to even know if the patient is the one who wrote the note vs someone else that wanted them dead. Let the patient die and the family will surely file charges against the doctor claiming the patient was not in their right mind.
Biker. That's a really good point about not knowing if the patient actually wrote the suicide note or somebody else wrote it. In 2010 my stepbrother was found by his mother dead from a gunshot to the head. Police ruled his death a suicide. But no gun was ever found.
Here's an interesting article that both Misty and I received via email. It is about why doctors lie along their excuses. I guess the food for thought is if they are willing to lie where does their willingness to lie and deceive end or does it? I don't care why they think they have to lie but rather they do lie. Since they lie that does put patients at more danger of harm when a patient is unconscious/sedated because we know there is a lack of ethics. Nurses and techs can also be labeled as liars too. If they lie about the small stuff then won't they also lie about bigger things? There is an old saying that goes like this: Once a liar, always a liar.
https://www.idealmedicalcare.org/why-doctors-lie/?inf_contact_key=2d2ad6aafa46a8e24e811f81ccc26488
Interesting article JR. I certainly have seen questionable billing myself and have felt at times that I was being scheduled for more tests or appointments than were warranted. I have also seen death certificates that simply grabbed hold of the ever so convenient "heart disease" as the reason for death. That the system is not operating in the interests of the patients and society as a whole that is paying for it is fairly obvious. Based on the final days/weeks/months end-of-life care my parents and my in-laws received, that is when they pull out all of the stops on billing opportunities. Both my wife and I had to intervene with "knock it off" directives to stop doing tests and treatments that no longer served any purpose but did diminish our parent's comfort and in the case of my father kept him in the hospital away from my mother for much of his final two weeks rather than let him go home to die (with hospice care) as they wanted.
As much as the doctors are complicit in all of this, I suspect the real drivers are the people in the corporate suites that are driven solely by maximizing share values and their own compensation packages.
I suppose it might be that at least a part of the "convenience prioritized over patient privacy" matter that we discuss could be a result of that push to maximize revenue coming from the corporate suite. Move the patients in and out faster, don't take the few extra moments to respect their inherent humanity, smiling and being polite while they needlessly violate patient privacy.
Isn’t it better for their bottom line to take the few minutes to discuss our care then have the patient walk out of elective surgery because we werent happy with the way we were treated? If they try and bill you then get the insurance company involved. They won’t like paying out for procedures that didn’t happen.
Had a good example today of a simple, yet excellent protocol. The pre-procedure room was single occupancy with a sliding glass door and a curtain across the front of it. After getting the "everything off, gown on, and providing me a sheet to cover myself once on the bed" instructions, I was told that when I was ready, to open the curtain so as to let them know it was OK to come in. A far better approach than the knock on the door as you are opening it approach w/o asking if it was OK to enter such as I have experienced at other times and places. Respecting a patient's privacy doesn't have to be complicated or cumbersome if in fact they want to protect the patient's privacy.
Recovery room areas can/should have the same type of rooms, so family can be there to comfort the patient as they are waking up.
catfostermom, the only post-op rooms I have seen following surgeries my wife has had are big open rooms with no privacy whatsoever. Patients still under the effects of anesthesia get exposed as staff for other patients and family members of other patients casually walk by. Shameful. Seen it myself.
Because I have such a hard time coming out of anesthesia myself, after my recent ablation procedure, I have no idea how many people I was exposed to every time they would have checked the groin wound site. Did they just whip the sheet off exposing me or did they shove it aside taking care not to expose me? I'll never know. It was one of those big open rooms, except at the time I doubt family members were being allowed in due to covid restrictions.
That is exactly why family members need to be there. They can easily turn them into bays that give access and privacy. Besides most facilities should have 1 nurse to 1 post op patient. They do not need to be looking out into the nurses station if they need to continuously monitor the us. They count on that extra dose of Versed right before we leave the OR do we don’t remember the first part of recovery.
Where do you all put the age of the physician and nurse into the misbehavior or worse that has been described here? It is an important factor to consider. For example, I was last attending as an internal medicine physician to patients in a "free clinic" at the age of "turning 90" in January 2020 and yet I got no feedback about any misbehavior towards them.
However, behavior and loss of skills may indeed be age related. You might be interested in reading this current Medscape article titled "How Old is Too Old to Work as a Doctor?" and here is the address of the article:
https://www.medscape.com/viewarticle/972844
I have a feeling my visitors here will say that their ongoing complaints of the medical system practitioners has nothing to do with the practitioners numerical age.
Would you all actually say that going into "old age" is not a factor in the issues that have been discussed on this thread? ..Maurice.
