Bioethics Discussion Blog: Patient Modesty: Volume 12





Sunday, March 22, 2009

Patient Modesty: Volume 12

We continue on, with Volume 12, in this discussion of patient bodily modesty in terms of the professional considerations, professional ignorance of it or alleged abuse by professionals, the history, the dynamics of the modesty concerns, the relationship to provider gender selection and alleged patient gender inequality of selection. Despite literally thousands of comments posted on this subject here since the subject was started 3 1/2 years ago, further discussion is welcome. Please be sure you stick to this specific topic when you write and try not to change the point of the discussion to other issues that are covered elsewhere on this blog. And again, I would like to remind our contributors who wish to remain anonymous, in order to maintain continuity for those who read, please use at least a consistent pseudonym or initials to end your postings.

One of the last posts in Volume 11 was an excellent presentation of the history of nudity and bodily modesty issues as written by our visitor MER. I thought it would be appropriate to start out this Volume by re-posting his writing here. ..Maurice.

Saturday, March 21, 2009 2:05:00 PM, MER said...
One point I’ve tried to consistently make in my past posts is – how we feel about nakedness is contextual, depends upon the situation. The same person who may frequent nudist events may be embarrassed or even humiliated being naked in other contexts. The same is true for those who are extremely embarrassed being naked in front of a female nurse or doctor. In other contexts, in front of a male doctor or nurse, they may not be embarrassed.

I’ve been trying to study the change in attitudes toward nakedness in Western culture, especially the US, within the last 100 years or so. This is a complex subject and I don’t pretend to have “the” answer. But I do have a few suggestions. In the late 19th century, early 20th century, interest in Greek culture with the start of the Olympics, reminded us that these Greek athletes competed in the nude, and often trained in the nude. The Greek perfection of the unity of mind and body became visible in statues of the “perfect” athletic body. I think the early Olympics had some influence on attitude changes. This about the time we begin to see the growth of modern nudism and males swimming nude in public swimming pools.

About the 1890’s, when Boy’s Clubs, YMCA’s, (the scout movement, etc.) became popular, attitudes toward masculinity changed. The notion was that we were becoming weak as a culture, especially males, with the closing of the frontier. These male bonding institutions in connection with exercise and wilderness experiences helped shape our attitudes toward nudity. In UK, as the empire was declining, a similar attitude developed about the decline of masculinity and the traits associated with it. Early indoor swimming pools started being built. They had filtering systems that were sensitive. For that reason among others, males were required to swim naked. It started in the YMCA’s and Boy’s Clubs and later came into some of the college and high school systems. But, and this is a big BUT – it seems to me that there was always an understood, tacit agreement – no females were allowed. This would be strictly for men and men felt safe in these situations.

I don’t think naked military induction exams really became standard until WW1. That’s not to say it didn’t occur during the Crimean War, the American Civil War or the Franco-Prussian War. We’d have to research that. But before “modern” warfare, governments were more interested in bodies in any condition to man the front lines. Doctor’s examining naked bodies didn’t really begin seriously until after the French Revolution secularized the hospital system and doctors from all around the world headed to Paris to study and get access to real bodies. Read George Eliot’s “Middlemarch” to see how one of the main characters, a British doctor, brings back modern medicine to England from his Paris studies. There’s a revealing chapter in Tolstoy’s “Anna Karenina” where Kitty is ill and must go through a complete examination with one of the “new” thinking doctors who insists that he examine her entire naked body. Very revealing. It shows the arrogance of that doctor, how the modesty of the patient is completely ignored. If ever there’s a literary example of Foucault’s medical “gaze” it’s there in Tolstoy. Kitty was simply an object for this doctor to examine. My point in all this is that the modern medical examination of the complete naked body doesn’t start until the mid to late 19th century.

We occasionally see photos of naked soldiers from WW1 and WW2 being examined. This was standard. But I would argue that there was a strict, assumed, tacit agreement that there would be no women present. The question is often asked as to why these men felt comfortable swimming nude together, or being examined naked during military inductions. I would argue it was because of this understanding that this was a male ritual that excluded women.

Now – something begins to change after WW2 and comes into being in the 1960’s. It has many sources, but I argue that it’s closely connected to what we call the “sexual revolution” and the growing feminist movement. As more women enter male occupations, as this process gets embedded in legal doctrine, that is, giving rights to the same access for women as for men – we see things change. As more women want access to these indoor pools the policy about men swimming naked changes. As gay rights becomes an issue and as more gays come out of the closet, some men show more homophobic tendencies and become less comfortable being naked around other men. As sexual abuse, predation and crimes become more publicized, people become more wary with exposing their bodies in more and more situations.

How does this relate to what we’re talking about? Before we get to medicine – we see one example with the military induction during the Vietnam War. With more women becoming doctors and joining the military, we find many anecdotal examples of naked male inductees facing female doctors and nurses. In fact, there are a significant number of anecdotes of female clerks and other non medical personal having access to these naked men. Here’s where we see the old understood, tacit, agreement breaking down. In the past, it was understood that there would be no females present for these nude male rituals. Things now change. I would argue that during WW1 and WW2, as a general rule males in the military (unless seriously wounded – again, I’m not referring to extreme examples) were not subject to intimate examinations by female doctors or nurses. I grant the exception of the USSR and some other European countries. But remember, medicine wasn’t opened to women in the early USSR because the Soviets were concerned with gender equity. I suggested more women became doctors than men because being a doctor didn’t have the social status it did in other countries. It wasn’t considered the highest, most honorable calling for men.

Combine all this with the dominance of post modern philosophy – the concept of gender doesn’t exist, it’s only a cultural construct – and we see this attitude enter the medical system. Exempting emergency situations, it wasn’t that long ago that male orderlies or nurses or doctors handled intimate procedures with male patients. Even the “older” retired nurses today will tell you that. As more women entered medicine, it was just expected that gender didn’t matter and that they would have access to males just as the male doctors over the years had had access to females. Although attitudes are changing, this world view is still significantly embedded with the medical culture. These attitudes changes that now claim gender neutrality have come relatively quickly and without an open, honest discussion which includes patients at the table.

I don’t claim this is the whole story. I’ve probably missed some important elements and movements. I present this summary, my opinion, for discussion and criticism. I believe it’s relevant to what we’re discussing here.

Graphic: Women and Men's separate toilet buildings, photograph recently taken by me at the Santa Monica, California beach.



At Sunday, March 22, 2009 12:14:00 PM, Anonymous Anonymous said...

Thank you MER. That was a very good post.

To Anonymous who refused to be talked into allowing a female nurse to give a PCA3 test. Excellent job! I would (and will) do it exactly the same way. I don't know if "oficially" that type of situation could be considered "unethical", but I certainly consider it to be unethical. If there were more guys like you, women in the healthcare professions will eventually be forced to treat men the same way they treat women. Nice going.

Others like Adam K., Jimmy, PT, Alan, and MER also make excellent arguments.

Hey PT, just ignore that Piffonitol guy. I've seen his posts in the Voy boards and he will say anything to anybody to pick a fight. People on the Voy boards have been ignoring his tirades there lately so I think he is trying to expand to other boards and blogs just to tick off as many people as possible. Negative responses to his insults is what he craves. He'll probably get bored after a while and stop coming here.

Thanks for all the great posts guys.


At Sunday, March 22, 2009 5:55:00 PM, Anonymous Anonymous said...

I have been looking at the cultural view of nudity as represented by our religious upbringing..another aspect to go with what MER is writing...not to get into a religious argument.
I have come across a group of Christian naturists.. who by their interpretation of scripture feel they are not constrained to being textilists...
The Christian perspective is generally a literal reading of everything from Adam and Eve discovering that they were naked at the same time as they discovered sin to many other incidents whereby nudity is mentioned in a very disapproving tone.(The son who covered his fathers nakedness when he found him exposed after a night of drunken debauchery...although the shame may have been that the nakedness of the father represented his actions more than his exposure of genitals)
It is my contention that when these teachings and the experiences of a person (good or bad) are combined you have at least two very powerfull factors in how that person views how modesty is defined as in their world. The combined views of many become how that culture defines modesty which further will determine what the next and future generations are taught is acceptable or unacceptable...and this will influence individuals who again will further define modesty by their own experiences.

At Sunday, March 22, 2009 6:22:00 PM, Blogger Suzy said...

I've noticed that my issue isn't so much being viewed naked, it's an issue of feeling bullied, blackmailed or violated.

I don't mind being viewed by a doctor or nurse if it is in my interest to do so. If I have come to the doctor for help with symptoms that appear in a private area, of course, I will have to allow him/her to look at the area. However, if the problem is, for example, on my buttock, I do not expect to be asked to disrobe from the waist up or to lie back and open my legs. This is done solely to put the patient into a vulnerable position to make them more cooperative.

The most frequent experience I've had with doctors is being asked to do something I don't want to do in order to get medication. In several cases, the procedures demanded of me had nothing to do with the medication I wanted. I have never had any concerns about cancer, nor have I wanted to be screened, but was told that I could not have hormonal birth control without allowing inspection and penetration of my genitals, anus and palpation of my breasts. No exam, no birth control. The pills helped me with terrible menstrual cramps and severe acne, so using another method wasn't an option. It was suffer or find a way to get those pills. I recognized that I was being bullied, that I had to trade violation of my body for the drugs. I had one doctor tell me (and this was a woman) that holding my pills hostage was the only way to make sure I had pap tests regularly. I felt completely violated, but very helpless because no doctor that I'd met would give me birth control without the exams. It effected my self esteem, my sex life, and many other areas of my life. I remember being shouted at by an abusive boss, and thinking that I deserved it if I was scummy enough to let a stranger finger my vagina and anus just to get drugs. Yes, that is the effect it had on me. I also eventually stopped having sex because I felt too ashamed of what I had allowed in exchange for the birth control.

During one of those awful visits, a nursing student walked into the room while I was sitting on the table in a paper gown and announced in the kindest, friendliest voice that she would be observing my exam as part of her training. She didn't ask, she announced. She had no regard for the fact that I might not have wanted to share a view of my breasts, splayed genitals and anus with her! I recall feeling absolutely trapped, wondering if the doctor would withhold the prescription if I said no. Finally, looking at the floor, I whispered--whispered because I felt so intimidated--"I don't want you here. I may be whoring for pills but I don't have to let you watch. Get out." I recall how startled she looked, but she left. The doctor glared and said that my comments were uncalled for. I said 'shut up and get YOUR pap test over with. It's you that wants it, not me. You can throw away the results, I don't want them. I just want my pills". I was so angry that the doctor had allowed this stranger to try to violate me for completely selfish reasons! Of course, they labeled me as mentally ill. For the rest of that visit, whenever the doctor tried to speak to me, I said 'shut up. Don't speak to me. You had your fun, now write my prescription and do not speak to me again.' All of the pain and shame caused by the demand for my dignity in exchange for medication was doubled by the betrayal of allowing a stranger to use me. I never went back, gave up the pill, learned to live with the cramps and acne. It just wasn't worth it.

I tried to get birth control from another doctor, who shouted at me--actually shouted--"You are making normal health care into something perverse. You are the pervert here, you!" I had not used the word pervert, only told her that I saw no reason to show my genitals to a complete stranger in order to get an unrelated medication.

It seems that when we go to a doctor for help, we are expected to check our own needs at the door. In exchange for whatever services we need, we are expected to bare out bodies to strangers and let anyone touch us, look at us, put us in humiliating positions, all in the name of 'getting help'. Many times, the nakedness, exposure, humiliating questions, exams, etc are not necessary for the treatment we seek, but the doctor wants to do them and will withhold our treatment if we refuse. Sure we can walk out, but we will do so empty-handed.

4. If we express any discomfort at the way we are being treated, we are scolded or our medication is withheld. It seems like the nakedness is a hazing, a punishment for needing their help.

5. I am not normally overly modest. I don't mind getting massages or brazilian waxing...I feel modest and ashamed when I am being told I must trade my privacy and integrity for medication, and that medication or advice will be withheld until I acquiesce.

Interestingly enough, this 'forced health care' plan backfired in my case. I haven't had a pelvic, pap or breast exam in 18 years. I now avoid the med providers unless I am truly desperate. It makes things difficult, but I'd rather have my dignity. I've bought painkillers and birth control on the black market to avoid going to a doctor. At least a drug dealer admits he only wants money and doesn't care how his clients feel.

At Sunday, March 22, 2009 8:28:00 PM, Blogger Maurice Bernstein, M.D. said...

I wasn't sure how pertinent Suzy's description of her experience to this blog thread. it seems it would have been better on "I Hate Doctors". On the other hand maybe her response shows something about the dynamics of the patient modesty issue which may have nothing to do with exposure of bodily parts but has more to do with the patient's upset with the way the providers respond to their request and needs. For example, by simply following some established protocol or standard of practice but without adequate education of the patient regarding the rationale, by failure to adequately listen to the patient and consider ways to mitigate the patient's concerns, through working out a plan with the patient and some compromise to meet both the concerns of the doctor and that of the patient, the patient leaves with Suzy's view.

It is important for everyone to realize that in the practice of medicine compromise is a necessary action which is always present. No disease presents and behaves exactly the same in different patients. No two patients with the same disease will look at their disease or symptoms in the same way. Therefore, how a doctor treats a patient may involve the offer of a compromise with regard to the "usual" approaches to diagnosis and therapy and not simply presenting to the patient some paternalistic order and expect the patient to take it or leave it.

In Suzy's example, much of the professional behavior she is describing could easily be due to lack of time and the concern on the part of the physician that simply providing pills while not performing standard examination, the doctor would be at legal risk of missing a contraindication for pills or a necessary baseline. Of course, one might assume the doctor is doing these exams for some perverse self-interest and that certainly has happened but I doubt this is the motive for all doctors.

Anyway, in conclusion, maybe the problem as illustrated by Suzy is not so much modesty and embarrassment on the part of the patient but the patient's lack of control of what occurs in the doctor-patient relationship. ..Maurice.

At Sunday, March 22, 2009 8:52:00 PM, Anonymous Anonymous said...

If female providers are so professional why are there nursing
boards for each state.
So, I decided to look into this
further. The state in which I live
has a nursing regulatory board. I
wrote to the board and asked for
a copy of the regulatory journal.
It lists the disciplinary records
for all rn/lpn and cna's that have
been disciplined over a 3-month
For cna's that were disciplined
there were 66 and the breakdown
was 8 males and 58 females.
Violations ranged from prior
felony convictions,patient abuse
and drug abuse.
For rn/lpn there were 108 disciplined and the breakdown was
13 males and 95 females. If you
consider a fair sampling that is
a high number of females despite
the male/female ratio.
The violations ranged from patient abuse,drug abuse and sexual
abuse. It was interesting to note
that the nurse who commited sexual
abuse was female.
Furthermore, last year in my
state a female nursing administrator, female nurse practitioner as well as I believe
a female case manager were found
guilty of not reporting sexual abuse of a patient. They were charged with a class 1 misdemeanor.
My state requires that any form
of sexual abuse in a hospital be
reported to the police in 24 hours.
Now let me get this straight! If
I rob a bank, the bank personel will push the silent alarm. They
certainly don't want the perp to
get away with their money. But, if
a patient in a hospital is sexually
assaulted, state law says "don't
worry, take your time. You have 24 hours to report it to the cops.
That gives a chance for the perp to get away or at least for memories to fade somewhat. These
people who were charged NEVER reported it to the police!
My point is this, patient privacy
has to be the last thing on their
minds! Every hospital has a risk
management department. It's not
for the benefit of the patient rather managing risk for the hospital.


At Sunday, March 22, 2009 9:50:00 PM, Blogger MER said...

One way to look at Suzy's story is through the eyes of the power dymanic. I'll again mention Chapter 8 "Nurses, Clients and Power" by Martin Johnson, in the book Sociology as Applied to Nursing & Health Care by Mary Birchenall et. al.

Although it focuses on nurses, the basic principles apply to doctors as well. The bibliography alone is worth a look. There's a significant literature on this topic.

Johnson summarizes a study by A. Hewison (1995) "Nurses power in interactions with patients" in the Journal of Advanced Nursing 21: 75-82. The nurses studied were working with the elderly. They used four strategies:
1. Overt Power --Nurses "openly giving orders or making decisions without consulting patients." This often worked. There was often a shared assumption between patient and nurse that the nurse will be in control. Johnson writes: "Thus we can see that overt power is not simply a matter of making people do things against their will. In many cases, patients interpreted nurses' open power as legitimate, and willingly went along with it."
2. Persuasion -- Nurses "cajoling patients to do things that they originally did not want to do. This often involved negotiation. But Hewison argued that "nurses' position within the organization of health care gives them a pegged position in the negotiating process."
3. Controlling the Agenda -- This was the most common method nurses used. In this case "the exercise of power is very subtle and comes in the form of manipulation." The nurse appeared to give the patient a choice by asking questions, but the questions were constructed in such a way that, "in reality, patients have little choice but to go along with" the agenda.
4. Terms of Endearment -- This was the most subtle form of power nurses used -- based upon "displays of affection." In other words, treating the patients similar to the way a parent would treat a child.

At the end of the summary, Johnson writes: "How should we view this rather despressing account of the care of older people?"

I don't quote this study as a definitive example of how power works within health care -- but as just one example of how power can be studied within the hospital culture.

The danger is that anyone in authority, especially those wearing a uniform, can sometimes forget in the routine of their jobs how much power they possess over people. Although this is especially true for teachers and children, military and civilians, police and citizens, guards and prisoners -- I think it has special significance with doctors/nurses and patients.

As I said in a previous post, power itself is neutral. In the right contexts and used correctly it's necessary, useful, important, protective, even good. In the wrong contexts and used incorrectly it can be embarrassing, humiliating, painful, forceful or even fatal.

I'm not questioning the need for healthcare professionals in the proper contexts to use their power. They can't do their jobs without using it. But it's how you use the power that matters, whether you use it to empower the patients or disempower them, with many degrees in between.

Anyone who has or has had power over other people can understand this to various degrees. But the doctor/nurse -- patient relationship is special. The trust relationship may be unique, perhaps only matched by priest or rabbi relationships.

Some healthcare workers may become so routinized that they become almost blind to how intimidating the hospital/clinic environment (including the scrubs and white coats) can be to some patients. I recall once reading the blog of a new female doctor who was shocked to realize how much power and authority she had over her first patients (CEO's, businessmen and women, and people in other powerful positions). She was specifically surprised to see that, though uncomfortable and perhaps embarrassed, it was easy for her to have them get undressed. She realized that she could perhaps have asked them to do almost anything and they may have done it. She had a epiphany -- a realization of how much power she really had. I believe it's important for health care workers to have these epiphanies often.

I think some healthcare workers sometimes become oblivous to this power dynamic in the routine of their day. Add that to the pressure of being understaffed, underpaid, trying to deal with more patients than they really have time for.

This analysis isn't specifically connected to Suzy's story. There may be much more involved with her story than is coming out. As doctor Bernstein commented, there seems to be real anger, almost hate invovled.

But her comment about the student nurse just popping in without asking, just assuming the "right" of accessability -- is all too common, I think. (And I'm not just referring to nurses here), I can understand anger, even rage at that kind of behavior.

At Sunday, March 22, 2009 10:31:00 PM, Blogger Maurice Bernstein, M.D. said...

MER, I would worry about any physician dwelling upon their own "power" over the patient. Any power the physician holds is power which is permitted by the State but more specifically must be permitted by the patients themselves. The patient's decision trumps any power granted by the State.

Yes, the physician does have the power to write a prescription for a drug but selection of the drug, dosage, risks and costs are part of the compromise made with the patient. Yes, the doctor can refuse to write a prescription for a specific pill requested by the patient but the patient also has the power to decide whether or not to take the pill or follow the physcians directions.

When you are a doctor, you can see that you don't have the power that others may think you have. Instead you have to be guided by the patient's acceptance of what you do or say to the patient. ..Maurice.

At Sunday, March 22, 2009 10:37:00 PM, Anonymous Anonymous said...

Maurice why can't women sign a waiver if they don't want a pap smear, pelvic exam and breast exam but want the birth control pill? We are adults. Also if cervical cancer is mainly caused by the HPV why can't women instead have a blood test to see if they have been exposed to the virus?

At Sunday, March 22, 2009 11:04:00 PM, Blogger Maurice Bernstein, M.D. said...

LH, I suppose if the woman was fully informed regarding the consequences of taking the pill without a screening exam or while taking the pill, continuing on the pill without followup exams, a waiver might be considered as a possible compromise for this situation. The waiver would have to clearly describe what the patient was told and what she understood and accepted. The physician and patient would have to balance the risks of unintended pregnancy vs the added risks of any serious medical results of taking the pill without examination.

It is signs of the cancer and not the determination of whether HPV was present that might cause a cancer which is the focus of any test. ..Maurice.

At Sunday, March 22, 2009 11:06:00 PM, Anonymous Anonymous said...

HPV wouldn't show up on any blood test. The do a pap smear to check the cervical cells. That can be followed up with additonal testing depending on what they find.


At Monday, March 23, 2009 12:03:00 AM, Anonymous Anonymous said...

PT, 6% of nurses are male. See the link.
So going by your figures, the male nurses are being disciplined at double the rate that is expected.
Also, how can you disagree on the last page that women didn't have a choice of male or female providers. Gynecology not too long ago was a boys' club ! My mother's generation could not find female gyn/obs.

Maurice, wouldn't it be better to see who has been exposed to the virus rather than wait and see if a woman has signs of cancer? Then if she does test positive for exposure to HPV she could be more closely monitored.

At Monday, March 23, 2009 11:27:00 AM, Anonymous Anonymous said...

