Preserving Patient Dignity (Formerly Patient Modesty) Volume 122
FROM ME:
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?
FROM BIKER:
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.
AND THE DISCUSSION CONTINUES..
posted by Maurice Bernstein, M.D. @ 2:06:00 PM
184 comments
184 Comments:
Hello Dr. Bernstein,
"having their views listened to and taken into consideration." This really sounds like, "We'll listen to you and determine how we'd like to proceed". It still smacks of paternalism. A better phrase might be "having their views acknowledged AND FOLLOWED to the best of our ability". (Of course, with the caveat that accepted, necessary "medical" procedures will be followed.) This sounds like a more patient-centered approach, doesn't it?
Reginald
There was 40 nurses walking out of an Orlando Hospital. The nurses worked extra short and a patient jumped out a window 8 stories up. The staff was made to sign non disclosure papers. While the investigators we're in the building, the hospital was well staffed. Afterwards back to the same ol same ol.
The preservation of patient dignity is surely a complex chore and one aspect of the chore is the role of the legal system, laws and lawyers and how they fail to participate in that need for preservation. How many patients need to be "injured" by the medical profession before something constructive or preventative or penalization is exercised? Yes, you read about the rapes and other terrible behaviors toward patients but often not near the time of onset on those criminal behaviors. And where is the preservation of patient dignity during the period when no actions are taken to punish the medical professional, male or female? Where is the legal system or is this all tainted with politics? ..Maurice.
Dr. Bernstein, lawyers are like any other business and weigh the cost/benefit when taking on cases. Huge healthcare systems can deploy their own army of lawyers to defend against claims. That serves to discourage lawyers from taking on what they know will be an uphill battle. In small town/rural settings such as I live in, the small local hospital which is not part of a larger system is still by far the largest employer in this county. The local newspaper isn't about to cast any shadows on what is probably their largest advertiser, nor is it likely that the local law firms will want to go up against them. And of course the hospital donates to or otherwise participates through employee volunteers in all the right local causes. Throw in courts seemingly automatically taking anything healthcare staff records as absolute truth and the legal system does not pose much of a threat to hospitals or doctors/nurses for bad behavior. Only the most egregious scenarios have much of a chance being pursued. Patient dignity is not even on the list.
Yes, we have discussed physicians' use of scribes in their medical practice. Here is a recent article by a female physician writing to the publication Kevin MD.
https://www.kevinmd.com/2022/05/to-scribe-or-not-to-scribe-that-is-the-question.html
Her description sounds worthy for her but fails to present the issues presented on this blog thread topic by those commenters here. Nothing is mentioned in the article about how patient feel about the presence of scribes even in the exam room. She wrote "She would accompany me into the exam room under instructions to remain unobtrusive and abide by HIPAA." I can already anticipate the reaction to that description by most of those currently writing here.
I bring this issue back up now just to let you know that my personal internist physician on each visit notifies me that there is a scribe listening and computer inputting the comments made by the physician...but that scribe is in another room who I will not see and will not see me. The physical exam findings are spoken our to me and the invisible scribe by my physician. I suppose I could reject even the remote presence of a scribe but I understand the value of the work of the scribe in providing more time for the physician to attend to me rather than a computer system.
Would any of my visitors here reject a scribe as presented to me as the patient in my doctor's office? ..Maurice.
Dr. Bernstein, though I would prefer scribes not be involved at all, I understand their benefit to physicians and would accept the scribe being someplace other than the exam room as a compromise. The doctor gets what they need and I at least get physical privacy.
I have no problems with scribes as long as they face the wall for all of the exam. It’s the ones that do nothing but leer over the docs shoulder. My other problem is not letting a spouse stay “ because the room is too crowded and intimate exams may take place.” But the doc is allowed to have someone else in the room.
I have been so pleased that Banterings had suggested and I followed up extending the topic of this blog thread to "patient dignity" and attempts to preserve that human quality. What follows are 3 clinical situations and how they are followed by the medical system and courts can make a mark on the preservation of such patient dignity.
Here are the situations dealing with patients who, at the time, the physician feels has no mental capacity to make decisions. What would be your reaction to each?
(1) treating ‘incapacitated’ patients over their objection, (2) the concept of ‘decisional capacity’ and its relevance to justifying involuntary treatment, and (3) following or disregarding advance directives when they clash with an incapacitated patient’s current expressions of their wishes or with their current interests.
Think about these issues and how you, as the patient, would want to be treated but also what should be the role of the physician who understands the immediate clinical situation. ..Maurice.
By the way, in the discussion regarding the preservation of patient dignity to what extent should a patient, through their own actions or inaction behaviors be responsible for the preservation of their own dignity? What should be the limits of patient behaviors, criminal or otherwise with regard to this issue of preservation of their own dignity? Or is patient dignity set by others and for which the patient has no responsibility themselves? I am not sure this point has been strictly discussed since the title of this blog thread had been revised. ..Maurice.
Dr. Bernstein, we all play a role in maintaining our own dignity via the choices we make as concerns how we conduct ourselves and live our lives. Patients can and surely do compromise their own dignity at times, but that is something they do to themselves. It's their free will choice.
Patients making such choices for themselves does not give healthcare staff the right to take away or otherwise compromise the dignity of patients. Conversely, patients do not have the right to compromise or otherwise take away the dignity of the healthcare staff. It is a two way street but given the power imbalance between patients and staff, the onus is on the staff to take the lead and set the tone in preserving dignity for all concerned.
Biker, I fully agree with what you wrote today. ..Maurice.
A 4th year undergrad who will be going into healthcare gets it. She is appalled at the comments many nurses make. She fully agrees that there is no reason family members can not be in the OR with their loved ones to be their advocates. ESP since they allow so many students in to “learn”. I told her good for her and hopefully she can get a group of peers together and voice their opinions on all of our concerns. She is what we need for healthcare reform.
Dr. Bernstein, I would add that what I said about healthcare staff pertains to every industry. In my corporate c-suite career, I was fully aware that the onus was on me to set the tone in interactions with staff and that it was my job to make employees at every level feel respected. It is never a level playing field when a power imbalance exists.
It is no different in my small town elected position. The onus is on me to make residents and others who come to me with a problem or request to feel like they've been heard and treated with respect. This is especially so with the elderly that have outlived their resources, are overwhelmed after the loss of a spouse, or that are slipping cognitively but still trying to be independent. Their dignity is all they have left, and the onus is on me to respect it, and shore it up if I can. This is because the power imbalance overwhelmingly favors me.
The question then is do the people who work in healthcare understand the power imbalance and understand that the onus is on them to respect and protect patient dignity?
Biker, excellent point in your last posting.
I'll tell you and the others what I think is the "problem" in the active practice of medicine. The "problem" is the patient's illness itself and the need or perhaps the "requirement" that the illness is properly diagnosed and properly treated and that the results of those areas of attention be the clinical recovery of the patient. The first thought in the minds of the medical professionals is to establish the cause of the illness, its name and provide what is necessary and acceptable for recovery. "Respect" is directed first to the diagnosis and treatment. So the healthcare provider is oriented to that direction.
And it really is unfortunate that what we teach the first and second year medical students, as I have written previously, is to attend to the patient not just to make a diagnosis for subsequent treatment but to make a human-to-human connection to the patient. Unfortunately, when the students move on to residency and later practice that human-to-human connection is fading because of the patient loads to be attended in limited time. Would more doctors and nurses available to work in the system solve this failure in the professional to patient relationship? I think so. ..Maurice.
Dr. Bernstein, the assembly line nature of corporate medicine certainly can impede the human to human connection given the time constraints. It can as well result in grabbing the first plausible diagnosis and a quick passing on of the patient to someone else. What is doesn't have to do is cause a patient's privacy and dignity to be needlessly compromised. Yet it does. More staffing and allowing more time with a patient is not a factor in staff choosing to needlessly expose the patient in terms of extent, duration, or audience. That is instead a factor of their not caring about the patient's privacy and dignity.
I will use my last dermatology exam as an example. The Resident brought a female scribe with him and positioned her facing away from me w/o me asking that she be positioned that way, and then I got a thorough full skin exam. If he could protect my privacy and meet his needs for note taking, why don't other dermatologists do the same? Because patient privacy isn't important to them. That Resident had the same time constraints as everyone else.
Supporting the argument presented here by our discussion participants is a study as currently published in the Hastings Center Report (a periodical regarding medical ethics)
https://www.thehastingscenter.org/news/hastings-center-report-commentary-helps-catalyze-connecticut-action-against-unconsented-intimate-medical-exams
Here is the Abstract of the article:
Published On: June 10, 2022
Posted in Health And Health Care, Professional Ethics, Racial Justice
A national survey, described in an essay in the Hastings Center Report, found a widespread practice, often for medical student teaching purposes, of doing pelvic and rectal exams in unconscious patients whose consent had not been sought. The practice was equally prevalent among males and female patients, but occurred four times as often in Black patients as white patients.
For years, there was knowledge of this practice but limited and inadequate legislative action. Connecticut legislators asked the Community Bioethics Forum, a consultive group founded and chaired by one of the authors of the Hastings Center Report essay, to provide their views on proposed “explicit consent” legislation. To gain greater clarity on the demographic patterns and frequency of UIEs, the authors conducted the first national survey of UIEs. Data from the survey suggest that UIEs may occur under a broader range of circumstances than addressed by most law and policy.
The Hastings Center Report essay was distributed to Connecticut lawmakers at a critical moment in their discussion of explicit consent legislation. The lawmakers passed the legislation, and the governor signed it last month.
Hmmn. ..Maurice.
Dr B. Your Wednesday post was FRUSTRATING. You talked about thinking modesty violations are because of overwork and understaffed. Being overworked is PART of the problem but it isn't the problem in a nutshell. Why is it so difficult for you to grasp that doctors nurses and medical staff in general have the same character flaws that the rest of humanity has? JF
JF, at no time do I think that doctors or nurses or others in the practice of medicine are immune to "character flaws" that are potentially present in humanity in general. And as I had written, one character flaw of a physician, in particular, is to be more preoccupied with the disease, its rapid and accurate diagnosis and treatment rather than including the need to be attentive to the patient as a whole human person with much more present than some established diagnosis for appropriate treatment. ..Maurice.
In one sentence the medical staff say it’s all clinical to them and nothing sexual. In the next they say they are human. Well humans don’t look at other humans clinically. You can’t shut off your subconscious from looking. Over exposure is the sexual aspect of that. I’ve said thousands of times and nobody gets it. When they tell us they don’t want to see our genitals then why do they not take the steps so they don’t have to? Every time you mention to Covr they say they get in the way. They don’t even know what they are.
Yes catfostermom, for people who say they don't want to see it, they sure do seem to go to a lot of trouble to make sure that they do.
Last Thursday I went to my new primary care doctor for the first visit. I had to discontinue with my prior primary due to his resistance in complying with the FAA requirements for returning me to flight status. That's a whole 'nother story which is sad since I have been with him for the past 18 years and he would no longer meet my needs.
I picked a doctor from a website since he was near me. The work up by the medical assistant went very well. She was unusually competent. From most MAs I have grown accustomed to the usual mouth breathing buffoons. However this lady was really up on her game and very intelligent. Soon, the doctor entered the room accompanied by a young woman and he made some remarks about how she was a "practitioner" student. He didn't ask if I consented nor did he provide her name. Typical. She came in and sat down in a chair. We then went through my history and I just went through why I was there and needed a new primary care physician. We discussed my medical history and my needs going forward which included keeping up with my current meds. The doctor then examined me which was very basic and non traumatic. Soon I had to advise him of my past sexual abuse by a female perpetrator and that it had occurred in a medical setting. I said that it should not be a problem and for the most part hasn't been for my more recent hip replacement surgeries but needs to be considered with future medical care. We also discussed my past Covid hospitalization.
All too soon the "practioner" student got up and offered to leave. I told her I was OK with her being there as long as there was to be no intimate exams. I had no idea what the doctor had in mind going forward but I kind of think he decided that he would not go with the prostate/hernia exam in light of what I had brought up. But she didn't know that. I emphasized that I had hopefully not overstated how I felt. I was not upset by her presence. However, she just exited the room.
I talked further with the doctor and said how I hoped the student was not offended by my remarks and he said he didn't think so but that she just didn't want to alarm me. After some discussion about other med matters the visit was over. The doctor was younger than me by far but I felt as though I could trust him going forward.
After some time after I left I thought about what I had said and I hope I didn't make the student uncomfortable. The doctor seems fine with me going forward and wants to continue with my treatment. The new doctor was very sympathetic about my past abusive experience though I didn't detail it to him. I felt good about the first visit and gave him a top 5 on the Press Gainey scores. I really wish he would have done without the student especially considering that this was my very first visit with him. Thoughts anyone?
58flyer
Good Afternoon:
Cat you are correct.
If they really didn't want to see they'd make sure in pre-op when you are getting ready they'd hand you a Covr type garment have a sample at hand to show you how it goes on then tell you to put it on after they leave to give you some privacy.
I'd wager over 98% of hospitals, clinics, & outpatient centers in this country have NO clue about Clovr type garments.
They need to become standard issue in ALL operating rooms, x-ray depts., gastroenterology & cath labs for starters.
Regards,
NTT
58flyer, the doctor erred by bringing her in w/o first asking but it seems like they handled it well after you spoke up. Her leaving was erring on the side or caution so as to make you more comfortable, her likely thinking it was best just in case you were being too polite in saying she could stay. It may have been a good learning experience for her for when she is seeing patients on her own. You too handled it well.
My primary care is a female PA. I recently had my annual "wellness exam" and after doing my weight, height, blood pressure etc, the medical asst said the PA had a PA student with her and was it OK if she came in for my exam. I said yes, and then when the PA came in, she also asked me if it was OK. That two step approval has been my experience in every dept. of that hospital, so I assume it is an established protocol there. Note that I have been with this PA for several years and I knew that her exams never include me taking off more than my shirt; thus I didn't have any qualms about the PA student being there.
It is an excellent learning experience and in my opinion the student did the right thing by getting up to leave. It shows that she respects the patient. Hopefully years down the road when she is the teacher she will teach her students the same. WE need to be consistent with what we need. We can’t complain about something then let it slide. My suggestion would be to agree to the student until the time comes for an intimate exam saying she can stay with her back turned toward me or leave the room. I would have no problem with the back turned. This way the doctor can verbally explain what he’s doing what he feels and get the students input without them actually looking. There are many people out there that have no problems with students.
I know they have paid patients and those people don’t have any modesty issues. But, wouldn’t it be great if those are the people who taught the students about bodily dignity. How you do the exams is a major part of your grade. If you unnecessarily expose you get below average. Also, marks against the professors for letting it happen. A certain number of marks and the professor looses something.