I’m not sure it’s age related so to speak. Every nurse that answers with attitude on Quora say they have been a nurse for 35+ years and have never seen this happen. Now, if it’s true or they are just so used to the behavior is unknown. But, here lies the problem. The students most likely got drilled about keeping a patient covered or it was mentioned in their books. Once they get in the field it’s the older nurses mentoring them. The older ones are now teaching them the opposite and how to do the job “quicker” and there is no modesty here, just do what you have to to get the job done so you can move on. The younger ones then don’t have a backbone to do it the way they know they should. So you end up with all ages being the problem. If the younger ones would stick to their morals then this might actually be mentored out. Now... there is always the chance that the new ones just want a fat paycheck and have no ethics to begin with. Maybe how would you preserve patient bodily dignity should be a prerequisite getting into the school to weed out the bad ones before they even start. Has there ever been an article in the medical journals about the benefits of the surgical undergarments? Most who’ve I’ve brought them up to has never even heard of them. Why not?
Interesting question Dr. Bernstein. I like the thought expressed in the article that at a certain age doctors be subject to testing to affirm their physical and mental fitness to continue practicing rather than a mandatory retirement age. Some people are quite old in their 60's and 70's and others are still going strong in their 80's and 90's. I see rather large differences amongst people I know in their 70's, some aging rapidly and others seemingly not aging at all, so perhaps testing sometime in the 70's might be in order.
In a general sense older doctors tend to more often fall into the "I'll tell you what I think you need to know, just do what I tell you to do until then" mode than do younger doctors that tend to be more collaborative.
As for physical privacy/dignity, I'm not sure the differences we experience are age based. My personal experiences make it hard to generalize as my good and bad experiences don't seem to fit a pattern based on age.
All in all privacy protocols are better now than they were decades ago but with a notable exception. Perhaps driven by women rapidly gaining equity amongst physician ranks, women are being celebrated as empowered if they want only same gender caregivers while men are being deemed sexist if they want the same. The "We're all professionals here" mantra is applied to female caregivers with male patients but not the opposite.
Just anecdotal perhaps but I will add that both male and female caregivers that began their healthcare careers in the military often seem less concerned with patient privacy, at least for male patients. Maybe they got so used to a primarily young male audience that was not allowed to speak up that they lost touch with the larger world outside of the military. And of course their own experiences growing up so to speak in the military.
It could well be that the behavioral mechanism with regard to the medical professional misbehaviors described here have much more to do with the limitation of time which doctors and nurses have to accomplish a responsibility. The limitation of time is most likely related to the medical system's current administrative process setting requirements toward "workloads" necessary for the system's benefit. As the medical professional ages into the later years of practice, the need to attain the "workloads" for progression in the profession becomes "less personally needed" and there becomes more time available for the professional to attain better synchronizing with the wishes and views of their patient. Do you all agree? ..Maurice.
Hello Dr. Bernstein,
I've found older doctors to be very thorough and competent. Hopefully, mature GP's will continue as long as they can. Surgeons may need to consider retirement when their hands begin to fail them. In the present milieu I don't think that doctors will continue beyond their expiration date. Burnout seems to occur before incompetence. I wish you continued good health.
Reginald
Hello,
The following is excerpted from Health Service Journal (UK). Unfortunately, a subscription is necessary to read the entire article. This excerpt eliminates only a few superfluous paragraphs.
"BLACKPOOL TEACHING HOSPITALS NHS FOUNDATION TRUST
Five charged after alleged ill-treatment of stroke patients at NHS hospital
By Shruti Sheth Trivedi6 May 2022
•
• Five people charged after investigation into treatment of stroke patients at Blackpool Victoria Hospital
• Trust contacted police in November 2018 after patient care concerns were raised
Three nurses and two healthcare assistants have been charged after an investigation into ill-treatment of stroke patients at a Lancashire hospital.
The five people, who worked at Blackpool Victoria Hospital, will appear at court on 31 May charged with various offences between August 2014 and November 2018, including ill-treatment relating to the unlawful sedation of patients, conspiracies to ill-treat and the theft and supply of medication.
They have been charged as follows:
Catherine Hudson, 52, of Coriander Close, Blackpool
• Seven offences of a care worker ill-treating/wilfully neglecting an individual
• Eight offences of conspiring to steal from employer
• One offence of theft by employee
• One offence of perverting the course of justice
Charlotte Wilmot, 47, of Bowland Crescent, Blackpool
• One offence of encouraging/assisting in the commission of an offence believing it will be committed – this relates to encouraging a nurse to sedate a patient
• One offence of conspiring to ill-treat a patient
• Four offences of conspiring to steal from employer
Matthew Pover, 39, of Bearwood Road, Smethwick, West Midlands
• One offence of conspiring to steal from employer
• One offence of theft by employee
• One offence of supplying a Class C drug
• One offence of offering to supply a Class C drug
Victoria Holehouse, 31, of Riverside Drive, Hambleton
• Two offences of conspiring to steal from employer
Marek Grabianowski, 45, of Montpelier Avenue, Bispham
• Three offences of conspiring to steal from employer
• One offence of perverting the course of justice
The charges come after a police investigation was launched in November 2018 into allegations of mistreatment and neglect on Blackpool Victoria Hospital’s stroke unit.