The student nurse situation that Suzy described along with the others just walking in as mentioned by MERseem to be a really common complaint by both male and female patients. I realise that Dr.Bernstein has addressed this issue several times.
It seems that many ask if it is ok..Beforehand.
For the rest of the time, it is no different than walking into my bedroom or bathroom while I am changing..and I think that this is how many patients view it. If it did not bother us, we would not have doors in our house...or would change in front of everyone in the living room/kitchen or on the front lawn...(where I live that would get you into jail faster than you can blink)
That said, I find I am having to rethink more of my views on tests run by a doctor in the ER. The tragedy of Natasha Richardson made a good case about knowing if you are injured or not....the capacity issue. I would hope that modesty would be the extent possible, but I am not going to be inclined to reject treatment out of hand. Not because of fear of death, but in the discussions that followed it was shown that serious damage might make life a lot more miserable afterward..damage that might be mitigated if caught early.

At Monday, March 23, 2009 12:35:00 PM, Blogger Maurice Bernstein, M.D. said...

LH, you write " wouldn't it be better to see who has been exposed to the virus rather than wait and see if a woman has signs of cancer? Then if she does test positive for exposure to HPV she could be more closely monitored."

The answer is that there are numerous subtypes of HPV that can cause cancer even possibly some subtypes that haven't yet been identified. No routine blood test will test for more than a few subtypes at the most and certainly not for all. Therefore a negative test result may mean nothing if the invasive sub-type was not tested in the blood specimen. Another issue is that a woman infected with a specific subtype that is associated with cervical cancer as she grows older and is not reinfected, the titer fades and may not be later detectable even though the virus is still around. Finally, most women who have a positive serologic test for HPV never develop cervical cancer. In conclusion, the presence of a positive subtype may or may not lead to cervical cancer but early detection can only be done by pap smear. Women whose blood test is negative for HPV may still be infected with a subtype which hasn't been tested in the specimen or who was infected years ago but whose subtype titer has disappeared. They too need a pap smear for early cancer detection.

It has been the greater use of the pap smear detection for signs suggesting that cervical cancer may develop that has kept the incidence of frank cancer lower in the United States than in the developing countries. ..Maurice.

At Monday, March 23, 2009 3:08:00 PM, Anonymous Anonymous said...

Thank you for clearing that up

At Monday, March 23, 2009 5:03:00 PM, Anonymous Anonymous said...

No statistics don't work that way
and by the way you didn't comment
that it was a female nurse who was reprimanded for sexual misconduct!
Additionally, 98,000 people according to the prestigous institutes of health die each year due to unnecessary deaths in healthcare.
Most think the numbers are due
to mistakes by physicians. In
actuality, deaths attributed to
physician mistakes are small compared to deaths attributed to hospital acquired infections.
How due most people acquire
these infections while in the
hospital? Nurses not washing their
hands. What is the gender breakdown
for nurses? You know the answer to
that and female nurses should wash
their hands even more then men.
A recent study found that women
have more bacteria on their hands than men. If there were not enough
female obgyn docs in the 70's then
why was there not such a big stink
about it? After all medicals schools in the 70's and 80's had
a policy in effect. The minimum
gpa requirement to get into medical
school is a 3.2. Essentially many
women entered medical school with a
3.2 effectively bumping some men
with a 3.5,it was called affirmative action.
You can't just open the gates and
leave them open after all you have to have some kind of quality control. My point is this, women
in the 70's had the same opportunity to see a female ob as
they do today. In fact, many women
choose to see a male obgyn today
despite the even more abundance of
female obgyn physicians. The prime
reason is this " women obgyn's seem rude and short tempered."
This is what many women say and I
can direct you to a survey on the
web! Don't shoot me I'm just the


At Monday, March 23, 2009 5:57:00 PM, Blogger Maurice Bernstein, M.D. said...

LH and PT, should a discussion of patient modesty be relegated to diatribes of gender bashing? As far as I am concerned, I welcome both females into physicianhood and males into nursing. ..Maurice.

At Monday, March 23, 2009 6:52:00 PM, Anonymous Anonymous said...

I support these posters but they are losing an ally when they refuse to acknowledge that women did not have their modesty respected in the past. I have lost count of the number of older women who have said to me they have "lost all their dignity" after having a baby. I have had two children and I don't feel that my dignity was taken away. Just a few weeks ago a friend was telling me that when her mother was giving birth, a curtain behind glass was pulled back and there was a whole audience of students watching. The mother was not asked. This was commonplace in the '60s.
I have encountered male nurses and I do not have a problem with them. I don't believe I am gender bashing, but somebody needs to inform PT of some facts. Here's another link for him:

At Monday, March 23, 2009 8:18:00 PM, Anonymous Anonymous said...

Suzie, there are LOTS of other women who feel the same way. Of course, many women have been brainwashed into believing this is all part of being a responsible woman.
Look at Australian and English women.
I wasn't brainwashed because I was raised in the UK. My Australian husband and I have lived in the States for the last 12 years.

Most women don't know they're completely misled about the "great" benefits of cervical screening and the "importance" of routine pelvic and other exams.
Most women are unlikely to benefit from screening, lots will face cervical biopsies for false positives.
The risk of this cancer is low, even in high risk women.
ANNUAL screening is very bad, it means LOTS of healthy women are harmed by false positives.
Other countries, it's 3 or 5 years and starting later at 25 or 30. In this country, some doctors are testing virgins and teenagers!
My friend, a virgin, was put through a full gyn exam just before her marriage; she wanted birth control. She has gone off the Pill and they use condoms now to avoid doctors.
No doctor in the UK or Australia would put a virgin or any woman through that, it can't be justified. A history, blood pressure check is all that's required and cervical screening can be "offered" as a separate matter.
I think these rules may partly explain the high rate of unplanned and teenage pregnancies in this country.

Our doctors know that testing teenagers and young women and testing frequently is harmful, but they carry on with their demands.
Most of my friends have had false positives; with annual screening it's almost a certainty.
One friend was left with such a damaged cervix that it had to be stitched closed during a recent pregnancy. She WAS a healthy woman before cancer screening.

I was refused birth control about ten years ago, because I didn't feel I'd benefit from Testing.
My husband and I were virgins and my pathologist Aunt gave me lots of information on screening. It was a well thought out decision on my part.
I have a VERY low risk of this cancer and a high risk of harm.
US doctors use birth control to control women - to FORCE women to comply. I believe it's unethical and amounts to coercion.

Screening has nothing to do with the safe use of birth control. There are many academics and doctors concerned about this unethical tactic, but it still happens all the time.
In the UK and Australia, doctors have been reminded over the last 5 years or so that informed consent is VERY important with cancer screening and past practices may have been unethical.

My US doctor refused to even discuss the matter. Full exam and annual screening or no birth control.
My husband & I refused to be held hostage and I receive my healthcare in Australia, when I visit my in-laws.
In that country, I gave my Dr a brief history and have my blood pressure checked.
I'm free to decline smears. The doctor readily admitted I was most unlikely to benefit with my very low risk profile. She also said she'd never refuse birth control and that cancer screening is a separate matter. She only insists on a blood pressure check every 3 months. (unless birth control pills are contraindicated for that woman)

In Australia and the UK, they DON'T recommend pelvic, rectal or breast exams routinely - they respond to symptoms.
When I'm about 40 or so, I'll be offered an annual clinical breast exam.
I'm free to accept or decline - no ultimatums.
My Dr will also give me information on mammograms (not recommended before 50) and the decision will be mine to make at the time.
My husband & I are SO pleased that we have access to reasonable doctors.
I'm in partnership with my Aussie Dr and in control of my healthcare.
My advice Suzie - take a holiday to Australia, if you want birth control - great excuse for a holiday!
I'm sure men have issues with doctors as they get older, but they have no idea what women are put through to get birth control. Most men can avoid doctors until they're older, it's harder for women. Men cannot be blackmailed either, you don't need access to birth control.
It seems men are better able to say NO or stay away. Would you agree? Maybe I've missed something but my husband rarely goes to the doctor and if he does, he doesn't come out having had every orifice examined!
Added an English review on the need for informed consent and the small number of women who benefit from this testing.

At Monday, March 23, 2009 8:22:00 PM, Anonymous Anonymous said...

I don't need to be shown facts, I
worked in healthcare for many years
and I know the game.
I've seen unprofessional behavior
by female providers and I have as
a patient experienced it as well,
I'm on this crusade to show support to my fellow "men" for the
inequities and discrimination that
our healthcare system allows and
I want to see a solution.
There are activities I'm involved
in to educate our youth. There exists a tremendous level of discrimination in todays healthcare
towards men on the basis of the
disproportunate numbers of female
to male nurses.
If you've never worked in healthcare one only has to visit
some of the nursing forums to get
a glimpse of the mentality of
female providers. The derogatory
comments about male patients and
their packages. What is up with
that? The way these nurses talk
about male patients you'd think
the nurses were expecting to have sex with these people. They are
in the hospital to get well, not
to be judged!
They claim to be experts about
penis size good for you,see if you
can get a job in the porn industry,
NOT! The fact of the matter is that
the public has lost trust in the
nursing industry and now you have
these nursing advocacy sites springing up everywhere. Their
usual comments "are we saved you".
No you did not! What saved me
are some rocket science organic
chemists making magic pills at a
factory. What saved me are the
technological advances in computer
electronics and knowledge in
disease processes in the last 50
years. Nobel prize winners in the
invention of the CT scanner and
antibiotics. Give me a break!


At Monday, March 23, 2009 9:03:00 PM, Anonymous Anonymous said...

Thanks for your story Suzy. Though I know that the same bad experiences happen to women as men, hearing of an experience like yours helps me to keep in mind that this isn't always men vs women.

I am very nude prude in all facets of my life (I could never even consider things like massages and waxes) but my biggest concerns and reasons are very similar to yours. The power they think they hold over me is what makes me a rebel more than anything. I'm sorry that all that happened to you. I never knew how difficult it is to simply be "allowed" to get birth control pills.

PT, I understand the outrage you have with all the legal issues concerning nurses. I don't believe that the percentage of the male/female ratio means much. The fact is that 153 female nurses were disciplined in your area and that has nothing to do with women being 92% of the nursing workforce.

I know it's a contraversial subject but something I believe is that many more female nurses get away with crimes, whether legal or ethical, than male nurses do. You can bet that even the mere thought that a male nurse is doing something illegal or unethical will get him reported to the "authorities". Many female nurses do the same thing or much much worse and aren't reported or even suspected. Even when suspected the complaint often gets covered up and goes nowhere.

I'm not a professional and I'm not aware of any studies that have been done so I'm sure most people will completely disregard anything I say about it, but I've heard and read a lot of experiences and that type of thing seems to happen a lot. Like many people here I've read a few strings on and if I were to believe everything I read there as well as the attitude of the moderators it seems "covering up" for fellow nurses is quite common. That website is only one of many places I've checked out and I also realize that anything can be said on the internet, true, false, or exaggerated. But in my unprofessional opinion there seems to be a lot of "cover ups" going on, and it's not many male nurses are having their exploits covered up. I think if more exploits by female nurses were not so commonly covered up there would be a much higher percentage of legal issues involving female nurses.


At Monday, March 23, 2009 9:26:00 PM, Blogger Suzy said...

Hello, Suzy here again.

There are many comments here I'd like to address.

First, Maurice, this is definitely about modesty. Modesty is about controlling who has access to viewing or touching our bodies. I have no issue about being naked, but about being expected to allow anyone who wished to have unnecessary access to viewing my body.

That I felt hate for these people who violated my privacy and my sense of dignity does not change the fact that the violation of my sense of modesty is what created that intense hate.

Doctors seem to forget that all patients do not want the same level of 'care'. Some people need to be told by a doctor or other health care worker that they are healthy. Without this reassurance, they worry. My approach is different. I do not want preventive care. I don't like the invasive feel of it and am willing to make an informed decision.

I have been told that it is 'bad medicine' or 'I wouldn't be doing my job if I don't examine you thoroughly.' Well, that's nice in theory, except I am an adult, and I do not need another adult to tell me that I'm required to bare all to them because they hold the power to refuse me the meds that I need or require. I asked one doctor if it was "good medicine" to put a patient who cannot tolerate being viewed and touched by a stranger into the position of having to purchase questionable drugs from spurious source, and having absolutely no monitoring during the use of these drugs. The doctor replied 'that's your decision to make'. She never answered my question about good and bad medicine.

The whole issue of modesty is really about loss of control. We want to control who sees and accesses our bodies. For those who feel the trade is worth the result, that is perfectly fine. Those of us who literally would rather die than be exposed or violated again would definitely prefer a route that respects our ability to decide how much medical meddling is good for us.

As for having a baby robbing a woman of all dignity, I have also had that experience. Again, my modesty and privacy were completely violated as I was assaulted repeatedly, and the residents involved simply kept reassuring me that they 'would be quick' or that 'we see this every day.' I couldn't have cared less what they did every day. That is like telling a woman who is raped by a serial rapist that she should feel no trauma because the assailant has raped so many women that he won't even remember your face.


At Monday, March 23, 2009 9:53:00 PM, Anonymous Anonymous said...

"The pap smear has reduced cases of frank cancer" - at what cost to healthy women?
Does anyone care about the thousands of healthy women put through biopsies?
Are healthy women unimportant in the quest to get to the handful that will get this cancer? Surely, women should be asked whether they're happy to participate, to risk their health to help a few...
I've heard doctors dismiss the colposcopy and biopsies as minor procedures. I doubt women would agree...
Women are often left distressed after biopsies, some have long term damage, some have psychological problems.
I'm ashamed that women are treated with almost callous disregard.
The success of the smear test is also debatable. One in 4 women have had a hysterectomy in the States, yet this large group are not factored into any statistics. Any decrease in the rates of cervical cancer is put down to screening.
We don't hear about the thousands of women harmed by false positives and false negatives.
We hear the success stories, never the downside, the huge downside.
I don't believe this Test was ever properly evaluated and doubt it was ever a suitable mass screening test.
I agree that using it as a barrier to birth control is unethical.
Whenever you have an unreliable test for an uncommon cancer, you end up harming a population of healthy women and it seems, drive women away from doctors.
I'd recommend an Article written by R.M DeMay in the Journal of Clinical Pathology in Nov, 2000;Suppl:S48-51 entitled, "Should we abandon pap smear testing?"
This is the information that doctors don't want women to see...

At Monday, March 23, 2009 10:15:00 PM, Blogger Maurice Bernstein, M.D. said...

Actually, these recent posts about screening is a very interesting twist to the threads on patient modesty and deals with the issue of whether genital or breast exams, {the anatomic areas of most modesty issues) are, indeed, really routinely necessary. It would be interesting to continue this specific discussion. Just as routine PSA testing for prostatic cancer is undergoing a change in medical thinking, would there be changes in the need for other exams? ..Maurice.

At Monday, March 23, 2009 10:26:00 PM, Anonymous Anonymous said...

Doctors don't need to change because they have control over women wanting birth control - they have the power.
Many doctors acknowledge that screening and the other exams have nothing to do with the safe use of hormonal contraceptives, but the Pills are withheld to force compliance.
I don't believe men can be placed in the same position.
We also have fear tactics aimed at us. Many women feel stressed about avoiding routine pelvic exams. We've been told we MUST have these checks and then you find out women overseas don't have these checks and they're doing just fine.
My husband had a vasectomy which ended the nightmare for me.
I no longer have to go into brain freeze to cope with these unnecessary intrusions. I've never been happier and healthier being away from their grasp.

At Monday, March 23, 2009 10:40:00 PM, Blogger Maurice Bernstein, M.D. said...

PT and others, I wish you would avoid carrying over to this blog the comments by others on discussion blogs such as allnurses. I still have to say what is quoted is worthless to make any point since anything that is written on this blog or other discussion sites has to be understood in terms of context and the motivation of these anonymous writers. To me, none of these comments from the other sites are of value here and should not be qoted here. Again, as moderator, I have to point out again that, indeed, even on this blog with all the truly anonymous writers, none of us reading the comments have any idea of the motivation or true intent of the writers who express views here. Motivations could extend from true personal concern to concern for others to lighting fires to watch the readers react and with no intent to solve problems. Please follow my advice. I don't want to start editing posts. ..Maurice.

At Monday, March 23, 2009 11:27:00 PM, Anonymous Anonymous said...


First off, let me add my compliments to those of others on your post that Dr. Bernstein used to start off this volume of the discussion.

On the topic of power, I agree with Dr. Bernstein - health care professionals only have as much power over patients as the patients choose to give them.

Yes, they use tactics that are specifically designed to sway things their way. The most important tools a patient can have to combat that are knowledge and the courage to stand up for themselves.


At Monday, March 23, 2009 11:36:00 PM, Blogger MER said...

I'm delighted to see more women on the blog. I've tried to stress in past posts that, although there may be a double standard for men in some areas regarding their modesty, the issue isn't limited to one gender. There are too many variables. Women have in the past and still face double standards and modesty issues.

Doctor Bernstein -- I think you can see from the posts of these women that power is a factor. They've mentioned it specifically. I agree that doctors shouldn't dwell on the power dynamic, but they also should never let the routine of their jobs blurr it.

You write: "When you are a doctor, you can see that you don't have the power that others may think you have."

I think it's a question of perception. I don't question your experience as a doctor. But I think the patient's perception is often different. They feel the power because, for them, it exists, it's real. Some patients just accept it as the status quo. Others go along with it but resent it. A few, not many, challenge it.

You also write: "The patient's decision trumps any power granted by the State."

This position that "The patient is in charge" may be the best of intentions, the theory -- but that's not how it often works in reality.

And I think that, just as some females feel a strong power imbalance when dealing with a male doctor -- some males feel a strong power imbalnce when dealing with a female doctor or nurse. Why is it that the medical profession these days seems, to some extent, to understand this more with women patients than with men?

At Monday, March 23, 2009 11:56:00 PM, Anonymous Anonymous said...

The whole business is so dishonest that even women who've had complete hysterectomies for benign fibroids are pushed into smear tests.
I don't have a cervix!
I've read a few articles in the newspaper over the last few years warning women not to agree to smears if they're in my position.
I told my doctor that he could just forget about it. I'm through with all of it.
It seems thousands of women in the UK and the States have been tested even though they have no cervix and haven't had cancer.
Just disgusting!

At Tuesday, March 24, 2009 12:02:00 AM, Anonymous Anonymous said...

I threw a "no more pelvic exams" party after my husband's vasectomy. I felt for the first time in my adult life, the most amazing freedom!
I can at last make my own health decisions.
I've got my body back...

At Tuesday, March 24, 2009 2:11:00 AM, Anonymous Anonymous said...

Okay, this is freaking me out.
I'm a 37 year old Australian woman and I've never had a breast, pelvic or rectal exam.
What's going on in the States?
How can doctors get away with doing these exams on a routine basis?
At least if you're sick, you understand the reason why these things might be necessary.
I rarely see a doctor, my husband is sterile and we don't need contraceptives. My friends who do, certainly don't go through all of that...
It would be front page news here!
I wonder if women are being used to keep waiting rooms full...over-servicing gone mad.
A fast way to pay off your beach house.

At Tuesday, March 24, 2009 8:14:00 AM, Anonymous Anonymous said...

Isn't the idea that each individual should be able to access competent medical services from a provider they can trust and are comfortable with one of the main points both male and female contributors to this blog have said they want?
This includes being able to choose a provider by gender.
The second idea seems to be one of having intimate exams/nudity being handled by the provider in a respectfull manner.. which includes not having others walk in and out during this time and not having anyone not essential to the exam/test present.
If a test is of value ,while it may involve issues of modesty, is a subject and issue all its own.
A favor I would like the contributors to this blog from outside the US to describe how the males in their societies feel and are treated with respect to gender care....andone I would like to make from everyone is...please do not attack other contributors who are respectfull even when they hold opposite feelings about these subjects.....Looking back over past volumes we seem to have driven off a few that may well have had a lot to contribute in finding ways to achieve a parity for multiple provider/patient preferences. is ok to have a gender preference...but don't bash those you don't want....and I do not think that statistics of violence/criminal actions by providers disqualify any gender from being a provider.
MER, I hope you are still pondering and researching the perceptions of nudity over time and in different cultures.

At Tuesday, March 24, 2009 10:49:00 AM, Anonymous Anonymous said...


In your most recent post, you made the comment "This position that 'The patient is in charge' may be the best of intentions, the theory -- but that's not how it often works in reality."

You'll get no argument from me. While the health care industry pays a lot of lip service to "patient centered care", "patient autonomy", "patient involvement in decision making", etc., in most instances the reality is far different. If patients are waiting for initiative from the health care industry to change that, I think it's going to be a very long wait. Unless/until patients take the steps to empower themselves, nothing is going to change.

The first step is to make a conscious decision to become an active participant in health care decisions and to decide what level of power or control they are willing to cede to others. The next step is to acquire the information or knowledge they need to make truly informed decisions about their health care. Step three is to make those decisions in accordance with their personal values and have the courage to stand by them. Finally, step four is to be willing to accept the consequences of those decisions. The short version I use to describe this is "My body - My decisions - My consequences - My responsibility".

The whole power/control strategies thing is another subject. The bottom line is you need to be able to recognize when someone is trying to manipulate you and respond accordingly. You don't need to be rude or abusive, in fact, it's better if you're calm and polite. Case in point - a couple years ago I needed a minor ortho procedure on an injured finger. They tried a local/ulnar block but it didn't work very well, so the ortho recommended a regional anesthesia procedure called a bier block. We discussed the particulars and I made my preferences known - she had no problem with it & sent me off to the anesthesia interview. When I told the anesthetist no sedation and absolutely no general anesthesia/intubation under any circumstances for any reason, she launched into the "persuasion" technique you described in your earlier post. I let her go through her spiel, then calmly stated "I'm sorry, but what part of "no" didn't you understand - the "n" or the "o"? Besides, I want to watch. I've discussed this in detail with my surgeon - if she has no problem with it, why do you?" The look on her face was absolutely priceless. Bottom line - I got what I wanted: none of that silly "NPO after midnight" crap, no IV other that for the regional, drove myself to and from the procedure, and I did get to watch!


