Preserving Patient Dignity (Formerly Patient Modesty) Volume 131

 Now is the time to move on to this Volume 131. There are still many aspects of this blog topic title which can be "born" or further developed. ..Maurice

Preserving Patient Dignity (Formally Patient Modesty) Volume 130

IF THE PRESERVATION OF PATIENT DIGNITY MEANS THE PRESERVATION OF THE INTRINSTIC POWERS PERMITTED FOR EACH AND EVERY PATIENT, THE QUESTION

IN THIS ERA OF MEDICAL CARE AND INTERACTIONS IS WHAT ROLE WILL FURTHER DEVELOPMENT OF ARTIFICIAL INTELLIGENCE (AI) MEAN TO THE DIGNITY OF EACH AND EVERY PATIENT.

Preserving Patient Dignity (Formerly Patient Modesty) Volume 129

Preserving Patient Dignity (Formerly Patient Modesty) Volume 128

 

Here, from EM's post in Volume 127 (November 2 2023) is a wonderful summary of this series of Volumes on Patient Dignity but also about the many years of publication of my blog itself.  EM, thank you, thank youfor your research and evaluation.  ..Maurice

Dr. Bernstein,
Congratulations on your upcoming birthday! I wish you all the best and continued good health.

You have created quite a legacy with this blog. I would like to thank you for the time and effort you have expended over the many years. I am retired now but can’t imagine being dedicated to something for over 20 years. I have seen several other blogs/sites that have addressed the same issues but none that have reached the quality and quantity of the discussions on your blog. It has been very therapeutic for me even though it took 8 years for me to contribute. I agree that the existing content should not be lost no matter what happens to the blog in the future.

I first found the site in 2014 and eventually went back and read all the posts since its inception to gain an understanding of what people have experienced. You added great value to the blog because of your medical background/perspective and thoughtful questions which prompted lively discussion. That does not really occur on other non-moderated platforms although there are responses from classes of people such as doctors or nurses. I don’t know how much time and effort that is required of you to maintain the blog but I would certainly understand if you were ready to step back from it.

I think the concepts of medical modesty/dignity have been thoroughly discussed and illustrated. Most participants in this blog understand what should be done to address the issues but the big question is whether there will be any movement towards the goals in the future or even how to accomplish them. I would hope that societal norms might change to embrace the concepts this blog espouses but due to the looming shortage of medical personal and the major problems the country faces, I am pessimistic that things will change.

The drop-off in readership could be due to a number of reasons. There are newer platforms that people may be more familiar with, such as Quora. I also think that interest in the idea of Medical Modesty/Dignity is somewhat random and occurs when people have a negative experience while seeking medical care. People who have positive experiences generally are not going to be doing searches on the topic. I also think that the horrific state of affairs in this country and the world over the last several years could have distracted people and suppressed interest. I personally find it difficult to think about the blog when we seem to be walking towards nuclear war and the economy/financial future of the country is in jeopardy due to indifference of our elected officials.

EM

Preserving Patient Dignity (Formerly Patient Modesty) Volume 127

 

A Worthy Posting today on Volume 126 to set off a discussion of  "Preserving Patient Dignity"which should be more acknowledgment that there has been, within the past, some ignorance by the medical profession that the concept of the dignity of the patient exists and should not be attacked and injured. 

Here is the last posting of our contributor Reginald:

Hello,

As I pondered why dignity is such a hard concept for healthcare, I mused regarding what has changed – realizing that what happened in the past was not always something better.
Thirty years ago I had a cardiologist as a GP. Yes, a cardiologist as a GP. That this was possible was astounding, even at that time. I visited him once a year and, the visit lasted for almost an hour. The session started in his office. Yes, in his office, not an exam room. His first statement was, “Tell me what has happened in the past year?” He’d then listen, respond, and ask further probing questions. After at least 30 minutes he’d invite you to the exam room while he followed with his black bag. (One would think that he was a doc out of the 1800’s.) The exam was complete – nothing missed – no rush. Bowel issues might be addressed in the exam room via a sigmoidoscopy, a modified colonoscopy without anesthesia. There was no need for another office or hospital visit. The exam might be interrupted as he was called out to answer a patient’s phone call. He could be heard saying, “No, Mr. Smith. You must take that medication for the rest of your life.” He’d return to the exam, apologize, and continue. His wife was his assistant and his receptionist. This was in Santa Ana, CA not in rural America. Sadly, when he heard that the insurance companies were limiting payments to 15 min. visits, he retired. He was too professional to be directed by non-medical entities.
What’s changed? Aside from the fact that a cardiologist could also be your GP, your visit took some time and the doctor LISTENED. An hour-long visit will not return but, LISTENING doesn’t really require much time.
Today, few in health really listen, nor do they ponder what they’ve heard. A quick diagnosis is made and you’re on your way. In a hospital setting, no one will listen to you AT ALL. For any procedure there’s a protocol and the protocol comes before the patient. Dignity issues are not addressed because they are not part of the protocol or, because they interrupt the procedure. No time is given for consideration of the patient’s requests for dignified care.
I do believe that this is at the heart of our responses (real or perceived) to what we consider breaches or dignity. Yes, there are bad actors; but, overall health care personnel don’t plan to harm. They don’t listen and, they are unwilling to spend the time to consider how protocols might be revised to accommodate INDIVIDUAL dignity. Group “dignity” is attended to via politeness and courteous; however, individual dignity is never addressed. This would require time and, getting to know the patient as a person and not a procedure. Is there any hope that this will change? What can we, realistically, do to affect change? Maybe, more importantly, the question is Would anyone in healthcare even consider the above explication of individual vs group dignity?

Reginald

Preserving Patient Dignity (Formerly Patient Modesty) Volume 126

 WELCOME TO THE NEW GENERATION OF COMMENTATORS TO ADD TO THOSE WHO HAVE BEEN PRESENTING THEIR VIEWS ON THIS SUBJECT IN THE PAST.  

REMEMBER, THE TOPIC SHOULD BE CARRIED BEYOND YOUR PHYSICAL MODESTY ISSUES BUT CONSIDER THE MORE GENERAL TOPIC OF PATIENT DIGNITY OF WHICH PHYSICAL MODESTY IS BUT AN ELEMENT OF THE ISSUE.  ..Maurice.

Preserving Patient Dignity (Formerly Patient Modesty) Volume 125

 TO ALL THOSE WHO HAVE BEEN READING AND CONTRIBUTING YOUR COMMENTS TO VOLUME 124,  BLOGGER.COM HAS SHUT DOWN THAT VOLUME (PRESUMABLY RELATED TO THE NUMBER OF COMMENTS EXCEEDING A LIMIT. )

PLEASE CONTINUE YOUR DISCUSSIONS NOW ON THIS VOLUME 125

I LAST POSTED THERE THE FOLLOWING:

I feel from a legal point of view of an ethics blog which this blog is an example, it would be legal, ethical and fair for this blog contributors to AVOID naming specific names of those individuals or institutions regarding their misbehavior or potential criminality unless you can provide publicly available news publications as reference that has been the resource for already having publicized that particular misbehavior or criminality. Specifically naming names of individuals or institutions which has not been already written in the news media should be avoided. We have to be fair. ..Maurice.

Preserving Patient Dignity (Formerly Patient Modesty) Volume 124

Since December of 2007 when Patient Modesty, as part of this bioethics blog begun, my question arises to my contributors and readers here: has there been any changes to the good or to the bad regarding how the matter of bodily modesty of patients male, female or otherwise have been interpreted and carried out?  Any changes?