Police said this investigation is not linked to that of a 51-year-old man charged in December 2021 with a number of sexual assaults at the hospital, and the murder investigation into the death of 75-year-old Valerie Kneale on the stroke unit also continues."
Maybe this is nursing mid-life crisis! Things don't look much better for dignity in the UK.
Reginald
Reginald, thanks for your reminder of the issue of "dignity", not just identified for the patient but also maintaining "dignity" for those professionals working within the medical profession. And, within the medical profession, there are so many ways that professional dignity can be ignored or if, in fact, destroyed if initially present. ..Maurice.
Something worth noting about Reginald's post from the UK is that it took until 2022 to bring charges against healthcare staff for offenses from 2014 - 2018. While it good action has been taken, the fact that it took 4 years to do so suggests that the authorities did everything they could to avoid taking action.
My husband went to a cardiologist other day. His MRs has it noted he is a medical sexual assault survivor and must be given TIC protocol. This time the MA was a male. He didn't look friendly and certainly proved that. When it came time for the EKG, the MA told him to take strip from the waist up. My husband found his voice and asked if the MA had read the file where it said he was a medical and sexual assault survivor and that he would not remove his shirt. The MA said it "was fine as removing the shirt was not necessary."
"...was not necessary" is the key here. I asked then why tell him to strip when he knew it was not necessary. The answer, of course, was silence. This begs the question of why this done and the only conclusion is to exert power and control over the patient, any patient. It must be a mind game they play to see if they can make patients bend to their will. Maybe private bets in the office as to how many a day do obey without question. It is funny to them? Probably. My thought went back to CS who has had the issue with male techs. Removal of the shirt and exposure of the breasts is not necessary for an EKG but most likely will happen. I wonder how many women especially older ones does this male MA and others like him sexually assault as the definition of sexual assault is something done in a sexual manner that only benefits one party--the predator because as the MA said it "was not necessary."
This brings me to the other point is when patients are sexually assaulted why is not taken seriously? This article which is recent from Texas is a prime example of why sexual assault is considered acceptable behavior in the medical world. Others would lose their jobs but if you are medical provider (doctor or nurse) no fear you can keep your job. Do medical providers have special genes which cure them of predatory practices once they have been exposed unlike normal people who are labeled for life? https://www.publishedreporter.com/2021/07/19/texas-doctor-accused-of-groping-24-female-patients-receives-probation-still-allowed-to-practice-record-to-be-cleared-by-end-of-2022/
Here are the details of how to place the leads to prepare for an EKG of a male or female and still maintain the patient's modesty concerns:
https://en.my-ekg.com/tips-ekg/electrodes-tips.html
..Maurice.
JR, it is even worse than the article you posted suggests. The medical Board gave him a slap on the wrist but apparently that's more than the judicial system did, and I'm not seeing where any of the hospitals he was associated with withdrew his privileges. And in this day and age, if sexually assaulting women in healthcare settings carries with it no penalties, surely the women in healthcare know that they can act with impunity. Twana Sparks, the Denver 5, and the ladies at Olympia Urology (Mr. Kirschner) likely all knew this when they did what they did.
I just typed in ekg leads. It gave different sites with different answers. Some said you must be naked from the waist up others said you don’t have to be. Some said bras off, some said sports bras are fine they will work around them. Why? Why is everything so different?
Hello,
Supposedly, Rome fell because of the lead in the water (probably, for other reasons also). Maybe our world water supply has been tainted by Martians (Please understand cynically.) The URL below cites more offenses by medical personnel. The article mentions seeking further measures to prohibit future offenses. Maybe the protocol should be that breasts and genitals will remained covered at all times and in all cases, unless these areas are areas involved in the procedure. Is this really such a difficult protocol to adopt???
Please see https://www.bbc.com/news/uk-england-south-yorkshire-61396018
Reginald
Every industry has its bad apples. The problem with healthcare is they generally choose to look the other way. Just as pedophile men found access to victims and protection from consequences in the priesthood and as Boy Scout leaders, voyeurs have access to victims and protection from consequences in healthcare.
All they will say is yes those are involved. Abdominal surgeries.. yup need exposed. Knee,hip yup need exposed.. shoulder yup need exposed.
Again, even the MA acknowledged that his shirt did not have to be removed. For women, if they wear a sports bra, they do not need to be removed. It is the metal such as in the underwire or the hooks that might interfere with the reading. If the tech is not good at performing their job, they might need total access but there are products for women called petals which will cover the areolae and nipple as they do not need to be exposed. Also, a good tech can attach a lead under a sheet without uncovering the breast. My husband did the stress echo with his shirt on and the tech was able to access the the area just fine. We were told he might get gel on his shirt which to us was better than he having to yield control of his body to them. Would it have been easier for the tech? Sure but it is not about that. It should be about providing the patient with the best experience.