Someone on Quora said that in her hospital in the UK you are automatically given colonoscopy shorts and paper surgical shorts. Others have said your genitals are never seen during a colonoscopy. My response was, if your genitals are never seen then why do they have colonoscopy shorts, that prevent your genitals from being seen? My husband is 6’2’ the gowns come to about mid thigh. Not a lot of room to remain covered when you roll over now is it? The sheet shifts as well. I sleep in an oversized T-shirt that comes to about mid thigh. I wake up and the shirt is by my waist most nights. I always remind my husband not to check the security cameras while people are around at work. Lol.
If you are interested in watching a YouTube over 1 hour long rendition of Medical Modesty in a Religious Perspective which contains a host of documentation on the subject and its significance. Here is the link to this video:
https://www.youtube.com/watch?v=8O-LySg0y88
After watching, does anyone want to comment on the validity or worth of this YouTube presentation? ..Maurice.
It was a good video. Banterings has talked about some of those same things some years back. Our " more than a prophet" (Adventist church ) has also. But she wrote such a ton of writings possibly a lot of Adventists aren't aware of it.
I didn't watch the entire video but rather kept skipping ahead to see if they ever got to covering male patients. Essentially it was a female-focused video with a significant emphasis on male gynecologists. Not being a religious person myself, I say fine if the narrator wants to hold her views based on her religious beliefs, but I see patient privacy and dignity matters in secular terms. Patients shouldn't have to have religious reasons to be treated right.
In addition to only being focused on female patients, the narrator also seemed to be oblivious to the fact that men are far more likely to have opposite gender intimate exposure in healthcare settings that women. This is simply based on healthcare staffing demographics and the fact that most intimate exposure occurs below the physician level.
A great book on this topic is "Yikes, I Have to Give Mom a Bath", by Robin Lenart. You can find it on Amazon. It really goes into all those types of embarrassing situations w/care-giving and medical situations. Glad it is now talked about, instead of blindly accepting the status quo of patient exposure. ~S.C.
Biker, you are correct that the video is primarily focused on female modesty. At 1:01:34 they do go into male modesty in the hospital setting. It is sad that male modesty doesn't have nearly the same emphasis as female modesty. It is as if men do not have the same value as women.
58flyer
Speaking of the preservation of patient dignity, we might as well consider and discuss what has happened today with within the United States of America. Its Supreme Court has just wiped away the once legal opportunity and need for a woman to have an abortion. Think about that with regard to any attempt of maintaining the dignity of that woman. This is much more than the act of someone looking at a woman's genitals but the United States government with its "potential eyes and hands" actively inhibiting or even actively destroying a woman's dignity for a purely political purpose. ..Maurice.
..Maurice.
Hello Dr. Bernstein,
Unfortunately, you've been watching too many inflammatory newscasts. Your statement, " .. but the United States government with its "potential eyes and hands" actively inhibiting ..." is actually the opposite of what occurred. SCOTUS stated what had been obvious since 1973, that the abortion debate was NOT within the purview of the Court. It was a matter reserved to the States and its people. Thus, Friday's ruling effectively REMOVED the Federal Government from any activity involving abortion. The States and the people will now decide. Now the controversy will be decided "of the people, by the people and for the people". The decision has been REMOVED from the third branch of the federal government and its nine members. Do you see any indignity with this?
Reginald
Good question, Reginald. But what I see is the Supreme Court, a body which should be supportive of Constitutional law for every state and citizens of the states in the United States, allowing a large number of states to set laws which are clearly lacking in dignity for living women and clearly statistically has been shown that these new state laws are not supported by "the majority of the people" but who has the capacity at this time to reverse these laws? And, until they are reversed, who currently will be providing dignity to those women? ..Maurice.
Hello again Dr. Bernstein,
As you know, there are remedies for changing laws which do not reflect the will of the people. In CA, we do this via initiatives (or via recall, for individuals who are not reflective of the will of the people). This is how our democracy works.
In the context of dignity, I fail to understand how the accessibility or inaccessibility of abortion impinges upon one's dignity. I can understand that one's convenience might be affected; however, this hardly qualifies as an indignity. A typical pregnancy is NOT an emergency. The image of women frantically seeking an abortion is a fantasy.
Reginald
Changing back to a more traditional topic here for a bit, I wanted to share some observations from my recent annual cystoscopy, and also an abdominal ultrasound.
A young woman did an ultrasound of my kidneys and bladder. All she needed me to do was lift my shirt up, same as occurred the last time a few years ago. It again served as a stark reminder of the sonographer having fully exposed me for my first bladder ultrasound some years ago when I had no idea how such things were done.
I had about an hour gap between the ultrasound and my cystoscopy, and having nothing else to do I checked in @ urology and sat with a book I had brought. As in the past I reminded the woman at the desk that I was had requested a male nurse. Again, no push back, just a note added to my sheet saying male nurse.
This is a large urology practice and while sitting there for an hour I saw an almost exclusively male patient mix, middle aged and older, get taken back by young female nurses. As has occurred before, I never saw my male nurse come for any other patient in that hour. It makes me think he is somehow apart from the standard workflow and being assigned to me is a change from his normal duties. Perhaps he is not fulltime in urology but shared with another dept? If I am right, kudos to them for having a system that can react to requests such as mine.
This male nurse is the 3rd one that I have had there, and I am guessing that they haven't had more than one male nurse at a time. My guess he is ex-military like many male nurses are today. Without me asking, all 3 male nurses have quickly covered me over as soon as the prep is done, and we then wait for the doctor to arrive. The only female nurse that ever did that was the one I had last year when a male nurse wasn't available, and I asked her to minimize my exposure to that which was necessary. All of the others I had in years past left me exposed no matter how long we had to wait. All 3 male nurses have busied themselves elsewhere in the room during the procedure. All of the females stayed right at my hip maintaining eye contact with my penis.
Male & female nurses all get the same training in nursing school. All of them, male & female have maintained a professional demeanor throughout the process. Yet the males have been consistently more protective of my privacy.
Good morning:
Biker, I'm glad your latest urology experience went well.
From your experience I think we can say without a shadow of a doubt that no matter what female healthcare workers say, they do like to look & do so therefore we have to always be on our guard around them.
Heading back to Washington next week to see what I can do about this issue.
Regards,
NTT
Perhaps I have moved beyond "moan and groan" per Dr. B's admonition, but probably in a different way than he meant.
Last week I visited my PCP's medical institution. Two of the three receptionists were staring into space [the third was on the phone]. They literally were looking up from their chairs toward where patients would sign in before waiting to be called. With no one at the counter and no one behind me, I started to ask a question. However, one receptionist interrupted before completing my first sentence. She said that I had to fill out the blue form before I could talk to them. The blue form required name, current time, and reason for wanting to talk to a receptionist. I left with a smile on my face, although I was curious as to how long they would have made me wait. If they keep getting worse in being all about those providing the service at the expense of those receiving the service, maybe patients who accept the current culture in the delivery of medicine will want changes.
It made me realize that a benefit of the current labor shortage is the ease of hiring employees for medical institutions. The practice manager can't be too particular, so she only has to ask prospective employees the critical question. "Are you a control freak or willing to be one?" If the answer is in the affirmative, then "Can you start tomorrow?"
BJTNT
Hospitals, suri centers etc are all inspected at least once a year. I have a feeling it’s known when they are coming if not know they are there, so everyone is on their best behavior. The Joint Commission needs to conduct surprise visits without the staff knowing who they are. Patient complaints need to be taken more seriously and an outside source ( not the hospital) needs to investigate. The JC HAS to realize the issue with the transgender complaint isn’t the only one if it’s kind and other violations happen across the country. Hell, just on Quora alone every question asked about the creepiest thing you’ve seen. What have patients said while under GA or waking up? Those questions get hundreds of replies. Hmmm... I thought you NEVER talk about patients? It’s not identifying anyone. Really? That person could be reading that and identify themselves. Someone else could have something similar. If the JC or even the medical board of licenses read any of those comments many nurses would have marks against them. The worst part is many of these nurses THINK they are the good ones and in reality they are the worst.
Reginald. How can you say that? The only way it could be a fantasy is is she could find the abortion doctor she wants and in a timely manner. I don't personally believe in abortion but I can clearly see how many women believe they need them JF
Cat,
This week making the Quora rounds were the answers to what weird things have you seen come from patients. Several answered and replied they have made displays outside of OR of the objects they have removed from patient's rectums, ears, guts, etc. Now we know we are told nothing peaks their interest but apparently that is not true as they are making displays so you know when the actual patient is present, there most likely is a line to view that patient.
I also saw the thread in which you were arguing with a RN and some others and I am amazed that some simply do not understand that exposing patients unnecessarily is a sexual abuse crime. Giving permission for shoulder surgery does not mean the patient knows and is consenting for genital exposure. It is their old, tired argument of "we are professionals" that make me choke each and every time. "Trust us" or find another doctor or don't have the procedure was her best argument. I imagine all those who have been molested by medical "professionals" trusted them up to the point where they were molested. The night my husband was victimized, it never occurred to him that he would be sexually assaulted. That's where blind trust got him.
My husband went to see his gastro today to find out when he needs another colonoscopy. I told him to please please discuss the boxers backwards. He also wanted to talk to him about doing it unsedated so he could drive himself home. The doc said he gets his without drugs and he mentioned that most countries they do not use drugs. He is foreign btw. Hubby said that’s what my wife has been reading. The doc also has no problems whatsoever with boxers backwards and there are NO RULES stating that the patient can’t wear something. He said it’s made up policies. I am very thankful that I got my husband to listen to me about he CAN and should speak up. I pray he doesn’t need another hernia surgery any time, but I’m pretty sure he will be on the his version of minimum exposure train from now on. The more I read the nurses comments to him the more pissed he gets, which is a good thing. We aren’t preaching to scare people into NOT getting procedures done. We are showing them they DO NOT need to put up with this nonsense. What I find amazing is more and more people seem to be coming out about how uncomfortable they are with the healthcare exposure. They can see the nurses bad attitudes and form their own opinion on who is telling the truth. Which we know is us.
Hello Catfostermom,
During your husband's hospital prep before his colonoscopy, he may wish to DECLINE the hand cannula which is inserted as a matter of protocol. This it the port through which sedation would be administered; and, the nurse will begin to insert it automatically. (They may say they're doing it "just in case".) I had my colonoscopy exactly as you described. I was later charged for anesthesia which I did not receive. When I mentioned that I refused the cannula and there was no indication of its use, the charge was immediately dropped. I wish him well.
Reginald
Hello again Catfostermom,
You may wish to read my testimonial at Medical Patient Modesty (https://patientmodesty.org/testimonials.aspx). It's the third one from the top (Reginald 2016). There I outline some of the alterations that may be necessary to the boxers. You may wish to get blue shorts which match the color used in hospitals. Additionally, when your husband is told to take everything off, be certain that he lets everyone know that he'll be wearing the boxers. He may even wish to have the boxers already on when he arrives at the hospital. If he feels rushed, tell them to S-L-O-W Down. This usually shocks hospital personnel into realizing that there's a person present in the room. I'm sure that he'll be fascinated as he watches the procedure on the screen. The human body is a fabulous organism. Please let us know of his success with the boxers. Take care.
Reginald
Thanks Reginald.. it won’t be until later in the year. I’ll definitely get him the blue boxers. Just for the fact that he asked his doctor if it was possible, I think he will say something if the facility says something. Not being sedated they can’t do anything non consensual and have him never know. Good thing versed and other drugs are IV. They can’t sneak something in to “make him relax” and wipe out his memory then take them off.
Some time ago, I posted my last colonoscopy experience. I brought with me the blue procedure shorts made by a company called Hygiene Pro. I was amazed they had never heard of such a garment. The shorts were still on me when I woke up so I have no suspicion that they were removed during the procedure. At my last Urology practice I used them for a cystoscope and a prostate biopsy. For my recent biopsy at a different practice, I brought them but the tech did not allow me to wear them. I went along with it because the tech was male and I was not required to remove my pants, just push them down a bit and lay on my side. That was OK with me. We need to educate the medical community on the availability of procedure shorts (or boxers turned backwards). So many seem unaware that there are alternatives to reduce the unnecessary exposure of the male patients.
58flyer
I’m assuming you are getting the prostate biopsies for cancer screening? The lab I work for ( OPKO, BioReference) does a blood test called 4K Score. It breaks down your chances of developing prostate cancer without biopsies or DREs. Look into it and ask your Dr to order it.
Catfostermom,
Yes, the biopsy was for cancer. I was previously diagnosed as positive for cancer based on a biopsy. There was a rise in PSA and then another biopsy which revealed no cancer. The PSA fell sharply after that. It's still down.
I have heard of the 4K Score test. I will mention it on my next Uro visit which is scheduled in November.
Thanks for your input.
58flyer
I thought that this article, Is a Colonoscopy Worth the Risk? was interesting because it mentioned that you should opt for the lightest level of sedation possible or none at all because full anesthesia increases complications such as perforation of the colon. Also, your bodily privacy is more likely to be honored if you are not sedated and awake.
The below two paragraphs in the article were interesting:
Many experts agree you should opt for the lightest level of sedation possible, or none at all, as full anesthesia increases risks. Those who have sleep apnea, are obese, have high blood pressure or diabetes are at increased risk from the anesthesia.16 Across the U.S. 34.4% of those undergoing a colonoscopy used anesthesia.
The use of anesthesia was associated with a 13% increased risk of experiencing complications within 30 days of the procedure and specifically associated with an increased risk of perforations of the colon and/or a stroke. The risk of complications varied by area, with those in the Northeast reporting an increase of any complication of 12%, but among those performed in the West this increased to 60%.
Misty
Misty, as someone who has had 4 colonoscopies w/o sedation, I suggest people at least try it. My original reasoning was that sedation left me nauseous for the rest of the day. I have severe motion sickness which sedation somehow triggers. Also, they would have to be protective of my privacy if I was awake. If it should turn out that doing it w/o sedation doesn’t work for you, they can quickly sedate you if you let them ready an IV beforehand.
As I have gotten older, I also see the benefit of not risking an adverse longer term memory event.
I will say that when I was in the hospital earlier this year for a cardiac ablation, the anesthesiologist was very thorough in interviewing me and reviewing my medical history. There was nothing casual in how she approached my case which is how it should be for any procedure, including sedating patients for colonoscopies.
They are way to quick to give you something to “ relax you”. If they won’t give Versed to the elderly why are they pushing it for everyone else, without truly knowing the long term effect? There can be only one reason and we all know what that is. They should at least ask the patient if they want recall. It’s very upsetting knowing that they have to ask you to verify yourself in the OR and not know what you are saying. What happens if you say yes not fully understanding and it’s not correct?
Biker: Yes, they are more willing to accommodate your wishes for bodily privacy if you are alert and awake.
Sedation has some other unpleasant side effects as you experienced in the past. The only time I was personally sedated myself was when I had my baby teeth extracted at the age of 12 years old many years ago. They used laughing gas on me and I did not like how it made me feel. I could not remember some things. I acted drunk for a while and I threw up. When I was 17-18 years old, they did not sedate me for wisdom teeth extraction. They just numbed my gums which was better.