It will be of interest to read about any changes within the past 15 years in behavior both of the medical system and the patients themselves with regard to this matter.  ..Maurice

Preserving Patient Dignity (Formerly Patient Modesty) Volume 123

 

  These days, particularly these days, there is much to write about the preservation of patient dignity by the medical profession.  Why these days? Well, it seems like pure politics has taken over important portions of how the medical profession is to behave when attending to the clinical status of their patients.  Some might disagree but there is no doubt, at least in my mind, politicians both in government and in medical professional services have taken over the "steering wheel" or the "reins" of how the medical system is being directed to the patient. It is important, in my opinion, that this "take over" be fully recognized by all and something done to bring it to an end... a conclusion.  I think that some in politics, law and medicine are failing to fully recognize and attend to this professionally degrading issue.  

You should appreciate the value of what you write on this blog thread and the needs of your hopefully constructive comments and actions to promote a betterment of the medical profession.

..Maurice  Bernstein, M.D.

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..

Preserving Patient Dignity (Formerly Patient Modesty) Volume 121

 

 

Actually APODYOPSIS is not only  the "Word of the Day" but is also the expression of the participants of this blog thread over the years as applied to  those within the medical profession who attend to patients. And, upsetting the visitors here, professional misbehavior involves more than "mentally

undressing" (though that can happen) but undressing the patient in a physical sense  for unneeded inspection or procedures. But either way, the visitors find such motivation and behavior clinically unnecessary but also destructive for maintenance of  the patient's dignity.

 Graphic: Jason Travis Ott via Google Images

Preserving Patient Dignity (Formerly Patient Modesty) Volume 120

 

Perhaps, as implied by many the participants writing over the years to this blog thread, the way the medical profession is behaving, in their eyes, this sign should be posted at entry of every hospital and medical office. The question arises is whether truly humane and worthy clinical diagnosis and treatment  can really be accomplished without respect for the intrinsic dignity of that patient.  How would such a sign reflect upon any dignity to be applied to the medical institution or its employees?  If no attention to dignity of those entering and no attention to dignity of those providing diagnosis and treatment what is left  to admire about the experience of the medical profession and their patients?  ..Maurice.

Graphic: From SmartSign.com via Google Images

Preserving Patient Dignity (Formerly Patient Modesty) Volume 119

 

As can been seen and read on the previous Volumes, defining and establishing recognition and preserving the inherent dignity of each and every patient is a challenge for all those who attend them.  It is a challenge which is not removable nor to be discarded but must be part of each and every interaction with a patient or even the patient's family.  

And even a pet cat as a ill cat and patient deserves dignified professional care. Such an example was published on Volume 118 but reproduced here as presented by JR. She contrasts the pet's attention and care with her current and prior description of the care provided for her ill husband.  ..Maurice.

As some of you might have noticed, I took some time off bc my one cat, Jimmy, was very ill and I wanted to devote as much of my time possible to him. He didn't make it so I needed more time but now I am ready to start working again.

I wrote to Dr. B. and he suggested I might share my experience w/ Jimmy's care as I am the wife of a medically/sexually abused patient. Jimmy's experience was totally different. Even though the family vet left Jimmy's illness go on for way too long without knowing what he had, I know he was doing his best. He and his staff were nothing but kind, compassionate, and caring towards Jimmy. Everything done to Jimmy was explained and permission asked. Completely different from my husband's experience.

The specialty vet center where Jimmy went for chemo was wonderful beyond words. Chemo and specialty treatments for animals is very, very expensive. They made sure before they did anything to check with us listing alternatives, risks, expectations, etc. before doing anything. We rec'd detailed summaries of every aspect of the medical encounter along with detailed billing even receiving a refund on an overcharge which truthfully we wouldn't have recognized if they had decided not to be honest.

During the visits, they would talk to us. They would talk and interact with Jimmy in our presence before taking him for testing to make sure he was comfortable with them. I remember once while we were waiting the tv was playing a show that was on tv the night I had to wait for hours & hours at the hosp from hell having no word for hours abt my husband (this happened while he was being sexually abused by Leather Hench & co.). I was distressed & so was my husband. I asked them to pls turn off the tv asap bc of the traumatic events associated with it. They did it asap and from then on there never was a tv on in our patient room. This clinic is actually just a few miles from the hosp from hell but to this day, we have never seen it again bc it represents hell.