Biker, I totally agree with what you said in your earlier. The issue with men's dignity violations, is I don't believe the public believe men have the right to dignity and that they can be sexually abused/assaulted. Most believe men welcome the attention of any female no matter what. While some might just as some women chase after doctors, I believe that many men want their dignity respected but are afraid to ask because they are afraid of being ridiculed.
Catfostermom, The medical system counts on patients being afraid of saying NO to how they are treated or being uneducated by not knowing they don't have to be sexually abused to receive treatment. The medical community goes mostly unrestricted in the way they deliver healthScare. That is why I continue to publicly "moan and groan" because I do have people listening. I have had people say I told my doctor/nurse this... and it worked. Education is the key. The stories of harmed patients provides education. I would encourage everyone to submit to info@patientrightsinfo.com their story or blog articles. It is important for everyone to have a voice. Of course, you do not have to identify yourself but can use a fake name. We would like the state but again, we don't want names of doctors or hospitals for the stories. Cindy tells her story using a hospital in Orlando. I use central Indiana. I also make up a name for the hospital or simple it hospital from hell.
Dr. B., if you are brave enough, you are welcome to comment. I have currently made contact with a nursing group here in Indiana who believes in informed consent for themselves of course but they want to see how they can work with my group so we will see.
If how healthcare is delivered is to change, it must be a coordinated effort of all including the healthcare workers as they too will someday have to receive healthcare services.
I wanted to share an article that a nurse recently wrote about patient modesty that mentioned Medical Patient Modesty and COVR Medical garments at https://judithsands.com/modesty-in-healthcare-privacy-needed/.
Misty
This was written 2 years ago and nothing has changed. That’s sad. The nurses of Quora and Allnurses still belittle and dismiss any concerns being brought up. This needs to be blasted everywhere. I keep saying that the only way things will change is by walking out if they will not meet our needs. Then they can explain to the corps why 4 surgery spots became vacant in one day. The only thing they understand is no money in their pockets.
Scratch part of the last comment. I rechecked the date and it was yesterday. Sorry.
Good article Misty, except the "same sex chaperone" part should be "ask if the patient wants a chaperone, and if so, provide someone of the same sex". Men almost universally do not want chaperones at all.
It is ironic how frequently people who work in healthcare profess that they they chose their professions because they wanted to help people, but then go about their day unconcerned about the degree to which they needlessly expose and/or embarrass their patients.
.
I sent Judith Sands an email this morning thanking her for writing that article. She sent me one thanking me for thanking her.
Thanks to Banterings for extending the title of this series of discussions from "Patient Modesty" to "Preserving Patient Dignity". It has opened up a host of other issues related to patient dignity beyond physical modesty.
One issue which has not yet been discussed here is the current public concern vs approval of legal actions currently started statewise in the U.S. or decision to be made by the U.S. Supreme Court with regard to the issue of abortion of pregnancy. Yes, if these legal actions are carried out not only will patient dignity be demolished but women will die.
Here is the posting I sent to a medical ethics listserv yesterday. Read it and follow the link and let us know how you feel about the argument presented and whether the dignity and the very life of a woman is at risk.
Overturning Roe vs Wade and Deaths Due to Preeclampsia: Any Court or Political Worries?
I have heard not one word of concern by courts and state governments regarding the effect of the overturning Roe vs Wade and its effect on the health of pregnant women as it may promote the incidence of potentially deadly preeclampsia. A review article on preeclampsia in the current May12th edition of the New England Journal of Medicine triggered my medical ethics concerns and that concern is supported by \a current NBC News article :
https://www.nbcnews.com/health/health-news/health-risks-overturning-roe-v-wade-abortion-rcna27109
Do the courts or state politicians even care about their decisions or actions with regard to preeclampsia itself? I am sure a host of women do.
So, now, what do our contributors to the issue of preservation of patient dignity say about this issue? ..Maurice.
Hello,
"Preeclampsia is a serious medical condition that can occur about midway through pregnancy (after 20 weeks). This condition needs to be treated by a healthcare provider. It typically goes away after your baby is delivered." - Cleveland Clinic website.
I'm confused. Why does one wait for 5 months to decide to have an abortion? Planned Parenthood sends pills by mail free to anyone in the country. If the Supreme Court sends the determination to the states, state laws will accommodate medical emergencies. The sky will not fall. At the very least, one can have an abortion "holiday" in California at the expense of the state taxpayers. Why the panic?
"The U.S. has the highest maternal mortality rate of any developed country."- NBC News Article that Dr. Bernstein posted. Why does the US have the highest maternal mortality rate? This is the more pressing question. Something in healthcare is broken. Statistics show this but, I don't hear people screaming or demonstrating over this. I'd be happy if someone merely mentioned that the mortality rate was a problem.
