What have you been reading, hearing or TV viewing that has provoked some feelings of comfort or concern about what is happening in the world of medicine, medical care, treatment or science? Ethics is all about doing the right thing. Are you aware of any issues in medicine or biologic science which are being done right, could be improved or in fact represent totally unethical behavior? Write about them here.. and I will too! ..Maurice (DoktorMo@aol.com)
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Let's hope this Volume 132 can continue with the needed emotional and intellectual support. .Maurice
posted by Maurice Bernstein, M.D. @ 6:18:00 PM
36 comments
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36 Comments:
Welcome Aboard.. I think the system for Volume 132 is working. ..Maurice
I hope this Volume 132 is working properly. ..Maurice
I’m responding on my end to acknowledge the new volume and was intrigued about the request of what the response would be from that urology clinic if a male was requested for the catheter replacement?
Would they accommodate or end up with a deer in the headlights expression.
Inquiring minds would love to know!
The valid response to Jeff is that there are virtually
no male LVNs in existence and if it is, as is the usual
situation, you will not be able to properly and safely
insert a Foley catheter into the bladder, you must have
the skills and caution awareness of a medical provider which will
be that LVN. It is just common current fact.."nothing more and nothing
less. And I know from experience and observation, male patients are
accepting the necessity of the insertion by a trained and experienced LVN.
There are some things in medical management where the patient has no
superiority to the skills of those in the medical system and every male
patient has to face this fact. Otherwise complications can occur which
puts the individual's life at risk. Of course you can't inspect the female LVN's mind at the time of the insertion but what is important that the Foley catheter is being replaced quickly and medically safely for the patient.
And my lengthy experience as a patient with women LVN is that is the
literal fact. ..Maurice.
Good evening.
Hope everyone is well.
I'm with Jeff on the catheter issue.
It's not about her as a professional or her abilities. It's the fact she's a female. Someone I've never met nor have I been with on an intimate level.
I have a mate that I took a vow with & she will be the only female that handles me much less sees me intimately period.
When I was single, having a female healthcare worker take care of my intimate medical needs if needed I would have had no 2nd thoughts about it.
Whether they like it or not, the american healthcare system must adapt to the changing times.
Men are no longer mindless bulls they can tell to leave your dignity & privacy at the door or don't bother asking for help.
If they refuse to adapt, then the blood of countless men whom they forced to walk away from the care they needed because of the way the healthcare system treated them, will be solely on their hands & they won't be able to lie their way out of it.
Males aren't asking for the world. They are asking for equality, compassion, empathy, integrity, & advocacy. The same thing they freely give their female patients.
That video on catheter removal should be SOP in every doctor's office & medical facility in this country.
If it's medically safe to do, every patient should be offered the chance to do it themselves in private.
,
Time for the healthcare system to wake up & embrace change where procedures are concerned.
Thank you NTT for validating my whole point in this matter! For all the years this blog has been running I think we can all agree to the need for sterility when placing a urinary catheter ! Doctor Bernstein it seems you are placing all the emphasis on the medical mechanics of the procedure while side stepping what I thought was the whole theme of this blog. MEDICAL PATIENT DIGNITY and how can we receive it? Although I have issues with unnecessary exposure which I have experienced on more than one occasion I thought that by now it would be Abundantly clear that the main issue is the gender of the person obtaining access to your most intimate areas! I have heard from multiple men on various sites that prefer women for intimate care and the only reason for that is they see what is being done to them through a sexual lens.and it is for the same reasons that other men do not want that kind of care by a woman when it causes you to feel embarrassed/ emasculated/disrespected and about a dozen other emotional words that could be chosen.
What has been expressed here for years is CHOICE or the lack there of and in many cases a total lack of transparency.