Catfostermom: You have excellent insights. It is strange that they would be wary of giving Versed to the elderly, but give Versed to young people who could end up with serious memory problems or even dementia.
Misty
Misty and Cat,
But they still give Versed to older people. It is supposed to be in a reduced dose but that is not always the case. My husband specifically told them he could not tolerate Versed and Fentanyl. So what did they do? They gave him full doses of both even after he had refused them. They had an IV in him so be very careful once they IV is in. He won't ever agree to another IV again because of that criminal assault. He was classified in his MRs as being of "advanced age" even though he is a fully functioning member of society. Also, I have read much about the side effects of sedation and general anesthesia especially for older patients. What I have found is many are never the same again afterwards especially when they are not aware of the side effects of memory loss that may affect them even more than someone younger. They are not as sharp as before either. Sedation and general anesthesia have many pitfalls especially for the elderly. Some will make it through the procedure only to die within months of the procedure. Some will be unable to independently function afterwards. It is sad this has been happening for years and yet the medical community is doing nothing except encouraging it. The UK has studied this more than the US as also the UK does not more on patient bodily dignity than the US. The US system is motivated entirely upon the concept of Power, Control and Greed. If the "cure" does more harm than good than it will make them more money until the patient dies and then there will be another to take their place. How's that for patient dignity?
Good Afternoon:
I'm in agreement with JR. The American healthcare system is completely motivated entirely upon the concept of Power, Control and Greed.
I see a lot of articles about dignity & privacy violations across the pond where they take it very seriously. They do studies on the subject. We don't dare broach the subject here.
As far as the drugs go, yes they use versed in full strength doses on seniors. They tell ya they will give you something that will help you forget any unpleasantness from a procedure.
What they neglect to warn you about is that's not all you are likely to forget.
All these drugs that effect memory are the healthcare industry's stay out of jail card.
The American healthcare system is in dire need of a complete overhaul. Power & control must be put back where it belongs, in the hands of the patient. Greed must be replaced with gratitude.
We need to get like minded people in Washington & get this rolling.
Biker. You've had 4 colonoscopies w/o sedation. Refresh my fading memory. The only time it would really sting would be going around the three turns in the intestine correct? I'm told the sting is less if they use the pediatric scope not the adult scope.
The problem with no sedation is finding a facility & doctor that will do it without it & let you wear privacy shorts to boot. They want the drugs because it make the patient more compliant & the fee goes up (power, control, & greed all wrapped up in one procedure). The east coast is famous for wanting those drugs.
58flyer, where might that company be located at where you got your shorts. Dr. Google doesn't seem to know them. COVR doesn't make a garment specific for colonoscopies. Thanks.
That's all from me for now.
Keep fighting, we have to take back control of what should have been under our control all along.
Regards,
NTT
I am watching skin tight and took 2 photos that I want everyone to see but this is not giving me the option of posting photos.
NTT,
I don't remember where I got mine but an online search for colonoscopy shorts revealed a number of vendors. There is Medexsupply, Alibaba, Keysurgical, Globalsources, and even Amazon.
Given the number of suppliers, I am surprised that more of the providers seem unaware of the shorts. Maybe they are but don't want to admit it. I bought enough for me and my wife to use for the rest of our lives so the clinics won't have to buy any for us. Therefore no excuse to deny us to use them.
58flyer
NTT, I have never felt a "sting" but rather just some pressure from the air being blown into the intestine as the doctor progresses to the end point.
My 1st time w/o sedation was at my small local hospital. They 1st told me absolutely not when I said I wanted it w/o sedation. I said no problem, I'll get it done at their primary competitor over in NH. They quickly did an about face and said OK.
The day of the procedure the doctor was resistant to doing it w/o sedation and kept pressuring me to be sedated. He apparently had recently had a colonoscopy himself and couldn't fathom anyone wanting it done w/o sedation. He was such a baby about the whole thing that by time he was done and it turned out to not have been a big deal at all for me, the female nurse & tech were making fun of him.
Not wanting to deal with that again, I shifted my future procedures over to that hospital in NH where doing it w/o sedation was a non-issue for the staff.
The doctor who did my 1st two colonoscopies in NH also did an upper endoscopy on me w/o sedation. The insertion was a bit unpleasant and it otherwise felt awkward but it didn't hurt. Doing it w/o sedation avoided the nastiness of a day's worth of post-procedure nausea that I'd of had were I to have been sedated. That doctor does one of those doctors w/o borders things in Africa each year and said he routinely does upper endoscopies there w/o sedation. He said it's not as big a deal as people in the US make it out to be.
I do agree with "just in case" IV's being readied beforehand because none of us can know beforehand if a given procedure might not go as anticipated and sedation end up being needed. This is especially so for the 1st time.
The problems with having the IV ready as a just in case is the bill. As stated above, they tried to charge for the sedation when the IV wasn’t even in. If you let them start the IV one of two things can happen. 1) they give it to you anyway without your consent and 2) you are charged for it even if you didn’t get it. Without the IV in how can they say you got it but just don’t remember it? IVs shouldn’t take long to start and the drug works in seconds IF and only IF you can’t tolerate it should the IV be placed.
My husband had his yearly mole/skin check. While they did bring in a female assistant the doctor did not ask him to remove his shorts only his shirt. She froze a mole off his back and he was done.
catfostermon, I hear what you are saying about the billing and basic trust concerning the IV but I have viewed it as a reasonable compromise between what I want (no sedation) and what they want (just in case readiness). In total I have had 6 procedures w/o sedation at this point, split between two hospitals, and they have never violated my trust. What they bill for is usually a mystery given how incomprehensible the billing documents are. Between Medicare and a platinum level supplemental plan, I don't have any co-pays or deductibles ever and haven't had any incentive to dig into what is being billed.
On your husband's skin exam, personally I want a complete exam; I just want my privacy respected as it is done, meaning no women just standing there staring at me. Yesterday I happened to look up the Resident that did my exam earlier this year. He was more thorough than I had previously experienced at the same time as being very protective of my privacy w/o me even asking. By that I mean he had the scribe face the wall for the entire exam. I was hoping he would be staying in NH or VT upon completion of his residency last month. If he did I was going to follow him to wherever he was practicing. Alas, he joined a practice in Indiana.
Dr B.
I don't know if it's okay to post this or not. If it isn't just don't approve of it. I know to not post on Facebook but does this count as Facebook? Approximately a year ago my sister's doctor told her she had Cancer and only a year to live. She had Chemo twice. Five kinds of Chemo both times and it made her really sick and caused her hair to fall out. He gave her no hope or options. So she sold her home and came back to Florida. Her kidney could still kill her. Today her new doctor here in Florida said that she doesn't have Cancer. My sister thinks the Arkansas doctor just had no interest in her case because of her being on Medicare.
So, as Judith has posted, does the maintenance of the dignity of a patient also depend on the source of payment for medical service? ..Maurice.
Dr. Bernstein, it isn't right but I don't doubt but that Medicare patients are sometimes discriminated against given the very low amounts Medicare pays for most procedures. Medicaid is even worse in terms of what they pay.
My guess is that most practices and hospitals get around the low payment rates by upcharging what services are billed, and billing for more services than were actually rendered. Low payment rates also contributes to the assembly line nature of healthcare; they have to process more patients through per hour. I saw this with my in-laws in their 80's & 90's having what seemed to be excessive numbers of follow-up visits that didn't amount to much more than "How are you doing Mrs.L?, good? That's great, see you in 3 months".
Not knowing whether I'd have greater difficulty being taken as a new patient once I was on Medicare, I purposely got myself established as a patient beforehand at the hospital where I now get all of my care. This included urology, primary care, gastroenterology, cardiology, and dermatology.
At what point is "life-support" contrary to a patient's dignity?
Here is the link to a current medical-legal issue in a London Hospital:
https://www.bbc.com/news/uk-england-essex-62175556
Would you agree with the medical professionals or agree with the family?
..Maurice.
And harassment isn't just directed physician/nurse toward the patient but is also coming from the other direction.
Read this from AMA:
https://www.ama-assn.org/practice-management/physician-health/harassment-doctors-rise-here-s-how-stop-it
Can we all agree that beneficially unproductive harassment is coming and going in both directions? And from or to either side, harassment has to stop for the benefit of all involved.
..Maurice.
Dr. Bernstein,
I agree with the family for the boy at London Hospital. Any children should remain on life support as long as their family members request.
Misty
Probably the most common cause of impairment of the doctor-patient relationship is because of ignoring or misunderstanding the patient by the doctor or nurse. Here is a current written example of such a misunderstanding.
It deals with the doctor's first name being obscured:
https://www.medscape.com/viewarticle/975742
Couldn't most of the friction between patient and physician originate from simple
misunderstandings? ..Maurice
JF here. Some would be misunderstandings and some is out and out ABUSE. Patients can be VERY abusive! And nurses can be abusive to the CNA's CNA's abusive to each other. I haven't ever worked at a hospital so I haven't seen it for myself but I've heard that doctors sometimes bully nurses.
JF, thanks for your personal observations regarding abuse relative to your professional work experience. It is important to understand that abuse within the medical profession is not simply displayed in one direction only. I found an article of research which fits exactly with what you brought up.
Here is the link:
https://www.researchgate.net/profile/James-Blando/publication/271076501_Violent_Patients_Abusive_Staff_A_Summary_of_Unpublished_Study_Findings
Many researchers studying violence utilize the categorizations provided by the Federal Bureau of Investigation, whereby workplace violence is categorized into four broad categories or types (Romano et al., 2011). Type I violence is considered acts of aggression where the offender has no relationship to the victim, as in the case of simple robbery. Type II violence involves aggression where the offender is receiving services from the victim, as in the case of a nurse providing care to a patient. Type III violence involves aggression where the offender is either a current or former employee acting out against other coworkers. Type IV violence involves aggression where the offender has a personal relationship with an employee and acts out at the employees workplace, as in the case of domestic abuse. All four types of violence have been observed in the healthcare setting, however, Type II violence appears to be the most prevalent
source of OSHA-reportable injuries among hospital workers
What JF is describing is not "one-sided" but is an unfortunate aspect of behaviors in medical care. ..Maurice.
Good morning:
just a quickie.
FYI the Florence Nightingale's are gone.
I give you today's brand of nurse.
https://nypost.com/2022/07/19/nurse-hits-back-at-trolls-who-call-scrubs-inappropriate/
I wouldn't want her near me or a family member.
Regards,
NTT
JF here.
I don't care either way about her body but it concerns me that she's working so many hours and studying. She's 22 and need to be more balanced about work and living life outside of work. Working so much will catch up and she's gonna be tired and grouchy and have no life outside of work. It's okay to enjoy your friends and family.
If I wrote the following previously, excuse me for the repetition. I think it is important as patients or family of patients to take into consideration the workload and stress on the doctors and nurses attending to them on the manner in which the professionals respond. In my years of teaching first and second year medical students, I couldn't simulate the full doctor-patient or doctor-patient's family behavior mixed with the patient loads and other stresses of the profession. But how doctors and nurses respond to the patient or patient's family within their clinical and even home environment should be taken into consideration as we focus on the preservation of dignity. What do you think? ..Maurice.
Sorry... but it’s not my responsibility as a sick patient to be concerned about them being over worked. That is for them to take it up with their administrations. Their job/concern is helping us get better in a professional manner with dignity/privacy etc etc. That is an excuse. Name one blue collar job that you aren’t overworked or overwhelmed in. The CEOs of these hospital corps need to get real sick and be hospitalized and treated like a NORMAL patient and not a VIP to see what’s happening. I’m tired of the excuse and the money grab being made at my expense literally and figuratively.
Many other people worked through Covid and we didn’t get a shred of thanks or have the ground we walked on blessed. Oh but they dealt with the sick and dying when loved ones weren’t there. Guess what THEY wouldn’t let us be there. Newsflash... if my husband had Covid I’d be exposed as well. We could get our own PPE to go and visit them.
Are MDs overworked because of the MD shortage. Why the shortage? For decades med schools have limited enrollment in med schools in order to limit the number of MDs - all in the interest of greed. [I respect you Dr. B. for your devotion to medicine since you gave up a higher compensation private practice to be a med school prof. We have a relative of a relative who gave up his med school prof. job to be a medical specialist for the compensation - a very nice guy who gave us free consultation when I was in the hospital.]
There is a solution to alleviate some of the shortage. So called AI [just another advancement in digital technology] with trained techs helping patients use the med station [a PC w/ AI software] - basically a tech helping patients who are unfamiliar with a PC and/or need assistance with keyboarding. This usage allows a diagnosis and the AI can prescribe an appropriate protocol with pharmacists explaining the use of the meds, not that the PC can't print all necessary info which minimizes the patient forgetting what a live MD would say [I appreciate that my PCP gives me a printed copy of the info from the visit and w/o a scribe].
There could be a transition phase. To provide medical care to patients, especially in rural areas, AI [with tech help] could provide the care with MDs sitting at their PCs anywhere [certainly not in the rural area] and "approve" the diagnosis and treatment. This should be quite acceptable to MDs since they could handle many patients every 15 minutes - greed could still prevail.
Medical institutions could have many AI stations since most patient can use a PC including keyboarding without tech assistance. Would this be any more impersonal than the limited time MDs have to interact with patients currently? [My former PCP's contract was not renewed because she spent too much time with patients. I feel some guilt because we would discuss non-medical things.] The patient could use any amount of reasonable time at the AI station. Physical privacy [even complete] could be provided if the medical institution so desired [when I state MD greed I'm mostly referring to institutional greed because MDs are usually just employees of the institutions]. Then again, according to the LA Times newspaper, all medical institutions in CA must be owned by MDs, but they could be just the titular owners.
PS - In the 1990s, my niece helped "populate the data base" in the AI software. In other words, the diagnosis by AI is a consensus of experts and not just the PCP's decision. Yes, this capability has been around a long time. Patients in underserved areas are lacking medical care because of ...
BJTNT
JF here
I haven't worked in hospitals. Just nursing homes and assisted living homes and we have often worked understaffed. The patients pay the same bill whether they get good care or no care. The staff receives the same wage whether we worked fully staffed or with a skeleton crew. So who's benefit financially? I don't know thos for a fact, it's just something that I heard said, but allegedly the people at the top are getting compensated financially with Covid money for their staff having to work short.
I don't recall posting on our current blog thread a thread I started in 2007 with 50 responses, the last in 2017. The title is "Being Hugged By You Doctor: Invasion of Privacy vs Sign of Compassion?"
https://bioethicsdiscussion.blogspot.com/2007/11/being-hugged-by-your-doctor-invasion-of.html
My Introduction comment was as follows: According to the article in Fox News "Affectionate students are feeling the squeeze around the country as their displays of affection land them in trouble with school administrators." Even if the intent is to express, though the act of a hug, a social connection with their peers on the school grounds, this behavior may be considered sexual harassment. I find this news story has directed me to consider something some of us doctors do as part of being a humanistic human being beyond simply a doctor of medicine. Some of us actually hug our patients or patients' family members. We hug, not out of sexual excitement or anticipation, but out of a sense of the need to express directly compassion and support at the time of a patient crisis. Is hugging a patient professional? Does it exceed boundaries of professional behavior? Does it invade the patient's privacy? Should doctors first ask the patient "may I hug you?" and wait for permission? When you are upset and in distress and need the attention and compassion of someone who shows that he or she cares about your feeling, should you or would you accept a hug from your doctor even without them asking?