On Jimmy's last day, I knew he wasn't doing well. He was supposed to get his 2nd dose of chemo as they gave it to him over 2 days each treatment time. His lymph nodes had swollen bigger than ever just basically overnight. He wasn't moving around much as it was getting difficult for him to breathe. I could tell Izzy the nurse knew he had issues as she took him back. Dr. W. came in a short time later to say he was in distress and needed to put a catheter in his arm while she still could. We agreed. She left and came back and we had the talk abt what was best for Jimmy for the final time as from the beginning Dr. W. had laid out all the scenarios and it was clear the chemo had failed and had in fact, caused the cancer to become more aggressive. Our son didn't like hearing that it was time for Jimmy to die before he suffocated to death. He said he needed to see the proof--the science. W/o any hesitation, she provided the medical evidence. She knew I didn't believe in killing them bc the shot can have bad consequences but she explained she doesn't merely give a shot but goes in through the catheter with a pre-med. Once it works, she goes in again through the catheter & administers the drug that actually kills so there are no horrific side effects of being killed. She said she would arrange for it to be as peaceful as possible. She did.

She had us taken to another room that is not an exam room but rather a private family space. She came back with Jimmy all wrapped up in these think furry blankets. She told us to spend time with him as he was stable for the moment. We all held Jimmy. He got up and moved around. She and Izzy came back and arranged us on the floor around Jimmy including her and Izzy. We sat there and held Jimmy's hands while she administered the drugs. All of us were crying including her and Izzy. She said would continue to cry later at home (she had told us one of her cats had brain cancer so she knew what we were going through). Jimmy left us very peacefully. Dr. W. had asked us what we wanted done w/ Jimmy & we wanted to take him home so she said she would take him back when we were ready & clean him up, clip some of his hair for me, and make prints of his paws. She also said she would take off his bell for his sister Danny to wear. I gave them Jimmy's blankets and later they came back with a packet of Jimmy's things and Jimmy in a little cardboard casket. She said we could leave by the side door and we could settle the billing later.

The Sexually Seductive Patient: How Should Doctors React? Chapter 2

 

On my other threads on patient modesty and why doctors are hated, there is much concern and worry about sexually seductive doctors. Such concerns are warranted even though I am sure most doctors will treat patients professionally and keep to the professional and legal boundaries of behavior. However, physicians have their own concerns. One of their concerns is the behavior that the patient will bring into the office. There are the angry, disruptive and frankly belligerant patients. Medical students are taught to expect such patients and to react by trying to understand what is motivating these patients to these behaviors since such understanding may provide a therapeutic approach rather than the physician simply reflecting anger back to the patient. One of the more subtle and difficult patient behaviors for physicians to deal with is the sexually seductive patient. Such a patient, often a female relating to a male physician enters with the expression of obvious greater attention and interest with respect to the physician's personality and appearance than true concern about her own symptoms. Her actions may be sexually provocative. The patient may expose her body to the physician during the interview or exam to an extent which is clinically unnecessary. Female physicians are not free of seductive male patients.

Psychologists explain these patients' behavior as expressions of transference--where psychologic unmet needs are attempted to be met by engaging physicians who seem to resemble and reflect critical persons in the patients' emotional life. Of concern is the issue of counter-transference--where the physician may respond to this situation in a manner to support the physician's unmet needs based on the physician's emotional life. This can lead to physicians responding to the seductive patient in a manner beyond the professional boundaries of sexual attention.

How should physicians react to the seductive patient? Should they consider the patient has a psychologic or psychiatric problem in addition to their other disease and seek out evaluation, patient education and treatment for this disorder? Or should the doctor go ballistic and spell out the established rules of further behavior? Medical schools find that the need to educate students regarding how to deal with the seductive patient an important topic. I would like to read the views of my visitors on the subject of the seductive patient and what they think would be the very best approach to deal with the issue if it arises. One point I don't want to read from my visitors is that there is no such person as a sexually seductive patient or that the way patients behave is simply a reflection of the doctor's unprofessional behavior at the onset of the relationship. You have to be in medical practice yourself to see that this conclusion applied to all is not true! ..Maurice.