How do they justify causing someone to be triggered by their treatment because of underlying trauma in their past whether it be male or female and apply ambush tactics. The alternative is you don’t receive treatment because they are unwilling to accommodate and refuse to try. This is the price we all pay when an Industry has been hijacked by the greater need to make money and not so much to heal and do no harm
As an active male physician in the past and now retired since the beginning of
2021, I did, since before and still now, look to what is in the best immediate clinical value to the patient and look who is in the very best clinical value to
provide the essential service to the patient. Of course, I cannot look into the current active mind of the person rendering the service or the patient. No one can..but to me it is the results, the clinical outcome, the medical or surgical results of that is being performed on the patient. Every patient has their own individual rights and have every right to express and follow their wishes but it would be unprofessional not to perform clinical/surgical care on a patient who is symptomatically unconscious unless if clinically untreatable or if family member surrogates order to the physician to avoid attempts to begin medical/surgical treatment under the patient's current and expected permanent mental status. Every conscious patient has their right to define who is to treat them if the patient requires that treatment.
I hope this explains the basic principles in ethical medical/surgical practice. ..Maurice.
I am also confirming access to the latest volume and will soon respond the the latest comments by Jeff, NTT, and Dr. Bernstein.
EM
Dr. Bernstein you made a statement that this whole topic hinges on and I quote
Every patient has their own individual rights and have every right to express and follow their wishes.
You are absolutely correct every patient has the right to express their wishes and that is where it all ends. At that point to follow your wishes will more than likely leave you with the choice to except the procedure in the manner that they chose to deliver it or they will show you the door
I guess the moral of the story is wishes are like noses, everybody’s got one but rights are a completely different story
Dr. B., I hear and comprehend what you are saying in your last post but unfortunately far too many medical personnel do not either hear, understand, or both. Yes, we cannot look into the minds of others but we certainly can guess as to what their intentions are by their actions. And yes, patients who are unconscious and no next of kin available then treatment is given. That is acceptable but there again it is how the treatment is given is what I am concerned with as are many others here on the blog. We know that most of the time and even admitted to by a doctor (https://pmc.ncbi.nlm.nih.gov/articles/PMC8935547/ that patients are generally unnecessarily exposed during code blues and that he realized this and failed to act. This doctor said, "However, why assume respecting modesty and restoring blood flow are mutually exclusive?" Why indeed? He went on to say, "Rarely do I leave a code, regardless of the outcome, believing I did everything I could. Sometimes I don’t have the courage to try to cover the patient. Sometimes I don’t think about it until later. But by preserving their modesty without compromising the efficacy of their treatment, we can better honor the trust they place in us. Rather than wondering what they would have chosen if they only knew, we can ensure that they do know, and then treat them with the dignity they expect and deserve." So why do we keep coming across stories of patients being exposed unnecessarily and patients being forced to have intimate "care" given by a gender or even a person they do not feel comfortable with for that purpose? Why do we especially have female caregivers saying--I've seen it all before? - You have nothing different/special. - etc. Are they not taught that patients have the right to bodily dignity? Are they not taught that yes a patient being unnecessarily exposed by them is not the prime focus--it is about what the patient wants and feels comfortable with? Why are they not taught to deliver humane, compassionate care? What would happen in today's world if a male caregiver came in alone to a female patient who didn't want his care and he said you have nothing I haven't seen before? I bet we would see that in a newspaper. Female medical providers for too long have successfully been able to sexually discriminate against male patients. Again, I understand that you, Dr. B., believe in what you say and have taught but you are not the problem but rather it is those who do not follow your same principles. And yes, I do realize that some do not have an issue with whatever gender delivers their care but again this does not justify in what I am generally talking about--the need of medical personnel to unnecessarily exposed patients. JR
Usually the answers that patients get on forums like Quora to matters of patient privacy & dignity are either that it doesn't matter or that it is an either/or issue. It is as if they believe a patient cannot both receive good care at a clinical level and be treated in a respectful manner. They seem to think that asking for both is asking for too much.