As the commercial exclaims, "But wait! There's more! Today's (13 May 22) WSJ has an article stating, "Bill Passes to Raise Malpractice-Suit Cap" - Page A4. In CA one will soon be able to sue for $350,000 ($500,000 per family of deceased individuals). "These amounts would gradually increase over the next decade until they reach $750,000 for injured patients and $1 million for families of deceased patients."
Dr. Bernstein, why are people leaving CA? Get a free flight to CA to have your abortion, sue the doctor (for any reason) and return to your home state and buy a house with your award. There's no need to worry about preeclampsia. There won't be any doctors to diagnose it. They will have all become lawyers to cash in on those medical malpractice awards.
On the brighter side, patients won't need to worry about their loss of dignity. There will be no more loss of dignity due to open-back hospital gowns. The remaining doctors will "close the gap" with their heads while kissing the patients behind in an effort to avoid lawsuits. Maybe this portends a great big beautiful tomorrow for patients. Who said that health care was broken in America?
Reginald
PS My wife had preeclampsia with our 41 year old son. This was, of course, when he was in utero.
I totally understand the "dignity" question as concerns a woman's inherent autonomy of body. I get it, I really do, but I also see that there is a dignity question for the 3rd trimester or even full term baby being denied the right to be born alive rather than killed during a partial birth abortion. Abortion on demand up to 9 months gestation for any reason or no reason at all. This will be enshrined in our State Constitution come this Nov., the 1st State to do so. It is already State law.
What we normally discuss here about bodily privacy, respect and dignity as patients is trivial by comparison, but a bit of a parallel can be drawn between female healthcare workers, college & professional sports reporters, prison staff, youth facility staff etc insisting their right to hold any position they choose trumps the privacy rights of any male patient, athlete, prisoner, youth offender etc.
Reginald,
I have to take issue with your description of MICRA in CA. My friend, Michelle Massey, has worked over 20 yrs to have this unfair law changed. Bc her daughter, Jessie, was only 7 yrs when a doctor killed her by failing to do his job, the family was told her daughter's life was financially worth nothing. The $250,000 cap is so pitiful and is why many malpractice cases are never taken bc for the lawyers, there's no $$$$ in it. A lawyer gets 33% or more off the top plus expenses like expert witnesses. The harmed patient is left with very little like maybe $50 to 60K. As for suing for nothing or any reason, that is a piece of propaganda that has been sold to the public. You can't sue bc for one thing you can't get an attorney. For another reason, very few cases ever make it out of the Medical Review Board if they ever get there. Some hospital systems like Kaiser have their own arbitration systems. Michelle has been a guest on CS and I weekly radio show. Michelle has testified before Congress, been in newspapers, been CA consumer of the year, been on tv, and talked with the Maria Shriver. She is well educated in malpractice and will be doing the malpractice portion of my website. My slant on malpractice is I want to fix healthcare so no patient is harmed to ever have to find out how the justice system will fail them. Only if you are a celebrity or a selected case will you prevail in a malpractice case. The awards you hear are generally not the amounts the patient will get as a settlement bc of laws like MICRA. The funny thing that sold CA on MICRA was it was supposed to keep the costs of malpractice insurance lower but has in fact not done that. Being a harmed patient going through a malpractice case is not that easy. You are required to give up every piece of personal information abt yourself, your family, everything. They will demand a list of anyone you ever spoke to abt the case. They will demand any scrap of paper you might have written anything about your case on. They will demand exams of you done by their people. They will paper-rape you. They will destroy your friends and family along with you in the process. Suing for malpractice is a horrendous undertaking and is not for the faint of heart. In return, you get no personal info on the doctor nor can their past malpractice suits be brought up. It is you, the harmed patient, that is the bad guy in the whole process. You should hear some of the stories I have heard from people who have filed malpractice and of course, none of them have won. It would break your heart to hear what they did to Michelle and all the lies they told. I know so many people from CA with malpractice horror stories to tell. It is not pretty.
How is abortion an offense to women's rights when I am being told men can have babies too? Please clarify this for me. Why is it women's rights on getting to have an abortion but those same women do not have rights in athletics?
As far as mortality rates, wouldn't the question to ask be why some are not seeking healthcare services when there are plenty of ways to get free care? We know the healthScare is dangerous and I avoid it but why are others avoiding it?
I can see you do not understand Roe v. Wade as it does not outlaw abortions but rather sends the abortion debate back to the states where it should have been in the first place. If birthing person (and we all know only biological women have babies) die then it is more due to their own irresponsibility by not using birth control as abortion is not birth control. If the mother is at risk of death, I imagine each state will make exceptions. As it stands, the US as a whole has the most liberal abortion policies even more so than Europe. You should be ashamed of spreading misinformation as Roe v. Wade being overturned does not outlaw abortion.