And here is the first response:
At Saturday, November 10, 2007 7:26:00 PM, Blogger #1 Dinosaur said...
Yes I hug,when I feel it's part of the therapeutic interaction. My "protocol" is to say, "Do you need a hug?" in a neutral enough tone so that "yes" and "no" are equally acceptable answers, which I then honor.
It was a patient several years ago who taught me the "right" way to hug: no pounding (conveys hostility); if you must, a slight rubbing of the back, though no movement is best. Let the patient release first.
I believe it works well for me.
Well, what do my current "preserving patient dignity" think about this issue? ..Maurice.
Some people are huggers, others are not. I am not but I graciously accept hugs from those who thrust hugs upon me. Were I to be asked by a doctor or nurse I would decline but if they did so without asking me I wouldn't complain as I know they mean well and I choose not to make a big deal out of small stuff.
Another thought with regard to the preservation of patient dignity. Do you think that, especially reflected in the current Roe vs Wade Supreme Court and various American state laws being created or reverted back to signs of PATRIARCHY (primary decision making by men) from a more gender equal society? Or does MATRIARCHY (primary decision making by women) still exist? What I am getting at is the following: Do physician and nursing staff express their patriarchal or matriarchal power to patients of the opposite gender? Or do patients also end up expressing their maleness or femaleness to healthcare providers of opposite gender?
Or should there be "fraternity" where neither males or females dominate their patients or attending physicians and nurses? ..Maurice.
JF
I want to say right upfront that I believe abortion to be a really wrong thing to do. That being said I know I can't stop anyone else from getting them. Neither can our Government. I don't feel like our Government cares about babies though. If they're gonna care about unborn babies, they'll care about them anyway. After they're born .. This is supposedly a political issue. But I've seen relatives who've had abortions posting against them on Facebook.
hello all, i am alive and well. (maurice has checked in on me.) i had to take a break because i was staying stuck in my trauma. i have been helping patients who were subject to abusive care seek justice, not in the form of monetary compensation, but in procedural changes. a number of providers have disciplinary actions that will follow them the rest of their careers.
i read this volume. one thing that i see on the horizon is that changes are coming. for the record, i am not antivax, but prochoice. we all know that the covid vaccines did not work as magically as they were promised to do (the president double vaxxed and double boosted got covid twice).
first will be the investigations then all the bad stuff will come out. i have been posting some of this on my blog and twitter. i fear what congressional subpoena will find. finally will come the protections of patients. i predict that laws (if not amendments) of bodily autonomy will be enacted.
while this will be aimed at vaccine mandates, it will extend to all aspects of the body. along with this will be further limitations put on providers and more power handed to patients. much of this will be voluntary by healthcare as they attempt to stave off the inquiries on the horizon and attempt to placate society by relinquishing power.
it is argued that some tried to seize power via the pandemic; whether governors or bureaucrats assuming powers never voted or legislated to them, political parties pushing their radical agendas, unions hiding school curriculum, or healthcare providers attempting to seize the paternalism they once enjoyed.
mark my words, change is' a coming...
-- banterings
Banterings, laws preserving "bodily autonomy" seem to have faded in the Roe vs Wade U.S. Supreme Court decision and the laws set up by various U.S. states which support and extend the Court's decision. The outlook for keeping the patient away from self-autonomy seems to be legislatively progressing. ..Maurice.
maurice,
this is a straw man argument.
The misgivings from late U.S. Supreme Court Justice Ruth Bader Ginsburg regarding Roe v. Wade and its susceptibility to come under attack may have ultimately been proven right given the revelations around a leaked opinion draft from the Supreme Court.
All other medical procedures are regulated by the states except for abortion. one difference in this case is that there is another potential party that may be harmed.
The founding fathers wanted decentralized power, and this is exactly what we got. Unlike vaccine mandated where a person had to do something (the vax). This simply lets the states decide if their licensed healthcare professional can perform abortions and under what circumstances.
This does not prevent woman from having an abortion whether traveling to another state for one, doing it themselves, or some doctor in a dark alley.
-- Banterings
My local hospital always takes out a large ad in the newspaper to introduce to the community any new MD, NP, or PA that gets hired. In today's paper they introduced a new hospitalist MD with the description including: ....she brings her experience with trauma-informed care....
Hopefully that is a sign that trauma-informed care is something increasingly deemed important.
I have been following this site for years but have never written in. I wish trauma informed care would have been afforded me for my open heart surgery. Instead they used tactics that lead to me suffering dissociative amnesia. They went out of their way to with hold from me the fact that they were going to have a young woman shave my genitals. I knew something was different when they separated me from my wife without explanation. I had been through 4 other pre ops before this and my wife was always with me. They gave no explanation other than she could come back in a little while. I’m sure everyone can imagine the extreme anguish that I was suffering at the prospect of having open heart surgery and than to strip me of my support individual was horrifying and it only got worse from there. I was asked if had any religious needs or concerns along with a bunch of other questions I told the pre op nurse that I had strong moral belief’s and I was very modest at that see told me I needed to leave my modesty at the door. At that exact moment the curtain opened up and a woman walks in with electric clippers in one hand and a vacuum hose in the other proceeds to expose me and starts shaving never saying a word to me. That is the last thing I remember until I heard my wife asking me what was wrong and what happened. For someone to be traumatized to that level is unexceptionable and this is their normal protocol. I have been in therapy ever since for PTSD and so far no relief in site. What is worse is I can’t go back because they can’t be trusted. I would have felt a little uncomfortable if a male was doing this but I would not have suffered what happened to me if they would have been honest and asked a few questions instead of ambushing me like they did.
Jeff
Hello,
Providence Health Care is offering a free lecture on prostate ablation on 18 Aug 22 from 12 Noon to 1 PM Pacific Time. This is a virtual lecture via Zoom. You can participate anonymously with video and mic off. Below is the registration URL. Much information is requested for registration; nevertheless, because there is no cost, pseudonyms and "artificial" data can be used.
This may be a great opportunity to "flood" the presenter with questions (concerns) regarding gender-concordant, and/or male-only care. Unless we begin to make urologists aware of our dignity requirements, no change will ever occur. If this urologist tells his colleagues, "Hey. There are a lot of men (and women) out there who want gender-concordant intimate care.", maybe (just maybe) change will occur. You don't even have to be present for the entire lecture. You could write your question and leave, if your time is limited for you. We need to get the word out; and, when will you have the chance to anonymously address a urologist about our concerns without an office visit or a bill? I hope you can make the lecture.
Reginald
https://psjhcrmwebsites.microsoftcrmportals.com/event?readableEventId=SJO_Community_Events_Online1408773138
Jeff, welcome to this blog thread. You have honestly expressed valid personal concerns about how you were treated for your urologic procedure--not strictly clinical but mainly behaviorally by the clinicians. Your experience and reaction certainly fits with the experiences of others writing here.
..Maurice.
Jeff... welcome. We are very sorry you had to deal with this trauma and assault/abuse. We are ALL TIRED of the same leave your modesty at the door. I’m not sure who the hell is teaching that crap or if it’s a learned behavior. Protecting a patients dignity is number 2 after safety in the code of ethics. We must speak up and put these nurses in their places. They are not the boss or on control WE ARE.
There was a question asked How to make a prostate exam less embarrassing. I replied have a blood test done. No DRE necessary. One nurses reply was blood tests are inaccurate and PSA can be elevated for numerous reason. I told her the 4K is highly accurate and it gives you a percent chance of you getting cancer. She came back with she is a woman and doesn’t work In primary and never heard of that test. My response was then why are YOU making an inaccurate comment on something you know nothing about? Just another example of them thinking they know all and dismissing others.
Dr. Bernstein
It was open heart surgery not urologic. Had it been urologic I could have safely assumed that there would have been genital shaving. I was instructed by the nurse weeks before the surgery not to shave my own chest all the while full well knowing the extent of the shaving that was going to occur.and purposely not making me aware of this.the whole thing is designed as a deception so that the patient won’t shave themselves to prevent abrasions to the skin that could cause infection so their way of preventing this is by deception.they know that this action could cause psychological harm on the right patient but the end justifies the means is the stance they take but what I find sad is they say in their oath to do no harm and send broken people home. There is a note in my record at the hand off from the surgical team to ICU that patient flipped out when genitals were shaved.do you think I was the 1st or is it more that they just don’t care.it’s pretty clear that it’s all about time and money. The patient is a commodity not a person
Thanks for sharing your experience Jeff. It seems there was no point to the questions that they asked because they were going to proceed as they did regardless of how you answered. Yes patients need to be shaved for certain procedures and yes the staff does it all the time, but they don't have to be callous in how they go about it. I am at a loss as to how healthcare staff lose their humanity in this manner. How can they forget that the scared patient before them is a real person still deserving of being treated in a respectful and dignified manner? I think the sad reality is that many simply don't care.
Jeff, I assume your last posting was from you as Jeff but there was no identification in the posting. Please be sure that you at least identify yourself at the beginning or end of your posting. Thanks. ..Maurice.
Who says they can do a better job then we can? If given a clipper with a disposable blade I can shave myself without nicking myself. Just as much as they can, if not better.
Yes that was me. Sorry about that
Jeff
JF
One solution could be to communicate with patients about what they're going to do and give that patient the option to shave himself.
They have protocols that they follow that are written in stone but when you ask why it is really hard to get an answer that makes any sense.
After my experience I went to patient relations about what happened to me and received a letter apologizing for my bad experience and promising to use this as a training opportunity. The question I have is is this a form letter that they send out with no intention of changing anything? I have read in this blog repeatedly to do something about this instead of crying about it and I 100% agree. The problem I’m having after the last few years of pondering this I’m clueless as to how to make a meaningful impact. I’m going in Monday to have an echocardiogram done because the aortic valve I had replaced is failing which is going to be my demise because I will not allow my dignity to be shattered because they are unable or unwilling to allow me to keep my self respect. I’m sure that many people on this blog may not have strong religious beliefs but I do and for me to relinquish my most intimate parts to a woman that I’m not married to is not an option for me it doesn’t matter to me how desensitized or how seared that woman’s conscience may be
Jeff
Hello Jeff,
I had a hip replacement a few years ago with an all-male team. I spent months sending weekly emails to the orthopedic charge nurse asking if she had secured an all-male team.
I also had the orthopedist sign a statement indicating that I would only undergo the procedure with an all-male team. Fortunately, he was a very compassionate young surgeon.
Find a doc to whom you can relate your feelings. By his responses (also body language) you'll recognize whether he agrees with your concerns. Remember that health care is a business with a bottom line - profit. Subtly indicate that, if necessary, you'll be looking for someone who's sympathetic to an all-male team at other facilities. Remember, your present facility (and doc) want to keep you for their "numbers" and, of course, the income. Get the doctor's agreement to an all-male team in writing.
With my hip replacement, I had the usual bs with the hospital intake personnel. I walked out. I drove the 15 min trip home from the hospital to be greeted by my wife who said that, amazingly, the ortho doc had called. I returned his call and he reassured me that everything would proceed as we'd agreed. The hospital had immediately called him at his busy office and, he quickly called me. That's the power of numbers - patient numbers and dollar signs.
Your heart situation is a bit more critical than a hip replacement; nevertheless, you and/or your wife can begin "shopping". Hopefully, you'll find that your present situation will accommodate an all-male team. We're not talking about securing 10 male nurses. Probably, only 1 or 2 would be necessary. You could even simply "negotiate" a male prep pre-op and post-op nurse for your intimate care. (I'd save this option as a last resort)
Again, remember to get this in writing.
For the hip operation I also wore a Medical Half Short Medical Garment ( see https://shop.covrmedical.com/). The garment was invented by an ortho surgeon for his patients' privacy. I sat in my ortho doc's examining room and asked him to view the website. (Be careful it's "Covr" not "Cover") He was receptive and, the rest I've already related to you. I believe I was one of the first to wear this type of garment in surgery. It probably isn't an option for you; but, my intent is to show you the power of persuasion.
I don't view doctors as uncaring. Sometimes they need to be slowed down and educated about our truly human concerns. As I mentioned earlier, constant vigilance was necessary with the nursing staff. When I arrived for the procedure, the nurse immediately said, "Take everything off." My son, who accompanied me, quickly said, "He'll be wearing this" (holding the packaged garment). He also had the signed agreement by the doc. The nurse said nothing. She just walked away.
Remember that the doctor's word is law in the hospital. Saying that the doc told me X is meaningless. Showing his signature on a document, turns heads. If we received any "static", my son and I were ready to pull out the IV and leave. Again, obviously, your situation is more critical then mine was. However, you do have options, if you're willing to "advocate" for them BEFORE you enter the hospital.
I think you'll find that the consensus on this blog is, SPEAK UP! Let your feelings and desires for dignity be know to everyone with whom you come into contact. Be firm without being obnoxious. You'll constantly ask yourself, "Why do I have to bare my soul to this stranger?"; but, unfortunately, it's necessary to achieve our ends.
I wish you much success. Please keep us posted.
Godspeed.
Reginald
Reginald
Thanks for the info
and encouragement!
It is very difficult to find a doctor that will work with you to that degree but it is worth trying. I was told about a year after my valve replacement that I now needed a pacemaker. At this point I had learned that all patients are stripped naked in the or regardless of the procedure because the gown they give you to preserve your modesty is not sterile knowing this I asked the surgeon if I could be allowed to wear my underwear he said he didn’t have a problem with that but I would need to clear that with the nurses. I placed a call to the hospital and spoke to one of the or nurses who informed me that I would not be allowed to wear my underwear because they are not sterile. I than requested to be given surgical underwear and was told that they are not sterile either. I kept pressing for the need for sterility down there when the pacemaker is placed near the collar bone. She finally let the secret out of the bag that my genitals would be sterilized in the event of an emergent situation. That was something that was never going to be told to me . At that point I requested an all male team and was told I need to contact patient relations
After speaking to them and making my request I was told they would make every effort to accommodate me.
When I arrived on the day of the procedure they had me set up with a male pre op nurse which I took for a good sign although it wasn’t necessary because nothing intimate was done to me. after the procedure I had to stay for 23 hrs observation and had 3 different nurses all male again not necessary nothing intimate but where they messed up was in the or. I think that the scheduler failed to see in my allergies no versed which is the drug they tell the patient will help them to relax well it does a hole lot more than that including amnesia which is the part they love and hide behind
Once I got in the or I saw 2 females and one was standing right next to me but not moving or touching me because they were aware of the request and the fact that I wasn’t drugged.
I was debating weather to cancel but I allowed them to knock me out and have that woman clean my genitals which was totally unnecessary how can you trust them!