Because I am well experienced in female staff being far more prone to needlessly exposing me than are male staff, I ask for male staff when that is an option. I accept the reality of healthcare demographics meaning that usually there isn't any male staffing, and I'm not going to deny myself healthcare on that account. My primary issue is the routine needless exposure, be it in the form of extent, duration, or audience. And audience includes chaperones which to me are at the top of needless exposure list.
https://www.nj.com/hudson/2024/12/jersey-city-doctor-charged-with-sexually-assaulting-patient.html This article should send up so red flags for those on this blog. An 88yr old male doctor sexually abusing/assaulting a male patient during 2 different visits is the main theme. First, IMO the doctor was too old to be practicing medicine. Secondly, it once again proves that same sex care is not safe or without its problems. Cindy and I do our best to inform/educate patients about good touch/bad touch in medical encounters. We have done numerous shows on what should not happen during a medical encounter. If you read the article be sure to scroll downwards as there are more cases of sexually inappropriate medical encounters listed. JR
JR since the horrifying humiliating experience, I had with open-heart surgery combined with other humiliations placed upon me in other surgical settings always at the hands of women. In recent years I’ve been digging into my past specifically childhood through the help of a therapist. Only to find out piece by piece of multiple incidents of blatant humiliation fostered on me by women of Authority. I have come to understand why some of the treatment that I received in a medical setting felt like more of the same disrespect and humiliation being placed on me by women of Authority (and what they did WAS disrespectful ) the deep wounds and scars left on me in my early developmental years by what I would classify as cruel women, all of that lay dormant in me throughout my adult life until I got introduced to the medical world and it manifested into one of the most traumatic triggering experiences of my life. That is why I focus and zero in on women stripping me naked and handling my genitals.
You have clearly and accurately described on many occasions the differences between what motivates female versus male medical professionals to violate patients. I believe that almost all literal sexual violations that involve an actual sex act are committed by men and men depending on their sexual orientation can will and do violate both sexes. Women on the other hand are generally motivated by other reasons and are much more clandestine in their approach and operating on different motives they-usualy pivot around power and the pleasure some of them achieve by watching a man turn red in the face and seeing how much humiliation they can inflict on a man without ever losing that persona of a true professional. This is not the case for most of the people in the medical profession. The hard part for a patient (actually impossible) is telling the good from the bad. Is this close to the way you see it?
In my case with my experience and background it doesn’t matter because a woman for me in that setting will never cease to be a woman of authority with all the power over my vulnerability.
Intimacy with a woman for me doesn’t happen like that although they claim there is nothing sexually intimate about it I beg to differ. All you have to do is read some of the Dictionary descriptions of what intimate touch is . When they speak of the erogenous zone ! Is the hospital an erogenous free zone ? Or is that achieved with a pill or an injection?
Sorry for being so sarcastic but none of this is that hard to understand or figure out
Jeff, I completely understand because my husband no longer females involved in his care period unless he is fully clothed. Until he was sexually assaulted/abused, he didn't have that issue. Although he didn't like it, he tolerated it like so many men do because they feel they have no choice if they want to receive healthScare services. Even though I am female, I would also say that women in authority do have axes to grind. They especially love grinding their axes on men but make no mistake they will also harm other women too. Women get by with abuse more than men because women can hide the abuse over the falsehood that women are nurturing, compassionate, etc. and this holds especially true for women in the medical field. I have found that while people will talk about male medical providers in a negative manner, they are less likely to do so about a female provider. Yes, men are more likely to act in a sexual manner but that is changing and women are becoming more and more sexual although like you so well described many women still do their harm for different reason.
I just want to make sure those who are seeking same gender care realize it is not the cure all as it also presents unique harm situations which is why I preach/highlight no unnecessary exposure. And yes, since it is your body you get to decide how you feel. The "naked" experience isn't about what the medical personnel think or feel but rather should only be viewed from the patient's perspective as they are the naked one. I have read so many articles abt medical students having to become used to seeing patients naked but where are the classes for the patients as they are really the ones who matter? JR
As a former first and second year medical student instructor for "Introduction to Clinical Medicine", my view to the students and the view of the other instructors was that these male and female students must attend and follow the privacy issues presented by their patient who accepted their presence. And the students obey. ..Maurice.
Dr. Bernstein, I hope you & yours & your home are far from the fires currently raging in LA. It staggers my imagination what I am seeing in the media.