Where was the concern for a woman's right when the govt wanted to mandate an untested vaccine which if you have read the Pfizer drops you should be upset? A woman should not be denied the right to kill a "child" (Joe referred to the fetus as a child) but yet that same woman must be denied the right to refuse a vaccine? Really don't follow the logic argument as there is none.
I saw on Twitter a woman was pride because thus far she has had 21 abortions. I say this woman is sick. Why is she not an ethical, responsible person and either abstain from sex or use birth control. Why should I have to complicit in her careless lifestyle and desire to murder?
Why isn't bodily dignity described as the choice to make sure you do not put yourself in the situation of not having to kill another being? Would that be more dignified to all involved or would that be too much responsibility?
To clarify, California's MICRA is known in 2022 to be needy of revision by the State and by the Medical Association.
Here is a recent publication by the California Medical Association regarding the need and the possible resolution of that need: https://www.cmadocs.org/micra2022
We must look to maintain the dignity of the medical system as we try to maintain the dignity of the individual patients within that system. So.. change is not being ignored in the California medical system.
..Maurice.
Hello JR,
Thank you for your passionate concern for women and for the unborn. You may wish to re-read my previous post as the cynical statement that it is. Having been closely involved with a pro-life pregnancy center for 47 years, I fully appreciate all aspects of the controversy. Additionally, I was the plaintiff in an injury lawsuit, enduring the same dehumanization that you describe. Our present society places individual desires above all else; and, the fetus is property to be disposed of as one wants. Our wise CA governor wishes to have post-birth termination as an option. (Oh! How we can disguise our desires with euphemisms!) This was previously termed infanticide and was considered a grave crime against the innocent. NY is also considering allowing the child to die within days after birth at the parent(s) discretion. The brokenness in healthcare is reflective of our manic self-absorbed society. Our quest for dignity is only one among many insults to the integrity of our humanity. Again, I applaud you for your self-less concern for those who cannot speak for themselves.
Reginald
Reginald,
I apologize for misreading. Michelle is a good friend of mine that I met through working on patient education so less patients will be hopefully be harmed. Every time I speak to her I can hear the heartbreak of losing a child to the medical horror show that is healthcare. Michelle was so excited to see that after 40 plus years, CA is finally going to start addressing the harm that MICRA has inflicted on countless people. She felt that after all her hard work Jessie was smiling down at her. I want to also thank you for all your hard work and research you have done as it helps newer people like me learn. Without some of you, it would have much harder for me to learn.
I can't help but see how fall society has fallen to even consider murdering a child after it has been born. That used to be a criminal offense but now....? At what age will this type of murder stop? Will it keep creeping up so that it is legal to kill your 7 yr bc you no longer want them?
For all, the Radonda verdict is a slap in the face of all harmed patients. A cop can kill an alleged criminal in a split second life/death decision but a nurse can blow through a dozen or more warnings and kill a patient while teaching other nurses how to do the same thing. Ignore what you learn in school because in real life we play Russian Roulette with patient lives seems to be the nursing organizations message. Radonda got a 3 year "sentence" of probation with the option of having it expunged from her record. Kim Potter got 2 yrs in jail. This country certainly does verify that patients do not matter at all. Nothing in healthcare is done for the patient's well-being or else Radonda would be in jail. Also, patients would not almost routinely be sexually abused during exams, procedures, etc. The court system had the opportunity to send a message that harming patients would not be tolerated and failed to do so as Radonda's actions were not split second actions but a serious of events that caused a patient to die from a med used to execute prisoners with. The drug she was supposed to use is our old friend, versed which itself is a drug used to render patients into zombies and is also used in executions.
Clarification is always an ethical act if the clarification represents a true conclusion with regard to the issue being clarified.
Here is a current source of clarification with regard to California law being discussed on this blog thread.
https://www.reuters.com/article/factcheck-california-law/fact-check-california-reproductive-health-bill-leads-to-misinterpretation-online-idUSL2N2W30U8
..Maurice.
Hello Dr. Bernstein,
You're right clarification is always welcome, provided it doesn't further obfuscate. The following is from the article you sourced.
"University College London Hospital clinical lecturer in infertility and a leading voice on medical ethics, Dr Francoise Shenfield, told Reuters: “Definition of perinatal death is stillbirth, plus early neonatal deaths under seven days.”
Rather, the bill seeks to protect parents from legal prosecution if that perinatal death is the result of accidental causes, she said."
‘perinatal death’ as an outcome of pregnancy, ensures that a parent who did not go on bed rest [because their work arrangements did not allow for this, for example] can’t be prosecuted because the pregnancy-related loss occurred after delivery rather than during the pregnancy.”
In your extensive practice of medicine or, if you prefer, in the annals of medicine can you cite evidence that a lack of bed rest caused perinatal death?
The following is a citation from the Mayo Clinic's website. "Is bed rest recommended?