At Tuesday, March 24, 2009 11:16:00 AM, Blogger Maurice Bernstein, M.D. said...

TT, I appreciate your dictum of patient autonomy: "My body - My decisions - My consequences - My responsibility". I think that some patients, however, will ignore the "my responsibility" and readily lay the blame solely on the physician and the medical system. I am not saying that physicians and the system deserve that part of the blame, if blame is indicated, for which the profession was specifically responsible but for the patient to disregard their own decision if the outcome is undesired is not appropriate. Of course, this statement is only valid if the physician has taken the time to fully inform the patient about all the reasonable benefits and risks and establishes that the patient understands what was disclosed. If not, then it is the medical profession that deserves all the blame. ..Maurice.

At Tuesday, March 24, 2009 12:29:00 PM, Blogger MER said...


You make a very good point in your last post. It's easy to say "My body, my decisions, my consequences, my responsibility" --but then, when all is said and done, not be willing to take that responsibility.

I'm reading a good book -- "The Insanity Offense" by E. Fuller Torry, subtitled "How America's Failure to Treat the Serously Mentally Ill Endangers It's Citizens."

I mention this book because in your last post, it seems to me that the subtext of what you're saying -- your reference to "blame" -- brings up all kinds of legal implications.

In his Chapter 1 of his book, Torry writes: "There are two major origins of this disaster -- deinstitutionalization and the legal profession." (p. 1)

Just as in our mental health disaster, the legal profession itself has, in some cases with all good intentions, has had an extremely negative influence upon how modern medicine is practiced. I'm not saying that they've done no good at all. They have. But overall, it's been negative. Add to this the influence of the insurance companies, and we can see why we have so much defensive medicine being practiced.

It's one thing to talk "patient atonomy" -- but when you combine the fact that a significant number of patients say they will take responsibility for their decisions, then are convinced by a lawyer to bring forth a lawsuit for the financial gain of both -- you end up with medical professionals who are constantly concerned with covering their backs.

This affects the doctor/nurse -- patient relationship negatively in ways that are hard to document.

At Tuesday, March 24, 2009 12:47:00 PM, Anonymous Anonymous said...

"There are, of course, women who want to have the examinations and give their consent voluntarily, but telling women that examinations and pap tests are mandatory to receive birth control is a form of coercion, not informed consent. Informed and voluntary decision making is instrumental to patients’ rights. Don’t patients, including women of child -bearing age, have the right to autonomy and bodily integrity? Withholding contraception from a woman if she does not wish to submit to unnecessary physical exams and tests is nothing short of provider bias and paternalism. This is medically unethical"

This says it all for me.
Of course, the WHO and most other medical associations confirm these exams are unnecessary to get birth control pills, but doctors ignore these directives.
I also refused to submit, the unfairness was something I couldn't take. I won't be using birth control pills until the system changes.

At Tuesday, March 24, 2009 1:11:00 PM, Anonymous Anonymous said...

Doctor Bernstein,

I completely agree. A patient has the right to expect treatment or procedures to be carried out in accordance with an accepted standard of care. The only "blame" either the physician or health care system should be assessed is for incompetence or negligence in the process of carrying out the agreed upon procedure or treatment. The patient absolutely must assume the responsibility for the decisions they make, and they must have the information necessary to make an informed decision.

Yes the physician needs to take the time to fully inform the patient about all the reasonable benefits and risks and establish that they understand what was disclosed. Isn't that how the principle of informed consent is supposed to work? Sadly, I'm afraid, that's not how it usually works in the real world.

Sure it takes a little additional time, but I think that would be preferred to spending hours or days giving depositions or in a court room. I was raised to believe that we are all responsible for our own actions - unfortunately way too many people these days are always looking for someone else to blame, when the real person responsible is facing them in the mirror.

With the right of self determination comes the responsibility for the consequences of our decisions.


At Tuesday, March 24, 2009 1:58:00 PM, Anonymous Anonymous said...

The General Medical Council has issued new guidelines to counter the unethical conduct by many doctors recruiting women into cervical screening.
Doctors are now required to obtain informed consent, must disclose their conflict of interest, must disclose the low chance of benefiting from screening and the risk of an incorrect test result that may lead to further testing.
It's way overdue - the behaviour of some doctors in this country has been disgraceful.
It will be interesting to see whether these new guidelines make any difference.
While doctors continue to be paid for reaching targets, it will be difficult to control unethical conduct.
I have been dismayed to watch this unfold over the last 20 years.

At Tuesday, March 24, 2009 3:13:00 PM, Blogger Maurice Bernstein, M.D. said...

MER, excellent comment. In these threads, I have mentioned malpractice but we haven't had a sustained discussion of how this threat as orchestrated by the law and insurance professions could contribute to the response of both the patient and the doctor. Certainly, if the patient indeed has a certain degree of final responsibility for the decision and if the patient is pressured by potential monetary benefit into denying that responsibility, this would put the entire burden of the results on the doctor which would lead to doctors taking defensive measures.

I keep saying there are dynamics of patient modesty that need to be considered and discussed, perhaps as side issues, and the reaction of doctors regarding patient modesty because of the issue noted above may well be pertinent in the discussion. ..Maurice.

At Tuesday, March 24, 2009 3:34:00 PM, Blogger Maurice Bernstein, M.D. said...

TT, maybe this concern that doctors fail to attend to the desires of their patients with regard to modesty and gender is because they still think paternalisticly that the patient is simply the object of their need to diagnose and treat and not a potentially equal participant in the process. It would help if a patient could say to the doctor to the effect "Your job is to educate me regarding the benefits and risk. My job is to provide you with a decision. Your job is then to help me achieve my goal of return to health. Each of us plan to work together and each will bear final responsibility for our part of the outcome." The doctor would then be attuned to the patient rejecting an examination but yet out of professional beneficence may try to work out with the patient a plan to mitigate the need for rejection. All this does take a bit more time and a willingness of both the doctor and patient to partner. ..Maurice.

At Tuesday, March 24, 2009 3:41:00 PM, Anonymous Anonymous said...

Are we doing our homework and finding doctors that meet our needs and who come highly recommended?

Usually for a male or female patient will get an exam from a new doctor for certain medication. I moved a couple of years ago and I saw my doctor right before I left and he helped me the best he good but could not wright a prescription for a certain medicine out of state. So with being busy with the relocation I kept putting off finding a new doctor and flipped thru the yellow pages and found a doctor and she gave a complete look over, I was a little shocked at first because I started out fully clothed and it went from there. When I called for the apt. I explained why I was coming in and gave all information of old doctor and had them fax me a copy of releasing medical records. All went well with them getting in touch with the old doctor. She was very nice and seemed like a good doctor from the start with me. The bottom line here was for that day I was in her care and not my old doctor and I can respect that and three years later she is still one of my doctors.

At Tuesday, March 24, 2009 5:21:00 PM, Anonymous Anonymous said...

Word of advice: a patient should obtain all medical records. Keep them filed by year. Any and all lab work, screenings, xrays, scans, medical records, surgical files. Everything. They are your records and you have a right to them all. Each and every time you go in for something request the record. When I moved I obtained all my medical file from every doctor. They will give you a CD now of any scan done and also get the radiologists report. This is very important. Surgical files are important because you have a record of exactly what was done for any future need when seeing another surgeon especially if you have a recurrence, etc.

At Tuesday, March 24, 2009 7:02:00 PM, Blogger Maurice Bernstein, M.D. said...

PT, I just had to delete you last attempted posting since I think it was too confrontational, if that is the right word. Please, I know you feel very strongly about your view but others feel strongly about their views too. So please "tone it down" so I can feel comfortable that you are trying, in a more civil way, to express what you consider important in this patient modesty discussion. ..Maurice.

At Tuesday, March 24, 2009 9:58:00 PM, Anonymous Anonymous said...

Actually I believe we need lawyers involved in these matters.
It will take legal action to force doctors to comply with Medical Association recommendations.

The practice of ignoring the need for consent and informed consent is well entrenched.
We have programs shrouded in secrecy that closely monitor the information they release to women.
The screening brochures only mention things that will persuade women to have screening and excludes anything that may dissuade them from screening.
Even with pressure for more honesty, they still fall way short of the mark.

A patient cannot give informed consent in these circumstances.
There is also a prevailing attitude that any criticism of these programs is unwarranted and simply, dismissed.

I'm not sure how they've avoided mass litigation so far with so many women injured by this testing. I agree ignorance and fear have been big factors.

I know when my firm represented a woman seriously injured by cervical biopsies, the matter was settled with incredible haste. This lady was astute enough to do her own research.
We assumed they were terrified of word getting out. Most women simply don't know their doctors are playing a game of chance with their health.
Even recommending screening or simply handing a woman the inadequate brochures on screening falls short of a doctor's obligation to obtain informed consent. All doctors are aware (or should be)of the risks and shortcomings of these programs.

You can't have it both ways.
If you provide no or little risk information, mislead, recommend or "require" a woman to have the Test, then you assume risk on behalf of your patient.
In that case, you must take responsibility for any harm arising from your actions or omissions.

I believe we'll see some large class actions in the next few years with more and more women getting to the truth. I believe these women will have a very strong case.
The current brochure provided to women by BreastScreen is a perfect example - very brief information with risks barely mentioned; totally inadequate and misleading. It's now WELL documented that serious harm can be caused by mammograms.
It's unfortunate that it takes legal action to force doctors to treat women fairly and respectfully.

At Wednesday, March 25, 2009 1:14:00 AM, Anonymous Anonymous said...

I think it's easier to find a doctor who suits your needs in the UK. You can shop around and find a doctor who'll treat you for the flu or gastro without pushing preventative medicine onto you.
That seems harder in the States where thoroughness seems to be standard.
I hear some American doctors are pushing for women to have ultrasound assisted pelvic exams every year.
When it seems the pelvic is not done in other countries routinely, is this just another thing to be endured for no real benefit?

At Wednesday, March 25, 2009 6:47:00 AM, Anonymous Anonymous said...

There is a simple blood test called the cervical specific antigen that is almost 100% reliable. It was patented in the States a few years ago.
It has been kept very quiet.
Many believe doctors, specialists and pathologists will be reluctant to give up the unreliable smear test and it's lucrative follow-up industry.

At Wednesday, March 25, 2009 7:57:00 AM, Blogger Maurice Bernstein, M.D. said...

Let's keep the discussion of this thread focused on patient modesty issues and not on unnecessary testing (which could be a new subject thread which I should put up especially since marked difference in practice is reported from outside the United States). Yes, I know how we got off onto the path of unnecessary testing and its implication for those who feel their modesty of breast and genitals are being challenged, but the point is already established.

Mattie, let's keep the "horrors" of hysterectomy on the "Use and Abuse of Hysterectomy" thread.

Since I have many thread topics available to write to specifically, I think that keeping each pertinent to the topic is the best for clarity and understanding by the new visitors who are coming to this blog from Google and elsewhere.

As the moderator of my blog, I suppose I have a duty to moderate. ..Maurice.

At Wednesday, March 25, 2009 4:32:00 PM, Anonymous Anonymous said...

Today I had a Urodynamics investigation. It is hard to envisage a more personally embarrassing test. I made a stand and would not budge until they agreed to provide me with an all male team. I cannot even begin to imagine how I would have felt (but would no doubt have just "gone along with") if I had been faced with females present. They do know how uncomfortable men are with women present under such circumstances, they simply hope most men will be "lambs to the slaughter". I researched it beforehand and was adamant that I wanted males only. My advice is, if faced with a test/treatment etc, find out first what it IN DETAIL it involves, then decide what would suit you best, don't wait to be ambushed.

At Wednesday, March 25, 2009 5:20:00 PM, Anonymous Anonymous said...

Apparently, Saudi women are boycotting linjerie stores in Saudia Arabia because they don't want to discuss the purchase of
these items with salesmen.
Now,Saudi women should know that
if they ever find themselves in a
U.S. prison they should not worry
so much. Male prisoners are raped
more frequently by female guards
then the rate that female prisoners
are raped by male guards.Those
statistics are from the justice
Furthermore, I don't think they
have to worry about male salesmen
in a linjerie shop here in the
states. Now if you are looking for
male underware at least 50 to 80% of the sales folks in this country
are going to be female.
If you have to make a trip to the
hospital at least 94% of the nurses
are going to be female. Don't expect any professionalism and be
careful, make sure you wear clean
If you were a young male entering
the military in the late 60's,70',
80's and 90's the AFEES and MEP
centers told you to be careful
about your choice of underware.
What they didn't tell you was that
you would be paraded around in front of non-medical female clerks
in those underwear and at some point you would have to remove them in front of said non-medical
female clerks. I won't discuss
female teachers having affairs
with their male students here,
however,there is a particular
county in Florida where your chances are real good.


At Wednesday, March 25, 2009 5:52:00 PM, Blogger Maurice Bernstein, M.D. said...

PT what the take away message of your posting? Can you provide us with the sources of your statements so that we can follow up on those stories? ..Maurice.

At Wednesday, March 25, 2009 8:10:00 PM, Anonymous Anonymous said...

Alright...Dr. Mo,
Although I do believe I am entitled to be labeled as the poster girl for the abuses of patient modesty violations. I'll go back to my doctor designated thread "" ethics blog post site. I would like to invite anyone on this patient modesty blog to visit me there. I would like to cordially the, use-vs-abuse-of-hysterectomy section, where I will post my question and comment.

At Wednesday, March 25, 2009 11:26:00 PM, Anonymous Anonymous said...

Do a yahoo search female teachers
sex with students,florida

Do a yahoo search saudi wome
n boycotting linjerie,there you
can read the various artlcles on \yesterday



At Thursday, March 26, 2009 7:58:00 AM, Blogger Maurice Bernstein, M.D. said...

PT, so I went to Zimbio and picked a random article which included the statement about the teachers "What's crazy is that many of these female teachers having sex with their students are kinda hot." This type of resource is not what I was after. How does female teachers having sex with students in Florida as the specific example you give provide us with any understanding of the need for physicians and the medical system to attend to some patients' concerns about the matter of gender selection of their providers? ..Maurice.

At Thursday, March 26, 2009 12:14:00 PM, Anonymous Anonymous said...

My problems have not been with my doctors, but with the peripheral staff. (I don't really understand the doctor haters, I have a great relationship with mine and think they are the bee's knees - and if I didn't they wouldn't be my doctors anymore). That said, there have been a couple of low points. Because what I have is relatively rare (amyloidosis), I am being treated at a teaching hospital with a stellar reputation. Again, by and large a great place.

But. When I had an ECG, I had to walk down a long, relatively dark hall in an old part of the hospital. I passed one female employee on the way in and went several more doors down for the test. The only people in the exam room area were the male technician and me. I'm about 30-40 years younger than their usual patients and in pretty good shape, so when he flipped the gown open exposing both breasts and kept it that way for a good 30 minutes, I was a bit uncomfortable. Since he never moved the instrument to my right side, I'm guessing that one didn't need to be exposed. It didn't help that he was about my age and that there no one else around. I know I should have asked for a female to be there, but it is a pretty intimidating experience at best.

I was also scheduled for an endoscopy, and was taken into a room with two male nurses, a male resident and a male attending (who called me "the amyloid," by the way). Again, most of them were in my age range, seemed a little giggly and I felt uneasy about being knocked out (I also woke up before they were done, but that's another story). I would rather take a shot of whiskey and bite on a bullet than be knocked out, so I was already nervous enough. I'm sure nothing inappropriate happened, but I think they might have been a bit more aware of how "the amyloid" might have been feeling.

At Thursday, March 26, 2009 3:14:00 PM, Anonymous Anonymous said...

It frustrates me when patients don't provide the hospital with feedback. Patients need to refuse and complain...
I know it can be intimidating in a hospital environment, but I believe it's the only way to force change.
If you have a bad experience and say nothing, chances are the patient who follows you, may have a similar experience.
I read on another forum a woman complaining about her treatment during a cardiac test - left naked while she was being shaved for the procedure with a male doctor and two male nurses making jokes and laughing at her large breasts.
Naturally, she was humiliated and mortified.
I also have a cousin who ended up with very sore testicles after a cricket ball slammed into him...
He was referred for an ultrasound. The female technician was professional, but on leaving he heard her talking to her female colleagues and laughing about his condition.
He found their behaviour unacceptable.
My point - if you say nothing and leave, how will the system change?
How can hospitals and clinic's rid themselves of this behaviour.
I've found when one person complains, it can sometimes be a catalyst for change. If people are reminded that their behaviour fell short; that bad behaviour has consequences, they'll think twice next time.

At Thursday, March 26, 2009 3:16:00 PM, Anonymous Anonymous said...

The technician should never remove your clothes. They should always ask you to do it.
I've been thinking about my breast exam that I had with my PCP who is male. It was totally professional, I trust him completely, but I still feel that at the end of the day, intimate exams by a member of the opposite sex will never be completely gender neutral. Why? Because we were both pretending that we were looking at my elbow. Normally my doctor has a few jokes but he had to put on his extreme professional demeanor, and he was far more wary of his body language etc. So there was tension in the air.( Albeit very subtle. He acted like a seasoned pro.)
When I have had breast exams by women, we're not pretending they're not my breasts. It is far more natural. The female doctors are not trying so hard to make sure no action or comment can be misconstrued in any way. So they can concentrate more on what they are doing.
So I truly believe it can never work.

At Thursday, March 26, 2009 3:30:00 PM, Anonymous Anonymous said...

Seems that one of the complaints by several postersdepersonalisation in their treatment. Could this be viewed as one reason that modesty issues recieve the treatment they do? Could this be a reason, at times, for the "we are professionals" or similar response? That the providers are not being voyeurs,but simply do not see a person....just some disease or injury?....Their focus on the disease or injury may be completely professional..but do they remember that is a human being that is bearing that injury or illness.
I am asking these questions in sincerity..not as an attack on anyone.
If they are viewing only the injury/ may be..that they aren't seeing the person.

At Thursday, March 26, 2009 7:31:00 PM, Blogger Maurice Bernstein, M.D. said...

LH, I can only inform you what I teach my first and second year medical students. of either gender, which is how I feel when I am examining a patient. They are informed that any examination of a patient is a privilege given to us by society which those who are not in the medical profession cannot legally have. That's number one. Number two is that patient comfort and modesty is important to practice from the beginning of any examination. Number 3, examination of the female breast and the male and female genitalia needs special attention to modesty concerns and care for the doctor to behave with caution, attentive to the possible patient concerns of impropriety. The students are taught this not only by me but by the teacher-subjects on whom the students practice. When they leave our domain after the 2nd year, this is what they leave with. Whether later. concern for patient modesty wanes. well that is the problem. But I know they are aware of the 1, 2 and 3s when they leave us.

Leemac, what I described above is all part of the 2 year course at my medical school I facilitate titled "Introduction to Clinical Medicine" and the primary principle that we teach the students is that they are dealing with a whole human being and not just a disease. As I have mentioned on previous postings, we emphasize the Unified Concept of Disease where we look at a whole person in terms of biology (the anatomy, physiology and pathology), the psychology (the emotional, mental component) and the social (habits,lifestyle,work,financial and so forth) contributions to the way the disease is expressed. So we should be looking at the whole person as a 25 year old hispanic female who has recently lost her job. became depressed and had no medical insurance to go to a doctor when she had her right upper quadrant abdominal pain episodes and only now after a severe attack did she appear in the ER--rather than looking at her as another case of acute and recurrent cholecystitis. So, in theory and hopefully in practice doctors should be looking at the person and not simply the disease.
But here again, the factor of the time available to face the patient is dominating. If there is no time..then the doctor may find it more appropriate to get going with the diagnosis and treatment of the disease rather than using up the time on some other patient issue.

I hope these comments will help those outside the medical profession to understand what doctors are taught and expected to do when they are in a doctor-patient relationship. ..Maurice.

At Thursday, March 26, 2009 8:33:00 PM, Anonymous Anonymous said...

Maurice, So you are saying that there are no specific lessons regarding if the patient is of the opposite sex to the doctor? If you look at the link there is specific advice for the male medical student in the blue box.
I think this issue needs to be addressed at medical school. You cannot pretend that they think of themselves as gender neutral.

At Thursday, March 26, 2009 10:05:00 PM, Blogger Maurice Bernstein, M.D. said...

LH, I read the link. I can't believe any doctor thinks of him/herself as gender neutral nor thinks that the patient considers their doctor as gender neutral. But I think each doctor who is competent to do what is necessary for the patient should consider themselves "gender competent". And therapeutically, that is the most important. Sure, the gender of the physician will make a difference in perhaps patient comfort especially if the patient has undergone some stressful sexual or modesty experience in life and so there is a duty for the patient to explain their feelings and the doctor to listen and respond in the best interest of the patient. Because the goal of the physician is to resolve the medical issue that doesn't mean that the doctor considers their own gender irrelevant. I never have. I am a male doctor and I expect my patients to recognize my gender. ..Maurice.

At Friday, March 27, 2009 2:36:00 AM, Anonymous Anonymous said...

I agree with someone above that said it is not the doctors I am weary of, it's the other employees that work with him.

In searching for a doctor it is easy to find one of the gender you prefer in the most part (unless maybe you need a specialist or at an ER). At the first visit you can decide whether you feel comfortable with this doctor and if you don't you can either leave the visit early or finish and not return.

The problems are the nurses, assistants, techs, Med students, receptionists and other people that are hanging around for some reason. Finding a good doctor has never been a problem for me, but sometimes finding a good doctor with a good staff has been difficult. I have no problem with modesty around a doctor and his particular helpers (must be male for me), but other people that feel entitled to watch or sneak peeks (possibly not necessarily to see my nudity but nonetheless, uninvited peeks) ARE a problem for me. Once in a while a doctor understands that and doesn't allow ANYONE else without discussing it with me first, but the majority just don't care.