Concerning Jeff's recent comments, I agree that men are far more often the ones who sexually assault, usually females but sometimes males too. Though it may seem that assaults by women have grown more frequent, I suspect that may be more a reflection of the legal system finally being willing to acknowledge it. If the steady stream of female teachers being arrested for statutory rape of their male Middle School & High School students is any indication, it seems that women are more assaulting minors than adults. However it could be that few men are willing to bring assault claims to authorities.
What men more commonly face is needless exposure by female healthcare staff. Some may just be poorly trained and unaware of what they are doing wrong. Some that are aware may be driven by the power dynamic that Jeff & JR mentioned; their enjoying the embarrassment of their male patients. If the patient is young, fit, and/or good looking, or if he is otherwise porn star material, the incentive might be basic voyeurism.
Just as male pedophiles found safe harbor in the priesthood & Boy Scouts for many years, female voyeurs & those on an anti-male powertrip still to this day can find safe harbor working in healthcare. This is almost always women below the physician level.
There are bad apples in every profession. The problem with healthcare is that they rarely weed out those bad apples.
Biker you tied in a very good point with teachers and students, Priest and scout leaders and young boys all being places where pedophiles, voyeurs and sexual predators can hide in plain sight. What would make anyone think or believe that medical settings would be any different?
Patients are probably the most vulnerable of all! it just takes a lot more effort and education to be allowed in a position that gives you that much access. Even that is not necessarily true if you consider medical assistants and CNA’s that require very little training. And chaperones can be the receptionist with no training at all.
All of the examples given by Biker have one thing in common they are all positions of trust and Authority and the one that is afforded the most trust and the belief and claim that they would never treat anyone with anything other than the upmost respect and professionalism has been proven to not be true in many documented cases.
Many people refuse to believe they have been handled in a way that didn’t require the amount of exposure they receive but once you do how and who do you trust going forward?
I just read an article that blew me away that everyone needs to read .
If you Google “ the legal and ethical imperative of explicit consent in intimate medical procedures” the article will come up
Jeff,
https://aihc-assn.org/the-legal-and-ethical-imperative-of-explicit-consent-in-intimate-medical-procedures/
The author of this article, Shelby, is the wife of a man who sexually assaulted/abused during medical treatment. She and her husband have een on our radio show and she works closely with Misty. Shelby wrote another article that was published in Voices in Bioethics, November 2023. https://journals.library.columbia.edu/index.php/bioethics/article/view/11927 Shelby is another wife who is not going to passively allow her husband to be abuse while seeking medical treatment and she is also a survivor of medical sexual harm when she was a child. JR
JR I remember when you had him on and I remember reading what happened to him. I didn’t Connect her name to his story . It is an excellent article and the issues that exist couldn’t have been spelled out any better. I got it from a site that I follow called #medical me too which obviously you are aware of.
Now that you pointed that out it all makes sense THANKS.
Jeff, They used aliases as they were pursuing legal action at the time. JR
Good Afternoon:
Shelby Harriel beautifully explained the issue we face in both articles. It's too bad, the healthcare system isn't listening because state & federal government isn't forcing them to.
The state legislation to stop unauthorized pelvic & rectal exams was a start be they must take it further however, I know from talking to elected officials in my state, they don't have the spine to go up against the medical community & make more rules for them to follow. One rep told me just getting the pelvic law was like pulling teeth.
Oh well, the fight goes on.
A pleasant evening to all.
Regards,
NTT
NTT, and if legislators won't ban non-consented pelvic exams of unconscious women, anything and everything else many of us would like to see isn't likely to even warrant an initial discussion on their part. Change will only come from patients speaking as and when they deal with the healthcare system.