Hello again Jeff,
Some other posters on this blog would probably call your situation an ambush. Once you're unconscious you have no control. That's why you need to nail everything down, in writing, before the operating room. Let everyone involved know what your requirements are and inform the charge nurse and dr., in writing, that these are the conditions under which you will agree to the procedure.
Usually the dr. and OR nurse(s) will meet with you in pre op before surgery. If they don't present themselves, ask to see all of them. If you see a female, let them know that this is unacceptable and threaten to leave. Have an advocate with you (preferably, your wife) and have her show the document the dr. signed regarding the all-male team. Hopefully, your advocate/wife will adamantly let them know that they need to honor their agreement. Remember only the next patient benefits if you leave. The whole operating team and the hospital loses. Obviously, if you procedure needs to be done immediately, you may not have this leverage.
As I mentioned in my previous post, I sent many emails to the hospital ortho head nurse months before my surgery. During one visit, before the surgery, the doctor mentioned that "she's our friend". I think this was his polite way of letting me know that I was "bugging" her. All of my emails to everyone were polite and direct. I tried to let them know exactly what I was expecting. They may get tired of hearing from you; however, they may also get the point that you're serious.
All of this is extremely stressful at a time when you need comfort and support. (Incidentally, medical personnel need to know that you feel this way.) Remember, speak up.
I commend you for pressing the nurse enough to get the truth behind no underwear. Covr garments were invented by an ortho doctor for use in surgery. These garments satisfy all "sterile" requirements. The following is from Covr's website about their garments:
"Manufactured in ISO-certified facilities to the highest standards
Designed in accordance with FDA Guidelines and regulated as a Class 1 Medical Device
Hypo-allergenic and tested to global standards for biological evaluation
Meets FDA, AORN, APIC, AST, and NFPA (fire prevention) standards
Quality guaranteed."
Some hospitals have signed on to their use. Additionally, there's a video on Vimeo showing their use in a cardiac prep. (See https://vimeo.com/294155564) You don't need to join. Just scroll done and click on the left arrow. You may want to have you dr. watch this with you. Additionally, Covr did a satisfaction study regarding Exposure-Related Anxiety (See https://pubmed.ncbi.nlm.nih.gov/35726887/) You might also wish to have your dr. and the hospital read this.
Unfortunately, those of us who value our dignity/modesty are still not being heard. We're frustrated that gender-concordant care and trauma-informed care are the exceptions rather than the norm. Please know that we (the posters on this blog) suffer with you when we hear of experiences such as yours. We're also elated when someone's dignity is validated.
Again, I wish you well.
Take care.
Reginald
PS I have no financial interest in Covr. I do, however, appreciate their efforts on behalf of patient dignity.
Good luck Jeff as you maneuver managing your privacy and dignity amidst such serious health matters. Fortunately you have experience and knowledge on your side.
You may recall my account of earlier this year where I, an old pro so to speak, was taken by surprise in the cath lab for my cardiac ablation while an inpatient. I was in the hospital for about 30 hours before getting a slot in the cath lab and knew my groin would be shaved but I naively assumed it would occur in private one side at a time like you can see on You Tube videos. When I was instead brought directly to the lab unshaved I was like a deer caught in the headlights realizing I would be shaved while naked on the table in a room that already had 6 people in it before the doctors and the medical students came in. It kicked myself afterwards for letting myself be ambushed. I did followup with the cath lab and with the doctor who agreed there was nothing that necessitated it be done the way it was.
The lesson I learned was to never assume that hospital staff would make any effort to preserve my privacy or dignity; that I need to instead speak up beforehand even for matters that I might otherwise consider routine with standard protocols.
Jeff here
I keep forgetting to leave my name.
Reginald once again thanks for all the information it is very valuable to me because I obsess over my fear of re entering the medical world.
My wife worked in a medical setting for 30 years and she keeps warning me to back off the modesty issue because I will just be kicked from the practice. I know I have been flagged as nut already. Their question is what is wrong with you when it should be what happened to you
Thanks to all. I’m sorry To go on about All this I guess for me it’s therapeutic
Jeff
Jeff again
I wanted to throw in the fact that prior to the open heart surgery my wife said if I pursued the modesty issue she would abandon me because she felt that I would be making a fool of her and myself . At this point see has decided to divorce me because the psychological effects this has had on me and many other reasons that she give’s. So I’m on my own
Jeff
Ps been married 42 years (sad)
Jeff, thanks for confirming your identity name. It is important for maintaining continuity in the valuable discussions by the other readers here.
I am pleased, Jeff, that you feel free to ventilate your personal story. I am sure that the other readers here understand your personal distresses and which from a clinical or marital point of view can be equally distressing in the preservation of your personal and patient dignity. ..Maurice.
Hello again Jeff,
As well as sharing ideas about dignity/modesty, I think all of us are happy that you find the blog therapeutic. Most of us have also felt like outliers. Nevertheless, we also find that many men feel the same way but, they're afraid to ask for accommodations or they don't realize that options can be provided. Many of us have stopped being apologetic. Most of us agree that health care protocols are designed for the medical staff and NOT for the patient. This will only change when many more men demand to be treated with the dignity/modesty afforded women. Our favorite example is the male mammographer. That's a contradiction in terms. Few women would feel comfortable with this; however, a man asking for a male nurse for intimate care is considered outlandish. Why should you be dropped from a practice because you seek such care? We hear "equal treatment" and "discrimination" being bandied around everywhere except in men's health care. Please exert your autonomy over how your body is viewed and/or cared for. You should have no reluctance in this respect.
Take care.
Reginald
I’m sorry Jeff, but your wife seems to be apart of the problem and brick wall we keep hitting. I hope she is retired because with her attitude we don’t need/want her.
Catfostermom
Your right! when I needed her help the most she abandoned me. Especially after the surgery . Her reaction to how badly that experience effected me was not one of sympathy but disgust. That surgery brought on a trifecta of emotional problems the first is the fact that I know of no other surgery where they strongly encourage you to join a support group because they know that depression is usually a side effect of open heart surgery they actually came to my room in the hospital to encourage me to join the support group. And they were right. the next thing was me reeling from the humiliating experiences that I had and then in the midst of all this my wife turned off to me emotionally and physically and it’s been like this ever since September 2019 and just in the last few months she served me with divorce papers. I find it interesting how people can look at modesty outside a medical setting one way ,which my wife does, she used to get on me years ago about my pants being to tight and revealing which is just one example of many but she’s fine with a woman touching my genitals in a medical setting as If she ceases to be a woman and I cease to be a man. It doesn’t work that way for me. I have done exhaustive studies in the last few years and know with out a doubt that the medical world is a haven for sexual predators and voyeurs and are seldom found out.
And all the standard lines of be professionals that doesn’t change peoples human nature and as a final note there are stats out that list nurses as the number one profession among women for extramarital affair’s and promiscuity
There has to be a reason for this? I believe it is driven by all they see much like pornography drives others desire. the industry is anything but pure and virtuous
Jeff
Hi Everyone .
Jeff . Sorry to hear about your experience . We have all heard the same story dozens of times over the years and nothing seems to change . Just copy and paste . Your comment about nurses reminds me of my wife when she started working as a nurse just out of college . She got a job working in the hospital in mother and new born . There were two brothers working in Ob as doctors . She would come home and tell stories about how they would spend time trying to bed the nurses . A new nurse got the most attention . They had already bedded most of the nurses that had been there awhile . Most were 30ish , divorced or had one foot in the divorce grave . They would talk about how easy those two were on the eyes . The nurses were constantly cat fighting for their attention to . How could they be doing their job if they were constantly hanging on them two ?
Here's a thought for everyone . Ask yourself why would a male go into ob/gyn ? They say because they love babies . How much time do they spend with the baby . The baby comes out , they make sure it's ok , then hand it over .They go back to the mother to check her breasts for milk and make sure everything is ok down there .
Ask yourself . Then why would a female become a urologist that specializes in male urology and prostate issues ? Just a thought . AL
How could we get in touch with paid medical patients? Obviously they aren’t modest, but can’t some pretend to be? They might be our first line of teaching students how to keep our dignity in the real world. Aren’t they the ones that can give students bad marks/reviews? Start weeding out the ones with potential to be the predators from the beginning?
The medical industry knows they have a problem! When ever I leave the hospital that I have become a frequent flyer at. the 1st page on the folder that I’m given with my discharge instructions is a list of people to contact if you suffered anything that made your experience less than perfect. The whole reason behind this is to identify anything that may have occurred that would be damaging to them and that way they can kick into damage control and control the situation. This is what happened to me during a recent colonoscopy when a nurse was trying to open up the back of my gown to see if I was wearing underwear an I was literally fighting with her to keep my gown closed while she was trying to see my ass instead of just asking? The call was placed to complain as instructed, according to them corrective actions were taken end of story! After thinking about it for awhile I realized that was pretty slick nobody knows about this but me the person I spoke to and the violator
I wonder how many violations get hidden this way. I don’t know if it’s just my luck but I can’t seem to make it out of one hospital setting without being violated in one way or another
That was Jeff on that last post
Al I’ve always wondered the same thing about a young man pursuing a profession in OB GYN without any motive’s that are sexual in nature and in regards to a female urologist maybe she had dreams of being a snake charmer. Who knows, but at best I find it suspect
Jeff
If they hired me I wouldn’t need to pretend
Jeff
It was most likely not handled AT ALL. As the one reporting the complaint we SHOULD be able to physically see the actions taken in written form with the nurses signature. You got ghosted by the generic reply.
Dr Ricardo Cruciani died in a NYC jail today ( 8/15/22). Why was he in jail? He was awaiting sentencing for sexual assault, rape and sex abuse of his PATIENTS. He was also going to be brought up on Federal charges next January for abusing patients over a 15 year span. Has anyone else ever heard of him? I haven’t. Is this only making the news because he’s dead? So much for it never happens and you only hear about the big cases.
Has anyone read the in-depth investigative report done by an Atlanta journal about doctors that have been investigated for sexual assault and abuse and the difficulty they had getting information because of the way they bury the information. Many of the doctors that were reported got a slap on the hand but were allowed to keep their license and keep practicing with the patients having no knowledge of the accusations. Unbelievable
Jeff
Jeff... As patients we need to be able to look up ALL of this information. This also applies to any support staff who could be in the OR with us. We do NOT meet them or know anything about them. We need to meet our anesthesiologists prior to the 5 minutes prior to us getting the knockout/loose our memory juice to discuss our concerns and be given options. One size does not fit all in medicine, yet they treat it like it does. One arrogant anesthesiologists will only do it his way. If you only have one cocktail that’s your go to, then I don’t want you knocking me out. They need to be proficient in multiple variations.
Jeff, yes I saw that article a while back (if it is the one I am thinking of). It seems Medical Boards bend over backwards to not take action against doctors that any reasonable person would conclude should not be practicing medicine, Nursing Boards too. It is no different than teacher's unions being more interested in keeping bad teachers in the classroom than in whether the kids are getting an education and police unions fighting to keep bad cops on the job rather than wanting to protect the public. "Clubs" protect their own no matter the harm to those they are supposed to be serving, and healthcare is a very large club.
catfostermon, any private organization with any degree of sophistication in their HR Dept. is not going to divulge any employee information to the general public. Too much legal liability in doing so. Short of there being some form of legal action, we're not likely to ever learn what disciplinary action was taken, though we might learn of protocol or process changes. Protecting the organization is the highest priority, but organizations will make complaint-driven changes if they see it as to the organization's benefit. That benefit might be avoidance of bad publicity or legal action or it might be patient retention & recruitment.
How would you all consider the age of the physician or nurse with regard to how they relate to preservation of patient dignity?
With regard to age, if you think there is a difference, would the doctor or nurse be a better preserver if they are young or if they are old? Or does age and professional experience have nothing to do with maintaining patient dignity
You may be interested in reading this brief article about a very old record age of 100 male American neurologist who is still teaching and attending to patients:
https://www.medscape.com/viewarticle/979319
Does age (and years of clinical experience) of the provider make a difference or should make a difference in that individual's behavior toward the dignity of each patient? ..Maurice.
Dr. B I think as time goes by an individual becomes hardened to what they do every day and loses touch with the feelings that a person feels when stripped naked in front of a stranger.
When a person enters the medical field striping a person naked and exposing their genitals is a new experience that the normal person feels that this is improper and according to all social morals is a violation of that person’s right to privacy.
This has been my claim all along that if you have to numb and desensitize yourself to these actions I believe you are stripping away the very moral fiber that exists in all of us that we don’t have a right to invade a person this way unless we are in a committed relationship.But time in that setting has a numbing effect.
Being a Christian I can’t help but think of the limited amount of medical procedures that existed in biblical days but men were never circumcised by women and men never delivered babies.
In exodus the pharaoh was concerned about the growing population of Hebrew male babies being born. So even the king of Egypt new who to approach to resolve this. He ordered the midwives to kill all the male children born and let the females live.
Men did not deliver babies in biblical days unless it was the woman’s husband
Jeff
I can tell you this much
my pre op nurse for my heart surgery was an older woman and was a hardened battle axe and she had as much compassion for me as a turnip
Jeff
Hello Dr. Bernstein,
My mother would say that crabby old people were probably crabby young people. They just disguised their crabbiness when they were young to retain social acceptance. I'd suggest that the same is true with medical personnel who do (or do not) respect patients' dignity. Those who had compassion when they were young, retain their empathy. Those who were insensitive when young, become more insensitive as they age. I'd suggest that age mellows people but, it doesn't change their basic attitudes. I see an older GP who is very sympathetic and a very young orthopedist who is equally sensitive to patients' dignity. Age doesn't seem to play a part here.
Reginald
Good question Dr. Bernstein. I'm not sure there is an age difference in terms of being respectful of a patient's privacy and dignity but rather that a person's true self comes out more as they age. If they didn't care when they were young they did know that they had to pretend that they did. As they age and learn that there are little to no repercussions for bad behavior, the pretense can drop. At the same time the opposite can be the case and the healthcare worker who does care can get better with time and experience in how to be respectful and show the patient that they care.
Dr. Bernstein, I have a similar question to yours. Is there a difference in urban/suburban environments vs small town/rural environments? Do healthcare workers behave different in large settings where staff and patients are effectively anonymous vs small settings where it is all but impossible to be anonymous? If I go to the small local hospital as a visitor or as a patient, I always bump into several people I know that are either there visiting, there as a patient, or there working. Though they may not know me personally, a significant portion of the staff can be assumed to know or be related to people I know and I may come in contact with them in other settings.
Other than ER scenarios where I'll be at the local hospital, I travel to a large hospital in NH for all of my care but I know that if an emergency situation causes me to become an inpatient locally or end up in the OR that I will be treated by people that know me or that know or are related to people I know.
I don't know the answer to my own question but am curious what others think.