There is no evidence that bed rest during pregnancy — at home or in the hospital — is effective at treating preterm labor or preventing premature birth."
Furthermore, in the above descriptions, what would constitute actionable or non-actionable "accidental causes"? Will this be the task of the Hospital Ethics Committee or the courts?
Yes, clarification is important provided that it doesn't further obfuscate.
Reginald
Fact checkers are only as good as their opinions allow them to be. Reuters isn't exactly known to be impartial.
On the other hand, as with all ethics, law and medicine, we must expect, over time, changes of views. The validity of such publicized changes depends on the basis of how the matter, by the resource, is investigated.
I found the documentations expressed by AllSides
https://www.allsides.com/news-source/reuters
to be a worthy research resource for publication. ..Maurice.
Hello again Dr. Bernstein,
I'm not as concerned with cited sources as I am with your (Dr. Bernstein's) responses to the questions posed in my previous post.
Reginald
Reginald, with a career of an internal medicine physician I have no prior direct experience or prior specific literature research knowledge with regard to the questions you presented. Sorry. Hopefully, a OB-GYN visitor here could provide their understanding, experience and conclusion to your questions. But thanks for asking. ..Maurice.
I want to repeat a Comment I have made here over the past years and that is my role as a Moderator of this blog. As some here may remember in the very first years of "Patient Modesty", I was entering my own opinion about the comments written here about the medical professional behavior. I suggested that those writing here, though honest in the description of their medical experience and the effect emotionally and physically on them, were part of a statistical minority ("statistical outliers") and that the majority of patients did not have their experience or conclusions. That was my opinion at the time but later I expressed my concern here that my written personal opinion may have been in statistical error and that a true Moderator should not be expressing a personal opinion on a pertinent topic being discussed. I have tried to follow a more unbiased moderation. ..Maurice.
I remember your comment about us possibly being outliers. But I also went back to earlier volumes from before I started posting on this blog. It's highly possible that a large number of patients aren't especially upset about modesty violations but it can't be for sure because there's to much communication being ignored. Some of the people posting here have talked about writing letters and the letters being ignored.
Sometimes people who haven't seemed to be modest at all are embarrassed. Like my grandson. He would run from the bathroom nude every day after his shower and never got embarrassed about whoever else was in the house. But he got embarrassed about his aunt and his other grandmother being in the room when some price of $#@ nurse (or maybe a female doctor ) made him get naked in front of them. His aunt was a kid at the time and teased him about it.
JF is right that sometimes embarrassment and modesty is situational. A piece of it may be control. When JF's grandson would run nude from the bathroom to his room, he was in control and comfortable with the circumstances of his exposure and who he was exposed to. At the doctor's office he had no control over being made to remove his clothes or who the audience was.
As to the outliers aspect, for many people admitting that they are embarrassed only serves to make the embarrassment worse. At least for men this is often the case in that they are acculturated from a young age that admitting embarrassment is a sign of weakness.
Following up on Biker's last comment with regard to embarrassment. Embarrassment may be thought to be a sign of vulnerability. and really not one of strength. But is that really true?
"Many of us might associate vulnerability with feelings of fear, uncertainty or shame. We may have been taught not to allow ourselves to appear vulnerable (especially men in our society). With vulnerability comes the possibility of rejection or failure, which can be scary. Because of this, we may try to avoid being vulnerable as much as we can. While being vulnerable is often thought of as a sign of weakness, it is actually a deeply important part of the human experience."
Read this and more "Why Vulnerability is a Strength"
https://eugenetherapy.com/article/why-vulnerability-is-a-strength/
In the preservation of patient dignity perhaps we all should look to patient embarrassment as a strength which should imply that embarrassment should be preserved. What do you think? ..Maurice.
Dr. Bernstein, the question isn't so much whether patients are embarrassed, but rather the extent to which they express their embarrassment to the healthcare staff. To the extent patients can get beyond their vulnerability and speak up could serve to improve protocols and staff behavior.
Female staff take advantage of males having been acculturated to suffer their embarrassment in silence, and continue to needlessly expose patients for their own convenience, power trip, or voyeurism. If more patients could get themselves beyond their own vulnerability, healthcare staff would be pressured to improve protocols and professionalism.
Biker... that sounds good in theory and it really should work. Except.... how many times and people have brought this up on Quora alone and there has yet to be a nurse who has said gee, I never thought of that thanks. I will work on getting this changed. Instead we get buck up and deal.
I’m having a row with one nurse who claims she will call out bad behavior and how she protects a patient. Ie: she will ask a man if he is comfortable taking off his shirt and will offer a gown. Whoa. That’s big of her since most guys are shirtless a lot anyway. Not once did she mention what she does for below the belt care. Then I said if you call out bad behavior why aren’t you calling out nurses comments. You could teach them to respect patients. I’m waiting for her response on that one.