There is no doubt in my mind that from a medical clinical viewpoint there is
an absolute value to the ventilation of information and personal perspective
which is written here on this "dignity" topic but on every other topic on
this Bioethics blog. It is both supportive or clearly informative to all the visitors to this many many year old blog. ..Maurice
Hello,
I'd like to relate what happened during my son's (age 52) recent hospital visit. I wheeled him in a wheel chair into a large room with six beds surrounded by curtains. I helped him onto a bed and, the nurse asked him to put on the gown. She said that only his shirt needed to be removed and, she closed the curtain. She asked if we were ready, opened the curtain and, said that I could sit in a chair near the bed. The doctor entered and spoke with my son re draining his abscesses. My son indicated that he was hoping for drains for the abscesses instead of just a one-time draining. The dr. said that he didn't think he had drains small enough and left to check. He found possible drains and, told my son that he would consult with my son's dr regarding them. After a short while, the dr returned to say that both doctors agreed to try the drains. The dr began prepping my son's back for the insertion of two drains for abscesses near my son's spine related to a previous back surgery. He lowered my son's pants a bit and placed a towel over a small portion of the top of my son's buttocks to (as the dr said) maintain his dignity. The dr readied an ultrasound unit and began the operation. He periodically asked my son how he (my son) was doing and, even asked me to turn off the lights that he didn't want to touch with his gloved hands. The doctor sutured the drains in place, gave the nurse instructions for my son and left.
I was astounded. The doctor actually listened to my son and allowed my son to voice his (my son's) requests. The dr actually agreed. I was not asked to leave. I did not gown. The dr was concerned for my son's dignity. I was treated as if I was an actual person. As we left, the nurse even thanked us for coming and wished us a nice rest of our day.
From what I've related, I'd suggest that hospital protocols need not be set in stone and, that patients and their caregivers can be treated with dignity and respect. However, finding the right hospital might be a challenge.
I hope that others here will have similar positive experiences.
Take care.
Reginald
You know to write the hospital admins about this. Wish they would teach other facilities this is how its done. With this kind of respect for patients id be glad to allow students. Cat
As folks here know, there are many possible reasons for feeling as we do about how healthcare is delivered. After more than a year of thinking about my reaction to an experience and then running a followup experiment of sorts I think I now understand what one of my drivers has been.
That prior experience was my not being embarrassed or self conscious with a female nurse's presence for a cystoscopy. I had always been somewhat embarrassed & self conscious previously with female nurses, but then this time I wasn't, and I didn't understand why. For several years I had male nurses but one wasn't available this time. The experience perplexed me, so this year I decided to not ask for a male nurse and see what happens, though I was hoping that if I had a female nurse it would be the same one from a year ago.
While waiting to be called I saw that they had a male nurse and almost went up to the desk to ask to be assigned to him, but then convinced myself to just take my chances. An older female nurse came for me, and I again found that I wasn't embarrassed or self conscious with her. It left me very perplexed but after thinking about what commonality there might have been last year and this, I realized what it was. Neither viewed me through a sexual lens.
How can I know this? A lifetime of being viewed that way. Starting at age 15 girls were throwing themselves at me and it continued in work settings, social settings, pretty much any setting, even in front of my wife. I learned how to react (or not react) in ways that wouldn't embarrass or encourage them. I always knew when it was happening and in non-healthcare settings I could control the situation because we were on even ground.
In healthcare settings it wasn't an even playing ground. I was undressed and powerless and they were dressed and in charge. I could tell when I was being viewed through a sexual lens, and it made me uncomfortable as I never wanted to be judged on my looks but rather intelligence & personality. Some would say it was a good problem to have but I was never fully comfortable with it.
Realizing that the commonality between last year's experience and then again this year was my not being viewed through a sexual lens was liberating, especially since I am now perhaps old enough that it isn't likely anyone working in healthcare will view me that way anymore. That said, next year I will go back to asking for male nurses to do my prep on account I know I will be comfortable with them.
I think one root of the problem of male patients being treated badly in this instance is there isn't any accountability for the female staff embarrassing the male patients. It's much harder for a female to cover up feelings of humiliation and often will cry. A large ratio of the Healthcare workers aren't feeling sexually towards the patients but who ever set things up the way they are weren't doing anything out of pure or innocent motives. It was never a coincidence when most gynecologiss were male. It isn't a that the surveys limit what a patient can complain about.
My sister talked about how bad the staff was about violating her modesty to just whoever else happened to be around. Ok. This doesn't have to do with modesty but my sister was told she only had a year left. Her doctor was adamant about that. She ended up dying after 3 years. Just a couple of weeks ago. My question is did she die of Cancer or the Cancer treatmentc JF
Good morning.