I've left a few doctors that I liked and was comfortable with, but who didn't try to control how his "helpers" acted.

At Friday, March 27, 2009 2:54:00 PM, Anonymous Anonymous said...

I would agree to a great extent the experiences I have had that were a concern were not with my doctors but those in support. My PCP is great, he has gone so far as to wait at the door for me to move to a part of the room where I could not be seen as he opened the door to leave. My urologist is the same way as is my dermotologist. I say to a certain extent becasue I personally experienced a gastro who had a female nurse present for a very minor role, and know of guy whose Dr. called in a nurse who knew them both for the sole purpose of holding the guys penis out of the way for his vasectomy, something my Dr. did by himself, or I have heard others whose Dr. asked them to help, or used tape. A provider has to know how a vasectomy is to a patient. I think in these and other cases it is more that while they are aware, their convenience and desire for speed outwieghs the concern for the patients comfort. So in a way, it is the Dr. who controls these situations and allows them to happen. On the other hand, most of the really troubling instances were done by support people, ie a female doing a testicular ultra sound when a male tech was available but asking a female if she had a gender choice for hers, etc. I think while they understand they are not genderless, they feel their rights or need to complete the "task" outwieghs the patients concerns unless the patient makes them known. I have to believe they understand the gender...but down play its importance to make thier job easier and more efficent. After all, who does the concept of gender nuetral really benefit....not the patient...and in practice it only benefits the patient becasue medical people have chosen to pursue the path of least resistance rather than trying to take more difficult measures to accomodate....alan

At Friday, March 27, 2009 5:26:00 PM, Anonymous Anonymous said...

Totally agree...
My friend had a great female gynaecologist, but was dismayed to find a male nurse in the theatre - she'd just assumed the nurses would be female - she'd asked for a female anesthesiologist. (one recommended)
She refused the procedure until the nurse was replaced, which took a LOT of courage. She has a history of childhood sexual assault and being unconscious and vulnerable with males present was impossible for her.
Her specialist was understanding but said she should have made clear she didn't want ANY males involved in her care. Sometimes women and men want to deal with same sex doctor, but don't care about the others, either because they'll be unconscious or assume the doctor will be in control (which isn't true usually - often the doctor enters the theatre after prep and leaves before the others)
It wasn't that she thought they would take advantage, more that she simply didn't want them there, involved with her care.

I guess patients need to be clear and firm with their requests.
Of course, this happened in a private hospital. If you're paying, you can have what you like (usually) it would be MUCH harder in a public hospital.
I'm not sure whether all male or all female teams could be arranged in a public hospital, but I assume if more patients asked, they could set aside a half day or so for these teams.
The medical profession is responding more and more to patient requests - they have to....
An older friend of the family is an almost retired male gynaecologist. He doesn't believe a woman's request for a female doctor should be accepted, that it amounts to discrimination.
He has been concerned to see that now women have a choice, many are choosing female doctors.
Curiously, he rejected a female urology resident while he was in hospital recently - his wife couldn't help herself and said, "Doesn't that amount to discrimination?"...
Sometimes it's only when a Dr walks a mile in the shoes of the patient that they see things from another perspective.

At Friday, March 27, 2009 7:11:00 PM, Blogger Maurice Bernstein, M.D. said...

Here is an edited version of a posting by PT today. ..Maurice.

I think the mentality of many posters here simply have a great
mistrust for nurses,assistants,
techs etc. One of the articles of
the oath of hippocrates, I will respect the privacy of my patients.
That physicians are expected to
respect the privacy of patients.Why
should we even have to ask. That to
me is a no-brainer. I'm not going to say to my provider "be sure to
respect my privacy and that means
no observers. Since when should I
have to voice these kinds of concerns. It teters on the bounds of silliness to even have to suggest that.It should be expected
that patient privacy will be respected.
I'm willing to say that the vast
majority of nurses,techs etc have
a different mindset when they are
patients and demand privacy,yet in
the workplace don't hold to these
standards and disregard patients
In the legal arena aspects of attorney-client are respected. Even
when the client is in prison or jail. If an investment advisor or
cpa discloses confidentiality
information to a third party legal
implications could follow.
Why are so many patients unhappy
and or very concerned about these
issues. I believe that change won't
come from within the medical community itself but rather through
legal intervention.


At Friday, March 27, 2009 8:48:00 PM, Anonymous Nellie said...

NU...imagine how he'd have felt if he was then told there were no male urologists and not to be silly she had seen hundreds of men that week.
What if he also had a history of sexual assault?
Older women remember those days and having female nurses gave you no comfort. People did not challenge doctors.
Doctors were Gods.
My SIL was a nurse and saw many improper things over her career. Even if a woman complained, it fell on deaf ears.
I think it's wonderful that we, at last, have choice of doctor and doctors are no longer Gods. Doctors are much more likely to find themselves in trouble if they behave improperly.
There were many brutal male doctors in the days when there were no female doctors and they got away with shocking behaviour for their entire careers.

At Friday, March 27, 2009 11:23:00 PM, Anonymous Anonymous said...

Providers will very likely respect that a person has been subject to assault or abuse and accomodate that person...but what about those of us who simply are extremely shy?
How does my wanting a specific gender based on my comfort zone discriminate? I have no problem admiting that a female provider may very well not only be equal in competency with a male but at times is probably superior to some least as far as ability...I am not trying to insult their ability nor am I even insinuating that they are in some manner a pervert I fear..I just am simply too uncomfortabe with them.
I do not see how this is offensive to is just part of my criteria in what I want in my provider...nothing more..nothing less.
I feel badly for any who have suffered mistreatment at the hands of anyone....and am in no way putting down the ladies who have posted their bad experiences..nor am I bashing female providers as a group..

At Saturday, March 28, 2009 12:22:00 AM, Anonymous Anonymous said...

Maurice I don't think that a doctor can consider him/herself "gender neutral" either. But that is a term I have picked from reading articles in medical journals and forums by doctors and writers who seem to think that it does exist.
PS, Oh the irony. NU.

At Saturday, March 28, 2009 6:11:00 AM, Anonymous Anonymous said...

Nellie, now imagine if you went to the hospital and walked through the door and registered where all the staff taking information were men, they then called a man to come up and take you back to the prep room where they introduced you to another man who gave you instructions, a gown, and preped you, pretty soon another man came in and itroduced himself as the circulating nurse who was in charge, pretty soon the NPCNA (male) came in and introduced himself, then two men in scrubs came in to wheel you back to the OR, when you awoke back in recovery there was another guy sitting beside the bed waiting for you to wake up...a couple other guys in scrubs mill in and out while you are shaking off the effects of being out....that is the reality in reverse of what I have and most men experience today. In all likely hood if it were a male who in that situation asked for the team to be all male, they couldn't have accomodated if they wanted to. I have no doubt women had it rough in the past, I have no doubt that women continue to experience instances or problems today. As we have discussed here there seems to be a disconnect between providers and patients as to not only whether this is an issue, but what exactly is reasonable accomodation. Providers want to be considered gender nuetral as it fits their needs, they often want to address it by "being professional", patients want different things ranging from respect to same gender care. Some providers as you indicated see this as a personal afront or discrimination while patients see the providers view as uncaring and even abusive. This "sub issue" of how we view things from our own personal perspective provides insight into the issue as a whole. While we may try to see it from the other side can we truely...while you and several other women cite past offenses and a history where only male doctors were available and that guides your current views, I see a system that did away with male orderlies which provided same gender care for males and replaced them with female nurses. You see a history where only a small percentage of Dr.s were women, I see a system where over 50% of med students are female and 94% or more of nurses are female and nothing is being done to address this. My personal opinion is yes modesty issues in medical care are an issue for both genders, but...the sheer gender make up of the majority of all health care providers being female provides certain challenges for males, and societies attitude in general that male modesty isn't as big of concern as evidenced by the differnt policys regarding the issue in sports locker rooms, prisons, restroom and changing facilities compounds that problem. None of this diminishes the severity of what happened in the past or what happens to either gender today. Recognizing the past is important, we learn from the past, but acknowledging current or other peoples challenges does not mean we discount the rest. I am a business man, I face lots of problems every day, the first thing I do is list them (acknowledge and recognize), then prioritize them by severity, frequency, and effort (to address) and impact (benefit and quanity). It doesn't mean just becasue an issue effects the business less or effects less people it isn't important. Often fixing an issue in one area fixes it in all areas. This issue isn't that much different. But the first step in solving this seems to be recognizing and admitting the issues, whether that be between the genders or between providers and patients......and to that very important first step...our personal perspectives seems to define that and we have difficulty in truely seeing the other side...that is why this dialouge is so important...and even more do you get this out to a larger audience?...alan

At Saturday, March 28, 2009 10:08:00 AM, Anonymous Anonymous said...

Would someone please explain this
issue of gender neutrality to me or
am I missing something. Can any
provider state that they are truly
gender neutral and what kind of
process do they undergo. Are their
sex organs removed followed by a psychological debugging process.
Would this new credential follow
their titles MD or DO and certified
gender neutral. Will this certification process soon entail
nurses, techs and aids. How does
this painful process solve the
observer problem.
It would seem ridiculous to make
these people pay a fee just to have
this extra title despite this long
and painful process! What would
Marcus Welby MD think about all


At Saturday, March 28, 2009 3:26:00 PM, Anonymous Anonymous said...

I don't think a patient needs to explain their preference - if you're a victim of past sexual assault or a private and shy person.
Why should it matter?
In Sweden women are not entitled to request a female doctor unless they have been sexually assaulted - of course, this means many women simply leave if they are allocated a male doctor or some choose not to attend at all and others will say they were a victim of sexual assault to secure a female doctor.
Why did this come about? Because most women wanted female doctors and the male doctors had a fraction of the workload.
The answer as far as I'm concerned is to employ more female doctors.
I think it's unacceptable to force a male doctor or female doctor on a patient.
Courts in the UK, Australia and the States have confirmed that it may be discrimination, but it's acceptable given the extremely private nature of the examination - these cases were examining the question in relation to female patient and male doctor - but the principles would remain the same IMO in the reverse situation.

At Saturday, March 28, 2009 7:08:00 PM, Anonymous Anonymous said...

No matter how "gender neutral" a provider strives to be...there is no way a patient is going to miss the sex of said provider..asking me to not see that my doctor/nurse/technician etc. is a male or a female is asking me too much. Maybe if I am in a coma or in last stages alzheimers I won't know it( although I have been told that comatose persons often are more in tune to what is going on than you might think)People avoid a situation they are not comfortable with..that is not is just human nature.

At Saturday, March 28, 2009 9:35:00 PM, Anonymous Anonymous said...

I left this discussion for a bit to recharge over in my world, among naturists for whom yin-yang is just one of life's cheerful duets. Catching up on reading here has agsin left me disturbed, The fixation on gender as a source of distrust, violation and confrontation, the sad stories of feeling, fearing or being treated with disrespect, the association of modesty with powerlessness, the assumption that modesty "solutions" involve gender aparteid rather than such full communication, understanding and respect that gender becomes a non-issue for modesty. Naturists are not naive -- we interact with people in the same communities -- but we simply expect, demand and act with mutural respect as people without reference to gender, veils or relative vulnerability. We must all do that and respect all who reciprocate. The gender of a doctor or caregiver is just not a very useful indicator, a priori, of their attitudes, or our gender of ours. Anyone who makes gender an issue, medical staff or patients, poisons all hope of natural respectful interaction. Mutual modesty must start at "hello" and be enhanced by each subsequent word, thought and deed. If there are specific or systemic missteps or misdeeds along the way, highlight them, discuss them, find a "solution" -- whether at work, on a bus, or at the doctor's office -- but through communication that brings people together and takes us all forward. Disentangling gender from modesty is just one aspect of moving forward and getting to the real issues of power, vulnerability and responsibility. (CSM)

At Saturday, March 28, 2009 9:37:00 PM, Blogger Maurice Bernstein, M.D. said...

I am not sure I made my opinion clear in the past, so I'll try again.
I think physicians don't think or believe they themselves are "gender neutral" but hope that the patients consider their physician "gender neutral" and will be interested only in the physician's competency to perform the needed diagnosis and treatment. The physician understanding they are not "gender neutral" in their thinking and emotions is the reason why the need for strictly professional behavior is indicated for a physician interacting with the patient. ..Maurice.

At Saturday, March 28, 2009 10:06:00 PM, Blogger Maurice Bernstein, M.D. said...

CSM. I couldn't say it any better than you have. In fact, though I wrote my last comment before I had access to yours, my comment was my feeble way of trying to imply the same thing though you obviously said much more.

Sure there are abuses in medical practice and what seems like frank ignoring of patient's desires in some doctor-patient relationships or in clinic-patient or lab-patient relationships but there are multiple reasons to explain this.

Maybe as CSM suggests, patient should ignore gender and expect in both men and women providers that they stick to professional standards, perform competently and communicate properly with patients to understand the patient's needs and concerns beyond diagnosing and treating the disorder. And that's it. Yes, the will be patient modesty issues by some patients based on a history and experience of various factors but what is really needed is for the patient to make the physician or other care provider aware and the professional to listen and respond.

My opinion is that all this talk about sexual perversion is way outside the issue of these threads. This is not the behavior of most physicians and one need not expect this behavior or consider it as the factor leading to patient modesty.

I agree with CSM, that patients should take the attitude of the naturists and expect the that all behavior will be proper, whether doctors or others, and then enter into the relationship with that attitude. Obviously, if something different occurs or is found, then that should be discussed, reported and corrected. ..Maurice.

At Saturday, March 28, 2009 11:22:00 PM, Blogger MER said...

I agree with most of what Dr. Bernstein and CSM say in their last few posts. I have been constantly stating in my posts that the bottom line is good, honest, open communication. But I do want to add this.

CSM wrote: “Anyone who makes gender an issue, medical staff or patients, poisons all hope of natural respectful interaction.”

I agree. But what does it mean “makes gender an issue”? Remember, it isn’t just the patient who wants a particular gender for intimate care who is making this an issue. A medical system that staffs, hires, and schedules in such a way – with primarily one gender -- so as to preclude the possibility of choice, is also making gender an issue. A system that doesn’t openly and honestly communicate the possibility or impossibility of patient choice in this area, is also making gender an issue.

The webpage of St. Michael’s Hospital in Toronto states this:

“No matter what exam you are scheduled for, everyone has the choice to request a same sex technologist to perform the exam. If a same sex technologist is not available in a timely manner, you have the following options:
• Wait for a same sex technologist to become available
• Reschedule your exam on a day that one will be available
• Have an opposite sex technologist perform your exam with a chaperone (a same sex individual who is not a technologist) present
• Continue with an opposite gender technologist performing the procedure”
To some medical professionals, this may seem like the hospital is actually making gender an issue. That’s why I think almost all hospitals in this country avoid such notices on their websites. Why bring it up? Why ask? Why make it an issue? Well, someday it may not be an issue in our culture. But today, it is an issue for a significant number of patients.
I would argue that this kind of announcement on the St. Michael’s Hospital website is an example of open, honest communication. This is an example of making sure that gender doesn’t become an issue. By doing what they’re doing, they’re talking gender off the table. They’re demystifying it. Don’t worry about it, they’re saying. We know it’s an issue for some of you. We’ll deal with it. We’ll work with you.
Do we want to get to a point where gender isn’t an issue in medicine? Then let’s face it openly, discuss it, deal with it, open it up. By hiding it and pretending it doesn’t exist, we’re making it a bigger issue that it is by giving it more power than it probably deserves.

At Sunday, March 29, 2009 12:00:00 AM, Anonymous Anonymous said...

Dr.Berstein and CSM, because I am not comfortable with opposite gender providers does not mean that I do not respect them nor that I am going to mistreat them...Do either of you think that by my having a preference or modesty issues that I am outside of my rights or that I am making the provider some kind of victim? Except for some very careless words a 12 year old overheard coming out of anesthesia, I can not and do not claim that I think anything untoward is going to be done to me...well..excepting being very embarrassed...
CSM, you have no problem being with other naturists and oviously do not have any modesty issues. Good for makes for a less complicated time in many situations I am sure.
I just had to ask my PCP for another referal for a determatologist..He had referred me to a practice with one male one female provider...when I stated I wanted the male they grudgingly said ok...when I talked to them about how he conducted his exams...They were most sure to let me know I had nothing to worry about as his female nurse is always present..always. She helped with notes and is most experienced in comforting a patient during the exam....I am sure they thought these things should make me happy..I did not make any nasty statements nor did I try to explain further my feelings..I did not in any way put anyone down...I just told them I had changed my mind and would not need the appointment...I freely admit that both doctors have excellent reputations for being tops in their field...Although he did not seem happy that I was not overjoyed with his first pick ( Yes, he did try to get me in with someone he considered to be first rate), he told me to let him know the name of anyone I chose within my insurance approved list and he would give the referal. He is not comfortable treating the skin cancers he found or I would be happy to have him do so.
This may go against what many believe, but it is my comfort zone I am interested in....people avoid a situation where they are uncomfortable....this does not make them bad..
To say that by making gender an issue it poisons something...when the embarrassment is when a person is naked in front of someone of opposite gender simply makes no sense to me...What do you propose? That I suck it in and suffer the emabarrassment? To be rude or disrespectful will surely poison a relationship..but that goes both ways...but to express a feeling that is deeply felt...that is honesty..which doctors say they want from a patient..and I keep reading and hearing..Choose a provider you will be comfortable with..why on earth would I go where I was uncomfortable and very embarrassed?..I wouldn't nor do I expect anyone else to....By the same token I do not expect a provider to have to be my provider if they are not comfortable with me..

At Sunday, March 29, 2009 3:37:00 AM, Anonymous Anonymous said...

And that is the crux of the matter, Maurice."The physician understanding they are not "gender neutral" in their thinking and emotions is the reason why the need for strictly professional behavior". For us with the suspicious minds, displaying professional behavior is not enough. We want to know what is really going on in the physician's mind. You've probably deduced by now that the people who read this blog are highly paranoid and suspicious of doctors but I think most of us have become this way from past experiences with them.

At Sunday, March 29, 2009 9:20:00 AM, Anonymous Anonymous said...

First off the issue from my point of view has nothing to do with any thought that providers are deviant in any way. I do not distrust providers of either gender. But it makes me very uncomfortable to be exposed to members of the opposite sex who is not my wife. Dr. Bernstein you admit providers do not see themselves as gender nuetral but hope their patients see them that way. Just as you recognize it is impossible for providers to consider themselves gender nuetral, it is just as unlikely most patients can see providers as gender nuetral, you may hope they will, you may think they should, but deep down you have to know for most that is impossible. Providers have to recognize that this wish is self serving, just as female reporters seem to believe that it is normal and not an issue for them to be in male locker rooms. This is understandable, providers may have the highest morals, the highest intentions and all sincerity, but you are still asking patients to put aside what for most is a life time of teaching and cultural standards. And while providers and people like CSM may feel it is the patients inability to ignore gender that causes a breakdown as communication and trust, the reality is this is still a society that has a standard of modesty that is held by a vast majority of its citizens. While there has been an attempt to over come or deal with this in the medical setting, to expect patients to just put a lifetime of conditioning behind them is not really reasonable. If all of a sudden a chain of businesses felt unisex bathrooms were appropriate, and women and men were now expected to use the bathroom at the same time. Just becasue they decided it was to their benefit and therefore for your benefit...seems ridiculous, but is expecting atheletes to accept female reporters just becasue they want to be sports reporters and the court says its ok...isn't much different. So when it comes to who is causing the damage to the communication part of the medical pointed out above is it the patient or the provider who is asking to much. Providers and reporters have a lot in common, they are expecting people to ignore or repress all of the things they have learned so THEY can conduct their profession as they see it should be and validate it with the benefit to the patient/athelete.....alan

At Sunday, March 29, 2009 3:03:00 PM, Anonymous Anonymous said...

I just want to clear up that I don't mean I think the providers are having deviant thoughts, but I cannot accept when they see your private parts for the first time there is not some kind of judgement even for a moment. I remember one of my father's doctors friends telling all of my family about a beautiful dancer's body he once operated on. It wasn't spoken in a sleazy way or anything but I still think doctors shouldn't be making any kind of judgements about anybody's body. Like they keep saying to us "it's purely clinical". Yeah right.

At Sunday, March 29, 2009 3:44:00 PM, Blogger Maurice Bernstein, M.D. said...

" I remember one of my father's doctors friends telling all of my family about a beautiful dancer's body he once operated on." LH, actually you brought up a great side topic which has been briefly touched here but probably should have more discussion for clarification.

The question is, if doctors don't and shouldn't look at themselves as "gender neutral" shouldn't they have the same impressions and "right" to speak as a ordinary person to others outside of a clinical relationship about their personal observations of patients without identification of whom they are speaking about? Shouldn't an attractive woman make an impression on a physician, male or female, about which the physician might remark in a general manner later to others? I would agree that expressions such as "a lovely vagina" or "handsome penis" would be inappropriate since these parts of anatomy would not be what an "ordinary" person would have the opportunity to access as part of their profession. But "a beautiful dancer's body", though not in the context of surgery, would not be an unexpected and unwanted expression for any observant individual to use. Again, in informal company, a physician might say "Last week I had a very seductive patient and here is how I handled the situation..." I see nothing unprofessional with that either. Everything that the physician witnesses should not necessarily be off limits for general informal discussion, without identification, in an non-professional environment. OK now let's dissect this argument. ..Maurice.

At Sunday, March 29, 2009 4:17:00 PM, Anonymous gve said...

There are fairies at the bottom of the garden, pigs can fly, doctors are gender neutral........ spot the odd one out.

Instead of all the side shows, side stepping, avoidance, why not simply make plans to make patients feel less uncomfortable?