Hello Biker,
I was reared in a small town in Western PA; but, left at 19 for the LA megalopolis. Small towns offer a close-knit society where people know other people on a familial basis - "He's Sarah's son. You know Sarah, she's Jack's wife." This offers a close affiliation. The medical staff may be great or not; however, there is again a relational attitude. Nevertheless, there is the possibility (probability) that much of your life will be known to others. Large cities offer anonymity. You can live on a street for 20 years and not know your neighbors name. Health care may be cutting edge; but, you may be treated like a number. Rarely, will you meet a friend at the supermarket and socialize, as you might in a small town. There always seems to be a trade-off.
Actually, you might have the best of both worlds - familiarity in the small town with the larger city nearby for more private care. It probably depends on whether you see the glass as half full or half empty.
Take care.
Reginald
Supportive about a lot of what is written here and more is this Medscape article titled
"Physicians Behaving Badly" for the year 2022.
https://www.medscape.com/slideshow/2022-physicians-misbehaving-6015583
"Medscape surveyed more than 1500 doctors about how often and where physician misbehavior crops up today, and what they've witnessed or experienced with other doctors in recent years."
After reading, most of my visitors here will respond with "I told you so". ..Maurice.
Reginald, I very much like small town living where everybody knows everybody and their business. Folks from urban areas think they've gone back to a simpler gentler time when they come here, and they have. This is paradise to me but the reality is nobody is truly anonymous when seeking healthcare either, which begs the question as to whether that causes staff to behave differently than in urban settings where everybody is anonymous.
Going back to the older doctor, I was just comfortable with an older doctor. My previous doctor was old school, like me. He wrote notes out longhand on paper, and then gave them to the scribe. He would not bring the scribe into the exam room. I appreciated that. When doing the DRE, he always locked the door. Again, I thank him for that. But recently, I had to drop him. After my COVID hospitalization, the FAA sent a form to my GP asking a number of questions about my recovery from COVID. This is all about my ability to continue flying. My GP said "I don't have time to go through 800 pages of records." Actually, he only needed to go through about 20 pages. Then he said that the practice was owned by an attorney who advised him not to answer the FAA questionnaire due to liability concerns. My aviation medical examiner (AME) said that is not the case. When I tried to set up a conference call between my GP and AME, the GP walked out of the exam room and slammed the door. That ended our relationship after 18 years. Personally, I think that a doctor who allows an attorney to advise him on how to practice medicine is not someone I want to be my primary. I am quite sure my primary does not advise the attorney how to practice law.
Biker, I live in a small enough town that I frequently run into people I know. I see the neighbors in the local Publix and other places like restaurants and auto parts stores. I have also run into the blonde we talked about many times in the last few weeks.
58flyer
Dr. Bernstein, physicians and everyone else who work in healthcare are human and subject to the same personal failings as everyone else. Every industry has its bad apples. At issue is what they do about it when they see it.
I will note that the survey did not focus on how well physicians respect patient bodily privacy. As discussed here many times, it doesn't seem to even occur to many that intimate exposure should be limited to that which is necessary in terms of extent, duration, and audience.
58flyer, the fact that you have run into that healthcare worker in your private life is the point of why I drive 1.5 hours each way for my scheduled care. I live in a much smaller setting where there is good chance that if my caregivers did not know who I was that they would be within 1 degree of separation.
I'm not saying healthcare staff will violate HIPAA, though I have had that happen in an ER scenario years ago, but I am not comfortable with the lack of anonymity when it comes to my healthcare were I to receive it locally.
I know this runs contrary to my loving living in a setting such as I do, but I see my healthcare as private, except to the extent to which I chose to share it. I don't want the nurse that prepped me for a cystoscopy on Tuesday and who I had never seen before, to turn out to be my friend's cousin that is at the cookout I am at on Saturday. Whether she is giving me a wink and a nod or is acting as if she doesn't know me, I'm not comfortable with it. I know this is my issue, not theirs, but have wondered about how it impacts behavior in small town/rural settings vs the anonymity of urban/suburban settings.
JF
Biker. I'm with you about wanting anonymity. It's also uncomfortable to me to take care of a person I know well from everyday life. I think it's true of other people also. When I had my gallbladder surgery in 2006, there was a nurse there with a nurse in training. I knew her vaguely because she was sometimes at our nursing home training students. About a year after my surgery l hired into an assisted living facility and she was the wellness director. I immediately recognized her and know that she recognized me also. She couldn't look at me. I suspect that after I was out somebody catheterized me because it felt different down below.
I find it very disturbing that many people are catheterized during the surgery and it is removed before they wake up. They are usually never told that one will be placed and never told afterwards. I think for something as invasive and intimate as that you should be told beforehand and who will be doing the placement.
It is pretty clear that they don’t want you to know so they do what they do well, operate under a vail of secrecy and deception
I know all to well because I have had to live through plenty of their ambushes and deceptions and anywhere else on planet earth that would be sexual assault with out specific consensual consent, instead they cover that under a blanket consent form that says nothing about what they will do just that you give them the right to do WHATEVER
Jeff
Jeff brings up an interesting point. The standard mantra concerning intimate care is that healthcare staff doesn't remember you 5 minutes after they've moved on to the next patient. That always struck me as self serving nonsense used to justify lack of concern for patient privacy.
In my parttime job at the town hall I come in contact with lots of people and am in a number of homes or are on their properties over the course of a year. When one of them comes into the town hall much later or I see them around town, I remember them, and if I've been in their home, I remember that too, even if I perchance have forgotten their name. The salient point here is that what I saw I remember, be it their face or their home, whereas I may have forgotten their name which is a different kind of non-visual memory.
Even anonymous patients will be remembered should they be encountered in the community, though they will pretend that they don't remember you. 58flyer has spoken to that from his experience. This is meaningful for those of us in small generally non-anonymous settings where the likelihood of subsequent encounters is fairly high.
Hello,
In a recent post I mentioned a Zoom discussion re BPH. The urologist advocated Urolift for acceptable candidates. During that meeting, I asked the Urologist whether he had a male assistant. He mentioned that he did not; but, one could be obtained, if desired. (A welcomed response, I thought.) After my question, a fellow attendee stated, "That's a weird question. Who wouldn't want a female? Ooo!" I didn't respond and, the doctor politely avoided a direct response. The other participants made no comments; however, I wondered whether they also thought I was "weird ". After the discussion, I pondered the question we've previously discussed at length, Are we outliers? To the above-mentioned individual, we definitely are. If this is true on a broader basis, it's obvious why time and money aren't expended to train and hire male nurses. The issue is not a relevant priority. Although I'm still willing to express my desires, the "fight" is becoming tedious. Maybe we can enlist our young, woke society to include us as individual deserving DEI.
Reginald
I have been reading a lot lately about ACEs ( adverse childhood experiences) which needs to be handled by the medical establishment with trauma informed care everyone has their own reason and needs for dignity and modesty to be preserved. Mine are based on moral and religious beliefs but I have come to the knowledge with the help of a therapist that the ptsd that I suffer at the hands of the medical establishment due to the humiliation that they fostered on me is also due to the multiple aces that I suffered as a child.this all came out of a study that was done by keyser and the cdc in the 90s. This is something that they are aware of but choose to ignore probably for cost reasons.the problem with them ignoring this is they take the chance of causing a patient to be re traumatized with serious and devastating consequences emotionally. What is the point of fixing a person’s biological problems while you send them home an emotionally scared person
This is something that is wrong on all levels but because they can’t be held accountable for this they just don’t care
I assume that they know that the majority of people will make it though there lack of patient dignity preservation and the ones that come out damaged are what they can consider collateral damage
I try not to be so bitter but how can you not be
Jeff
Jeff... my husband didn’t know he was going to have a cath for a laparoscopic ingunial hernia surgery either. The ONLY way I figured it out was because his groin was tinted and he ended up getting a bruise on the head of his penis. So much for informed consent. The simple fact he was only shaved mid chest to the top of his pubis was no indication that he would have been exposed at all. The extent of the exposure was never told to him. His incisions were bellybutton and 5 inches either side. We must change these consent laws. They get away with abuse/assault under the guise of medical necessity. Bull.
I drew blood for years. I saw patients for 2 minutes if it was an easy draw longer if I had a hard time finding a vein. I remembered them when they came back a year later for their next annual blood draw. Interesting how I can remember them but they can’t when they’ve most certainly seen more intimate parts then the crook of their arm for a longer period of time.
catfostermom's example is good. I hadn't thought about the difference between visual and non-visual memory until Jeff's comment earlier. If I have driven somewhere once and then need to go there again a couple years later, I am not likely to remember the road names or the date that I was there last, but visually I remember the route. If at the town hall I get a query about a property and they give me a street address or perhaps a name, I may not remember it, but as soon as I call that name or address up on the computer and see a photo of the house, then I remember its the place set back off the road that added a new deck a couple years ago and that its a 2nd home for a guy from NY.
A while back I had read an account of a couple nurses in a small town hospital where a boy 12 or 13 was an inpatient for some surgery. Upon seeing the boy's genitalia one nurse quipped to the other that he's going to be just like his father, an apparently well endowed guy that had been a patient there previously; their memory being no different than catfostermom recognizing previous blood draw patients. Those nurses may well have maintained totally professional demeanors with both father and son, and conducted themselves in a purely clinical manner but that doesn't preclude their viewing them through a sexual lens. Healthcare workers are human too. I just wish they would own up to it because that in turn might allow an honest discussion about necessary vs unnecessary exposure and staff gender.
Catfostermom
Along with all my other medical issues I also need hernia surgery but I refuse because I know what is involved so I live every day in pain. I wish there was a way for a patient to express their needs for modesty to preserve their emotional well being. A person that has been sexually assaulted still has the sympathy of the general population but when in comes to how you feel in a medical setting there are completely different views. But those rules were established by the institutions that benefit and the patient is kept completely in the dark because if enough patients knew what really happened to them there would be a greater public outcry and they can’t afford for that to happen because they would have to change.
For all the years that this site has been running there has been very little movement because we are trying to fight a very large and powerful organization.
I will never give up trying because my very life depends on it and I can not sacrifice my emotional well being any further than it has already been damaged by them even if it costs me my life
If there was true human compassion in our world today they would do something about it. The efforts that we all make is to try and make them aware of the issue! The problem is they ARE aware they prove that everyday by hiding behind their drugs and never openly admitting what they do to you and if they find what they do to you to be so exceptable why the secrecy????
Jeff
Amen
Jeff
I have always felt that with every response to this blog or particularly to the "Preserving Patient Dignity" thread that ventilation of feeling and ideas to others, even those views or feelings to which I didn't professionally or personally agree, was, in fact, emotionally and even medically therapeutic for the writer and for some readers here. "Facts" are one thing, "feelings" is another. Agree? ..Maurice.
More people need to read this blog. And blogs like say no to versed. I’m not sure that one is active, but it’s great knowledge. Sites like Quora is where the change can begin. In the short time that I’ve been reading over there, more and more have been coming out with the assault/abuse they have had to deal with. The nurses sink themselves with their attitudes. Proving our points constantly Truth is... by finding a provider who WILL accommodate you and your needs is taking away the much wanted $$$$ of the greedy. The higher ups need to know WHY they aren’t having their pockets filled and you went to the competition. Then we would see a difference.
Literally 1 hour ago a 24 yr old EMT from Philly was arrested for exposing a women’s breast and taking cell phone pics of her while she was being transported from 1 hospital to the next.
And we are considered outliers because we have come to know that people are at their most vulnerable in a medical setting and have learned from investigation that it is a breeding ground for voyeurs and sexual predators. I think that the larger amount of medical personal have an Ernest desire to help people and the good ones would probably prefer not to interact with the opposite sex on an intimate basis if given the choice but with the way they are structured it wouldn’t flow well if the female nurse had find a male nurse to take care of cleaning a man’s penis that has a catheter in place. I wasn’t even aware that they did this until after my colon surgery and a female nurse came to my room to do that to me. No matter how much they try to convince me that it is purely medical, a woman wrapping her hand around a man’s penis has a sexual element to it no matter what they say. And they also instruct a nurse what to do if a man gets an erection. They teach them that it is a meaningless biological reaction when the reality is it is a sexual response to intimate touch. I feel the same way about men performing intimate care on a woman. I know that some men don’t care and some men actually prefer a woman but because of the intensely intimate nature of this everyone should have a choice instead of being deceived. If they were serious about their patients bill of rights instead of their bottom line they would meet that patients needs
Jeff
I believe that most who work in healthcare are there to use their skills and training to benefit patients to the best of their ability, and earn a living while doing so. They do not become asexual when donning scrubs but their training causes most to assume a professional demeanor as they perform their duties in at least a superficially clinical manner (being polite). Of course there are some that purposely take advantage of their access knowing the odds of getting away with it are in their favor.
At the same time people don't become asexual upon becoming patients, and yes there are some creeps amongst the patient population that also behave in inappropriate ways. Most patients however are only there to have their health problem addressed in as dignified and clinical a manner as is possible.
The problem is that the healthcare world pretends that staff and patients are somehow magically made asexual in the process. That is simply not human nature. Of course most patients are not going to stand out as concerns their overall body, looks, or genitalia. Average is average and most patients are simply going to be more of what they see every day. It doesn't matter whether the judgement is good, bad, or indifferent. The fact that neither staff nor patient are rendered asexual should be cause for efforts to be made to minimize exposure (extent, duration, audience) and to acknowledge that opposite gender scenarios pose a much greater chance of the interaction being seen in a sexual manner.
A lifetime of locker rooms since age 11 has rendered me not modest in front of other men. A lifetime of being hit on by women since age 15, sometimes not in a very subtle manner, and including in healthcare settings, might be seen by some as a good problem to have, but for an inherently shy person such as myself, it has not been, especially in healthcare settings given the power differential.
I accept the reality of the overwhelmingly female demographics of healthcare, but that is all the more reason for protocols to minimize patient exposure so as to keep it as clinical as possible. This isn't too much to ask, yet it doesn't seem to be their priority.
Biker. Well said! It is actually very simple and completely reasonable to expect your idea of dignity as a patient but without legislation nothing will change unless they see profit for them in it.
In the meantime they will continue to cause a portion of their patients to suffer emotional harm that many will live with the rest of their lives
Hello,
Biker, you are right about the staffing "excuse" regarding same gender care. In an attempt to rectify this situation, I sent the following to the Leapfrog Group - A non-profit that monitors hospitals for various quality metrics.
"Would Leapfrog consider a further hospital category of "Number of Male Nurses Available" or "Ratio of Nurses - Female to Male" or some similar category? There are many, many categories involving women but, few involving men. If a woman desires an all-female care team, this is immediately accessible. A male seeking an all-male care team will encounter much difficulty (sometimes, even resistance or disparaging remarks). In any other field, this would be considered grossly unacceptable or viewed as a discriminatory situation. The standard retort is that there are not enough male nurses available. The response to this should be "What is the facility doing to rectify this shortage?" In science and technology, STEM programs were established to encourage the participation of females and minorities in these fields. There do not seem to be similar programs in health care which promote nursing for males. It would seem that this inequity could be displayed [in your Leapfrog metrics] by requiring medical facilities to report the number of their male nurses or their female to male nurse ratios. Please give this your consideration."[End of note to Leapfrog]
I receive the following response:
"Thank you for contacting the Help Desk. We will take this recommendation to our experts.