I read your comment Biker.
You said an older female nurse came for you. Could the fact you dealt with an older female nurse instead of a 20-something nurse have been what made you feel comfortable with the situation.
Some men are more accepting & more at ease when the opposite gender caregiver is closer to their own age.
Regards,
NTT
NTT, it's possible that her age was a factor. I think most guys find it more embarrassing being exposed to young women. In this case, I think it was more her attitude. I could tell that my exposure didn't mean anything to her. The interaction almost got off to a poor start when she asked me if I wanted a gown. It startled me and I responded "yes I do, I'm not an exhibitionist" but even then I knew for her it was just a practical question in that the gown would only provide cover as I walked about 6 feet from the changing room to the table. She took no offense at my response.
Once I was changed (in private in an adjoining room) and on the table she proceeds with the prep and we had a nice conversation. Turns out she is a travel nurse from the South. She was planning on giving up on the travel and returning home to her family and going back to working in pediatrics. I found it interesting that urology was not her area of interest.
So again, given my life experience, I just knew she had no interest at all in me or my exposure. There aren't many advantages to getting older, but for me I now realize that healthcare interactions might be a bit more comfortable than they were in past years.
Something about what you and BRT said made me remember about a memory from recent years. I don't believe my coworkers got sexual gratification from seeing our elderly patients nude but they DID however get something out of exposing nude patients to other patients. One coworker insisted on leaving the door open in case somebody fell in the hallway we'd be able to hear them but this same coworker would leave the building at night for two or three hours I tried to protect the privacy but sometimes met with resistance. One coworker just told me No. She's just gonna see his ass I should have turned her in but I strongly suspect it wouldn't have been taken seriously anyway. If I'm spelling badly I'm sorry. I'll be getting cataract surgery in a couple of months JF
JF, were those co-workers very young? Most of the stories I have read about sexual improprieties directed at nursing home patients involved very young staff.
Different ages. Younger than me. JF
One of the worst experiences I’ve ever experienced was at the hands of a nurse in her fifties. Age doesn’t always matter. For me gender is the issue not the age. It is always possible that after years of being desensitized to exposing patients it becomes so commonplace that what can be perceived as professionalism is really complacency. When it comes to that kind of exposure to a woman I want it to be meaningful (like in a relationship) not meaningless. That is when I feel disrespected ,dehumanized and emasculated. I know everyone doesn’t feel that way but I have a long history of abuse by women in authority taking those kinds of liberties with me going back to childhood. For men they only have one option, let women expose and touch you intimately or forgo treatment
Biker all different ages all younger than me JF
Greetings to All,
I have not contributed in a while and thought I would comment on the topic of whether or not the age of medical staff makes a difference. I am also more leery of younger staff and would be more comfortable with older nurses as I perceive the younger staff to be more immature and prone to the types of behaviors that I see illustrated on AllNurses or in Facebook memes (body shaming i.e. a scared turtle needing a catheter). I have a slight twist to Biker’s perception of whether the nurses were looking at him through a “sexual lens”. I have never felt that a woman is looking at me in a sexual way but I find that if I do not have any potential sexual interest in the nurse, I find the situation to be much less troublesome. I am more concerned with the intentional humiliation through unnecessary exposure.
I may be forced into coping in the near future as it turns out that my ESWL procedure to fragment my kidney stone did not work and a 6x5mm stone still exists. This may necessitate an ureteroscopy with laser lithotripsy which is the procedure that caused me the most anguish 11 years ago and brought me to this blog.
In a side note, I have been looking for volunteer opportunities in my community and have decided to apply at a local hospital. In addition to helping relieve work pressure on the nursing staff by performing menial tasks not requiring medical training, I hope to gain some insight into what actually happens in a medical environment from the inside and will be a “fly on the wall”. If I observe positive interactions affirming patient dignity, it might help lessen my concerns or at least make me feel that the bad behavior is an exception and not the rule. In addition to the menial tasks, I am thinking I could be available to lessen another modest man’s discomfort by being available to assist in dressing or other activities where exposure to women is embarrassing to the patient.
EM
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