Nobody who is being honest doubts for one moment that opposite sex intimate care causes the patient embarrassment. How the carer feels is of no relevance whatsoever.

When I recently underwent Urodynamic, conducted by 2 males, I felt completely relaxed and not in teh slightest bit bothered.

When I was being refused such an option and was fighting for it, i felt very uncomfortable at the prospect.

Start to consider how the patient feels, NOT how comfortable and unembarrassed the carer feels.

At Sunday, March 29, 2009 8:13:00 PM, Anonymous Anonymous said...

I would venture to say that being
gender neutral is a phrase synonymous with "were professionals". Both mean nothing to most patients.
It's interesting to note that HIPAA laws and its provisions although with inadequate bite,most
likely all began as unnecessary,
meaningless and unprofessional
comments in elevators and the like
about patients.
Certainly, one can see that given
enough time and enough complaints
from the public this too will change. Its unfortunate that change from within the medical community itself won't be forthcoming. You'd think that people would put two and two
together and say "OK, we can't
trust you with our medical records
other related medical information,
what makes you think we can trust
you with other related issues about
our bodies and personal life".
The HIPAA law was passed in congress in 1996, 13 years ago
and despite this law with potential
fines of $100,000, violations continue. I believe that not one
celebrity can enter a medical
facility anywhere in the U.S without a HIPAA violation. Ask a
typical hospital employee why they
prefer NOT to use the hospital
where they work for medical care!
Several years ago in a hospital
in California roughly 25 hospital
employee's were reprimanded and
fired for delving into the medical
records of a celibrity. Two that
were reprimanded were physicians.
Hospitals are prime sites for
identity theft since information
about patients far exceeds information that any financial
institution might have on clients.
It's a simple process to conclude
that anything about you as a patient that is known will be known,turned upside down and talked
about however irrevalent by staff,
especially those not involved in
your care.


At Sunday, March 29, 2009 9:51:00 PM, Anonymous Anonymous said...

I fully agree that a doctor or any provider is human...and that they can talk about anything they want to..especially in their private long as they don't break patient confidentiallity in any way by identifying a patient..
Others listening to a doctor may form their own opinion of what type of person the provider what and how they discuss any event or person.
after of the weather is only going to go so far....and it would be ludicrous the expect a provider to refrain from saying something about a specific event or even a specific illness...and to discuss how they handled the is educational and provides a method for the exchange of valid information..something that offers benefit to other patients and providers....Just as long as there is no way the individual can be identified...
It doesn't seem likely providers would do much talking that amounted to ridicule....I am sure that would offend any and all listeners.
Thanks for the posts MER....and all other posters.

At Sunday, March 29, 2009 10:58:00 PM, Anonymous Anonymous said...

OK, here's my take on "gender-neutral" in the context of a doctor visit. Whether you are a man or a woman and you are concerned about modesty, say something to your doctor, perhaps about having had previous uncomfortable experiences. Whether you are a man or a woman, ask to talk in advance with any examining person, whether they are a man or a woman, so that you can assess "what is going on in the mind". If an advance interview is not possible and you are concerned, whether a man or a woman, ask that at least a person of your gender is present (eg. a chaperone). This protects while giving everyone a chance to prove themselves, in contrast to a preemptive approach of demanding a same-gender doctor or tech, which is pure gender discrimination on the basis of assumed stereotypes. In requests and explanations, always associate modesty with respect, not directly with gender, even if you yourself assume respect is more difficult for the opposite gender. You may be surprised when you do find out "what is going on in the mind" by the gender of the people likely to "judge" when "they see your private parts for the first time." It is my experience with new naturists that same-gender judgmentalism is more common. Later, even with new naturists, probably like medical staff, judgmentalism subsides to clothed levels, for instance "what 'a beautiful dancer's body'" -- an observation that is "gender-neutral" since it might be made by either gender. "Gender-neutral" doesn't mean "neutered"! "Gender-neutral" means treating people as people whatever their gender happens to be, without sexual undertones or overtones and with equal respect no matter which body operating system they happend to have been born with. If you ever visit one of our naturist venues, you will be shocked by how impeccably your modesty is respected, how little your gender counts, and how quickly you'll feel completely safe and comfortable no matter what your gender. That, to me, is what "gender-neutral" health care should feel like. (CSM)

At Monday, March 30, 2009 3:32:00 AM, Anonymous Anonymous said...

Has someone ever said my new doctor is handsome to a friend?

Or thought that nurse is so fat?

Not much difference really how a patient thinks or acts from a health care worker.


At Monday, March 30, 2009 7:21:00 AM, Anonymous Anonymous said...

Dr. Bernstein
I think the thought by providers that it is perfectly fine for them to talk about "the beautiful body" of a dancer because they are only human, but then claim the patient should view them as gender nuetral shows a basic issue. Providers often use the I am a professsional, or I have done this a thousand times, its no different than looking at an arm or leg to me. You can't claim you are human with the same wants, needs, and desires as everyone else when it works for you and then claim to have by training or other methods acquired the mentality that makes you different from everyone else in how you view the nude patient. While it is possible "beautiful body" could be meant as strictly gender nuetral...I doubt if most people, especially non-medical people would take it that way. You can't have it both ways, either you view your patients in a way that makes them...for lack of a better word...sexless and have no effect on your as such...which would justify your patients looking at you as gender nuetral or you are a professional who is human and such acknowledge that a beautiful dancer has a different effect on you than a 75 year old over wieght woman and as such acknowldege the relationship between provider and patient has this dynamic, and the provider will behave professionally and the patient has to decide if that is sufficent to make the comfortable. You can't ask for unparelled trust and handing over rights and control that we would give no one else and then say we are just like you.

more than once you accuse those who have modesty concerns as discriminating, basically calling them sexist. Yet I would make the case that you and some other naturalist are actually more judgemental and prejudiced than the general public at large. You have chosen a life style that is viewed by the majority of society as abnormal, yet you judge the majority very harshly.
To make statements that preference of a same gender provider amounts to "pure gender discrimination" is utterly ridiculous. Automatically you start from the basis that the concern is centered in the fact that we distrust, judge them as deviant, or as having some negative attribute that arises soley from their gender. While there have been numerous posts here from people who have expressed that sentiment, there have been many more that state the obvious...this is not about the provider, this is about me, this is what I feel comfortable with, and it is based soley on the situation...a situation defined by most societies in the world..exposure..not the fact that they are one gender or the other. If someone says I don't like female or male providers period, I don't want a male or female doctor for anything, I would be more likely to agree with you, however what they are saying is I do not feel comfortable being nude infront of opposite gender....something society has said is doesn't say they are a pervert, it doesn't say becasue they will talk about me or get off on seeing me naked, it says uncomfortable. What makes them uncomfortable is a situation society has taught for generations should make them uncomfortable. It isn't about the provider, its about what the patient is comfortable with based on society and upbringing. you suggest having a same gender person present "protects everyone while giving everyone a chance to prove"...this isn't about proving, this isn't questioning ability, this is about feeling comfortable. It is my understanding that if someone went a nudist camp and decided to stay clothed for an extended time, perhaps forever, it would not be accepted. Why not, if we are not making judgments based on the norm...why are clothed people not just viewed the same as nudist...once again, you are judging people from your perspective, suggesting what they are thinking, and how they should approach this from your perspective. I have a lot of respect in general for naturalist, that they feel a certain way and don't let society define right or wrong for them. They have the ability to rise above public or majority opinion...unfortunately there seems to be a tendency for some naturalist not to recognize that their lifestyle is not THE only correct one and seem the feel the need to convert others to their way of thinking. I am not you, I do not have your views, nor do I feel I am being a bad person or discriminating becasue I do not....I do not judge you negatively because you follow an different life style, why do you feel the need to judge those that don't. You are saying we are discriminating or being sexist because we have gender preferences for A SPECIFIC INSTANCE is about like us saying you are a nudist because you are a perv and like looking at naked can't deny some naturalist do...but should we paint you all with the same brush. Does the fact that I do not practice homosexuality mean I am discriminating against homosexuals because I am not open to trying that...alan

At Monday, March 30, 2009 10:09:00 AM, Blogger Maurice Bernstein, M.D. said...

Alan, MER, Leemac, PT, LH, CSM and the all the others contributing to this thread: I just wanted to thank everyone for their contributions. These discussions here over these years on patient modesty, I think, have been of value to those writing and those simply reading and may, indeed, represent a unique documentation of this topic on the internet or elsewhere. (Though, I shouldn't ignore Joel and his blog!) And yet, there may be further valuable discussions to come.

As you know, I have written here repeatedly encouraging those who find that the medical system needs to be changed to go beyond writing here but to be activistic in other ways to help make those changes. What has been accomplished in this regard since we started this topic? Or is anyone out there arguing that no system changes are necessary?

Again, thanks to all. Let's continue on... ..Maurice.

At Monday, March 30, 2009 1:52:00 PM, Anonymous Anonymous said...

The use of a chaperone is ok when one feels a need to insure that a witness is a deterent to patient or provider from taking liberties. For those without concern about the other persons intent all it does is provide an audience. I have an issue about the private areas with opposite gender providers...a chaperone (audience) does nothing about that and would only make it worse.

Dr. Berstein, I feel that there needs to be more activism, but the knowledge obtained from you and the other posters has made a huge difference in how I can achieve my comfort zone and still get whatever care I need...primarily from just by asking and looking around until I can be accomodated. The activism needs to be to find a way to let the medical community that there really is such a thing as male modesty and that reasonable accomodation is in order. This includes hiring more males when they are available..
I know, Dr. Bernstein, that you have attempted to draw attention to this issue...but your blog has also given a forum for folks to exchange ideas..Thankyou.

At Monday, March 30, 2009 3:14:00 PM, Anonymous Anonymous said...

I agree that more needs to be done in the way of activism. I myself have actually started doing some research/training in web design and will be attending a web design course this year. My first project, design a website to start a membership of some type in regards to what were discussing here. I realize now through this blog and my own personal experience that providers won’t change just for me and it’s going to take a collective effort of MANY to get things changed for the better. Just as MER, I’m glad more women are posting here as well. They’ve had to endure much worse than many of us and don’t deserve to be left out of the conversation. This is an across the board issue that effects everyone and should be discussed as such. I agree that they have more options today than years past but I also recognize that they have been more vocal to get to that point than we have…to this point. As much as I avoid being on display for women, I couldn’t stomach the thought of another man examining my wife. It has never happened and won’t regardless of any situation as long as I have a voice…..

Just a side note ---- You can purchase BC pills off the net without a prescription; your insurance will even cover it as I found out. I can provide a few sites if anyone wants to know. All they ask for is a brief history and a BP check. Jimmy

At Monday, March 30, 2009 4:00:00 PM, Anonymous gve said...

The most significant thing we can all do is to simply refuse to accept opposite gender care when we are uncomfortable. DO NOT attempt to justify it, simply insist that they offer a team you will be comfortable with. Eventually, the penny will drop and they will realise that a commercial opportunity is being missed.

Fairness. equality and dignity are not the sole preserve of women, men deserve equality too

At Monday, March 30, 2009 4:07:00 PM, Anonymous Anonymous said...

I have been reading this blog for months, and the doctor's comment about the "beautiful dancer's body" has finally prompted me to post my comments for the first time. If I had overheard a doctor make that statement, my first thought would be, "Oh, my goodness ! What is my doctor saying about me ? That he saw a patient with the most awful cellulite thighs ? "
A doctor should not casually discuss anyone's body. Period.
For what it's worth on the modesty issue, I care more about personality & manner of the physician than I do about his gender... but I HATE gyn chaperones. It actually makes me more self-conscious.
And yes, men have been treated differently than women in regards to modesty issues, and that needs to change. Just my two cents worth.

At Monday, March 30, 2009 5:23:00 PM, Blogger Suzy said...

As I read these posts, I become more and more convinced that there is no way for me to ever feel comfortable being naked, even partly naked, with these strangers. The "care" that they offer is questionable at best since most of it is comprised of feeling and looking at symptomless bodies.

I always feel compromised and embarrassed after any exam that involves exposing any body parts that would be covered by a bathing suit. It seems that I've been 'had', that I could have easily collected the sample needed to diagnose, say, an infection or described the symptoms well enough for the doctor to have diagnosed and treated the issue easily, without forcing me into the miserable choice of removing my clothing and lying exposed to hands and eyes in order to obtain any medication.

I have always been very uncomfortable with the humiliating demands of doctors procedures, and I will continue to be. This discussion has very much helped me to feel comfortable in the decision to refuse any more exams.
Thank goodness for the internet! We can talk, compare notes, and when necessary, purchase the medications we need without having to compromise our integrity.


At Monday, March 30, 2009 11:05:00 PM, Anonymous Anonymous said...

Alan, when I argue that a "preemptive approach of demanding a same-gender doctor or tech pure gender discrimination on the basis of assumed stereotypes", I am not speaking as a naturist, but as an incurably male gender-equality feminist! :) You are quite right to scold me for not understanding that it is not about the gender attitudes of the care provider, but about your own comfort as a patient with same gender care providers -- I sincerely can't grasp how this is different from prejudging another human being on some other physical attribute that they were born with and that is unrelated to their expertise or to the service being rendered. Whether my doctor or me are straight or gay is a sexual issue, Sox or Yankees fans is a sports issue, Jewish or Muslim is a religious issue -- to me, these are separate from health care and modesty. I was just providing some counterpoint -- to highlight the apparent interweaving of sexuality, gender and modesty for modesty activists, to note that some folks like me are just as activist about eliminating gender as an issue in any workplace, and ultimately, for myself, to try to better understand the dynamics of gender-focused modesty. In contrast, I readily understand Suzy's straightforward feelings about being uncomfortable "exposing any body parts that would be covered by a bathing suit." (CSM)

At Tuesday, March 31, 2009 5:31:00 AM, Anonymous Anonymous said...

To your question Dr. Bernstien, what have we done. I personally have done the following:

On a personal level,

(1) I called & e-mailed a imaging center in a hospital and addressed what I felt was a problem when they assigned a female tech for an testicluar ultra sound, I pointed out the positives of offering choice for intimate exams including the fact that they could offer and advertise something those with only single gender techs could not. As a result they told me they intiated a policy where they had a list of procedures that when schedule through central, the patient was given a choice of gender.
(2) I make it a point to watch the papers and billboards, when a facility advertises I send them a letter saying I saw their advertising and suggested they consider gender sensitive care which would be a great advertising hook that few are using...have gotten responses but have not seen it in practice.
(3) I have requested a nurse step out side for a exam that I didn't feel she was needed
(4) I have written several facilities and told them that I respected their work but I use an out of town facility as I can get same gender tech's and asked them to notify me when it is available at their facility and I will start using them.
(5) I have met with two of my state representatives and provided them data on the pending nurse shortage and the dire consequences. I then presented them the data of the lack of males in nursing and provided that as a possible partial solution. Presented them with copies of "Are you man enough to be a nurse". And told them I would follow up. (just wanted to plant the seed)
(6) I am currently working with a male nurse to develop some litature and advertsing that i can make avaialable in some of my retail outlets in places like men's restrooms about the job opportunites in nursing for men and what nurses are making now.
(7) I regularly write facilities and compliment them on the positive aspects of my visit related to modesty as well as point out the need for improvement.
(8) I also have on numerous occassions made requests for accomodation that I would never have before...please step out, I would like a gown, etc

All of these are a direct result of this and Dr. Sherman's two have made a difference in how I approach these things...including the fact that I had my first head to toe skin exam because I felt comfortable making my wants known

I think the key to writing and addressing facilities is to be respectful. Try to write intellegently and be calm, provide suggestions and the benefits to the facility. Things like financial from attracting patients from facilities that do not address it. The impression and image benefit when you offer choice to a patient whether they care or not about the gender of the provider. If you come off as aggressive, threatening, they will be more likely to dimiss you as a crack pot. I also drop small refefences to HIPPA, JACHO etc. Not in a threatening way, but enough to give the impression that I am a little more knowledgable than I am....

I think the ultimate would be a large organization such as NOW, but that takes a lot of time, effort, and money. But in lieu of that, if there was an organization even small, with a web site etc. similar to what Jimmy is talking about. If people had a clearing house for issues where they could send concerns, and someone would respond/inquire on their behalf...a faclitiy getting and inquiry from The National Association of Patient Rights....rather than Joe Average, it would have a little more impact, the more things you have to give a appearance of legitimacy, web site, stationary, etc the more impact. It could end up staying small or it could take off.....I would be willing to help with such an effort...but I have a business to run and could not dedicate myself to it would take a little effort to set up to make sure you don't do something like slander a facility or Dr.. And you would have to have a basic charter so you don't have someone acting radically, threatening under the name of the group when the group opposes such acts...etc.......alan

At Tuesday, March 31, 2009 9:48:00 AM, Anonymous Anonymous said...

Alan, the steps you are taking and the actions you take are probably one of the most effective ways in achieving same gender provider parity that can be...Thankyou both for your postings and your a reasonable makes others more likely to give attention to the issue.
CSM, because I am very uncomfortable with opposite gender providers does not mean I am stereotyping them... that you are a male or a female is a fact and is not stereotyping.
Perhaps I feel I am being discriminated against...a provider has rights, but so do I.
You want people to allow you to be you...but you need to respect their feelings in order to ask for yours to be respected. I was raised in an area that a naturist would be immediately suspect of all kinds of immoralities and perversions..I would say that that was stereotyping....No one has an automatic right to be my provider.
You mentioned a concern about not wanting to pay higher medical costs over same gender care...1) It should not be any higher in most cases. 2) I can counter with naturists getting more exposure to the sun over a larger part of their body increases skin cancer incidence (this is a fact already) and that this increased skin cancer raises my costs of medical care..for something I do not participate in..maybe I don't like that....but it doesn't mean I have a right to say that naturists should be denied access to the medical services they need.
At least the courts have issued some opinions recognising that the practice of medicine has issues no other ones do..when it comes to peoples bodies and feelings.
I also wish to acknowledge Dr. Shermans contributions here and on his blog and thank him.

At Tuesday, March 31, 2009 2:55:00 PM, Anonymous Anonymous said...

CSM I would appreciate a little clarity on how you see Suzy's comment about what a bathing suit covers and what most of the other posters are saying. Most of the posters have indicated they are fine with opposite gender providers for all procedures that do not include exposure of their "privates" which as I took it was exactly what Suzy was saying. So if you could clarify where you come up with the difference. I think the other issue is as you have touched on, your activist point seems as I understand it to say we "non-naturalist" should adopt your view that we are gender nuetral where we say you should be allowed your own choice. If you see it gender nuetral we have no issue with that but we should have the same choice for our preferences. We do not limit your option, you seek to limit ours. The other thing you are imposing here is your instance that we are some how making comments on thier skill or ablity based on gender,,,,I don't think I have seen a single post to say the opposite gender is not as capable, they are saying exactly what Suzy said...they don't feel comfortable exposing thier privates to members of the opposite gender...the exact parts a bathing suit covers. Could a female be the best urologist in the world, of course she could, would I feel comfortable being nude in front of I would not. Let me take this to extreme to make a point, if the head of the KKK was a good doctor, would you knowing this have no problem with him treating you? If a member from the far right who believed that public nudity was a crime and violators should be locked up was a great doctor...would you feel comfortable getting treatment from them...while granted they are more extreme because we (I) disagree with their says absolutely nothing about their ability or skill. And if the Doctor who was against nudity and naturalist was a great person in every other would you feel about going to them. I nor many of the people who post here have made a single comment that indicated this was anything at all about their skill, ability, or qualifications, nor what kind of person they. We are saying, I am not comfortable exposing what my underwear/bathing suit covers to members of the opposite sex....if I said I felt comfortable walking naked in the men's locker room, but not into the women's locker room...would that make me a sexist?

There was an interesting post on Dr. Sherman's site. It made the observation that perhaps this was a conflict between the primary socialization and professional socialization... or something to that nature. I thought that had a lot of merit. We are socialized early on (ok many of us are) that it we should be embaressed when our "privates" are exposed to members of the opposite gender. That we should cover our "privates" in public and especially in front of the opposite gender. But, when we come into the medical arena, there is an effort to resocialize us that it is ok to be exposed in front of the opposite gender. Perhaps, that resocialization is seen differently between providers and patients. Perhaps our primary socialization overides the attempt to redefine and resocialize us. As the medical community has pushed more and more for resocialization for their purpose/benefit...conflict is casued for the patient...and perhaps it explains why providers often have a different view of this when they are the patient..not they revert more to primary vs medical socialization....interesting thought put out there by MER I believe......alan

At Tuesday, March 31, 2009 5:04:00 PM, Anonymous Anonymous said...

Anyone who knows anything about
patient satisfaction surveys and
Press Gainey should or ought to know that privacy is not on the
top ten priorities.
This leads me to believe that the
data and or questionaires are rigged. For example, here are some
of the top concerns from patients.
1) Physicians concerns/questions
2) Physician kept you informed.
3) Nurses kept you informed.
4) Wait times for tests and treatments.
5) Likelihood recommending hospital.
Now, my top concern being in the
hospital is " when am I going to
get my pain meds. Cause if I'm not
in pain,I shouldn't be there. Why
would I be concerned about wait times for tests. It's not like I
have a ceo board meeting in the hospital. Some patients think that
the physicians can stand there all
day answering questions. They have
other patients to look after. Give
me a break.
Finally, many often wonder why some of us prefer same gender providers. Is it because we're bashful as some say or have we had
some very unprofessional and bad experiences and finally said,enough
is enough. Personally, I believe
that if you stick with the same
sex provider you save yourself a
lot of grief and problems. I'd like
to end this post by saying I found
out something rather bizarre today.
An emergency room physician that
I'm acquainted with was terminated
recently for a HIPAA violation. It
seems that he took a pic of a patient with his cell phone. The
story goes that somehow it ended up
in the wrong hands and it was
reported,he was then fired. I don't
know the specifics, however, this
hospital does not have residents nor students and I don't know his
excuse if any.
I do know that it's disturbing
and I know this kind of behavior
occurs much more then people
realize, so why subject yourself
to risk? There is no guarantee that
people will be professional in any
setting wether it be a hospital or


At Tuesday, March 31, 2009 5:27:00 PM, Anonymous Anonymous said...