We do include measures related to adequate nursing staff ... , however, these measures do not specifically look at male/female staff ratios at this time." [End of Response]
To me, this is tantamount to a file 13 notice. Again, DEI in health care seems to be a sham. And the beat goes on.
Reginald
Biker,
I wanted to respond to your posting on June 2nd.
Yes, many lawyers will not take on cases unless there has been a death or serious injury / infection from surgery due to negligence because there is only pretty much a guarantee this kind of case would win.
Yes, it is true that many newspapers do not want to publish articles about problems including patient modesty because they do not want to lose one of their largest advertisers, the hospital. In many communities, hospital is one of the largest employers.
I have written to the letters to the editor in my local newspaper and they were published. But I could tell that the editor of the newspaper had some hesitancy.
I recently did a fundraiser event for Medical Patient Modesty and I did not bother to contact the local hospital about sponsoring our event because I knew they would not. All of the businesses that sponsored our event were non-medical related.
Misty
Biker and 58Flyer,
I wanted to respond to Biker's June 22nd posting.
There are certainly some videos that focus heavily on female patient modesty because of childbirth. Many women in fact have horrible childbirth experiences so that's why that issue is addressed a lot. I have been contacted by numerous women who are upset that they cannot be guaranteed that their baby will be delivered by a female gynecologist. In my experience with dealing people who come to Medical Patient Modesty, both men and women have their dignity ignored in a variety of ways. Both are vulnerable to being violated during procedures where they are sedated or under anesthesia.
Both men and women experience problems in medical settings. Male patients are more likely to be mocked at when they express their wishes for modesty in medical settings.
Many men do not visit the urologist until they have a problem. Many women visit the gynecologist at a much earlier age than men who do not have any issues.
You can find a list of cases both men and women have submitted to our web site at this link.
Of course, you know many urology clinics in the United States do not even employ any male nurses or assistants. There are hardly any all-male urology clinics in the US. Men should have the option of an all-male staffed urology clinic in big cities. Most big cities have at least one all-female ob/gyn clinic.
As for Male Patient Modesty issues, I recommend you all read this article, Male Patient Modesty . You will notice that there are two videos at the end of the article. They specifically deal with men. Discussion about childbirth is not included in those videos. Another man made one of the videos many years ago and has no association with Medical Patient Modesty.
Misty
I have really appreciated Jeff and Al's contributions. I also find it strange for women to be urologists for male patients and for men to be gynecologists. Medical School decided that opposite sex intimate medical care is okay and that is why opposite intimate medical care exists in modern medicine.
Misty
As I have stated before I am seeing a psychologist for ptsd and depression which are the consequences from what I suffered at the hands of the medical community
I was told to write down a a brief summary of what my feelings are in regards to this topic by my therapist . I wanted to reprint what I wrote to get any feedback that might be offered
When a young girl decides to pursue a career in medicine many of the aspects of what she will be doing on a daily basis are not always front and center of her thoughts. It soon becomes clear that many of her duties will involve the viewing and touching of a man’s penis. This is something that doesn’t come naturally to her and she will have internal struggles with this because all of life teaches us that these kind of actions are only supposed to occur in a committed relationship not with perfect strangers.in the real world women don’t touch a stranger’s penis. There are times when this kind of touching produces an erection in a man and they are taught that this is a meaningless biological reaction which is completely untrue it is in fact a sexual response to intimate touch which than causes the man to be even more embarrassed for her to see and touch him in an aroused state and God forbid he suffers from PE
As time goes by she starts to become desensitized to what she is doing and effectively seers her conscience to an act that I believe is morally wrong.
Then there’s me! I enjoy every aspect of a sexual relationship with a woman but my moral beliefs dictate that this is only supposed to occur in marriage
For me to be put in a position where a woman I don’t know is exposing me and touching my genitals in a manner that is not elevating my manhood is actually emasculating me as a man.to me this cause’s extreme embarrassment and is completely humiliating and the callus disregard for my feelings causes an emotional response that is devastating to my psychological well being.
The medical community in their ignorance says it shouldn’t bother you because it’s not sexual but for me if a woman is touching my genitals and it’s not sexual she doesn’t morally belong there
I know this may be held by some to be unfair because nurses are only there to help but to me any woman that would allow herself to perform these intimate acts on a man she doesn’t even know has destroyed any claims to purity and virtue and has actually put herself in a league that is shared by only one other profession which is prostitution. Don’t get me wrong I’m in no way trying to liken them to prostitution it is only in the sense this
is the only other profession that would have you potentially touching a different man’s penis every day
Biblically when it comes to intimate care men took care of men and women took care of women plus it is a known fact that the medical profession has voyeurs and sexual predators mixed in their ranks and no one knows who they are, where they are, or how many?
Jeff
Hello Jeff,
You're not alone in your sentiments regarding same-sex care. I would also like this. Unfortunately, our society doesn't share similar sentiments. In fact, many men "relish" intimate care from women. Additionally, some men "flaunt" their sexuality, leading many in the medical profession to assume that men don't care about privacy/ modesty. This leads to protocols that do not even consider that men have feelings in this regard. Of course, this causes problems for those of us who do care about who provides our intimate care. We face an uphill battle.
I'm looking for a facility with an open CT Scanner and a male operator for a medical problem I have. I might as well be looking for a three-legged chicken. Invariably, females operate the machinery and few imaging centers have open CT's. I live in the Southern California megalopolis where almost anything is accessible. If male care was a priority for the medical profession, "hunting" for someone to assist me should not be required. I guess that's why we must keep advocating for ourselves and, we must keep speaking up. I wish I could be more confident that the situation will change but, no one seems to be available to champion our cause. Hang in there.
Reginald
Jeff,
You have made many excellent points.
You are correct about Biblical standards. Modern medicine did not exist in the Bible. Of course, there were no nursing or medical schools.
I have been contacted by some female nursing students who had strong convictions that they should not do intimate procedures on male patients. But they were frowned on by their professors.
I heard of a Christian female nursing school student when she first started nursing school who expressed how uncomfortable she was to do intimate procedures on male patients because they were not her husband. But as she went through nursing school. She became desensitized and no longer sees anything wrong with intimate procedures on male patients today.
I am very thankful for the increase in male nurses today. But I am very disappointed that male nurses are allowed in Labor & Delivery units at some hospital. They should be assigned to the urology departments where there is a big need for male nurses. The female nurses for urology clinic for men should be moved to Labor & Delivery or other departments.
Misty
I wanted to encourage everyone to read the blog of a man who was abused during a venous ablation procedure.
Misty
Hi Misty Jeff here
Thank you for your response and I want you to know that I stumbled on to your site years ago after my experience in the hospital. I have to say it was truly a blessing for me it let me know I wasn’t alone and that I wasn’t a weirdo like my wife called me. And then I found Dr. Bernstein’s site and it added more validation to how I felt
I want to thank both of you for what you have done and what you do. Just having all of this put on an open forum makes it difficult for the medical community to hide like they do.
All the information that I have received has been invaluable and emboldens me
to fight the good fight
We live in a crazy mixed up world where good is called evil and evil good
I can’t say enough what a blessing and help you have been to me
And I want t thank all the other people that give so much input on this site ( you know who you are to many names to list)
God bless you all
Jeff
I have been stating what he is saying for awhile now. They go to greater lengths to expose us then they do to keep us covered. Unfortunately, nobody seems to read or care about the new research about clipping the hair. And what makes them think they can do a better job of not nicking us then we can do ourselves?
Good morning Catfostermom
I have had spots on my chest shaved with a standard razor blade where they can’t get EKG leads to stick but when it comes to surgery they use electric barber clippers so that the hair is cut close but preventing skin abrasions
Before my heart surgery I was given a list of pre operative instructions to follow
1) I was to take a pill once a day for 5 days before the surgery
2) I was to apply an ointment around my nostrils for 3 days before the surgery
3) I was was to wash my body the day before surgery and the morning of with hepa cleanse an anti bacterial cleanser
All of these instructions were to be followed but the hospital had to trust that I would follow them but when it came to hair removal which is the humiliating thing to be done they want to do that themselves because you can’t be trusted to do it with barbers clippers instead of a razor blade although they had to trust you with all the other instructions. I spent an hour days before the surgery with a pre operative nurse going over the booklet they gave me that went into every aspect of what to expect with the surgery but not one word about the shaving!
This is a planned deception by omission because as a patient you can’t be trusted.
How about some instruction on the importants of doing it properly to avoid infection
Instead they take a man that is terrified the morning of and immediately separate him from his wife and take him back alone and confused and then tell him that this young girl is going to shave your genitals and I’m going to watch. and by the way we didn’t want your wife here to watch a young woman shave her husband’s genitals because that would be disturbing for the wife and uncomfortable for the tech while she invaded his genitals
That last part is not what they say but it is why the do it that way
All of this has to do with feelings and emotions but not once is the patient taken in consideration. He is left to suffer the consequences of their actions.
In traumatic situations there are 1 of 3 re actions fight/ flight/ or freeze. I froze and then suffered dissociative amnesia and have no memory after I felt that young girl touching my genitals
Your right Catfostermom I could have done as good a job and I also own electric clippers but with them being so deep in their protocol of deception I didn’t stand a chance
Jeff,
The point missing is why exactly did your genitals need to be shaved? Your genitals are not part of the surgery except for the insertion of the foley catheter and for that, they do not need to be shaved. The area of your groin on each side of the femoral artery would possibly need to be shaved but your genitals could have been covered. Also, since your surgery was scheduled, there was no reason a male tech could not have done the foley cath and any shaving necessary. It all goes back to the medical community believing they own patients once they enter their doors which feeds their need for power and control. Of course, they will not give "informed consent" about the issues they feel might cause a patient to react negatively or will cause the patient to question them which is why they do not disclose the shaving, the amount of patient nudity they carelessly require or whom will be present.
My husband also has medical PTSD. It is documented in his file but the cardiologist's office has a big turnaround of medical techs and apparently they do not know how to read and if they can read, they don't care as each time the female tech tells him to strip to the waist for the EKG. This past year, a male tech told him to the same. For him having been a victim of medical sexual abuse/assault coupled with having been a victim of medical assault, he doesn't care who tells him to strip. There is no need for any patient to strip from the waist up for an EKG. He will unbutton his shirt but keeps hold of it. For my husband, it is about retaining the control taken away from him in the previous assaults. In other circumstances, he has no issue with going without a shirt but in medical cases since they victimized him, he must retain control over his body and he will decide who will see it or touch it. I asked the male tech if it is necessary to strip from the waist up for an EKG and he admitted it was not. For women, they shouldn't have metal on their bras and they may have to readjust their bras but they should be the ones doing it not the tech. As you have found out as my husband did, cardiology is the hidden area where patients are more likely to be ambushed by unnecessary exposure. Many have no clue what awaits them thus making them powerless to defend themselves.
The other thing I tell people is same gender care may not be the answer because in today's society we cannot be sure of the medical care provider's sexual preference(s) so we should not become less vigilant just because you have same gender care. What we need is to have full disclosure about exposure and who will be present. We also need to make sure exposure is medically necessary. We also should either have a witness of our choosing present or have a video of the encounter that is solely ours meaning they do not have a copy. Why should the patient be the only one who has no clue what happens to them once they are sedated? How many of us allow total strangers access to our house and families without some kind of vetting? Why are we allowing total strangers access to our body without full disclosure or investigating who they are?
Jeff, I presume the posting just prior to JR above was from you. But there was no name signed for that posting. Please be sure to end your message with your identification or as JF and Biker, as examples, enter the blog with a formal blog system registered name. Thanks. ..Maurice.
It’s because they have the fox watching the chicken coop
Jeff
Yes Dr. B that was me my bad
Hello JR
I found out though medical records when I got home that my catheter was placed in me by a woman
There were concerns about the catheter before the surgery because I had a nurse from a previous surgery pull the catheter out of without fully deflating the balloon which was extremely painful and caused urethral damage that I still suffer to this day
When they moved me to the step down unit after ICU I was visited by a woman who declared to me that she did my catheter and she wanted to know how my penis was doing. Needless to say I was extremely embarrassed by her question and the fact of having the woman that became intimately involved with my penis look me in the face and ask about it. I just looked a her and never responded
But the best part of this story is when I finally read my records she was the surgical assistant to my heart valve replacement so as I’m laying in that bed with tubes coming out of my chest draining fluids from my chest cavity and I don’t know how many lines coming out of my veins and extreme chest pain she never once told me she assisted with the surgery or asked me how I was doing she only wanted to know about my penis? REALLY
And what I would have said terrible what was she going to do about it? She not a urologist the only thing I can come up with is morbid curiosity and weather or not she can give herself a pat on the back.
How do these people become so tone deaf not to know
that question like that might embarrass a man
Jeff
Jeff,
They are "tone deaf" because they believe they have the right to your body while you are in their facility. They do not recognize bodily privacy as we do. They believe whatever they do is giving "compassionate" care. Also, if your records mentioned anywhere in them you required bodily dignity measures (which if I remember correctly they did), she may have been dared to do this to you as a revenge measure to make you aware that your wishes did not matter. Some of my group on Twitter have termed this as "medical retribution". It happens as it happened to my husband.
My husband said NO to their gold standard treatment and the use of versed and fentanyl. They isolated him from me and medically assaulted him with the drugs, the gold standard treatment, and sexual abuse to boot. The sexual abuse was he was unnecessarily stripped and left exposed for hours. He was used as entertainment in the CCU as the nurse demonstrated to a room full of techs (both the blood girl and IT), nurses and whoever else how to clean a grown man like a baby. He was left exposed for 6 hours while she tortured him. He was asked questions like did his spouse sexually abuse him while they were abusing him. He wasn't able to move or speak due to the side effects of the versed/fentanyl which he had told them would happen. He was trapped like a war captive. He wanted to die. He was allowed to choke on his vomit and then suffered through more sexual abuse by that -itch. This is only a small part of what happened but because of this, he will never again seek hospital treatment. He merely goes now to the cardiologist to monitor the damage they did to him so he will have an idea of .... Both he and I suffer medical PTSD. I know many others who suffer medical PTSD from sexual assault/abuse by medical "professionals". It is not as uncommon as you might think.
It is a well accepted stat that many men do not seek routine care because of how they are treated by the medical community. The "strip as you go" prostate exam complete with the young girl watching is humiliating and unnecessary. It must provide them entertainment. I know one nurse admitted she and others do like to sexually abuse male patients by unnecessarily exposing them because they like to see the male patient's horrified expression. She said this a few years back and when I reminded her, she denied but luckily I had saved the conversation to refresh her memory.