NOTE: THIS TOPIC WAS FIRST PRESENTED TO MY VISITORS IN 2007   bioethicsdiscussion.blogspot.com/2007/08/sexually-seductive-patient-how-should.html   WITH THE MOST RECENT VISITOR POSTING IN 2008 BUT STATISTICS SHOW MANY HAVE VISITED THAT TOPIC IN THE INTERIM PERHAPS NOT CONTRIBUTING IN LATER YEARS BECAUSE OF CONCERN THAT NO ONE WOULD BE READING. SO I AM RESTARTING THE TOPIC HERE NOW IN 2021 AND LOOKING FORWARD TOWARD MODERN DAY VIEWS OF THE SUBJECT WHICH I CAN''T IMAGINE HAS DISAPPEARED BUT NEEDS THE INPUT OF DOCTORS AND POTENTIAL PATIENTS.

Preserving Patient Dignity (Formerly Patient Modesty) Volume 118

 

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

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

Preserving Patient Dignity (Formerly Patient Modesty) Volume 117

 

A primary care physician writing an article in 2010 on the
"Health Care Blog" wrote the following and much more. Read it and read the interesting back and forth discussion by the responders to the article.

Here is one paragraph from the writing. JR and others: will this view be acceptable to you coming from a physician?


I am not sure why people bristle at calling patients consumers; that’s what they are. They are also customers, participants, autonomous, and humans in need. This is not an “or” proposition. If we forget the humanity of patients and just treat them as customers, they lose. But they also lose if we forget that they are paying us and demand our respect and our attention to their needs. We are as much servants as we are professionals. Signing up to be a doctor means you agree to give yourself to your patients. All of them. It’s hard, and it’s complicated. It’s a human-human relationship.

..Maurice.

AS OF APRIL 21 2021, THIS VOLUME WILL BE CLOSED FOR FURTHER

COMMENTS .  COMMENTS CAN CONTINUE ON VOLUME 118

bioethicsdiscussion.blogspot.com/2021/04/preserving-patient-dignity-formerly_21.html

Preserving Patient Dignity (Formerly Patient Modesty) Volume 116

Let's get started on Volume 116 with this video from YouTube.  

It's about 4 minutes or so in length but clearly shows a potentially upsetting relationship between a patient and his physician and physician's office.  On completion of the story,  consider whose dignity has been preserved and which has been degraded.  If degraded, then tell us: by whom?  ..Maurice.  P.S.- You can click again when the first video is completed to see more patient-doctor  relationship issues as presented on YouTube.

TIME TO MOVE ON  TO VOLUME 117 https://bioethicsdiscussion.blogspot.com/2021/02/preserving-patient-dignity-formerly.html.
I HAVE COPIED MY LAST POSTING REGARDING "HEALTH CARE BLOG" ARTICLE TO START THE NEW VOLUME AND WE CAN CONTINUE THE DISCUSSION THERE. ..Maurice.

Preserving Patient Dignity (Formerly Patient Modesty) Volume 115

 Oops! I just noticed that the title of Volume 114 was wrong  (missed "Formally Patient Modesty) and didn't follow the recent Volumes correct sequence titles.  I hope that error didn't prevent visitors to join our conversations. With this Volume, we are back to our correct title which continues the specific "modesty" issue which started this discussion from 2005. Obviously patient modesty and its apparent ignorance by some members of the medical profession, Bantering's suggestion to enlarge the scope and thus title to "Dignity" was certainly important when discussing how the medical system interacts with their patients.

I would like to continue a discussion I began on Volume 114 and to which JF responded: This was followed by another issue I presented related to citizen's freedom in self-decision making. ..Maurice.