When in the world are "urologists" going to employ 'male' nurses - "female" ob/gyn's employ 'female' nurses.

At Tuesday, March 31, 2009 6:13:00 PM, Anonymous Anonymous said...

You're offended because she wanted to do the job your doctor hired her for? You needed a test and she was explaining it before she proceeded. That's what your doctor wanted her to do. You assumed the doctor would do the prep and you assumed wrong.

When you said you were uncomfortable the nurse should have asked if you wanted the doctor at that point but when she does make the offer you still walk out in a huff.

You could have talked to the doctor and explained your discomfort. He might have worked with you but instead you chose to leave the care of a wonderful doctor and good friend because she offended your modesty by explaining a prep process?

If that's your worst experience at your age consider yourself lucky. Shame you didn't speak to your doctor. He reached out and you refused. You ended up the big loser here because he helped you in the past and reached out to help you which was the professional and right thing to do.

At Tuesday, March 31, 2009 6:31:00 PM, Anonymous Anonymous said...

Maurice, I am going to mention this link again
and I would like everybody to read it. Because, although it deals specifically about male medical students in gyn/ob it reveals the general attitude of the medical profession regarding modesty, namely it shouldn't exist for the patient.
There seems to be no respect whatsoever for the patient. One midwife actually uses deception to get the patient to agree to having the student there by saying she needs the student to document the process. In the letters section a doctor from Nigeria says that fathers are not allowed in the delivery suite, but male medical students are! And because the fathers are not there to object there is a high incidence of compliance by the patient. Only one letter writer shows any understanding of patient's feelings. I feel quite depressed when I think that these are our future doctors and they have no understanding of basic human feelings.

At Tuesday, March 31, 2009 6:49:00 PM, Anonymous Anonymous said...

I also would like to mention this blog where they discuss muslim women's insistence on female ob/gyns in European countries.
The head of the gyn department of one Flemish hospital says this "In my own hospital every patient that absolutely insists on a woman is dismissed from the hospital".

At Tuesday, March 31, 2009 7:16:00 PM, Anonymous Anonymous said...

I hope the 77 year old anonymous poster finds a new urologist he can be comfortable with. Although this is specualtion on my sounds like teh nurse figured if she just kept on andacted like the gentleman had not said a word...I think it probably works a lot of times...and the patient goes along anyway... I suspect the nurse would have heard several of the posters here much earlier than she did with this gent...
The tactic described by the 77 year old taught in the training process...I know because I heard this same ploy being explained to a student nurse about 3 years ago. the hospital is a teaching one.
Perhaps the activism we have discussed should be towards outlawing this tactic as part of reforms that respect males with modesty issues...

At Tuesday, March 31, 2009 7:27:00 PM, Anonymous Anonymous said...

Although the second anonymous poster mad some good points that the 77 year old should have talked to the doctor, the nurse should have stopped at the first comment about his not being comfortable...and asked him why he was uncomfortable....not acted like he would just shut up and comply if she ignored him...which appears to be the case right up to where he refused to get on the table.
Again, I was not there so I can only guess why the nurse kept going so long as to tell him to get on the table...but I repeat..I heard a nurse tell a student nurse that a patient often will comply if you act like you don't hear their saying they do not want to do something.

At Tuesday, March 31, 2009 8:33:00 PM, Anonymous Anonymous said...

When the 77 year old urology patient refused that should have
been the end of it. The nurse should have excused herself and
told the physician. Her continual
persistance was unprofessional.


At Tuesday, March 31, 2009 9:37:00 PM, Anonymous Anonymous said...

I agree that after the first comment she should have asked if he wanted to see the doctor. I don't however know if that would have helped here because his initial complaint is that urologists should hire male nurses and his beloved doctor clearly has females on staff.

It seems the female coming in to do the prep is what offended his modesty to the point he wanted to get another doctor. That's his choice but he might have had more luck telling his doctor he didn't want a female and see if his doctor would do it instead. As they had a long relationship he might have obliged him. Now he's out a good urologist who even called him at home to follow up, but he was so insulted by a nurse being sent in to do the prep he wouldn't speak to him. Bad decision as it's possible this could have been rectified to his satisfaction. At the very least he could have made his feelings on opposite intimate gender care known.

At Tuesday, March 31, 2009 9:43:00 PM, Blogger MER said...

I think we may be missing the point with the story of the 77 year old and the Urologist.

The 77 year old's first sentences is: "When in the world are "urologists" going to employ 'male' nurses - "female" ob/gyn's employ 'female' nurses."

That sentence begins to get to the root of the problem. What would that urologist say if we asked him why he had no male nurses or medical assistants?
-- They're hard to find? True, but why is that so? Are they impossible to find? No. If it were important enough to the urolgist, he'd find one.
-- I really don't need a male assistant. That would show his ignorance of the problem. Or, it would show it knew it was a problem but that's just the way it is.
-- It's more efficient and cost effective to hire females because I can use them as chaperone when I see female patients, but I can't use a male nurse for that. Well, the urologist certainly won't say that, but there is much truth to it.

Now, I agree that the 77 year old should have talked with the doctor. That may have solved the problem, or not. And he certainly should have talked with the doctor when he phoned later. It is a shame, because that 77 year old had a real opportunity to get his point across. And since this doctor was a friend, he probably would have listened and may have leaned something and made some changes in his practice. It's possible.

Again, the importance communication. But communication goes both ways, and this urologist's office showed some poor communication skills as well.

One poster commented: "You assumed the doctor would do the prep and you assumed wrong."

Let's understand something-- the 77year old isn't the only one "assuming." That urologist just assumed that it didn't matter to men, any men, anytime, at all. If he did think it mattered, he would have either asked the man ahead of time or had a male staff member available. That nurse just "assumed" that this is the "job" she did and she was just going to do the "job" as she ususally does it? Apparently, the man felt like he was a "job" that needed doing. That's how he "felt." Again, patient "feelings."

Notice that the 77 year old writes in all CAPS. What does that suggest? He's angry. Really angry. Apparently he feels he was treated with disrespect. Why? Perhaps because he wasn't told ahead of time specifically what was going to happen and who was going to do what. Not an uncommon situation with these kinds of procedures. And once there, he wasn't give a choice of gender. He walked it the door, so it was just "assumed" that the clinic had his permission to do whatever they wanted and/or needed to do, regardless of how embarassed or humiliated he might feel. And once he said he wasn't comfortable, he was pressured to --as he seemed to feel -- to either "get comfortable" or "get out."

I'm trying to look at this from a patients point of view, not from the nurses or the doctors point of view.

And I must say to the poster who wrote: "If that's your worst experience at your age consider yourself lucky." That's a very condescending remark. But it's good to hear that kind of remark because, from the patients point of view, that's partially what he heard in the attitudes at the urologist's office. That's how he read the situation.

And I agree with leemac who wrote: "it sounds like the nurse figured if she just kept on and acted like the gentleman had not said a word...I think it probably works a lot of times...and the patient goes along anyway..."

That's very true. It is a strategy. Several nurses have told me that -- not just with men but with all patients. And I quoted a study about how nurses use power earlier on this volume. Female nurses do know that most men don't speak up, and not just men. Patients in general. Work needs to be done. Nurses have many patients to deal with, many things to do. They need to get their "tasks" done and move on to the next "task." I'm not suggesting that nurses don't care about patient comfort. That's an essential part of their job. But we can see with this case how comfort isn't high on a priority list, at least for men.

Note also in this case that there wasn't a male nurse or assistant available, anyway. Perhaps the doctor absolutely needed some assistance with the procedure. So what's she supposed to do? She knows it can't continue without her or another female nurse. So, from he point of view it makes sense to put a little pressure on the man to "get comfortable."

But let's not forget how the 77 year old begain his post ""When in the world are "urologists" going to employ 'male' nurses."

That situation, regardless of why it exists, comes off as disrespectful to some males.

Having said all this, I must add that I'm writing as if the man's account is accurate -- at least form his point of view. But it reads real to me, from what heard from other men. How don't know how common it is. But it does happen.

At Tuesday, March 31, 2009 10:19:00 PM, Anonymous Anonymous said...

He should have talked to the doctor. He lost a great opportunity to make his feelings known and express his displeasure and discomfort. He also lost out on a doctor who helped him in the past and called to speak to him after the fact so it seems he did want to discuss the situation. he cared. In the end it might not have changed anything but now he'll never know.

Doctors might be willing to hire male nurses but a lot of male nurses don't go into office nursing or urology. There is more money in bedside nursing along with more opportunities to move up the food chain. They also tend to like departments that are fast paced like the ER and OR. If they find a male nurse that is willing to work for them and they are qualified they should hire them.

At Tuesday, March 31, 2009 11:01:00 PM, Anonymous TT said...


I concur with your comments. The process of "steam rolling" a patient into compliance with a procedure or treatment is definitely a common tactic used to overcome hesitance or resistance on the part of the patient. Another is springing something on a patient without warning in order to take advantage of the element of surprise.

One other thing I noticed in the post is what appears to be a blatant lack of an informed consent process - he specifically states regarding the cysto "I didn't even know what it was and thought he was going to do it". Obtaining informed consent is the responsibility of the physician, not the nurse. If, in fact, the physician did not explain the procedure to the patient, I find that disturbing.

I agree that it would have been better if he had spoken with his physician and feel it was a lost opportunity for both that he didn't.


At Tuesday, March 31, 2009 11:49:00 PM, Anonymous Bill said...

Sometimes you're left wondering whether certain behaviour is a BAD system, a system out of control or total lack of common sense and sensitivity...
My 18 year old daughter was in hospital last month with an inflamed appendix.
Prior to surgery, a male nurse (on his own) was sent to wash and shave her for surgery.
My daughter was shocked and objected...
Instead of the nurse accepting this very understandable reaction, he argued and debated the point with my daughter. He was a fully qualified nurse and it would be discrimination if he were unable to carry out all his duties because his sex was an issue for some patients.
My daughter became upset and decided to leave the hospital.
I spoke to her over the phone, got to the hospital and spoke to her Dr and the hospital administrator in no uncertain terms.
I'm afraid to send a male nurse in these circumstances is very hard to understand...or a female nurse with a young male patient.
Older people are better able to refuse treatment, but young people will often be overwhelmed by the situation and suffer in silence.
I'm certain had my daughter been overwhelmed and allowed this nurse to prepare her, she would have been left with lasting psychological issues. (she said it would have been like an assault)
Even if the male nurse had a chaperone, it would have been unacceptable to my daughter.
That makes no sense anyway...
Why tie up two members of staff? The answer is simple - send a female (or male, depending on the patient) and avoid all the hassle.
I'm hopeful that my freely expressed disgust might mean the "system" might be changed to avoid placing another ill patient under unnecessary stress.

At Wednesday, April 01, 2009 12:26:00 AM, Anonymous Anonymous said...

"You're offended because she wanted to do the job your doctor hired her for? You needed a test and she was explaining it before she proceeded. That's what your doctor wanted her to do. You assumed the doctor would do the prep and you assumed wrong.

When you said you were uncomfortable the nurse should have asked if you wanted the doctor at that point but when she does make the offer you still walk out in a huff.

You could have talked to the doctor and explained your discomfort. He might have worked with you but instead you chose to leave the care of a wonderful doctor and good friend because she offended your modesty by explaining a prep process?

If that's your worst experience at your age consider yourself lucky. "Shame you didn't speak to your doctor. He reached out and you refused. You ended up the big loser here because he helped you in the past and reached out to help you which was the professional and right thing to do.

Tuesday, March 31, 2009 6:13:00 PM"

-- I would like to ask the sex of this poster(?) I'm sure it's a woman, possibly a nurse.

I hope the 77 year old will call his doctor back and say he's calmed down enough to speak. Let the doctor know your anger was off the scale at his "assumption". Something you have every right to assume. Any women in your position would assume she would have a female for a similar procedure.

At Wednesday, April 01, 2009 12:54:00 AM, Anonymous KM said...

Suzy - I understand and agree with you.
I've never agreed to these routine annual intrusions.
They're unnecessary and should only be carried out if a woman requests routine preventative care.
It's well known that preventative medicine means lots more testing and causing more harm than good in many cases.
Women should not be FORCED to have these exams to get BCP's.
Women shouldn't be misled as to the risk of getting cancer and the accuracy and need for these exams and tests. It's all to frighten us into attending for these exams.

After working in Ireland, the UK and Australia, I know the rest of the world are NOT having these exams.
It meant I was unable to access BCP's, but have remained true to myself.
I think this annual intrusion detracts from our quality of life. I know most women hate and resent these routine exams and tests. Some take medication to get them through...
When you know that most women around the world don't have these exams, you don't feel afraid and can confidently say "NO!"
When you KNOW you're being manipulated and deceived, it's easy to refuse.
Doctors are always shocked by facts and statistics, they rely on us asking no questions and just submitting to their demands.
I'm afraid going through that every year would leave me resentful and unhappy and defeat the purpose of the BCP's.
I prefer to avoid doctors and their unnecessary and unethical demands.
Defending yourself comes down to knowing the facts and figures.
Doctors can't manipulate and deceive when you have that information.

At Wednesday, April 01, 2009 4:24:00 AM, Anonymous Anonymous said...

I agree, I hope 77 will read these posts and call his doctor, if you can't call write him a letter and tell him why you left. Tell him how you felt and what you felt the nurse did wrong...and what could have been done. To have a doctor who would call you at, evidently he may find out he will take care of you and it may spur change in his will never know if you don't try.

Dr. Bernstein, this is a little off the subject...I have seen counters on sites to measure the "hits" on a web would be interesting to see how many people visit this site but don't comment. I have not idea how that is done, how difficult it is, if it is even real....heck I am still thrilled by the fax machine and have no idea how to use my blackberry much less start a blog....just curious, I also notice we have almost no providers commenting on this issue, now part of that seems to be when they do they get slaughtered and in today's world...if I got some of the aggressive attacks even on a thread like this I would hide for fear of being tracked down....but I also think it is a little indicative of providers unwillingness...or at least preference to ignore and pretend this isn't an issue. If you look at some of the other threads, when this topic breaks out, it gets heated, and it gets shut down by the moderator. Providers seem to really take this personal, much like CSM's view, the issue ends up being about them...not the paitent,,,alan

At Wednesday, April 01, 2009 7:14:00 AM, Anonymous Anonymous said...

After looking up the procedure for cystoscopy, I am left wondering why the nurse was going to irrigate the guys bladder? Out of four sites, including WebMD, I saw nothing which mentioned this as part of pre-procedure preparation.
I only read that a person would need to empty their bladder just before the procedure...and that solutions would be needed during the procedure...a catheter could not be in place and a cystoscope inserted (two objects trying to be in the same place at the same time ) even if he had tried to learn about the procedure beforehand..he would not have been prepared for what happened.
It sounds like one giant snafu where a failure to communicate occured. Perhaps the doctors office is so used to doing this precedure that someone forgot to explain it to the patient beforehand. I do think he missed an opportunity to have a real talk with his urologist though...even if he did not intend to remain his patient. I am left to wonder what the guys cancer treatment was like.The procedures for diagnosing and treating prostate cancer all consist of a great deal of exposure of ones body..especially genitals.What was the demeanor of those he was exposed to during this time? Perhaps a seed was sown and culminated in his perception of being taken for granted..a lot of unanswered questions which will probably remain so...
That a line of communication needs to be open at all times between providers and patients...a two way line is the message I get from this guys experience.

At Wednesday, April 01, 2009 9:51:00 AM, Blogger MER said...

Bill, writing about that male nurse almost trying to "force" his services on his 18 year old daughter -- wrote: "Sometimes you're left wondering whether certain behaviour is a BAD system, a system out of control or total lack of common sense and sensitivity..."

In my opinion, there's a significant amount of what I'll call "gender conflict" within the medical system, esp. in hospitals and especially between male and female nurses. Now, we can't generalize about this. It's not happenening everywhere. So much depends upon how healthy the culture of an individual hospital is and that depends a large degree on the common sense of the nurse supervisors and her supevisors.

This "gender conflict" issue between nurses isn't discussed much. Men don't talk about too often, but they do occasionally. Male nurses, being in a minority position, need to be careful about what they say and to whom.

This goes to the issue with his 18 year old daughter that Bill is talking about. This guy was really out of line. But, you see, he got right to the issue from his point of view -- which was sexual discrimination. You won't often see that come out into the open, especially with a patient. Depending upon individual working conditions, male nurses tend to feel:
-- they are not alwaYS taken seriously by their supervisors.
-- they are not made to feel that they can do the same kinds of procedures with both genders that female patients do.
-- Like all nurses,but even more so, they need to be assertive and take the lead in "educating" patients that their gender doesn't matter -- that there are just nurses, no male or female nurses.
-- that they don't belong or really fit into the professional "social" relationships that the nursing profession have.

Now, as I said, these attitudes vary from work place to work place. Some males feel more comfortable than others in their situation. But it's not something they often talk about outside the profession.

Nurses can't be constantly running to their supervisors saying that this or that patient won't let me do this or that because I'm a man or woman. If the nurse does that, they lose the respect of their supervisor and their competentance is questioned.

Many male nurses seem to understand this cross gender caring problem better than their female counterparts (my opinion) because they'd better understand it. Keeping their jobs depends upon it. Occasionally you'll get a militant male nurse like the one described, who will fight for his "right" to have access to both genders. I don't think that's typical.

In the best hospitals and clinics, the male and female nurses have an understanding and trade off jobs when gender becomes an issue. This is rarely made public. Some nurses will tell you about this "system" if you ask, but patients are rarely informed that the system exists. It's the old "Don't ask and create a problem."

Nurse staffs that trade out have faced the issue. Recognized that it exists. Deal with it day to day. By facing it, they've taken it off the table and not made an issue of it. I think this happens more often than we think, especially in larger hospitals with more varied staffs.

My point is, as Bill suggested, that there's no real standard in this area. What happens, as Bill says, depends upon how much common sense and sensitivity exists within the leadership of each individual supervisor. There's no evaluation tool to deal with this specific modesty issue, so hospitals get almost no feedback unless someone like Bill really gets made and goes to the top.

At Wednesday, April 01, 2009 9:56:00 AM, Anonymous Anonymous said...

I too agree with most comments about the urology visit. I also wonder how many guys walk in and apply for work in a doctors' office?? Because the office managers are female they would no doubt hire females anyway even if they did have male applicants. The problem I also see here is that this 77 yo will go to another urology office only to be met with the same scenario. What then? And as was said prior what invasive personal exposure of his genital did he experience with his prostate cancer treatment? Were there only male attendents in the OR or ?

Doctors need to be told by patients what is unacceptable practice for the patient. And you know what a patients AGE doesn't matter on bit.

At Wednesday, April 01, 2009 10:22:00 AM, Anonymous Anonymous said...

Just quickly to respond to questions posed earlier to me:

Leemac, many good points about discrimination, stereotyping and rights working both ways. My primary thought had to do with needing some standard way to establish a conversation and a trust relationship with a care giver, before the gender of either care giver or patient automatically cut off any dialogue. That means both sides taking a moment to listen, assess and adjust -- basically your "giant snafu" idea in connection with the 77-yr old.

Alan, my point on Suzy was that her modesty about "privates" was about exposure and vulnerability, without a priori pillorying the "opposite gender." Does a bathing suit cover "privates" only for the opposite gender? Your questions about my comfort with doctors of different philosophies, etc goes directly to the point -- my answer is that, unless they bring their outside lives and viewpoints into the doctor's office, I would fine accepting their expertise. There may be "added comfort" in knowing that my doctor is a naturist (as part of the conversation mentioned above), but not being naturist doesn't automatically disqualify him/her. On "primary socialization and professional socialization," it is my radical view that "professional socialization" is the essence of civilized society. It is not "resocialization" beyond identifying "functional" activities that are not personalized. We are most familiar with this idea in politics, eg. where power is not personalized, where we debate an issue in Parliament instead of resolving it in a storm of death by claymores, where tribal chiefs give way to bureaucrats and lawyers, where job opportunity may no longer limited by race or creed. Gender is just a current area where "functionalism" is gradually supplanting "personalization", as primary socialization recognizes gender equality and refocuses on undifferientiated standards of behavior. (CSM)

At Wednesday, April 01, 2009 11:20:00 AM, Anonymous Anonymous said...

leemac, whether or not this was a "real" part of a cystocopy is not the only issue here. When a doctor does the cysto the female nurse is in the room during the task to assist him/her. The nurse hands the doc items, etc.

Yes, a failure to communicate is rampant.

At Wednesday, April 01, 2009 12:36:00 PM, Blogger MER said...

CSM writes: " it is my radical view that "professional socialization" is the essence of civilized society. It is not "resocialization" beyond identifying "functional" activities that are not personalized. We are most familiar with this idea in politics, eg. where power is not personalized, where we debate an issue..."

Interesting. But let me point out a few things. Who gets to "identify" what "functional" activities that are not personalized? The professions, themselves, of course. And, in medicine, who's really to say what's personal and what isn't personal when there's a person, a human being, attached to every organ a doctor or nurse is working on.

You use politics as an example and talk about how we "debate" an issue rather than going to war. Good point, and an excellent example of this.

But notice the "debate" aspect of this. And in politcs who gets to do the debating? In a democracy, we elect representatives. But what about the vast majority of people who don't live under republics or democracies?

But at least there's a debate, some communication. This is where we need to move with medicine. How many hospital ethics committees have a patient advocate on it? I don't mean someone hired by the hospital. I mean someone outside the system.