I have had so many "fights" with nurses about unnecessary patient exposure. They think nothing is wrong with it until I tell my husband's story and then they will say something like only rarely happens. This, to me, is glossing over the fact and somehow tries to make it acceptable. The other time they will admit it is wrong is when it happens to them. Many of the will seek treatment elsewhere bc they do not want to be seen naked by their peers. So being naked/exposed does matter. With this, I say let it happen to them and their loved ones until it doesn't happen to us anymore. I have as much sympathy for them as they have shown to us.
Hello,
I sent the following two messages to Anthem Blue Cross in an attempt to have them consider gender-concordant care. Although I mentioned to them that this was a request and not a complaint, they issued a complaint for me with Medicare. Maybe we should all issue complaints to Medicare regarding our dignity issues. Possibly, someone at Medicare will finally get the message that there are a significant number of individuals interested in gender-concordant care / dignity. Even if you're not yet 65, Medicare is in your future and, Medicare "controls" much of what the medical profession is permitted to do. "Flooding" Medicare with complaints might help our cause.
Two messages to Anthem follow:
I'm requesting Anthem to be at the forefront of advocating for gender-concordant care. Unfortunately, there is a disproportionate number of female nurses in health care relative to male nurses. This places male patients at an extreme disadvantage if they prefer same-gender care. I'm asking Anthem to attempt to address this disparity by promoting male nursing. This can be done in many ways. In an effort to encourage females to consider science or technology, STEM was instituted. The government and many private entities have embraced STEM in an attempt to encourage female participation in traditional male fields. Anthem could create a program to Encourage Males to Enter Nursing via scholarships, hospital or nursing school incentives, etc. Additionally, hospitals are graded on many metrics. One metric might be the Ratio of Female to Male Nurses. Another might be to score medical facilities regarding their offering of Gender-Concordant Care. As I mentioned in my previous note (attached below), Anthem can be in the forefront of change in health care. Many companies now have departments specializing in DEI. In many areas of life, men are not considered as being marginalized, except (as I've described above) in nursing. This is a chance for Anthem to be innovative in advocating for more male participation in nursing and health care. I do believe the following taken from Anthem About: "At Anthem Blue Cross and Blue Shield we understand our health connects us to each other. What we all do impacts those around us. So Anthem is dedicated to delivering better care to our members, providing greater value to our customers and helping improve the health of our communities." Anthem's innovation today could be the industry's best-practices in the future. Being a leader can be extremely rewarding.
Note to Anthem Your Voice Matters dated 23 Feb 22 Hello, I have not yet received a survey letter from Medicare; however, I'd be happy to let you know my thoughts. Please consider a program to encourage men to enter the nursing profession. It is very disconcerting (as a male) to visit a urologist (or other provider re male intimate issues) and be interviewed, prepped or otherwise tended to by a female. This is a dignity/ privacy issue, rather than a competency one. Just as women might want to receive care for intimate issues by a female, many men have the same desire. Anthem has the "clout" to require that their male subscribers be given the same gender-concurrent options that are given to female subscribers. Why has this not been done? Please consider the outcry if a woman needed a mammogram and was told that there were only males available for this procedure. A male faces the correlate situation when he is to be prepped for an intimate procedure - a female is the only one available for the prep. Shouldn't men be given the option of a male caregiver? Would you do what most males do (i.e. forgo the procedure)? Is this fair? Place yourself in this situation. Would you think that no one considered your feelings or your dignity? Having more male nurses available would be a solution. Anthem should be in the forefront of this effort of providing gender concordant care if desired by the patient.
Reginald
Jr. sometimes it feels like we live in a parallel universe
A friend of mine’s bother was charged with indecent exposure and had to register as a sex offender. What happened was he had been drinking and was at a convenients store when he left the store he had to relieve himself and went to the rear of the store to do this. a woman saw him reported him and the rest is history
His intent was not to offend anyone but it obviously turned out to be a bad choice but he is now marked for life.
But if you enter a facility with bright lights and a hospital sign over the front door you can show what ever you have and they can look at what ever you have even if the amount of exposure isn’t necessary.
I personally can’t switch gears like that but they do and they look at us like we are being ridiculous
I always wondered if the woman that reported my friends bother was a nurse LOL I find the thought of that ironic but not impossible
Jeff
Reginald EXCELLENT
I am on Medicare through Aetna. maybe if everyone was to send letters to their respective insurance companies it might create some positive movement.
Do you mind if I use your letter as a template?
Jeff
I’m sorry Reginald I went back and re read what you wrote and what I just suggested is what you were proposing at the very beginning
But it is an excellent idea
Jeff
Excellent letter Reginald.
Concerning the oft quoted 90% female non-physician staffing, that is an overall average. In the nursing arena at least, my understanding is that males tend to gravitate to ER's & ICU's rather than general patient floors or office practices. That in turn means non-ER, non-ICU areas have less than 10% male staffing.
The reality of non-physician demographics will take decades to address even if there was a concerted effort to encourage more males to choose non-physician health careers. What can be changed rather quickly if it somehow was deemed important is changing protocols to not needlessly expose patients in terms of extent, duration, and audience. The casualness with which male patients are needlessly exposed is a learned and/or chosen behavior, not a demographic reality.
On the bright side, there are some hospitals that do make an effort. When I was having an ultrasound of my foot, I had a good conversation with the male sonographer that did it. He said he had been purposely hired to do testicular and other intimate ultrasounds for males that preferred a male do it. The urology practice has consistently had at least one male RN on staff and a male RN has been available to do my cystoscopy prep 5 of the 6 times that I have had it done there. Hospitals can make some effort if they choose to.
Hello Jeff,
I'd be honored if you used my notes as a template. We're in this together. The more exposure our ideas get, the better. Whenever I get a medical survey, questionnaire, etc., I always try to mention the lack of male nurses, privacy and medical garments to avoid needless exposure. Hopefully, someone will view these areas as important, especially if we refuse elective procedures which don't respect our privacy. Take care.
Reginald
You need to refuse them while there, not before hand. Then explain to your doctor WHY you left and he won’t be pocketing a hefty paycheck. Also to the hospital board why they won’t be getting your money. $$$ talks
I do the same thing with the surveys I even put a note in the suggestion box for what I would like to see in there monthly news letter. They asked and I offered. I’m sure they won’t know what to do with that but if you beat the drum loud enough eventually someone will hear it
Jeff
First, Reginald, excellent post!
Now to my most recent experience. On 8/22 I had a procedure done on my left hip called a iliopsoas tendon release. In 2018 I had a total left hip replacement. The socket where the hip joint goes into was reamed out and replaced with a metal and plastic insert that received the metal (titanium) ball of the new hip joint. The only problem was is the front of the socket has a sharp corner. The iliopsoas tendon runs across that corner. It causes pain. My solution is to smooth down the sharp corner with a Dremel like device, but the doc says that would put too much metal into the surrounding tissue. The professional solution is to trim away some of the tendon. Well, I am not a doctor so I go with their decision.
The pre-op visit was on 8/18. I explained my past abuse experience to the nurse and she said she would advise the OR coordinator so I could have an all male team. Upon my arrival on 8/22, I was surprised to learn that my wife would not be allowed to come with me to the prep bay. She was with me on my 3 previous surgeries and I was with her on her 2 previous surgeries. It was a Covid thing. OK, I was disappointed but understood that my support person would not be there. Once in the prep bay, I asked the female nurse if she was aware of the abuse past. She said she wasn't. She then read the notes from the pre-op nurse and saw that it was mentioned. Strangely, she asked for details, which I provided. She said that I had a male OR nurse assigned to me. Soon, the team came to my prep bay and introduced themselves one by one. The doctor,the nurse, and the anesthesiologist, all said that they had no knowledge of the past abuse, so I had to tell them each of it. It was difficult.
Continued...
58flyer continuing,
I was rolled into the OR and kept awake long enough to help them transfer me from the gurney to the OR table. Then I went to sleep. I woke up back in the prep bay with my wife there. She took a picture of me with my mouth hanging open. Now, she couldn't be with me in the prep bay before but was brought back to the same prep bay when I was recovering! I don't understand that! My wife helped me get dressed and we left.
Once back at home I saw that the betadine solution, based on the coloration of my skin, only went from my hip to my knee and about 6 inches wide. Contrast that to a hip replacement where you are skin prepped from nipples to knees all the way around.
The surgery was successful and I have had a great recovery and my hip pain is gone. On 9/1 I went back to the practice to have the sutures removed. I felt really good about my team so I brought candy and a "Thank You" card to both the office team and the OR team. I had called previously and asked who was on my OR team so I could properly list them on the thank you note. One of them was Amanda. I was never introduced to Amanda! My thought at this point was that she, a surg tech, was brought in after I was sedated, so I never saw her. My thinking was that my team was the doctor, the anesthesiologist, and the OR nurse. But it now appears that there was also a surg tech. I don't know what she saw of me and I am not going to make an issue of it. I did hit them on the Press Gainey scores for not telling me my wife could not be with me.
At least I am happy to report that my hip is doing fine!
58flyer
58flyer, I am glad that your surgery was successful and that overall you are satisfied with how you were treated. Not letting your wife into the prep bay is odd but likely it was different people making that decision than the people that let her into the post-op area.
Was this done in a large hospital? I ask out of curiosity as to their including Amanda as the surgical tech vs having assigned a male tech, assuming a larger hospital would have both male & female techs.
Reginald
There is no such thing as an open CT scanner. You must be referring to an MRI. Appreciate that an open MRI scanner does not produce good diagnostic images as a closed MRI scanner.
PT
Jeff and Reginald
Medicare, Aetna as well as every other health care insurer on this planet and throughout the Cosmos couldn’t really care about who the gender was that was involved in your care. They are just the middleman that passes the buck! Now, if you were a female that was doing the complaining there may be some eyebrows raised if and only if those eyebrows were a female at said health insurer. You can be assurred that it is mostly females that work at these health insurance companies and your complaint, suggestion letter would end up in the trash along with some laughter.
PT
PT, welcome back with your comments here today. ..Maurice.
Hello PT,
My reference to the CT was relative to the opening. I'm looking for one like the Siemens Somatom Definition Edge which is like a large donut, rather than the older tube CT's.
Additionally, I do believe that a great amount of neglect for male dignity is the result of ignorance. Many are not aware that men actually are sensitive to their exposure. When they are made aware, they usually resort to the lack of male nurses. My retort to this is Why isn't there a "push" to enlist more males in nursing? This must be addressed to those who can affect change - gov., CMS, insurers, hospitals, nursing schools, etc. We need to get the word out. Yes, there are those who will utter disparaging remarks; but, I do think most people are accommodating. The Anthem individual who filed a complaint for me with Medicare was a female who responded, "I understand your concern." Maybe it's just our task to educate others. Isn't it worth a try?
Reginald
Biker,
It was not a hospital but a surgery center, even though it was in a large university setting, the University of Florida, ie, Gainesville, The Swamp. Yep, it was in a major university level teaching center. I expected that. The tendon release procedure is a cutting edge technology. I was a teaching example. But I was happy to have no students!
PT, welcome back, glad to hear from you!
58flyer
Sorry Reginald.. How was the I understand your concern said? Did she say anything personal after that? My husband/son feels the same? That’s what they are trained to say. Unless there was emotion behind those 4 words, it’s just words.
Cat
I will continue to fight for what is my God given right and even the founding fathers realized this in the constitution. just because the medical community feels that they set the rules of engagement. that is not their right and they should not be allowed to claim the moral high ground when it is not theirs to claim. it is 100% the patients right because it’s their body. And to give people drugs to hide what they do to to the vast majority of patients that are unaware and never told is a deception that wouldn’t be excepted in any other area of our society
Jeff
PT is correct. Neither the insurance companies nor CMS/Livanta care abt male patient dignity issues. While the insurance company, United, pretended to care, they did nothing. CMS sent the info to Livanta who said just "get use to it" as he was getting older and would have more and more medical encounters. PT is also correct in saying that most would laugh as they are tossing the complaint in the trash because many do not believe patient dignity is a right that should be afforded to male patients. Patient dignity still is not perfect for female patients who have fighting for that right forever--just ask Cindy with whom I do Patient Partners with every week as well as other guests we have had on there.
What I didn't see here is that 58flyer was lied to as there was a female surgery tech who was present and was most likely there and most likely the one who did the actual prep. 58flyer had set this surgery up in advance with his need fully explained and yet they deceived him. They didn't allow his wife to be present beforehand because they probably thought he would be easier to control without her present. Divide and conquer as there are more of them to gang up on a "difficult" patient.
Reginald, I have to take issue that I don't believe that male dignity is violated more because of ignorance. I believe that in today's society it is done as kind of a private laugh and that also when you bring up you want bodily dignity, they go beyond to make sure they violate it. I also think that many of them simply do not care as they feel you should accept and be grateful to them for allowing you to pay for and experience medical "care". Many of the nurses, techs I have spoken to become agitated when questioned over patient nudity and is all the nudity really necessary. Also, same sex care does not guarantee that whoever is providing the care is not sexually interested in your body. Greater emphasis needs to be on severely limiting genital exposure and educating the patient on when it is going to be, how, and by whom. Every walk of life except that as a prisoner, we are able to control this access. Why are patients treated the same as a prisoner? Why weren't (for instance) the Denver 5 charged with a crime that if it had been done by men to a woman in life outside of the medical world. Here locally, a restaurant male restaurant manager had put a camera in the women's restroom. He was criminally charged with a sex crime. Isn't that the same thing but since they(Denver 5) are "medical" they got by with doing it? Just because you are a patient receiving medical services, it does not give them ownership rights to your body in order to do whatever they want to it. This is the time where there should be very strict protocol in place but there is not.
The medical world is a great place for sexual predators to hide within plain sight because patients are routinely naked, drugged incapable and alone. Why would anyone not be scared of this is beyond me as the medical world does not employee just "angels" as there is no mental health requirements to be meet or to be ongoing throughout their career. The nurse who killed all those people in LA was I believe on meds for bi-polar. That's scary to me because many believe they are cured bc the meds puts them on an even course so they stop them and the result can be horrendous. Read her story and it should scare you too. According to one article, she had just come from work and was upset from arguing with her boyfriend. To me, this is a huge red flag. I don't want anyone who is angry to be alone and in "charge" of my defenseless husband or anyone else that matters to me. I do not believe they leave their personal problems or convictions at the door as we have been told over and over. This nurse left work and within minutes many people were dead.
I am in the process of putting up VOLUME 123 of Patient Dignity (Formerly Patient Modesty). No further postings will be reproduced on Volume 122. Write your Comments to Volume 123 when present. ..Maurice.
Here is the link to Volume 123:
https://bioethicsdiscussion.blogspot.com/2022/09/preserving-patient-dignity-formerly.html
..Maurice
Any idea when volume 123 will be up and running?
Jeff
To Jeff: This Volume is Closed for further
comments by participants. Click on this link to go to Volume 123 and there click on Comments.
https://bioethicsdiscussion.blogspot.com/2022/09/preserving-patient-dignity-formerly.html
..Maurice.
Click
https://bioethicsdiscussion.blogspot.com/2022/09/preserving-patient-dignity-formerly.html
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