Hello,
Having read the eugenetherapy.com article, I tried to keep my head from spinning. Has the definition of "vulnerable" been changed? I searched the following: Definition of vulnerable
1: capable of being physically or emotionally wounded – Merriam-Webster.
Vulnerable: able to be easily physically or mentally hurt, influenced, or attacked – Cambridge Dictionary
Britannica Dictionary definition of VULNERABLE
[more vulnerable; most vulnerable]
1
: easily hurt or harmed physically, mentally, or emotionally.
No! The definition doesn't seem to have changed. The only way that being vulnerable can be considered a strength is when a vulnerable person makes every effort to escape vulnerability. The author has concepts completely reversed. Brene Brown (if this is the author) states, " Vulnerability allows us to be our authentic selves…" NO! NO! NO! A thousand times NO! The reverse of this is true. Being our authentic selves allows us to be in a position of being ridiculed, derided or ostracized. Again, Ms Brown affirms, " With vulnerability, we build empathy. We can let down our walls…" NO! Being AUTHENTIC builds empathy. We let down our pretenses, etc. Further she avers " Being vulnerable can help us to work through our emotions…." NO! AUTHENTICALLY stripping away our facades FOR OURSELVES allows us to see ourselves as we really are. Finally, ” Vulnerability also is a sign of courage." Again, NO! If you are a female (or even a male), don't feel that looking vulnerable while walking to your car will make a mugger think you are courageous. NO! Being AUTHENTIC is a sign of courage. Please, please you, your friends or, especially, your children should NEVER be vulnerable to anyone. Choose to whom you wish to be authentic. This is true genuineness.
Reginald
Reginald.
I can see Dr B's point in one certain way. Why are female patients better accommodated than males. We are more likely to cry. It's involuntary. A female patient is highly unlikely to act like she's enjoying the exposure where as a guy sometimes will.
Recently when nobody was posting here I went back and was looking at comments from earlier volumes and came across an article written by Trisha Torrey.
I have to admit to not liking or agreeing with her . She sounds reasonably intelligent but this is an emotional issue that for many people it can't be rationalized away.
Why does SHE think woman are better accommodated? She'll never figure it out but it's because the vulnerability is more visible.
Hello JF,
My comments re vulnerability revolved about the author's absurd statements that vulnerability engenders authenticity, empathy and courage. Vulnerable people need protected, either self-protected or protected by caring individuals.
Many women are vocal about their expectations of privacy or dignity. Many suffer quietly. A few years ago my wife was scheduled for a pap smear. Gritting her teeth, she QUIETLY endured this. After the procedure she asked the doctor, "Why is this necessary since I've had a hysterectomy and my cervix has been removed." He answered, Yes. Your right." No further pap tests were ever scheduled. Sometimes health care individuals proceed robotically without asking Why?
The problem isn't whether one expresses emotions, or not. The question is Why isn't compassionate care given which would obviate an emotional response? Why can't patients be treated as individuals and not as procedures?
I've read one of Ms Torrey's missives. It seemed as if she indicated that privacy issues might require psychological help. I don't think she appreciated that many privacy issues arise from previous negative experiences. These experiences can last a lifetime. They aren't always whisked away on a psychiatrist's couch. (The previous sentence dates me. Couches have been replaced with pills.) Aside from recommending that one let his/ her concerns be expressed to physicians/ nurses, I didn't find Ms Torrey's statements terribly enlightening.
It remains for us to continue to advocate for dignity/ privacy for both males and females. Maybe sometime, before we exit this world, we'll see the fruits of our labors.
Take care.
Reginald
Here is a definition I read describing "patient dignity":
being treated with care and compassion; • polite, courteous staff; having their privacy and dignity actively respected; and • having their views listened to and taken into consideration.
Do you all agree? Very shortly we will be moving on to "Preserving Patient Dignity Volume 122". ..Maurice.
Dr. Bernstein, on the surface that definition is a good one but where it will fall apart is likely in their underlying definition of what "having their privacy and dignity respected" means.
Healthcare staff almost universally say they respect patient privacy and dignity. Then they turn around and completely ignore the patient's privacy by bringing in chaperones, assistants that don't assist, and other audience members to stand there and stare at the patient. They needlessly expose the patient in order to get access to the abdomen or the groin area. Most urology, dermatology, and other specialty practices make no effort to hire even a single male staff member for male patient intimate exams and procedures. Many small hospitals only hire female sonographers, and they in turn expose their male patients more than is necessary for procedures such as testicular ultrasounds.
So, a good definition if in fact privacy and dignity uses a patient-focused definition rather than a staff convenience based definition.
NO FURTHER COMMENTS WILL BE POSTED ON THIS VOLUME 121. CONTINUE THE DISCUSSION ON THIS LONG RUNNING AND WORTHY TOPIC ON
VOLUME 122
https://bioethicsdiscussion.blogspot.com/2022/05/preserving-patient-dignity-formerly.html
..Maurice.
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