On NPR recently, someone pointed out that, within the President's inner circle, including the cabinet, everyone is represented except the consumer -- labor, business, etc. Why not a Dept. of Consumer Rights.

Now, I'm not pushing the analogy of patient as consumer, although there is some merit to that comparison. But my point is that, where is the patient within the debate over these medical issues we're discussing? Do patients get any input as to what doctors are taught in medical school and how they're taught? Should they? When codes of conduct are drawn up by the professions, are there any outside patients involved within the process? Maybe there are, but I don't see it.

There needs to be much more open discussion and debate between the professions and the clients they serve -- especially in medicine.

At Wednesday, April 01, 2009 2:07:00 PM, Blogger MER said...

JW wrote: “I too agree with most comments about the urology visit. I also wonder how many guys walk in and apply for work in a doctors' office?? Because the office managers are female they would no doubt hire females anyway even if they did have male applicants.

I’ve commented several times as to the close relationship, historically, between the nursing and elementary school teaching professions. Today they are both dominated by women, most likely for economic and perhaps social reasons. But they are jobs that historically have not been appreciated or had much status in society.

This brings up an experiment, or informal study. It was conducted by Glenn (Max) McGee when he was Superintendent of the Wilmette School District 39. Before that he had been Illinois State Superintendent of Schools. He has degrees from Dartmouth and U of Chicago.

He was investigating his district’s hiring practices, and wondered why they had so few male elementary school teachers. He believed that more men would be good role models for the boys, so we went about trying to hire more males. As he studied male applicants in his district, he found that they rarely made it past the initial written interview process. So McGee asked his human resources director to conduct an experiment.

They identified the most respected and well-loved male elementary teachers in their district and asked them to reapply, using another name. So these master teachers reapplied and answered the standard set of questions asked by all applicants. Most of the hiring committee was made up of female teachers and administrators.

Guess what? The hiring committee didn’t like the way most of those male teachers answered the questions. For example, they were asked how they would respond to differences of opinions at staff meetings. The operative words the women were looking for were “understanding” and “collaboration.” The males tended to say that they were not especially interested in coalition building. One male teacher wrote that he “respected other people’s right to disagree.” The committee found that answer to be too “confrontational.”

The females on the hiring committee didn’t feel comfortable with those male applications. The men didn’t use the correct “buzzwords.” The implication I get from the summary I read is that these men, the best of the best in that district, wouldn’t have made it past that initial hiring committee to even get an personal interview.

So – how does this apply to nursing? Who decided who gets accepted into nursing schools? How are the committees comprised? Who decides who gets hired as nurses in the hospitals? How are the committees made up? In a large private clinic that is already dominated by female nurses and/or medical assistants, who does the hiring or gets the input?

In the case I described above – when McGee realized what was going on, he had is human resource department “expand the definition of “acceptable” in order to encompass answers that qualified male as well as female applicants might supply.
The male elementary staff began to rise within a year.

As I’ve said many times before, when any professions becomes dominated by one race or gender, it’s not a good thing. Women went through this same kind of discrimination in trying to get into “male” occupations, as have African-Americans and other racial groups.

Anyone know of any studies or research in this area that goes beyond the surface hiring practices of nurses and delves into the reality?

My source for this experiment is “The Trouble With Boys: A Surprising Report Card on Our Sons, Their Problems at School, and What Parents and Educators Must Do” by Peg Tyre (pp. 129-130).

At Wednesday, April 01, 2009 3:15:00 PM, Anonymous Anonymous said...

As I stated, I have no idea just what all was not adequately communicated, but that a failure happened...somewhere..that poor guy did not get so angry or frustrated over nothing...
I have stated that I am easily embarrassed anyway..just the way I am adn I do beleive that the sytem needs some adjustment,,but I also believe in fair play..the following happened to me on one of the rare times I went to a Dr. in the last 40 years..where I was at fault and not the doctor for my embarrassment.
I went i (Idrove over 200 miles to a doc I knew outside of medicine because I trusted him) I had a hemorrhoid that finally made it imposible for me to do my job..the pain really got in the way.( the guys will go to the doc when the pain gets too much thing, I guess) He asked me ,while he was injecting the local, if I would allow a doctor from a third world country to observe the procedure as he wished to demonstrate how he made a cut the didn't need stitches..I said ok..I was a lot younger and did not want this doctor to know of my modesty and really wanted to keep on his good side (he was married to a family friend) only after he left the room did I realise he had said he wanted HER to see his method...I could only keep my upper arm over my face and be glad the table was against the wall...I had given my ok and felt I had to keep my word..It taught me to be a closer listener...and to take a moment to reflect on what someone really said.
My statements about the irrigation of the guys bladder means that either the guy missed something in his previous talk to the doctor or the doctor failed to explain that something extra was needed. I assume..(a dangerous thing to do)that there had to be more to what was going on..and again the nurse was obligated to stop on the spot and address why the patient was uncomfortable. He did his part by speaking up.
CSM, you are pretty hard to pin down, guy. Do you feel that my personal feelings of modesty and my embarrassment are subordinate to someone feeling they are entitled to be my provider? I am not talking about removing female providers from medicine..just about not having them as my provider. Where do my feelings get to come into play?

At Wednesday, April 01, 2009 3:17:00 PM, Anonymous Anonymous said...

I was watching a British documentary on plastic surgery. The host of the show is a doctor. Anyway at the beginning of the program the doctor hooks himself to, I think, a mri machine to monitor his brain while he looks at random photos of people's faces. Every so often, they flash up somebody with a hideous facial deformity. After the experiment, they look at the results of his reactions of the photos of different people. When he sees the photo of somebody with a facial deformity, his brain reacts in the repulsion centre in a primitive part of his brain. He was disappointed as he thought as he was a doctor, he would have a compassionate response. Anyway, the point that I'm making is that doctors and any other health provider cannot fool themselves and us that they are detached from what they see. It is hardwired in their brains.

At Wednesday, April 01, 2009 4:11:00 PM, Anonymous Anonymous said...

MER you have made such valid points regarding males not being hired in typically female dominated careers including nursing. How sad is this?

Look how long it took for females to be seen in careers dominated by males. Construction, police, firefighters, pilots, etc. It still turns heads when you see a female operating a huge crane or walking out of the cockpit of a plane or the captain of a huge ship.

You are absolutely correct in the hiring practicing hampering males in many fields dominated by women.
And it irks me when I read that nurses feel they have an absolute right to proceed with an intimate procedure on a patient regardless of the patients feelings. Common sense and decency needs to prevail.
They are way off base.

At Wednesday, April 01, 2009 4:41:00 PM, Anonymous Anonymous said...

Other than an emergency you can pick your provider. Look into a male or female doctor if that is important to you. As far as the nurses go most will be female. If there is no procedure being done you should be able to have a private exam. The doctor sets the precendent in the office so if he comes in with a nurse ask them to leave and make your request known to your doctor. If they say they won't proceed without the nurse you have the option to leave.

In an emergency situation you will have less options. You can still ask and if able to do so you could still leave but depending on how ill or injured you are that might not be the wise thing to do. The doctors will be more concerned with stabilizing you versus hunting down same sex care and I can understand that.

And leemac it would have been okay to change your mind even after you said yes. You could simply ask the other doctor to leave the room and explain to your doctor you didn't realize it would be a female and spoke too soon. Totally acceptable.


At Wednesday, April 01, 2009 4:45:00 PM, Anonymous Anonymous said...

The machine in question was a pet
scanner. Positron emission tomography, regarding the british
I'd like to respond to the 77 year old male patient visiting the
urologist. Cystoscopies are done
under general anesthesia, not at
a urologist's office! I can't
imagine any procedure at a urologist's office that would require a catherization of patients
unless a straight cath for a urine
Furthermore, I can't see any procedure that would require irrigation of the bladder at a urologist's office as well. That
would again be something at an
outpatient surgery center or at
a radiology center such as a voiding cystogram or a voiding
Perhaps the poster can elaborate
more specifically as to what the
procedure was and why, otherwise
I have my doubts. In conclusion,
any procedure that is done at a
urology clinic can be done by
the physician and the physician
only. Vasectomies, catherizsation's
There is really no reason why the nurse needs to be in there,
make your choices known at the beginning!
State law requires that any
procedure requiring general anesthesia be done at a outpatient
surgery center or a hospital based
surgery center.


At Wednesday, April 01, 2009 5:18:00 PM, Anonymous Anonymous said...

MER have made a lot of good points today..and are on to something I thik. I can't hold the territorial thinking female nurses come across as having...for many years it was one of the few decent paying socially acceptable jobs open to them..I just wish they would realise that we have come a long way and they have a lot of opportunities that used to be denied them.
LH, I think doctors often try to be perfect..and very demanding of themselves to their own detriment. they should realise that they try and that they don't let the patient know of any feelings that may be negative is all that can be expected from them..and often forget that they are human beings (something they often accuse the public of)This is not to say that most doctors are not exceptional in many ways...but they are human beings and not perfect..I am not good woth words..perhaps Dr. Sherman or Doctor Bernstein can say it better...or one of the otehr posters here.

At Wednesday, April 01, 2009 6:02:00 PM, Blogger Maurice Bernstein, M.D. said...

The comment pasted below is from 4:21 PM today and I strongly suspect it was written by CSM but there is no further identification than the nature of the response. Perhaps CSM can confirm the content.

By the way, in 10 days we have reached 125 comments, does everyone think it would be time to start a new Volume? Does everyone agree that the number of postings of this size on one thread should not be exceeded simply for the ease of scanning or what? I also still worry about losing postings if we go into higher numbers as we did in the past. ..Maurice.

MER writes: "Who gets to "identify" what "functional" activities that are not personalized? ...In medicine, who's really to say what's personal and what isn't personal when there's a person, a human being, attached to every organ a doctor or nurse is working on."

The answer of course is that we all have a say. Functionalism works through a kind of negative determinism -- not by knowing what should be, but by agreeing what shouldn't be. Think of how this worked with race, another "state of being" issue, like gender, indelibly attached to every individual, and with upbringing and cultural aspects. Should race be a deciding personal attribute for jobs? No. Discard. Housing? No. Discard. etc. And health care? Well, for patients, we've discarded all the barriers to access, etc while learning about how to be sensitive to and respond to distinct identified vulnerabilities. On the care giver side, race is fully "functionalized". Some patients may still seek out same-race doctors, but systemically race is considered irrelevant, no matter what the patient's preference.

leemac writes: "Do you feel that my personal feelings of modesty and my embarrassment are subordinate to someone feeling they are entitled to be my provider? ... Where do my feelings get to come into play?

There is a not so subtle boundary between preference and exclusion. I may prefer to hire a blond blue-eyed admin assistant, but I cannot exclude other candidates by giving that preference precedence over functional qualifications. This is because of mutual guarantees against that kind of immaterial "discrimination" I may prefer blond female singers, and nothing prevents me from buying only their CDs because this qualifies as individual choice, since there is no higher opposing standard or protection.

It seems to me that with modesty and medical care, we are not being clear about the line between preference and exclusion. Sovereignty over one's own person, and hence modesty, qualifies as a mutual guarantee. So does being hired as a care giver on the basis of qualifications, not gender. Rejecting an opposite-gender care giver, hence giving gender precedence over functional qualifications, may seem like and can be an individual choice to a patient based on "personal comfort", but at any higher level -- team, facility, system -- it is discriminatory and exclusionary. Modesty, yes. Gender, no. Creed, no. Race, no. Anyway, in the context of "functionalism", that's what I would vote to discard.

(I can't resist a naturist sidebar. The best logical arguments for respect of individual modesty are the same as for respecting a person's right not to wear anything.)

At Wednesday, April 01, 2009 6:16:00 PM, Anonymous Anonymous said...

Many urologists do cystocopes in their office under local. Mine does.

At Wednesday, April 01, 2009 6:34:00 PM, Anonymous Anonymous said...

Would any of the men posting here have considered nursing themselves? I am afraid that when it comes to nurturing type jobs like teaching,nursing and childcare, men do not like doing them because it does not appeal to the male ego. Men like to make lots of money, have status and gain respect. And there is nothing wrong with that. Therein lies the problem. Also if a man chooses nursing people suspect that he might be homosexual. Why is it that women usually stay home to raise the children? They seem to have a natural talent for nurturing. I've only read positive posts from female nurses re male nurses, i.e. wishing there were more. I can't say that many male doctors were as welcoming of female doctors in the past.

At Wednesday, April 01, 2009 7:15:00 PM, Anonymous Anonymous said...

Just to confirm the earlier comment was from me. Sorry about forgetting the (CSM) tag!

At Wednesday, April 01, 2009 7:32:00 PM, Anonymous Anonymous said...

I too think the poster must be CSM
Hey look CSM your philosophical ponderings are being expressed in a verbage that leaves me thinking you are both saying yes and no at the same time and make me think you are yanking my chain...To be blunt I have no idea what you are saying...If I can't understand you how do you expect me to give any credence to what you are saying.

cm, thanks...but I both felt I had to keep my word as the mistake was mine and I had no intention of having to be embarrassed even to admit my embarrassment or my issues...I liked and trusted this doctor, but my modesty feelings might have made it out...and in that place and would have been as bad for me to have others know of my modesty isues as the issues were being embarrassed and being embarrassed that I was embarrased...I hope you manage to understand it was a double issue...and when you added that I had said yes.. my decision was to pay the price and learn the lesson..and I did. I also did not go to a doctor for many years afterward...

At Wednesday, April 01, 2009 8:01:00 PM, Anonymous Anonymous said...

A lot of the reasons you cite are why males have avoided nursing...but also males were expected to do the hot hard and dirty manual labor and dangerous protect the ladies..also I think many would have been discouraged from taking a job that was one of the few that was respectable and paid decent money from a lady..not as a put down...just the way it was.
Many of us had to go to work early money or time for school...often it was difficult to even finish high school..

At Wednesday, April 01, 2009 8:24:00 PM, Anonymous Anonymous said...

Most male nurses I know earn 100k
a year. The best nurses are male!
The cystoscope is the instrument
and the procedure is cystoscopy
although rarely referred to as
cystourethroscopy. Risks are
perforated ureters,bleeding and
possibly sepsis.
Ideally, cystoscopy is followed
by a retrograde pyelogram which
requires an x-ray machine. I know
of no urology office in the U.S.
that has one.
A cystoscopy under local,yea
right. I'd keep on walking! With
regards to the comments referring
to the british documentary those
results were detailed several years
ago in scientific american and
science today. The emotion of fear
has been studied the most using
pet scan and radioactive tracers.
The end result is to eventually
understand depression.Even those results were inconclusive,despite years of study. You can't erase what evolution took millions of years to build and you can't evaluate the intregrity of a human
being with a pet scanner!


At Wednesday, April 01, 2009 9:27:00 PM, Anonymous Anonymous said...

If they are using a flexible scope they often will do it in an office and with local. Always go this route if you can. Rigid is much more painful and they will put you out for that. Ask your doctor if they use rigid or flexible and if it's rigid I'd ask for flexible or find a doctor who will use one. It's less painful and you can avoid general.

At Wednesday, April 01, 2009 11:26:00 PM, Anonymous Anonymous said...

leemac, I am not "yanking your chain"! LOL I seem to get in trouble for being either too prescriptive or too nuanced! My point made bluntly is that it is ok to be modest, but with all care givers equally, regardless of their gender. Gender barriers are rightly being eliminated in every workplace. It is consequently unproductive to debate ratios of male to female nurses, or devise elaborate strategies to hire nurses based on gender. History -- what I was labelling "functionalism" -- is going in the other direction. The good news for modesty, and where energy can be focused, is that health care workers of both genders can be, and are being, trained to be super sensitive to modesty concerns. The conuncrum is when we hear patient modesty being projected as insistence on "same-sex techs." If I become a nurse, it is to serve all people, not just my own gender.

At Thursday, April 02, 2009 6:06:00 AM, Blogger Maurice Bernstein, M.D. said...

CSM again wrote the comment below without identifying himself with an initials tag. May I suggest, CSM, that you actually logon to with initials as MER does so that you don't have to remember to add the tag. ..Maurice.

leemac, I am not "yanking your chain"! LOL I seem to get in trouble for being either too prescriptive or too nuanced! My point made bluntly is that it is ok to be modest, but with all care givers equally, regardless of their gender. Gender barriers are rightly being eliminated in every workplace. It is consequently unproductive to debate ratios of male to female nurses, or devise elaborate strategies to hire nurses based on gender. History -- what I was labelling "functionalism" -- is going in the other direction. The good news for modesty, and where energy can be focused, is that health care workers of both genders can be, and are being, trained to be super sensitive to modesty concerns. The conuncrum is when we hear patient modesty being projected as insistence on "same-sex techs." If I become a nurse, it is to serve all people, not just my own gender.

At Thursday, April 02, 2009 6:21:00 AM, Anonymous Anonymous said...

CSM The one issue you continue to skirt...or I think you do, is the fact that we are not excluding a gender based on the usual thought processes associated with discrimination. We are defining a specific situation that culturally has been defined as uncomfortable. Suzy, while you say your are uncomfortable exposing anything a bathing suit covers, do your find it more acceptable or comfortable when you choose the gender of the provider? When we look back at discrimination and exclusion it was based on a general feeling that the party was inferior. Blacks were seen as less than whites, they were seen as more primative, less intellegent, and inferior to whites. Women were seen as less qualified, to emotional, not as capable simply by their race or gender. Very few people here have expressed that sentiment, you have injected that sentiment becasue it fits your argument. We (those who feel uncomfortable with opposite gender nudity, not opposite gender providers in general) are saying they are just as qualified, but I prefer, I feel more comfortable with a specific gender WHEN I AM EXPOSED and therefore I have the right to choose a provider based on that alone. We are not saying I don't want that gender because they are less, inferior, or less qualified as a provider....your skirting this issue and twisting it to meet your argument, it is a usual argument, make the issue about something socially unaccpetable. I have two daughters, I understand gender discrimination...this is primarily situational not gender based. And that situation is defined by our cultrual upbringing. Usuing your criteria, I am going to go down to the local Curves (female gym) and apply for a job cleaning the locker room, and if they won't hire me and let me walk into the locker room anytime I want including when women are showering...then they are sexist and I am going to sue them for discrimination.....think I would win that one in way, our courts have recognized bona fide occupational qualifications for a reason. Our society recognizes that making decisions based on among other things...nudity and reasonable. We are not disqualifying a gender, we are saying for US, your reaching when you accuse people who request who request a specific gender for intimate proceedures of being, are using the same narrow perspective to judge modest people as much of society uses to judge naturalist. Respect your opinion, enjoy the banter, but your reaching and trying to apply what we would consider "fringe" opinion and criteria in our culture to the masses. Society does not define modesty, qualified, and gender as being inseperable.

The duties and pay of RN's has come a long way from the wiping butts and changing bed pan days. I teach a class each year on business through junior achievement at our school. I do this experiment, I start out and ask the class (7th graders) how many of your would be willing to be a nurse, (no boys), a doctor (quite a few boys), if you could make $100,000K being a nurse how many would be a nurse (a few boys), if you could make $100,000 being a anestheiologist (after explaining what they do, many boys), then I tell them, the Anest. at our local hospital is a CRNA and makes $175,000 per many of you would be a nurse now....lots of boys. We had to go through the process of breaking down the perception that doctors are male, yet we still accept nursing is "womans" work. RN's are medical professionals that make great money and have a ton of opportunity . To encourage women to become doctors we had to make the effort, go gender nuetral in speaking of Dr.'s rather than he, at my college there was out and out solicitation of females to go into the field etc. Male nurses face the same challenges, the money is there, the status is there, but we have to let males know it is acceptable. There is a program called Are you man enough to be a nurse in Oregon that had success in this effort...yet it is a rare effort as men are not seen to be needing opportunity like women are. And while in many cases this is true..not so in nursing......alan

At Thursday, April 02, 2009 7:34:00 AM, Anonymous Anonymous said...


i realize that you are being deliberately contentious. You and others who feel as you do have a perfect right to your OPINION, it is however, just that, an opinion, it is not fact, it is not THE OPINION, it is just your narrow view on things.

The likelihood of doing away with separate male and female changing rooms, rest rooms etc is nil. The reason for that is simple, people feel more comfortable in same sex environments when any form of nakedness is involved. Naturalists are an obvious miniscule exception to that rule.

I have not the slightest concern as to how my request for same gender techs goes down with females. I don't care if i hurt the feelings of females when I make such requests, I care about my own comfort and dignity, I will not be told who will treat me, I will not be told how to feel. If anything, your attitude that i am being sexist, ensures that I will be MORE proactive in my choice of carer, right down to who clerks me or makes appointments for me. I choose who has anything to do with my care, not your opinion, nor anyone else's opinion.

Your need to recognise that your view of sexism is very narrow and unrealistic.

The double standards that pervade almost all aspects of public life are becoming sickening, we are all expected to pretend equality exists when it patently does not. Watch the "lock up style series, see the female guards go to the back of the queue when it comes to any violence kicking off, they are paid the same as men. They are always used to "escort" prisoners who are about to be released, so it can appear that they actually do that job on a par with men. It is all a farce and most people know it is, of course political correctness says we should not say so. Female guards may strip search male prisoners, the converse is not true. Female guards may supervise male showers, the converse is not true. Equality for women is fine as long as it is all one way, when men begin to ask for equality in terms of same sex health care, suddenly we are being sexist!

Apologies for the length of this "rant" just sick to death of double standards.


At Thursday, April 02, 2009 7:58:00 AM, Anonymous Anonymous said...

CSM, thankyou for the clarification...while we both agree on that sensitivity for modesty is for both genders..I think that a maleo r female has the right to request a provider of a gender they are comfortable with and that it is ok to raise the numbers of males in all areas of health care...Your premise simply ignores the patients embarrassment..your argument simply says that no consideration is due that person...I am not all that fond of body exposure even with the male providers...and absolutley mortified with the female ones...sensitivity by the opposite gender does very little in making me sufficiently comfortable with the situation.