NO FURTHER COMMENTS WILL BE PUBLISHED ON VOLUME 115. CONTINUE TO VOLUME 116 https://bioethicsdiscussion.blogspot.com/2021/01/preserving-patient-dignity-formerly.html

I want to present here a general issue which stimulated me which I read on a clinical ethics listserv. It led me to consider the issue about whether employers had or should have a public health responsibility to require their employees, particularly those who interact with patients or closely with the public to accept being vaccinated with the COVID-19 vaccine or, if one their refusal being removed from their occupation. Is the employer responsible for the health of their employees and to the public who are exposed to those employees? ..Maurice.

JF said...

I'll let you know if I'm required to get vaccinated. I've been wondering the same thing.

Maurice Bernstein, M.D. said...

Another legal-ethical question which was raised by the clinical-ethics lisserv to which I subscribe: Should all patients entering the hospital who have not been recently previously tested for COVID be legally compelled to be tested? Would that be Constitutional under that specific circumstance? In general, should COVID testing be not personally voluntary but be considered a legal requirement, symptomatic or not? ..Maurice.

 

Preserving Patient Dignity (Formerly Patient Dignity) Volume 114

 I find that Volume 113 will accept NO further posting.  Please continue here on Volume 114.. Please do not write further messages to 113, I cannot get them published.  ..Maurice.

AS OF TODAY DECEMBER 10 2020, NO FURTHER COMMENTS WILL BE PUBLISHED

ON VOLUME 114 BUT WILL CONTINUE ON VOLUME 115.

Preserving Patient Dignity (Formerly Patient Modesty) Volume 113

This is the misunderstanding that I agree, at times, is an unfortunate consequence of treatment of patients by all phases of the medical profession.  This sick patient may need to be "fluffed" as part of effective treatment for the underlying disease but, unlike the bed pillow, the profession should always keetp in mind that such "fluffing" may be unwanted and unacceptable by the p1 11amatient and that unlike a pillow, an object, it is as a person, a human subject, the patient, who should be first informed and consulted for permission.
And, if the professional fails in this regard, well.. the patient or the family should "speak up"!  (p.s.- I  hope this analogy meets our blog thread discussions, but feel free to correct me. ) ..Maurice.

Graphic: From Google Images2

AS OF SATURDAY NOVEMBER 14 2020, NO FURTHER COMMENTS CAN BE

PUBLISHED HERE.. MOVE ON TO VOLUME 114.

https://bioethicsdiscussion.blogspot.com/2020/11/preserving-patient-dignity-formerly.html

  ..Maurice.

Preserving Patient Dignity (Formerly Patient Modesty) Volume 112

The ongoing anguish being presented by the participants on this web blog topic is whether being a patient who doesn't conform ("be yourself") with the behavior and requests or even demands of the medical system itself  will provide harm to the patient. This patient concern may be the basis for many patients to hesitate to "speak up!".

It is my opinion that patients entering into the medical system should indeed "be themselves" and the challenge for the medical profession should always be beyond making a clinical diagnosis and performing a treatment to understand their patient as a individual, a unique individual to which the diagnosis and treatment and overall attention should be crafted for that patients personality and goals as well as the clinical diagnosis.

Unfortunately, in many relationships between the patient and members of the medical system it is the clinical diagnosis and treatment which overrides consideration of the patient as a unique individual who presents as "himself" or "herself". This defect in the system as expressed to the patient leads to  forcing the patient into personal non-conformity toward themselves in order to get diagnosed and treated and does limit the option or, if attempted, the volume of "speaking up" to the system.  

Remember, patient dignity involves the patient as a unique human and not just a named disease or when hospitalized a room number. So.. "BE YOURSELF".  ..Maurice.

Graphic: Provided by a reader of this blog thread.

Starting September 12 2020, Volume 112 will be CLOSED FOR  COMMENTS.
HOWEVER COMMENTS WILL CONTINUE ON Volume 113.