At Thursday, April 02, 2009 8:22:00 AM, Blogger MER said...


I enjoy your philosophical excursions. But that's me. But I do question some of your assertions.
You write: "Gender barriers are rightly being eliminated in every workplace." First of all, that's a very USA-centric if not Euro-centric position. And I don't think, even in those places, it invovles "every workplace."
You write: "The good news for that health care workers of both genders can be, and are being, trained to be super sensitive to modesty concerns." I will buy the "can be," but I don't necessaraily buy the "are being trained" -- especially your wording "to be supersensitive to modesty concerns." Where's that coming from? Do you know where and how this training is being conducted?
Remember, when we talk about training we're talking about academic training, and then the professional socialization process which includes the hidden curriculum. I question whether health care workers are being trained to be "supersensitive" to modesty concerns in any of those areas. But I could be wrong.
You write: "It is consequently unproductive to debate ratios of male to female nurses, or devise elaborate strategies to hire nurses based on gender."
I'm confused. Nurses are already being trained and hired, to either some or a large degree, based on gender. Isn't that the case with any profession that becomes dominated by one gender? How does that happen? By accident?
Are you then saying that you are philosophically against affirmative action, quotas and incentives to open up "closed" shops?

At Thursday, April 02, 2009 9:56:00 AM, Anonymous Anonymous said...

CSM "if I become a nurse, it is to serve all people, not just my own gender". And just why do you feel that your desire to serve all people over rides my personal right to determine who does what to my body. Whether you want to admit it or not, whether you like it or not, the majority of our society does recognize gender differences when it comes to nudity.
Also, so do you feel the affirmative action which was utilized to bring equality for African Americans, Women, and other instances of inequality...was that also a waste? Was the effort to bring more females to med school and into being physicians...was that a waste as well...a large part of the focus was for the benefit of their female patients...was that wrong...alan

At Thursday, April 02, 2009 1:57:00 PM, Anonymous Anonymous said...

Zak, alan, MER..thankyou for expressing my feelings far beter than I have been able to. As I have said before, I am not good with words.

At Thursday, April 02, 2009 2:12:00 PM, Blogger MER said...

CSM -- I hope you don't think we're all going after you. I appreciate your points of view.

It is interesting, thought, that, you being a naturalist and not caring about opposite gender care or your body exposure in medical situations -- that probably means that you haven't faced any situations medically where you had to ask for specific gender care? Am I correct?

If that's so, I can see why you paint an overly "rosy" picture of what life is like out there in the medical community (to whatever agree) for patients who request same gender intimate care.

Am I correct that, since it doesn't matter to you, you've never really asked, thus, you really don't know what it's like?

Most of us on here have had this experience of making this request. Sometimes it works; sometimes it doesn't. But we can assure you of one thing -- we can't assume that the issue will ever be considered unless we bring it up.

I'd be interested, CSM, in learning of your experiences in this area? Have you ever made these kinds of requests?

At Thursday, April 02, 2009 2:23:00 PM, Anonymous Anonymous said...

I was trying to pull the "backless gown" to cover my husbands buttocks before he stood up last week after a medical test. I made a comment to the female nurse. The nurse said "we see a lot of heiners around here" loudly and laughed, in the recovery room filled with male and female patients coming out of anesthesia.

At Thursday, April 02, 2009 3:13:00 PM, Anonymous TT said...


This must be rag on CSM day!

Guess I'll join in....sort of....but I'll be nice, I promise :-)

Like MER, I enjoy your philosophical excursions, but find little link to reality with some of your assertions. I agree that a person has the right to become a health care professional without respect to their gender. However, simply being a health care provider does not give them the right to force their services upon a patient, regardless of their gender or the patient's. Only the patient can give or rescind permission for treatment, and they have the absolute legal right to refuse any provider for any reason they choose. No need to expound further - others have already done so quite effectively.

I have nothing against naturists, but their views are a minority and not representative of society and should not be held up as the standard to compare to. From the World Naturist Handbook - "Naturists reject contemporary Western standards of modesty which discourage personal, family and social nudity, and seek to create a social environment where people feel comfortable in the company of nude people, and being seen nude, either just by other nudists, or also by the general public".

Just my $0.02......


At Thursday, April 02, 2009 3:26:00 PM, Anonymous Anonymous said...

This may be a bit out of date but when I reread anon's experience of the female nurse and his "cysto", he did not clarify with the nurse what he was uncomfortable with! He did not say he was uncomfortable with a female doing it. She would have assumed he was talking about the procedure not the sex of the provider. I would have like to have known what would have happened if he was clearer with his concerns.

At Thursday, April 02, 2009 4:45:00 PM, Anonymous Anonymous said...

Currently, there is no training for
modesty(privacy issues) within health care. The old school antiquated mentality still exists.
Ask me if the double standard discrimination still exists against men and I'll tell you that you can find that answer next time you are a patient.
See how easy it is to get a female nurse if you refuse personal
care by a male nurse. Yet you will
get a negative experience in refusing care from a female nurse
when requesting a male nurse.
Ask why intensive care units are
locked down and require an id card
to get into as well as er's. Ask the next endoscopy tech what educational background they have.
I asked that question and she told
me that she was promoted from being
a janitor last year. Do you think
they embrace privacy issues and
take it seriously. Most couldn't
tell you what hipaa stands for.
I'm responding to the issues regarding the prison system and
issues of privacy among male prisoners. Continually, I've mentioned that female guards have
a higher incidence of having sex
with male prisoners as opposed to male guards having sex with female
prisoners. Department of justice
statistics. The crime of having sex with male or female prisoners by guards is considered rape.There have been several lawsuits that have made it to the I believe 9th district court in the late 90's by male prisoners. Their contention
was that their privacy was continually violated by unnecessary
strip searches by female guards and lack of privacy when showering.
Many of these male prisoners have
stated their hatred for women because of this and would rape women when discharged from prison.
Three female prison guards were
arrested in wisconsin several years
ago for having sex with male prisoners. One of the female guards
was married to a detective at the
time. A female nurse was also fired
for having sex with male prisoners.
You can do a google search to find
the article.Many men commented on
this site as to why would a woman
want to be a prison guard in an
all male prison in the first place.


At Thursday, April 02, 2009 5:03:00 PM, Anonymous Anonymous said...

Dan -the 77 yo 'Male' replies posters ~ thank you for your support - I thought it was all me - - I researched what a 'cysto' is - - the 'nurse' wanted to insert a 18Fr catheter to first flush my urine to clean it out to prevent infection. Then she wanted to refill my bladder, clamp the catheter - then call the doctor in to insert his "flexible" cystoscope to exam the filled bladder to see why I have incontinence - - mainly a residual effect from the intensive radiation I had for prostate cancer 4 yrs. ago that caused this problem. I was under general anesthesia, had 112 seed implants - didn't care who saw what in my 'private' area. This was done in a Ambulatory Surgical Unit by the Hospital. I had 3 heart attacks in '92, and could not have prostate surgery. Upon arriving home, a nursing agency called me about home care by a nurse and to see if I wanted a Male or Female nurse to care for my catheter, emptying the bag and checking the catheter and then removing it. Of course, it was a male nurse.
As many of you said, she didn't want to hear about my discomfort - she talked even louder and more intensely to get my attention and quiet me down to succumb to her demands. She insisted on talking over me in a very demeaning way through pressure. One poster said a cysto is done 'only' in the hospital - no - a 'flexible' cyso is done in the office using a syringe w/5cc of lidocane gel insert into the urethra to numb it - then the catheter is inserted all the way - the n 5cc of water is injected into the side of the catheter to fill the balloon - then the catheter is pulled out so it stops at the inflated ballon. Then the bladder is filled with saline or water prior to the insertion of the cystoscope for bladder examination.
Since walking out, I called my urologist and apologized to him - he was glad I did - I made an appointment at his 'other' office and saw him there. He fully understands how I felt and he was apologetic as well. I told him the only way he will give me a cysto is, that I go to where I had my seed implants and be anesthetized. Instead, he said he will do an ultrasound this Wed. - and HE would do it at the other office. I made it clear that I cannot go back to the other office and he doesn't mind that at all.
The cystoscopy that requires general anesthesia or a spinal is a "rigid" cystoscope (very painful) - in a hospital.
I am very happy that many of you understand my feelings, and I thank you for your support -if the others were in my shoes, perhaps they may further understand - thank you again - (I still say, Urologists should have '1' male nurse - this doctor has 4 female nurses.)

At Thursday, April 02, 2009 5:19:00 PM, Anonymous Anonymous said...

M, what you were told in in the manner it was said show why so many folks feel so stressed about the medical care they are going to get..and demonstrates just how desensitised so many providers are...and how insensitive they come across as...glad you were there for your husband...they may see a lot of "heiners" but I bet your husband is not used to being seen.
LH...the nurse should have stopped and asked what and why the guy was not comfortable..when he first said it.
I have no problem with CSM having his own opinion...I am just trying to let him know that I am entitled to mine as well...He seems to have discrimination and right of self determination confused..
I am greatly appreciative of the efforts by Dr. Berstein in bringing the folks from the naturist site to tell us their experiences and views...and of them for coming in and posting.
Y'all have to admit that CSM has been good at getting a lot of you to really express your feelings in a real coherent and organised manner.

At Thursday, April 02, 2009 5:48:00 PM, Blogger Maurice Bernstein, M.D. said...

As I am getting more visitors to this thread, I again want their help in finding two classes of folks whose views may contribute to our understanding of the patient modesty issue such as the help CSM has provided from the naturist community.
Those classes, as I have noted previously, are artists nude models and pornographic actors. What they say would be very helpful in this discussion. I hope I can get some help in finding such persons and getting them here to communicate.

However, even though these folks may be missing from the discussion, I wonder what those who have been reading and writing here think MIGHT be the views of such folks who though I suspect are not necessarily naturists, must use nudity as their occupation. Do you think they are immune to the modesty concerns of patients described on these threads? I think even talking about them would be an interesting extension to our conversations. ..Maurice.

At Thursday, April 02, 2009 6:24:00 PM, Blogger MER said...


I would also like to hear from artists nude models and pornographic actors.

But more importantly, why is it that we're not hearing from nurses and cna's. They are the foot soldiers in healthcare, and the cna's and medical techs especially ae the ones involved in much intimate care.

The nurses I've interviewed about this issue are generally open and honest about this issue. They could give us much insight.

You have contacts with nurses and cna's. Maybe you could get some join us.

Then, we need to make sure we engage in civil discussions regardless of where these nurses are coming from. We need to listen and try to understand their points of view.

At Thursday, April 02, 2009 6:30:00 PM, Anonymous Anonymous said...

It actually was an MRI that the doctor put himself under in the British documentary.
This is an interesting medical blog as well.

At Thursday, April 02, 2009 9:25:00 PM, Anonymous Anonymous said...

Be it a rigid or a flexible is
irrevelent. Be it local,spinal
or general anesthesia is irrevelent. Wouldn't you want it
to be done properly, appropriately,
and thoroughly the first time. If done properly then a retrograde pyelogram would be done with the cystoscopy thus insuring the intregrity of the ureters as well as the renal collecting system. You can't do that at a urologists office!Anything less is just a cheap quick office visit. Suppose a biopsy is needed which is within
the capability of a cystoscope.
You need a pathologist as well
as a microbiologist to evaluate
the samples. You going to get that
at a urologists office. Some biopsie's require an electron
scanning microscope. You only have
a specific time frame before this
biological sample degrades. Would
you trust the urologists office to
TRANSPORT this sample to an
appropriate facility. You need a
competent and well equipped medical
lab to do this. Outpatient surgical
centers and hospitals have rigid
protocols to handle samples like
this. Want some horror stories
regarding lost biopsy samples. I've
got truckloads.
As I said previously, I'd keep on
walking. The pet scan is the tool
of choice in any kind of research.
In the 70's and 80's that's
exclusively what it was designed for. Here is the links.
And finally //


At Thursday, April 02, 2009 10:14:00 PM, Anonymous Anonymous said...

Dan the 77 yr old guy, I am glad things are working out for you...and I thankyou for clearing up what went on..and the info on the obviously read the questions we had....was kinda afraid youwould not come back and let us know the rest of the story...I hope things get better for you.
The point that you were not given the respect to ask you why you were concerned at your first voicing of such concern is one that I hope your doctor addresses.
I completely agree MER...It would be most interesting to get others here...and we most surely have got to be civil to them...or we are no better than that which we condemn.
CSM, you are obviously a young man of great ideals...and are very idealistic..very laudable...but you will find that reality has to be reconciled with idealism...especially when you make it to nursing.. All of us would love to live in a Garden of Eden Utopia where everything and everyone was perfect...and it is good to try for that goal..but this is life and reality..( I am not ragging you)
I am not quite sure what to say about nude models or porn actors..I don't know any and have no contact with any...All I know is the models seem to not be embarrassed at folks staring at and painting their nude stars carry that..way beyond that naked in fron of a lot of people..having sex..and all of it going to be made public..for everyone including mom to see. Obviously both of these have overcome normal modesty issues

At Thursday, April 02, 2009 10:47:00 PM, Blogger CSM said...

First of all, no I don't think you are all "going after" me! :) I'm glad if, and hope that, my counterpoint views, even if from a "miniscule" perspective, are pertinent.

On whether I have ever asked "for specific gender care", it indeed has never occured to me to ask. Having grown up naturist, I am incurably blase to the point that if I saw someone walking down the street naked, my first reaction would be to reflect that it was indeed a nice warm day.

On whether I know that "the majority of our society does recognize gender differences when it comes to nudity", I do and think that we all should respect each other's individual choice and preferences up to the point where choice turns into, for example, intolerance, threatens harm to others, and/or restricts equal opportunity. On affirmative action, I am consequently an enthusiastic proponent when it is targeted at these things, Eliminating hidden barriers to "male nurses" is hence valid affirmative action, but pushing for 50/50 gender distribution is not.

On patients' embarrassment, of being not "fond of body exposure" with same-gender providers but "absolutley mortified" with the opposite-gender, I believe that "the system" can and should be smart enough to respond sensitively without fuss, but that it cannot and should not be re-engineered to re-establish gender quotas for staff. Equal opportunity for staff combined with effectively assessing patients' "whole person" needs should provide the necessary flexibility and a mutually happy solution.

On double standards, I am sticking to my guns concerning "equality in terms of same sex health care" -- the parameters for both men and women should be the same, the valid considerations (eg. genital exams) for both should be of the same nature, and hence the gender of either the patient or care giver should never be the sole justification. Basically, I am making a plea again for a clear definition of "exposure" in connection with modesty. For example, both men and women have breasts, so breasts can be taken off the "intimate exposure" list, right?

On me "using the same narrow perspective to judge modest people as much of society uses to judge naturists", yes, we have much in common. On whether "the likelihood of doing away with separate male and female changing rooms is nil", the Swiss Parliament overlooks a public swimming pool complex with a unisex changing room. On the fact that "only the patient can give or rescind permission for treatment, and they have the absolute legal right to refuse any provider for any reason they choose", this is of course correct, but the logical converse is not true that the patient has an absolute right for any reason they choose to require a provider have a specific immaterial attribute. On nude models and pornographic actors, the former are non-sexual whilst the latter are sexual -- it would be interesting to see if their participation would clarify or muddle the definition of modesty.

On forgetting to tag my comments with (CSM), you will notice that I have taken Dr B's sage advice and signed up with blogger.

At Friday, April 03, 2009 1:34:00 AM, Anonymous Anonymous said...

I'm a barrister and had some contact with the pornographic industry a few years back.
Several of our witnesses were female pornographic actors.
My impression was that these women had lives completely out of control. They seemed to have gone through a numbing process to help them cope with their job. The three that I interviewed were all heroin addicts.
I thought they were tortured and tragic figures.
I had no contact with male pornographic actors.
I assume these women are now deceased.

At Friday, April 03, 2009 4:39:00 AM, Anonymous Anonymous said...

CSM I hope I didn't come off as to aggressive and attacking. I do respect your right to have your own opinion. I do think your perspective has brought some great conversation here. This is an emotionally charged issue for many here. Obviously when you come to a thread like this the numbers are stacked against you. I respect naturalist, I respect anyone who has the mentality to go against the grain for what they feel is right and not bow or care what the majority think...I just don't agree that your choices have to apply to me. best wishes

I also question why we do not have more providers here. They have to know it is here. I have seen this blog referenced on Allnurse, and several other blogs....Dr. Bernstein has they fear being attacked or do they not want to engage in a debate that has been treated with a don't ask don't acknowledge attitude?

I am also interested in hearing from people who seem to have no issues with modesty. Models, exotic dancers, etc. how did they get to the point where they have gone past what society deams "normal"....of course, we have to attempt to treat them with respect....I thought things went pretty well with CSM for quite awhile, but seemed to add on as the discussion went longer and longer.....the young ER doctor got beat up early on and left, hopefully if we get someone we can disagree....respectfully...perhaps CSM can give us a little feedback on how intense the discussion was from his side so we can learn how to engage as well.......alan

At Friday, April 03, 2009 8:49:00 AM, Anonymous Anonymous said...

PZ your experience is a welcome adition here..if you would please continue..we have really wanted attorneys and barristers to help with some issues here.
CSM..I don't think that anyone is expecting a 50/50 ratio in genders..but where practical there is no reason a provider or instituion..should not also have a male or males on staff...I do not expect a private practice with only one nurse per doctor to be able to meet this standard..forcing the doctor to hire two nurses when he can only use one would be unfair to the doctor and raise costs ..but this situation is rare as most doctors have more than one..and often more than two nurses and have partners with nurses as well.
For the times that a doctor can not provide a male...he either needs to change the routine and do any intimate or embarrasing procedures himself...if he can't or won't the patient just needs to look for one that can and will.
Once again, CSM, there is an issue of reality...guys are seldom concious of their breasts and it is not an issue guys go bare topped a lot...the ladies do not..I have been told several times that the ladies are often sensitive about exposure of their breasts than about genital exposure..whereas guys tend to be concerned only about the parts covered by a swimsuit..The earlier posting by the lady about swimsuits is a pretty good indicator of how many/most feel.
The porn aspect is timely ..there have been several news items lately that more ladies are going into it because of the economy.

At Friday, April 03, 2009 8:52:00 AM, Anonymous Anonymous said...

"leemac, whether or not this was a "real" part of a cystocopy is not the only issue here. When a doctor does the cysto the female nurse is in the room during the task to assist him/her. The nurse hands the doc items, etc."

Where's the rule that says a FEMALE nurse must be there to assist? If a doctor understands medical ethics at all he should have a male nurse if requested, and in my opinion a male nurse should be standard.

MER, thanks for the great study about male teachers. It says a lot.

Leemac, there is nothing wrong with what you say and do. Female nurses should NEVER be FORCED on anyone. There should always be a choice.

At Friday, April 03, 2009 9:25:00 AM, Anonymous Anonymous said...

LH - What female nurses post on blogs and what they really believe or how they really act are two different things.

Someone said,
"The good news for modesty, and where energy can be focused, is that health care workers of both genders can be, and are being, trained to be super sensitive to modesty concerns. The conuncrum is when we hear patient modesty being projected as insistence on "same-sex techs." If I become a nurse, it is to serve all people, not just my own gender."

All that doesn't really mean anything. What your rambling tells me is all that matters is what the "caregiver" is comfortable with. For you to be trained on how to be "super sensitive" doesn't change the patient's modesty issues. If someone isn't comfortable being stared at and fondled by an opposite gender caregiver, no amount of training is going to change that. If a patient wants a same-gender doctor, nurse, tech, assistant or whatever, his or her wishes should be honored. Period. Any medical "professional" that whines, complains and gets offended at that isn't very "professional".

At Friday, April 03, 2009 10:58:00 AM, Anonymous Anonymous said...

Responding to April 03, Friday post by Anon.. There is no rule that I am aware of posted that a female nurse must be present to assist a physician during an office visit. However, that said, it seems the majority of doctors now days can blow their own nose without a nurse there to hand them a tissue. I don't get it at all. When I had a urologist suggest an ultrasound guided prostate biopsy in his office, I asked specifically who would be present in the room. He said the nurse would be there to assist. I said "no thanks." He refused to allow my wife to be present during the procedure. I didn't have it done. Go to dermatology offices..same thing. A female office worker is in the room to take notes or hand the doctor a bandage. Ridiculous.


At Friday, April 03, 2009 11:25:00 AM, Anonymous Anonymous said...

agreed the 50-50 is only symbolic, what it represents is a real effort to address the gender discrepancy in nursing. We don't need to have 50/50 split, we need more males than the current 6-8%, if the ratio was different, we had 92% male nurses, would we see this as a area that needed affirmative action?

There are other ways to address this than staff 50-50. I read of a facility that shared male techs, they paid his travel and he was at one facility 2 days and the other 2 days. This allowed them to schedule accordingly. Likewise often nurses are preferred not REQUIRED for many procedures. They hand instruments etc to make it easier of the Dr. but the Dr actually could do the proceedure by himself if he wanted to. I have cited my PCP did my vas himself, a friend's Dr used a nurse they both know, likewise the same Dr. did another friends vas without the nurse when he are alternatives. And lets face it, we have started to define nurse pretty loosely, very few "nurses" in offices are RN's in our area. One of my friends wife took a couple of courses and is now what I understand is a PA and does all sorts of stuff along the lines of what we are asking. I think there are a lot of retired, semi retired, displaced men that would do this kind of work if they knew it was available....if you are worried about discrimination...look at the double standard, discrimination, and sterotyping that causes the 92/8 embalance.......alan

At Friday, April 03, 2009 11:39:00 AM, Blogger Maurice Bernstein, M.D. said...



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